Purpose: Testicular cancer survivors who have received platinum-based chemotherapy are at risk for premature cardiovascular disease. The etiology of this risk is not well understood. This pilot study explores the impact of platinum-based chemotherapy on endothelial function. Methods: Testicular cancer survivors <30 years old at the time of diagnosis who received platinum-based chemotherapy between 2002 and 2012, as well as 17 similarly aged male controls, were identified. Consented subjects underwent vascular assessment using the HDI/PulseWave CR-2000 Cardiovascular Profiling System and the Endo-PAT2000 system. Biomarkers and functional test markers were compared among cases, controls, and a group of historical controls using two sided two-sampled t-tests and Wilcoxon rank-sum tests. Results: Thirteen survivors with a median age of 30.2 years and body mass index of 27.3 were enrolled, along with 17 healthy controls with a median age of 27.1 years and body mass index of 24.8. Median time from chemotherapy was 4.7 (range: 0.8–14) years. There was no statistical difference in reactive hyperemia peripheral arterial tonometry ratio between cases and controls (p = 0.574). There was no statistical difference in small or large artery elasticity between cases and controls (p = 0.086) or between cases and historical controls (p = 0.729). There was also no statistical difference in the blood levels of circulating endothelial cells, von Willebrand factor, and vascular cell adhesion molecules. There was a trend toward increased metabolic syndrome in cases (15%) as compared to recruited controls (6%), though this difference was not statistically significant (p = 0.565). Conclusion: Testicular cancer survivors have no clinically significant difference in endothelial function compared to controls 4 years after the completion of chemotherapy. Further research is needed to explore the secondary modifiable causes that may contribute to the risk of premature cardiovascular disease.
Bibliographical noteFunding Information:
The results of this study were presented at the meeting of the American Society of Clinical Oncology in June 2014 as a poster presentation and published in abstract form in the Journal of Clinical Oncology. We greatly appreciate Dr Douglas Yee, for his time and effort in discussing the concept and providing insight on the overall project, as well as Dr Rachel Lerner and Dr Dylan Zylla, for their time and assistance in helping recruit subjects at the Park Nicollet Health Services. Finally, we thank Dr Jason Baker for sharing data on historical controls, as well as Natalia Florea for her contributions in performing vascular assessments. We also thank the following sources of funding for our project: AFLAC Young Investigator Award in Young Adult Oncology and Building Interdisciplinary Research Careers in Women’s Health (National Institutes of Health grant number K12-HD055887).
© 2018 Blaes et al.
- Cardiac disease
- Cardiac injury
- Testicular cancer
- Vascular injury