Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
J Clin Oncol. 2023 Jul 1;41(19):3512-3522. doi: 10.1200/JCO.22.01016. Epub 2023 Apr 18.
Testicular cancer (TC) treatment is clearly associated with cardiovascular morbidity and mortality. To enable development of preventive strategies for cardiovascular disease (CVD), we assessed cardiometabolic risk factors and quality of life (QoL) in TC survivors.
Incidence of coronary artery disease, myocardial infarction, and heart failure after TC treatment was assessed in a multicenter cohort comprising 4,748 patients treated at the age of 12-50 years between 1976 and 2007. Patients who had developed CVD and a random sample from the cohort (subcohort) received a questionnaire on cardiometabolic risk factors and QoL. A subgroup of responders in the subcohort additionally underwent clinical evaluation of cardiovascular risk factors.
After a median follow-up of 16 years, 272 patients had developed CVD. Compared with orchidectomy only, cisplatin combination chemotherapy was associated with an increased CVD risk (hazard ratio [HR], 1.9; 95% CI, 1.1 to 3.1). Patients who were obese or a smoker at diagnosis (HR, 4.6; 95% CI, 2.0 to 10.0 and HR, 1.7; 95% CI, 1.1 to 2.4, respectively), developed Raynaud's phenomenon (HR, 1.9; 95% CI, 1.1 to 3.6) or dyslipidemia (HR, 2.8; 95% CI, 1.6 to 4.7) or had a positive family history for CVD (HR, 2.9; 95% CI, 1.7 to 4.9) had higher CVD risk. More TC survivors with CVD reported inferior QoL on physical domains than survivors who did not develop CVD. Of 304 TC survivors who underwent clinical evaluation for cardiovascular risk factors (median age at assessment: 51 years), 86% had dyslipidemia, 50% had hypertension, and 35% had metabolic syndrome, irrespective of treatment.
Cardiovascular events in TC survivors impair QoL. Many TC survivors have undetected cardiovascular risk factors. We advocate early lifestyle adjustments and lifelong follow-up with low-threshold treatment of cardiovascular risk factors, especially in obese and smoking patients treated with platinum-based chemotherapy.
睾丸癌（TC）治疗显然与心血管发病率和死亡率有关。为了制定心血管疾病（CVD）的预防策略，我们评估了 TC 幸存者的心血管代谢危险因素和生活质量（QoL）。
在一个多中心队列中评估了 4748 名 1976 年至 2007 年间 12-50 岁接受治疗的患者接受 TC 治疗后的冠心病、心肌梗死和心力衰竭的发生率。发生 CVD 的患者和队列中的随机样本（亚组）接受了心血管代谢危险因素和 QoL 的问卷。亚组中的 responder 亚组还接受了心血管危险因素的临床评估。
中位随访 16 年后，272 名患者发生了 CVD。与仅行睾丸切除术相比，顺铂联合化疗与 CVD 风险增加相关（风险比[HR]，1.9；95%CI，1.1 至 3.1）。诊断时肥胖或吸烟的患者（HR，4.6；95%CI，2.0 至 10.0 和 HR，1.7；95%CI，1.1 至 2.4），发生雷诺现象（HR，1.9；95%CI，1.1 至 3.6）或血脂异常（HR，2.8；95%CI，1.6 至 4.7）或 CVD 家族史阳性（HR，2.9；95%CI，1.7 至 4.9）的 CVD 风险更高。与未发生 CVD 的幸存者相比，更多的 TC 幸存者报告 CVD 后的身体领域生活质量较差。在接受心血管危险因素临床评估的 304 名 TC 幸存者中（评估时的中位年龄：51 岁），无论治疗方式如何，86%存在血脂异常，50%存在高血压，35%存在代谢综合征。
TC 幸存者的心血管事件会损害 QoL。许多 TC 幸存者存在未被发现的心血管危险因素。我们提倡早期的生活方式调整和终生随访，并对接受铂类化疗的肥胖和吸烟患者进行低门槛的心血管危险因素治疗。
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