Meuleman A T, Volders E L D, Lubberts S, Kerst J M, Wymenga A N M, Aarts M J B, Goncalves M B, Lefrandt J D, Steursma G, Meijer J, Nuver J, Gietema J A
Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen.
Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam.
ESMO Open. 2024 Jul;9(7):103631. doi: 10.1016/j.esmoop.2024.103631. Epub 2024 Jul 13.
Patients with testicular cancer treated with chemotherapy have an increased risk of developing early cardiovascular events. Identification of patients with testicular cancer at a high risk of these events enables the development of preventative strategies. This study validates the vascular fingerprint tool to identify these patients.
We carried out a multicenter prospective study in patients with metastatic testicular cancer [International Germ Cell Cancer Collaborative Group (IGCCCG) good or intermediate risk; retroperitoneal mass <5 cm]. In eligible patients, the vascular fingerprint was assessed before the start of cisplatin-based chemotherapy, which consists of five risk factors, namely, smoking, overweight (body mass index >25 kg/m), hypertension (blood pressure >140/90 mmHg), dyslipidemia (fasting cholesterol >5.1 mmol/l or low-density lipoprotein-cholesterol >2.5 mmol/l), and diabetes mellitus (fasting glucose ≥7.0 mmol/l). The presence of three or more risk factors was defined as high-risk vascular fingerprints. A log-rank test was carried out with a cardiovascular event within 1 year after the start of chemotherapy as the primary endpoint.
A total of 196 patients with metastatic testicular cancer were included; 15 patients (8%) developed a cardiovascular event: 4 (2%) arterial events and 11 (6%) venous thrombotic events. Overall, 189 vascular fingerprint scores were available. Patients with a high-risk vascular fingerprint (62/189) had a higher risk of developing a cardiovascular event (hazard ratio 3.27, 95% confidence interval 1.16-9.18; log-rank: P = 0.017). Histological diagnosis, prognosis group, cumulative chemotherapy dose, and retroperitoneal mass size did not differ between patients with or without a cardiovascular event. All patients with an arterial event had a high-risk vascular fingerprint compared with 5/11 patients with a venous event. Overweight was more prevalent in patients with cardiovascular events (87% versus 59%; P = 0.037).
The vascular fingerprint is a validated tool to identify patients with testicular cancer at a high risk of developing early cardiovascular events. This tool can be used to develop preventative strategies with anticoagulant treatment.
接受化疗的睾丸癌患者发生早期心血管事件的风险增加。识别出具有发生这些事件高风险的睾丸癌患者有助于制定预防策略。本研究验证了血管指纹工具以识别这些患者。
我们对转移性睾丸癌患者[国际生殖细胞癌协作组（IGCCCG）良好或中等风险；腹膜后肿块<5 cm]进行了一项多中心前瞻性研究。在符合条件的患者中，在基于顺铂的化疗开始前评估血管指纹，其由五个风险因素组成，即吸烟、超重（体重指数>25 kg/m）、高血压（血压>140/90 mmHg）、血脂异常（空腹胆固醇>5.1 mmol/l或低密度脂蛋白胆固醇>2.5 mmol/l）和糖尿病（空腹血糖≥7.0 mmol/l）。存在三个或更多风险因素被定义为高风险血管指纹。以化疗开始后1年内发生的心血管事件作为主要终点进行对数秩检验。
共纳入196例转移性睾丸癌患者；15例（8%）发生了心血管事件：4例（2%）动脉事件和11例（6%）静脉血栓形成事件。总体而言，获得了189个血管指纹评分。具有高风险血管指纹的患者（62/189）发生心血管事件的风险更高（风险比3.27，95%置信区间1.16 - 9.18；对数秩：P = 0.017）。有或无心血管事件的患者在组织学诊断、预后分组、累积化疗剂量和腹膜后肿块大小方面无差异。所有发生动脉事件的患者均具有高风险血管指纹，而发生静脉事件的11例患者中有5例具有高风险血管指纹。超重在发生心血管事件的患者中更为普遍（87%对59%；P = 0.037）。
血管指纹是一种经过验证的工具，可用于识别具有发生早期心血管事件高风险的睾丸癌患者。该工具可用于制定抗凝治疗的预防策略。
