Cognitive Impairment in Long-Term Survivors of Testicular Cancer More Than 20 Years after Treatment.

Impaired cognition can be a late effect after treatment in long-term testicular cancer (TC) survivors, negatively affecting their daily life. However, little data is available beyond 20 years post-treatment. We assessed cognitive impairment in very long-term TC survivors after CT or RT and compared the results with stage I TC survivors and controls.

In this cross-sectional multicenter cohort study, we enrolled TC survivors (treated with orchiectomy followed by CT or RT or orchiectomy only)-with a follow-up duration ≥ 20 years-and age-matched healthy controls. Cognitive testing included the Auditory Verbal Learning Test, Letter Fluency Test, Category Fluency Test, and Trail Making Test. We used fasting blood samples to assess the presence of hypogonadism and measured cardiovascular aging parameters, including carotid pulse wave velocity (c-PWV) and advanced glycation end products (AGEs).

We included 184 TC survivors (66 CT patients, 53 RT patients, and 65 orchiectomy-only patients) and 70 healthy controls. The median follow-up was 26 years (range: 20-42). TC survivors had a lower combined score of the cognitive tests (mean cumulative Z-score -0.85; 95% CI -1.39 to -0.33) compared to controls (mean 0.67; 95% CI -0.21 to 1.57, p < 0.01). In univariate analysis, the presence of hypogonadism (β -1.50, p < 0.01), high c-PWV (β -0.35, p = 0.09), and high AGEs (β -1.27, p = 0.02) were associated with lower cognitive scores, while only AGEs (β -1.17, p = 0.03) remained a significant predictor in multivariate analysis (Model R2 0.31, p < 0.01).

Long-term TC survivors performed worse on cognitive tests compared to controls. Physicians and patients should be informed about timely cardiovascular risk management and testosterone supplementation therapy during follow-up to reduce the risk of cognitive impairment.

NCT02572934.

Cancers. 2021 Nov 12*** epublish ***

Johannes Stelwagen, Andrea T Meuleman, Sjoukje Lubberts, Gerrie Steursma, Lara M Kruyt, Jan W Donkerbroek, Coby Meijer, Annemiek M E Walenkamp, Joop D Lefrandt, Sandra E Rakers, Rients B Huitema, Marianne A A de Jong, Erwin M Wiegman, Alfons C M van den Bergh, Igle J de Jong, Joost A Agelink van Rentergem, Sanne B Schagen, Janine Nuver, Jourik A Gietema

Department of Medical Oncology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands., Department of Internal Medicine, Division of Vascular Medicine, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands., Department of Neuropsychology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands., Department of Radiotherapy, Radiotherapeutic Institute Friesland, 8900 CC Leeuwarden, The Netherlands., Department of Radiotherapy, Isala Hospital, 8025 AB Zwolle, The Netherlands., Department of Radiotherapy, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands., Department of Urology, University Medical Center Groningen and University of Groningen, 9728 NT Groningen, The Netherlands., Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, 1018 WV Amsterdam, The Netherlands.

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