Long-term cardiovascular complications in stage I seminoma patients
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A. Terbuch [1] ; F. Posch [1] ; L. M. Annerer [1] ; T. Bauernhofer [1] ; M. Pichler [1] ; J. Szkandera [1] ; G. C. Hutterer [1] ; K. Pummer [1] ; R. Partl [1] ; K. S. Kapp [1] ; H. Stöger [1] ; A. Gerger [1] ; M. Stotz [1]
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[1] Medical University of Graz
Medical University of Graz
Graz, Austria
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- Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 19, Nº. 11 (November 2017), 2017, págs. 1400-1408
- Idioma: inglés
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Resumen
Purpose The 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.
Methods This retrospective cohort study included 406 consecutive stage I seminoma patients. Primary endpoint was CVE rate.
Results During 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).
Conclusion We 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.
