Predicted cardiovascular mortality and reported cardiovascular morbidity in testicular cancer survivors.
BACKGROUND
We examined if testicular cancer (TC) treatment is associated with any risk for cardiovascular morbidity or predicted mortality according to the SCORE model, in which a 10-year future risk of >or=5% for developing a fatal cardiovascular event qualify for high-risk status.


METHODS
One thousand one hundred thirty-four TC survivors treated 1980-1994 participated in this study (1998-2002). Patients were categorised in four treatment groups: surgery (n = 225), radiotherapy (n = 445), and two chemotherapy groups: cumulative cisplatin dose <or=850 mg (n = 375) and >850 mg (cis>850, n = 89). Patients with cardiovascular disease, diabetes or SCORE >or=5% constituted a high-risk group, and those with SCORE >1% an intermediate/high risk group.


RESULTS
Age-adjusted mean SCORE was 0.93% for the surgery group. In comparison, chemotherapy treated patients had significantly higher SCORE (1.07%, p = 0.01). Only 15% of patients were scored to be at high-risk, while 53% qualified for the intermediate/high risk group. Patients in the cis>850 group had increased odds for having intermediate/high risk, compared with the surgery group (OR 3.4, 95% CI 1.3-8.7). Only 23 cardiovascular events had occurred since the testicular cancer diagnosis.


CONCLUSIONS
The SCORE model indicates that patients treated with cisplatin-based chemotherapy have a significantly increased future risk of a fatal cardiovascular event.


CONCLUSIONS
TC survivors should be followed regularly with respect to cardiovascular risk profile beyond the routine 10-year clinical follow-up.
Haugnes
H S
HS
Department of Oncology, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway. hegesa@fagmed.uit.no
Aass
N
N
Fosså
S D
SD
Dahl
O
O
Klepp
O
O
Wist
E A
EA
Wilsgaard
T
T
Bremnes
R M
RM
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002277:Carcinoma / Q000453:epidemiology* / Q000628:therapy; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012107:Research Design; D018570:Risk Assessment; D018239:Seminoma / Q000453:epidemiology* / Q000628:therapy; D017741:Survivors / Q000706:statistics & numerical data*; D013736:Testicular Neoplasms / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult
D002945:Cisplatin
Am Heart J. 1991 Jan;121(1 Pt 2):293-8
1985385
J Clin Oncol. 2004 Feb 15;22(4):640-7
14726503
Eur Urol. 2003 Sep;44(3):322-8
12932930
Ann Oncol. 2002 Feb;13(2):229-36
11885999
Eur Heart J. 2005 Dec;26(24):2673-80
16204260
J Natl Cancer Inst. 2005 Nov 2;97(21):1580-8
16264178
Br J Cancer. 1995 Mar;71(3):619-24
7880748
J Clin Oncol. 2006 Jan 20;24(3):467-75
16421423
Int J Epidemiol. 2004 Apr;33(2):235-9
15082618
Eur Urol. 2008 Mar;53(3):478-96
18191324
J Clin Oncol. 1990 Jan;8(1):21-6
1688614
Circulation. 1983 May;67(5):968-77
6219830
Lancet. 1979 Aug 11;2(8137):267-70
88606
Eur J Cardiovasc Prev Rehabil. 2007 Sep;14 Suppl 2:E1-40
17726406
Int J Radiat Oncol Biol Phys. 1992;24(5):913-9
1447034
J Cancer Surviv. 2007 Mar;1(1):8-16
18648940
J Clin Oncol. 2000 Apr;18(8):1725-32
10764433
J Clin Oncol. 2003 Apr 15;21(8):1513-23
12697875
Circulation. 1991 Jan;83(1):356-62
1984895
Eur J Endocrinol. 2003 Aug;149(2):145-52
12887292
Eur J Cancer. 2004 Mar;40(5):701-6
15010071
Eur Heart J. 2003 Jun;24(11):987-1003
12788299
Eur J Cancer. 1997 Jun;33(7):1038-44
9376184
Lancet. 1999 May 8;353(9164):1547-57
10334252
Cancer. 1987 Aug 15;60(4):772-6
3594400
BMJ. 2003 Nov 29;327(7426):1267
14644971
Br J Cancer. 2000 Dec;83(12):1623-9
11104556
J Clin Oncol. 1999 Apr;17(4):1146
10561173
Circulation. 2007 Dec 4;116(23):2694-701
18040028
J Clin Oncol. 2005 Aug 1;23(22):4980-90
16051950
J Clin Oncol. 2005 Jun 1;23(16):3718-25
15738540
Eur J Endocrinol. 2004 Jan;150(1):65-71
14713281
Ann Oncol. 2007 Feb;18(2):241-8
17060482
J Natl Cancer Inst. 2007 Apr 4;99(7):533-44
17405998
J Clin Oncol. 1990 Mar;8(3):509-18
1689773
Eur Heart J. 2003 Sep;24(17):1601-10
12964575
J Clin Oncol. 1996 Apr;14(4):1106-13
8648364
Diabetes Care. 2004 May;27(5):1036-41
15111517
J Clin Oncol. 1997 May;15(5):1844-52
9164194
Eur Heart J. 2003 May;24(10):937-45
12714025
J Clin Endocrinol Metab. 2008 Jan;93(1):68-75
17911176
J Clin Oncol. 1991 May;9(5):818-26
1707957
BMJ. 2005 Sep 10;331(7516):551
16103030
Am J Med. 2004 Aug 15;117(4):219-27
15308430
Ann Intern Med. 1992 May 1;116(9):709-15
1558341