J Natl Compr Canc Netw. 2018 Mar;16(3):257-265. doi: 10.6004/jnccn.2017.7046.
Testicular cancer survivors (TCS) are at significantly increased risk for cardiovascular disease (CVD), with metabolic syndrome (MetS) an established risk factor. No study has addressed clinical and genetic MetS risk factors in North American TCS. TCS were aged <55 years at diagnosis and received first-line chemotherapy. Patients underwent physical examination, and had lipid panels, testosterone, and soluble cell adhesion molecule-1 (sICAM-1) evaluated. A single nucleotide polymorphism in rs523349 (5-α-reductase gene, ), recently implicated in MetS risk, was genotyped. Using standard criteria, MetS was defined as ≥3 of the following: hypertension, abdominal obesity, hypertriglyceridemia, decreased high-density lipoprotein (HDL) cholesterol level, and diabetes. Matched controls were derived from the National Health and Nutrition Examination Survey. We evaluated 486 TCS (median age, 38.1 years). TCS had a higher prevalence of hypertension versus controls (43.2% vs 30.7%; <.001) but were less likely to have decreased HDL levels (23.7% vs 34.8%; <.001) or abdominal obesity (28.2% vs 40.1%; <.001). Overall MetS frequency was similar in TCS and controls (21.0% vs 22.4%; =.59), did not differ by treatment (=.20), and was not related to rs523349 (=.61). For other CVD risk factors, TCS were significantly more likely to have elevated low-density lipoprotein (LDL) cholesterol levels (17.7% vs 9.3%; <.001), total cholesterol levels (26.3% vs 11.1%; <.001), and body mass index ≥25 kg/m (75.1% vs 69.1%; =.04). On multivariate analysis, age at evaluation (<.001), testosterone level ≤3.0 ng/mL (odds ratio [OR], 2.06; =.005), and elevated sICAM-1 level (OR, 3.58; =.001) were significantly associated with MetS. Metabolic abnormalities in TCS are characterized by hypertension and increased LDL and total cholesterol levels but lower rates of decreased HDL levels and abdominal obesity, signifying possible shifts in fat distribution and fat metabolism. These changes are accompanied by hypogonadism and inflammation. TCS have a high prevalence of CVD risk factors that may not be entirely captured by standard MetS criteria. Cancer treatment-associated MetS requires further characterization.
睾丸癌幸存者（TCS）患心血管疾病（CVD）的风险显著增加，代谢综合征（MetS）是一个既定的危险因素。目前还没有研究探讨北美 TCS 的临床和遗传 MetS 危险因素。TCS 被诊断时年龄<55 岁，并接受了一线化疗。患者接受了体检，并评估了血脂谱、睾酮和可溶性细胞间黏附分子-1（sICAM-1）。最近有研究表明，rs523349（5-α-还原酶基因，）中的单核苷酸多态性与 MetS 风险有关，对其进行了基因分型。使用标准标准，MetS 定义为以下 3 种或 3 种以上的情况：高血压、腹部肥胖、高三酰甘油血症、高密度脂蛋白（HDL）胆固醇水平降低和糖尿病。匹配对照来自全国健康和营养检查调查。我们评估了 486 名 TCS（中位年龄，38.1 岁）。TCS 高血压的患病率高于对照组（43.2%比 30.7%；<.001），但 HDL 水平降低（23.7%比 34.8%；<.001）或腹部肥胖（28.2%比 40.1%；<.001）的可能性较低。TCS 和对照组的总体 MetS 发生率相似（21.0%比 22.4%；=.59），治疗方式无差异（=.20），与 rs523349 无关（=.61）。对于其他 CVD 危险因素，TCS 更有可能出现低密度脂蛋白（LDL）胆固醇水平升高（17.7%比 9.3%；<.001）、总胆固醇水平升高（26.3%比 11.1%；<.001）和体重指数≥25 kg/m（75.1%比 69.1%；=.04）。多变量分析显示，评估时的年龄（<.001）、睾酮水平≤3.0ng/mL（比值比[OR]，2.06；=.005）和升高的 sICAM-1 水平（OR，3.58；=.001）与 MetS 显著相关。TCS 的代谢异常表现为高血压和 LDL 及总胆固醇水平升高，但 HDL 水平降低和腹部肥胖的发生率较低，表明脂肪分布和脂肪代谢可能发生变化。这些变化伴随着性腺功能减退和炎症。TCS 有很高的 CVD 危险因素患病率，这可能不完全由标准的 MetS 标准所捕捉。癌症治疗相关的 MetS 需要进一步描述。
