Long-term cardiovascular complications in stage I seminoma patients

Abstract

PurposeThe cure rate of stage I seminoma patients is close to 100% and so the recent focus of clinical research has shifted onto the prevention of treatment-related complications. We assessed long-term cardiovascular complications and identified risk factors for cardiovascular events (CVEs) in stage I seminoma patients.MethodsThis retrospective cohort study included 406 consecutive stage I seminoma patients. Primary endpoint was CVE rate.ResultsDuring a median follow-up of 8.6 years, we observed 23 CVEs in 406 patients [10-year CVE risk 5.6% (95% CI 3.2 to 8.8)]. In univariable competing risk analysis, higher age, positive smoking status, history of diabetes and hypertension were significantly associated with the occurrence of CVE. In multi-state analysis, new onset of diabetes, hypertension and hyperlipidemia during follow-up predicted for an excessively increased CVE risk. In multivariable analysis adjusting for age and smoking, the development of hypertension and hyperlipidemia after tumor-specific treatment prevailed as risk factors for CVE. Regarding adjuvant treatment modalities, patients receiving adjuvant radiotherapy had a significantly higher probability of CVE than patients receiving adjuvant carboplatin [16% vs. 0%; risk difference (RD) = 16%, 95% CI 6 to 25%, p = 0.001]. This difference prevailed after adjusting for age, follow-up-time, diabetes, hypertension and smoking (RD = 11%, 95% CI 1 to 20%, p = 0.025).ConclusionWe identified a panel of baseline risk factors and dynamically, occurring predictors of CVE in stage I seminoma patients. This information may be used for targeting comorbidity management in these patients. The observed association of adjuvant radiotherapy with higher CVE risk warrants further investigation.

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Non-Coding microRNAs as Novel Potential Tumor Markers in Testicular Cancer

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Readressing the rationale of irradiation in stage I seminoma guidelines: a critical essay

“…), the absolute number after AUC 7 treatment could be > 70 per 1000 (CI +3.5%) which is an increase of 75%. This difference was confirmed in a retrospective analysis where 1.8% of the irradiated patients relapsed (median follow‐up: 9.7 years) compared with 8.1% after one cycle of carboplatin (median follow‐up: 3.4 years) . This high relapse rate was confirmed in other analyses where up to 10% of patients relapsed after one cycle of carboplatin with mostly retroperitoneal relapses .…”