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

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.

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.

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).

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.

Clinical genitourinary cancer. 2018 Feb 05 [Epub ahead of print]

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, Platinum Study Group

Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ., Indiana University, Melvin and Bren Simon Cancer Center, Indianapolis, IN., Division of Preventive Medicine and Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA., University of Rochester Medical Center, James P. Wilmot Cancer Center, Rochester, NY., Division of Urology, Princess Margaret Cancer Center, Toronto, ON., Department of Medicine, University of Pennsylvania, Philadelphia, PA., Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA., Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, and Karmanos Cancer Institute, Detroit, MI., Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY., Department of Oncology, Oslo University Hospital Radium Hospital, and Oslo University, Faculty of Medicine Oslo, Norway.