Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy: Application of the Framingham Risk Score

Darren R. Feldman, Shirin Ardeshir-Rouhani-Fard, Patrick Monahan, Howard D. Sesso, Chunkit Fung, Annalynn M. Williams, Robert J. Hamilton, David J. Vaughn, Clair J. Beard, Ryan Cook, Mohammad Abu Zaid, Steven E Lipshultz, Lawrence H. Einhorn, Kevin C. Oeffinger, Lois B. Travis, Sophie D. Fossa

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background: Testicular cancer survivors (TCSs) are at increased risk of cardiovascular disease (CVD) after cisplatin-based chemotherapy (CBCT). Identifying at-risk survivors would allow early intervention, but risk prediction tools such as the Framingham Risk Score (FRS) have not been applied to TCSs given modern chemotherapy. Methods: TCSs > 1 year post-CBCT were evaluated. Associations between FRS and clinical, socioeconomic, and lifestyle measures and treatment regimen (4 cycles, etoposide and cisplatin [EP × 4]); 3 or 4 cycles, bleomycin plus EP (BEP × 3, BEP × 4) were analyzed with general linear multivariable models. Controls from the National Health and Nutrition Examination Survey were matched 1:1 to TCSs by age, race, and education with differences in mean FRS evaluated with 2-sided t tests. Results: Of 787 TCSs (median age, 37.3 years; median follow-up, 4.2 years), 284, 342, and 161 received EP × 4, BEP × 3, or BEP × 4, respectively. TCSs had higher median systolic blood pressure (126 vs. 119 mm Hg; P < .001), but fewer were smokers (8.4% vs. 28.2%; P < .001) than controls. In multivariable analysis, no significant differences in FRS between EP × 4, BEP × 3, and BEP × 4 were observed, but less than college education (P < .001) and lack of vigorous exercise (P = .006) were associated with higher FRS. Mean FRS did not differ between TCSs and controls (6.8% vs. 7.3%; P = .67). Conclusion: This is the first study to apply the office-based FRS to TCSs. Chemotherapy regimen (BEP × 3 vs. EP × 4) was not associated with FRS, but less educated and less vigorously active patients had higher FRS, and present a high-risk subgroup for intense follow-up and counseling.

Original languageEnglish (US)
JournalClinical Genitourinary Cancer
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

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Keywords

  • Cytotoxic drugs
  • Germ cell tumor
  • Late effects
  • NHANES controls
  • Risk model

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Feldman, D. R., Ardeshir-Rouhani-Fard, S., Monahan, P., Sesso, H. D., Fung, C., Williams, A. M., Hamilton, R. J., Vaughn, D. J., Beard, C. J., Cook, R., Zaid, M. A., Lipshultz, S. E., Einhorn, L. H., Oeffinger, K. C., Travis, L. B., & Fossa, S. D. (Accepted/In press). Predicting Cardiovascular Disease Among Testicular Cancer Survivors After Modern Cisplatin-based Chemotherapy: Application of the Framingham Risk Score. Clinical Genitourinary Cancer. https://doi.org/10.1016/j.clgc.2018.01.011