Cardiovascular morbidity in long-term survivors of metastatic testicular cancer

Purpose: To determine whether long-term survivors of metastatic testicular cancer have an increased risk of cardiovascular morbidity more than 10 year s after chemotherapy. Patients and Methods: Eighty-seven patients treated with cisplatin-containi ng chemotherapy before 1987 who were in remission for at least 10 years and whose ages were less than or equal to 50 years at the time of analysis wer e evaluated for the occurrence of cardiovascular events. Sixty-two of 87 pa tients were additionally evaluated for cardiac damage and cardiovascular ri sk factors. Their cardiovascular risk profile was compared with that of 40 patients with comparable age and follow-up duration treated with orchidecto my only for stage I disease. Results: Major cardiac events were found in five (6%) of the 87 patients (a ge at time of event, 30 to 42 years; time after chemotherapy, 9 to 16 years ): two with myocardial infarction and three with angina pectoris with prove n myocardial ischemia. An increased observed-to-expected ratio of 7.1 (95% confidence interval, 1.9 to 18.3) for coronary artery disease, as compared with the general male Dutch papulation, was found. In addition, one patient experienced a cerebrovascular accident. Exercise ECG did not reveal cases of subclinical coronary artery disease. Echocardiography showed normal syst olic left ventricular function in most patients, but diastolic left ventric ular function was disturbed in 33% of the patients. Of 62 chemotherapy pati ents, 79% had hypercholesterolemia, 39% had hypertension, 25% still experie nced Raynaud's phenomenon, and 22% had microalbuminuria. Compared with pati ents with stage I disease, the chemotherapy patients had higher blood press ure and higher total cholesterol and triglyceride levels and were more insu lin-resistant. Conclusion: In long-term survivors of metastatic testicular cancer, we obse rved a significantly increased risk for occurrence of cardiac events accomp anied by a persisting unfavorable cardiovascular risk profile. Accurate fol low-up, focused on cardiovascular complications and aimed at intervention i n these young cancer survivors, seems to be important. J Clin Oncol 18:1725-1732. (C) 2000 by American Society of Clinical Oncolog y.