title: Cardiovascular Disease Mortality After Chemotherapy or Surgery for Testicular Nonseminoma: A Population-Based Study.
abstract: OBJECTIVE
  Increased risks of incident cardiovascular disease (CVD) in patients with testicular cancer (TC) given chemotherapy in European studies were largely restricted to long-term survivors and included patients from the 1960s. Few population-based investigations have quantified CVD mortality during, shortly after, and for two decades after TC diagnosis in the era of cisplatin-based chemotherapy.
  
  
  METHODS
  Standardized mortality ratios (SMRs) for CVD and absolute excess risks (AERs; number of excess deaths per 10,000 person-years) were calculated for 15,006 patients with testicular nonseminoma reported to the population-based Surveillance, Epidemiology, and End Results program (1980 to 2010) who initially received chemotherapy (n=6,909) or surgery (n=8,097) without radiotherapy and accrued 60,065 and 81,227 person-years of follow-up, respectively. Multivariable modeling evaluated effects of age, treatment, extent of disease, and other factors on CVD mortality.
  
  
  RESULTS
  Significantly increased CVD mortality occurred after chemotherapy (SMR, 1.36; 95% CI, 1.03 to 1.78; n=54) but not surgery (SMR, 0.81; 95% CI, 0.60 to 1.07; n=50). Significant excess deaths after chemotherapy were restricted to the first year after TC diagnosis (SMR, 5.31; AER, 13.90; n=11) and included cerebrovascular disease (SMR, 21.72; AER, 7.43; n=5) and heart disease (SMR, 3.45; AER, 6.64; n=6). In multivariable analyses, increased CVD mortality after chemotherapy was confined to the first year after TC diagnosis (hazard ratio, 4.86; 95% CI, 1.25 to 32.08); distant disease (P<.05) and older age at diagnosis (P<.01) were independent risk factors.
  
  
  CONCLUSIONS
  This is the first population-based study, to our knowledge, to quantify short- and long-term CVD mortality after TC diagnosis. The increased short-term risk of CVD deaths should be further explored in analytic studies that enumerate incident events and can serve to develop comprehensive evidence-based approaches for risk stratification and application of preventive and interventional efforts.
authors.affiliation: Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway.
authors.forename: Chunkit
authors.initials: C
authors.lastname: Fung
authors.affiliation: Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway.
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fossa
authors.affiliation: Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Milano
authors.affiliation: Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway.
authors.forename: Deepak M
authors.initials: DM
authors.lastname: Sahasrabudhe
authors.affiliation: Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway.
authors.forename: Derick R
authors.initials: DR
authors.lastname: Peterson
authors.affiliation: Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway. malmile@iu.edu.
authors.forename: Lois B
authors.initials: LB
authors.lastname: Travis
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009919:Orchiectomy / Q000009:adverse effects* / Q000401:mortality; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents