Abstract 4026: Treatment-Related Differences in Cardiovascular Risk Factors in Long-Term Survivors of Testicular Cancer
Background: Previous studies have shown that successful treatment of testicular cancer tends to be followed by later development of risk factors for cardiovascular disease. Here we have examined whether the specific mode of treatment influences which specific risk factors are developed.
Methods: Blood levels of inflammatory markers, atherogenic lipoproteins and gonadal hormones were measured in 589 patients who had been successfully treated for testicular cancer 7 to 15 years previously. Included in this population were 140 patients previously treated by surgery alone (SURG), 231 who had been treated by surgery and then infradiaphragmatic radiotherapy (RAD), and 218 who were treated by surgery and then chemotherapy (CHEM).
The RAD group had higher levels of high-sensitivity C-reactive protein (median 1.50 (interquartile range 0.86–2.60) mg/l) and soluble CD40 ligand (median 105 (interquartile range 78–154) pg/mL) compared to the SURG group (median 1.20 (interquartile range 0.63–2.05) mg/l, p = 0.001 and median 91 (interquartile range 64–123) pg/mL, p = 0.002 respectively.
The CHEM group had lower levels of high density lipoprotein cholesterol (median 1.10 (interquartile range 1.00–1.30) mmol/L) and an increased apolipopro-tein B/apolipoprotein A-1 ratio (median 0.80 (interquartile range 0.64–1.00)) than the SURG group (median 1.20 (interquartile range 1.05–1.40), p < 0.001 and median 0.75 (interquartile range 0.60– 0.86), p < 0.01). The prevalence of metabolic syndrome was higher in the CHEM group than in the SURG group (17.6 % versus 6.3 %, p = 0.02).
Hypogonadism was significantly more prevalent in the CHEM than in the SURG group (13.3 % versus 5.0 %, p = 0.04).
Conclusions: These findings suggest that the manner in which testicular cancer is treated influences which specific cardiovascular risk factors subsequently develop. Radiation treatment tends to be followed by elevated indices of chronic inflammation and endothelial dysfunction, whereas chemotherapy tends to be followed by the development of atherogenic lipid changes and the metabolic syndrome.