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Study Finds Increased Short-Term Risk for Cardiovascular Disease Mortality After Chemotherapy for Testicular Nonseminoma

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Key Points

  • Risk of cardiovascular disease mortality was increased during the first year after diagnosis in patients receiving chemotherapy for testicular nonseminoma.
  • No increased risk was observed in patients after surgery.

In a population-based study reported in the Journal of Clinical Oncology, Fung et al found a significantly increased risk of cardiovascular disease mortality during the first year after chemotherapy for testicular nonseminoma. No increased risk of cardiovascular disease mortality after surgery was observed.

Study Details

The study involved data from 15,006 patients with testicular nonseminoma reported to the Surveillance, Epidemiology, and End Results program between 1980 and 2010 who initially received chemotherapy (n  = 6,909) or surgery (n = 8,097) without radiotherapy and had 60,065 and 81,227 person-years of follow-up, respectively. Standardized mortality ratios (SMRs) compared with the general population were calculated for cardiovascular disease mortality.

Increased Short-Term Risk

Risk of cardiovascular disease mortality was significantly increased in patients who received chemotherapy (SMR = 1.36, 95% confidence interval [CI] = 1.03–1.78; n = 54) but not surgery (SMR = 0.81, 95% CI = 0.60–1.07; n = 50). A significantly increased risk of cardiovascular disease death after chemotherapy was restricted to the first year after cancer diagnosis (SMR = 5.31, absolute excess risk of 13.90 per 10,000 person-years; n = 11), including an increased risk of death from cerebrovascular disease (SMR = 21.72, absolute excess risk of 7.43/10,000 person-years; n = 5) and heart disease (SMR = 3.45, absolute excess risk of 6.64/10,000 person-years; n = 6).

On multivariable analyses, increased cardiovascular disease mortality after chemotherapy was observed for the first year after cancer diagnosis (hazard ratio [HR] = 4.86, 95% CI = 1.25–32.08) but not thereafter (hazard ratios = 1.35 for 1–4 years and 0.90 for ≥ 5 years). Other independent predictors were distant nonseminoma (HR = 1.91, P < .05) and older age at cancer diagnosis (hazard ratios = 3.47, 8.97, and 34.26 for ages 30–39, 40–49, and ≥ 50 years; P < .01).

The investigators concluded: “This is the first population-based study, to our knowledge, to quantify short- and long-term [cardiovascular disease] mortality after [testicular cancer] diagnosis. The increased short-term risk of [cardiovascular disease] deaths should be further explored in analytic studies that enumerate incident events and can serve to develop comprehensive evidence-based approaches for risk stratification and application of preventive and interventional efforts.”

Lois B. Travis, MD, ScD, of the Center for Cancer Survivorship Research, Indiana University Melvin and Bren Simon Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.

The study was supported by the National Cancer Institute and James P. Wilmot Foundation. For full disclosures of the study authors, visit jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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