Survival and vascular damage in long-term testicular cancer survivors after chemotherapy treatment

Kruyt, L.M. (Lara) (2016) Survival and vascular damage in long-term testicular cancer survivors after chemotherapy treatment. thesis, Medicine.

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Abstract

BACKGROUNDS: Following the introduction of platinum-based chemotherapy in the late 1970s, testicular cancer (TC) survival rates increased exceedingly. However, chemotherapy-related vascular morbidity is likely to pose a major threat to TC survivors in the long-term. Arterial stiffness, as measured by pulse wave velocity (PWV), may be predictive of cardiovascular morbidity and mortality. Both survival and arterial stiffness have never been assessed in TC survivors who underwent treatment more than 20 years ago. DESIGN: (i) retrospective cohort study, (ii) cross-sectional cohort study. AIMS: (i) To describe overall, TC specific and non-cancer specific survival, (ii) to compare survival results with age- and sex-specific mortality rates for the general population, (iii) to describe arterial stiffness at long-term follow-up, (iv) to describe prevalence of cardiovascular risk factors and their relationship with arterial stiffness at long-term follow-up. METHODS: Survival was analysed in a retrospective cohort of 306 patients treated with platinum-based chemotherapy more than 20 years ago (1977–1995). Twenty-five of these patients additionally participated in the cross-sectional cohort study. Arterial stiffness, measured as carotid-femoral pulse wave velocity (cf-PWV) was assessed and compared to a reference population from literature. Furthermore, disease- and treatment details and cardiovascular risk factors (i.e. BMI, dyslipidaemia, hypertension, history of smoking and family history for cardiovascular disease) were evaluated. RESULTS: TC survivors had a 1.75 times higher risk of dying from non-cancer causes (SMR 1.75, 95% CI 1.33–2.14) resulting in a median life expectancy of 10 years shorter than life expectancy in the age- and sex-specific general population. After a median follow-up of 29 years, no significant increase in cf-PWV was observed compared with a reference population (Z-score = 0.31, 95% CI -0.20 – 0.81). Patients with high PWV (Z-score > 1) were significantly younger than patients with normal PWV (49.5 vs. 59.3 years, P = 0.005). Hypertension was found in 68% of the patients, 92% percent had dyslipidaemia, 68% had a BMI above normal, 32% were current smokers and 56% of the patients had the metabolic syndrome. CONCLUSION: After successful completion of the treatment, TC survivors have a higher risk of dying from non-cancer causes and a remarkably high prevalence of cardiovascular risk factors compared with healthy controls. Extended follow-up is needed for adequate detection, prevention and treatment of modifiable cardiometabolic risk factors. Further studies are needed to evaluate the value of PWV as a screening modality for cardiovascular disease after TC treatment.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisors: and Gietema, Prof. Dr. J.A. (Jourik) and Lubberts drs. S.(Sjoukje) and Institution: University Medical Centre Groningen and Department: Medical Oncology and Research line: Testicular Cancer
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:56
Last Modified:	25 Jun 2020 10:56
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1699

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