Erquicia Peralt Josu, Fernandez Gonzalez Luis, Garcia San Román Koldobika, Astorga Burgo Juan Carlos, Acín Labarta Aida
Cardiology Department, Cruces University Hospital, Bilbao, Spain.
Interventional Cardiology, Cardiology Department, Cruces University Hospital, Bilbao, Spain.
Eur Heart J Case Rep. 2024 Aug 2;8(8):ytae365. doi: 10.1093/ehjcr/ytae365. eCollection 2024 Aug.
Germ cell tumours (GCT) are the most common malignancy affecting young adult men. The introduction of cisplatin-based chemotherapy in recent decades has significantly changed the prognosis of these malignant tumours into highly curable cancer, even in the setting of advanced disease. However, in the last decade, the success of these chemotherapy regimens in curing GCTs has been slowed by a growing recognition of their important late toxicities, such as cardiovascular disease.
We present the case of a 23-year-old male, recently diagnosed with a mixed non-seminomatous testicular germinal tumour, on stage IIIA (pT3 cN2 cM1a), with retroperitoneal adenopathies and pulmonary metastases. After performing a right inguinal orchiectomy, he started chemotherapy treatment with cisplatin + etoposide. Shortly after starting treatment, the patient presented an ST-elevation acute coronary syndrome. The cardiac catheterization revealed a non-occlusive thrombus in the middle segment of the right coronary artery. Intracoronary imaging techniques were used to study the arterial wall, which revealed the presence of atherosclerotic plaque that could have ruptured, with the consequent response of platelet aggregation and thrombus formation. Barely 7 months after this event, the patient was again admitted to hospital for pulmonary thromboembolism with pulmonary infarction.
To date, there are two hypotheses linking the association between cisplatin-based chemotherapy and cardiovascular disease. The direct hypothesis argues for the presence of direct chemotherapy-induced vascular damage. The indirect hypothesis, on the other hand, is based on the induction and development of cardiovascular risk factors by chemotherapy. This cardiovascular toxicity of chemotherapy is aggravated by a cancer-induced proinflammatory and prothrombotic state.
生殖细胞肿瘤（GCT）是影响年轻成年男性的最常见恶性肿瘤。近几十年来，基于顺铂的化疗的引入显著改变了这些恶性肿瘤的预后，使其成为高度可治愈的癌症，即使在晚期疾病的情况下也是如此。然而，在过去十年中，这些化疗方案在治愈GCT方面的成功受到了阻碍，因为人们越来越认识到它们重要的晚期毒性，如心血管疾病。
我们报告了一名23岁男性的病例，他最近被诊断为混合性非精原性睾丸生殖细胞瘤，处于IIIA期（pT3 cN2 cM1a），伴有腹膜后淋巴结肿大和肺转移。在进行右腹股沟睾丸切除术后，他开始接受顺铂+依托泊苷的化疗。开始治疗后不久，患者出现了ST段抬高型急性冠状动脉综合征。心脏导管检查显示右冠状动脉中段有非闭塞性血栓。采用冠状动脉内成像技术研究动脉壁，发现存在可能破裂的动脉粥样硬化斑块，随后血小板聚集和血栓形成。在这一事件发生仅7个月后，患者再次因肺血栓栓塞伴肺梗死入院。
迄今为止，有两种假说将基于顺铂的化疗与心血管疾病之间的关联联系起来。直接假说认为存在直接的化疗诱导的血管损伤。另一方面，间接假说基于化疗对心血管危险因素的诱导和发展。化疗的这种心血管毒性因癌症诱导的促炎和促血栓状态而加重。
