Toxicities Associated with Cisplatin-Based Chemotherapy and Radiotherapy in Long-Term Testicular Cancer Survivors

Table 1

Prevalence of cardiovascular disease risk factors in chemotherapy-treated patients in select studies since 2000.

						Prevalence of cardiovascular risk factors versus Controls^b (%)
Author (year)	N^a	Treatment dates	Median length of follow-up (range)	Median age at follow-up (range)	Control group (N)	HTN (definition)	Increased lipids^c (definition)	DM (definition)	Obesity (definition)	Metabolic syndrome (definition)
Meinardi et al. (2000) [16]	62	Before 1987	14 y (10–20 y)	42 y (30–50 y)	Stage I TC (40)	39 versus 13 (SBP > 150 mmHg, DBP > 95 mmHg)	79 versus 53 (TC ≥ 201 mg/dL)	NA	21 versus 28^d (BMI > 27.8)	NA
Strumberg et al. (2002) [30]	32	1977–1981	15 y (13–17 y)	40 y (30–59 y)	None	25 versus NA (DBP > 95 mmHg)	81 versus NA (TC ≥ 200 mg/dL)	NA	48 versus NA (BMI ≥ 25)	NA
Huddart et al. (2003) [35]	390	1982–1992	10 y (0–20 y)	41 y (23–72 y)	Stage I TC (242)	13 versus 9^d (antihypertension medication)	1 versus 2^d (lipid-lowering medication)	NA	NA	NA
Nuver et al. (2004) [14]	90	1988–1999	7 y (NA)	37 y (20–65 y)	Stage I TC (44) and healthy patients (47)	22 versus 23 versus 11^d (SBP ≥ 135 mmHg, DBP ≥ 85 mmHg)	71 versus 59 versus 45^e (LDL > 131 mg/dL)	NA	22 versus 27 versus 11^e (BMI ≥ 30)	NA
Nuver et al. (2005) [36]	86	1988–1999	7 y (3–13 y)	37 y (20–65 y)	Stage I TC (44) and healthy patients (47)	NA	NA	NA	NA	26 versus 36 versus 9^e (≥3 factors per NCEP definition [163])
Sagstuen et al. (2005) [37]	500	1980–1994	11 y (4–22 y)	44 y (23–75 y)	Surgery-only^f (242)^g	50 versus 39 (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertension medication)	NA	NA	18 versus 13^h (BMI ≥ 30)	NA
Haugnes et al. (2007) [33]	464	1980–1994	11 y (5–22 y)	43 y (15–52 y)	Surgery-only^f (225) and healthy population (1150)	45 versus 34 versus 50^i (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertension medication)	68 versus 67 versus 84^d (TC ≥ 201 mg/dL)	3 versus 2 versus 3^d (by patient self-report)	18 versus 13 versus 21^d (BMI ≥ 30)	9 versus 7 versus 15^h (≥3 factors per NCEP definition [163])
Haugnes et al. (2010) [34]	364	1980–1994	19 y (13–28 y)	49 y (31–69 y)	Surgery-only^f (206) and healthy population (990)	26 versus 12 versus 13 (antihypertension medication)	14 versus 14 versus 9^e (lipid-lowering medication)	5 versus 4 versus 4^d (by patient self-report or fasting glucose ≥ 198 mg/dL)	17 versus 19 versus 23^d (BMI ≥ 30)	NA
Willemse et al. (2013) [38]	194^j	1977–2008	7.8 y (0.1–30 y)	39.6 y (18–70 y)	Surgery-only (57) and healthy population (360)	29 versus 14 versus 22.5^k (per NCEP definition [163])	NA	NA	29 versus 18 versus 19^k (per NCEP definition [163])	16 versus 9 versus 8^k (per NCEP definition [163])
de Haas et al. (2013) [39]	173	1977–2004	5 y (3–20 y)	37 y (19–59 y)	Healthy population (1085)	59 versus NA (SBP ≥ 130 mmHg or DBP ≥ 85 mmHg or antihypertension medication) (AHA/NHLBI definition)	44 versus NA (HDL <1.03 mmol/l or lipid-lowering medication) (AHA/NHLBI definition)	14 versus NA (fasting glucose ≥5.6 mmol/l or medication) (AHA/NHLBI definition)	17 versus NA (waist circumference ≥ 102 cm) (AHA/NHLBI definition)	25 versus NA (≥3 factors per AHA/NHLBI definition)
Fung et al. (2017) [40]	952	1979–2015	4.3 y (1.0–29.9)	37 y (19–68 y)	NHANES matched controls (952)	16.8 versus 19.4^d ever diagnosed with high blood pressure and current use of antihypertension medication	10.5 versus NA^l current use of cholesterol lowering medication	3.1 versus NA^l diabetes requiring insulin or diabetes requiring medication	31.3 versus 35.4^k BMI ≥ 30	NA

Adapted with permission from Feldman et al. [9] (Table 2). AHA: American Heart Association; BMI: body mass index; DBP: diastolic blood pressure; DM: diabetes mellitus; NHLBI: National Heart, Lung, and Blood Institute; NHANES: National Health and Nutrition Examination Survey; TC: testicular cancer; HTN: hypertension; LDL: low-density lipoprotein; NA: not available; NCEP: National Cholesterol Education Program; SBP: systolic blood pressure; TC: total cholesterol. (a) N varies slightly for individual factors due to missing data in papers for some variables. (b) Definitions of individual factors vary by study. Comparisons of chemotherapy group to controls significant unless otherwise stated; percentages vary slightly due to missing data for individual factors. (c) Cholesterol and fasting glucose values in definitions were converted from mml/L to mg/dL, where necessary for uniformity. (d) Not significant. (e) Significant versus healthy population controls but not versus surgery patients. (f) Includes both orchiectomy and primary retroperitoneal lymph node dissection patients. (g) A healthy population control group was also included in this study, but prevalence rates of cardiovascular risk factors were not reported for this control group, and therefore these data are not included in the table. (h) Significant only for patients who received >850 mg of cisplatin. (i) Significant versus surgery patients but not versus healthy controls. (j) 20 patients received carboplatin and 174 patients received combination chemotherapy. (k) Significant for patients who received combination chemotherapy compared to healthy population. (l) Significance versus controls not tested.