Sanchez Victoria A, Dinh Paul C, Rooker Jennessa, Monahan Patrick O, Althouse Sandra K, Fung Chunkit, Sesso Howard D, Einhorn Lawrence H, Dolan M Eileen, Frisina Robert D, Travis Lois B
Department of Otolaryngology-Head & Neck Surgery, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 73, Tampa, FL, 33612, USA.
Department of Medical Oncology, Indiana University, Indianapolis, IN, USA.
J Cancer Surviv. 2023 Feb;17(1):27-39. doi: 10.1007/s11764-022-01313-w. Epub 2023 Jan 13.
Ototoxicity is a prominent side effect of cisplatin-based chemotherapy. There are few reports, however, estimating its prevalence in well-defined cohorts and associated risk factors.
Testicular cancer (TC) survivors given first-line cisplatin-based chemotherapy completed validated questionnaires. Descriptive statistics evaluated the prevalence of ototoxicity, defined as self-reported hearing loss and/or tinnitus. We compared patients with and without tinnitus or hearing loss using Chi-square test, two-sided Fisher's exact test, or two-sided Wilcoxon rank sum test. To evaluate ototoxicity risk factors, a backward selection logistic regression procedure was performed.
Of 145 TC survivors, 74% reported ototoxicity: 68% tinnitus; 59% hearing loss; and 52% reported both. TC survivors with tinnitus were more likely to indicate hypercholesterolemia (P = 0.008), and difficulty hearing (P < .001). Tinnitus was also significantly related to age at survey completion (OR = 1.79; P = 0.003) and cumulative cisplatin dose (OR = 5.17; P < 0.001). TC survivors with hearing loss were more likely to report diabetes (P = 0.042), hypertension (P = 0.007), hypercholesterolemia (P < 0.001), and family history of hearing loss (P = 0.044). Risk factors for hearing loss included age at survey completion (OR = 1.57; P = 0.036), hypercholesterolemia (OR = 3.45; P = 0.007), cumulative cisplatin dose (OR = 1.94; P = 0.049), and family history of hearing loss (OR = 2.87; P = 0.071).
Ototoxicity risk factors included age, cisplatin dose, cardiovascular risk factors, and family history of hearing loss. Three of four TC survivors report some type of ototoxicity; thus, follow-up of cisplatin-treated survivors should include routine assessment for ototoxicity with provision of indicated treatments.
Survivors should be aware of risk factors associated with ototoxicity. Referrals to audiologists before, during, and after cisplatin treatment is recommended.
耳毒性是基于顺铂化疗的一个突出副作用。然而，很少有报告评估其在明确队列中的患病率及相关危险因素。
接受一线基于顺铂化疗的睾丸癌（TC）幸存者完成经过验证的问卷。描述性统计评估耳毒性的患病率，耳毒性定义为自我报告的听力损失和/或耳鸣。我们使用卡方检验、双侧Fisher精确检验或双侧Wilcoxon秩和检验比较有和没有耳鸣或听力损失的患者。为评估耳毒性危险因素，进行了向后选择逻辑回归程序。
在145名TC幸存者中，74%报告有耳毒性：68%有耳鸣；59%有听力损失；52%报告两者都有。有耳鸣的TC幸存者更可能表明有高胆固醇血症（P = 0.008）和听力困难（P < 0.001）。耳鸣也与调查完成时的年龄显著相关（OR = 1.79；P = 0.003）和累积顺铂剂量（OR = 5.17；P < 0.001）。有听力损失的TC幸存者更可能报告有糖尿病（P = 0.042）、高血压（P = 0.007）、高胆固醇血症（P < 0.001）和听力损失家族史（P = 0.044）。听力损失的危险因素包括调查完成时的年龄（OR = 1.57；P = 0.036）、高胆固醇血症（OR = 3.45；P = 0.007）、累积顺铂剂量（OR = 1.94；P = 0.049）和听力损失家族史（OR = 2.87；P = 0.071）。
耳毒性危险因素包括年龄、顺铂剂量、心血管危险因素和听力损失家族史。四分之三的TC幸存者报告有某种类型的耳毒性；因此，对接受顺铂治疗的幸存者的随访应包括对耳毒性的常规评估并提供指定的治疗。
幸存者应了解与耳毒性相关的危险因素。建议在顺铂治疗前、治疗期间和治疗后转诊至听力学家处。
