Journal article
Cardiovascular Risk Factors and Disease After Male Germ Cell Cancer
Copenhagen University Hospital Herlev and Gentofte1
Danish Cancer Society2
Odense University Hospital3
Aarhus University Hospital4
Department of Health Technology, Technical University of Denmark5
Bioinformatics, Department of Health Technology, Technical University of Denmark6
Disease Data Intelligence, Bioinformatics, Department of Health Technology, Technical University of Denmark7
To analyze the risk of cardiovascular disease (CVD) after treatment of male germ cell cancer (GCC). Clinical data were extracted from the Danish Testicular Cancer database. For each patient, 10 men matched on date of birth were identified in the Danish normal population by risk-set sampling. Cardiovascular risk factors, CVD, and associated deaths were identified in Danish registries.
The association between treatment and outcomes was analyzed by separate Cox models for each outcome. Cancer treatment was included as a time-varying covariate. We included 5,185 patients with GCC and 51,850 men in the normal population. Median follow-up was 15.8 years. Treatment with bleomycin-etoposide-cisplatin (BEP; n = 1,819) was associated with increased risks of hypertension and hypercholesterolemia.
Hazard ratios (HRs) of CVD <1 year after initiation of BEP treatment were as follows: myocardial infarction (HR, 6.3; 95% CI, 2.9 to 13.9), cerebrovascular accident (HR, 6.0; 95% CI, 2.6 to 14.1), and venous thromboembolism (HR, 24.7; 95% CI, 14.0 to 43.6). One year after BEP treatment, the risk of CVD decreased to normal levels, but after 10 years, increasing risks were found for myocardial infarction (HR, 1.4; 95% CI, 1.0 to 2.0) and cardiovascular death (HR, 1.6; 95% CI, 1.0 to 2.5).
Radiotherapy (n = 780) increased the risk of diabetes at long-term follow-up (HR, 1.4; 95% CI, 1.0 to 2.0) but not that of other outcomes. With surveillance (n = 3,332), cardiovascular risk factors, CVD, and cardiovascular death data were comparable to that of the normal population. Treatment with BEP was associated with highly increased risks of CVD <1 year after treatment start and mildly increased risks after 10 years of follow-up.
Radiotherapy increased the risk of diabetes but not incident CVD. The risk of CVD in patients followed in a surveillance program was comparable to that of the normal population.
Language: | English |
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Year: | 2020 |
Pages: | 584-592 |
ISSN: | 15277755 and 0732183x |
Types: | Journal article |
DOI: | 10.1200/jco.19.01180 |
ORCIDs: | Gupta, Ramneek |
Adult Antineoplastic Combined Chemotherapy Protocols Bleomycin CHEMOTHERAPY Cardiovascular Diseases Cisplatin DIAGNOSIS Etoposide FOLLOW-UP Humans LONG-TERM SURVIVORS METABOLIC SYNDROME MORBIDITY MORTALITY Male Middle Aged Neoplasms, Germ Cell and Embryonal PLATINUM Radiotherapy Risk Factors TESTICULAR CANCER Testicular Neoplasms VALIDITY