ASCO 2024: Long Term Cardiovascular Adverse Outcomes in Testicular Cancer Survivors: Real-World U.S. Population-Based Study

(UroToday.com) The 2024 American Society of Clinical Oncology (ASCO) Annual Meeting held in Chicago, IL between May 31^st and June 4^th, 2024 was host to a prostate, testicular, and penile cancers poster session. Dr. Khalid Alkhatib presented the results of a real-world, US-based study evaluating long-term cardiovascular adverse outcomes in testicular cancer survivors.

There has been growing interest in improving the survivorship outcomes of testicular cancer patients, particularly given the high cure rates with single or multi-modality approaches. Numerous studies have previously linked a history of testicular cancer and associated treatments (systemic or radiotherapy) with an increased risk of long-term cardiovascular disease events. As such, it is essential to evaluate this association at a population level to develop early prevention strategies to improve testicular cancer survivors’ overall quality of life. In this study, the investigators interrogated the U.S. Behavioral Risk Factor Surveillance System (BRFSS) to evaluate the long-term outcomes of testicular cancer survivors in a real-world random population sample.

Using BRFSS cycles between 2014 and 2022, the investigators extracted data for all patients who reported having a history of testicular cancer and compared them to the remaining male population sample without a history of a cancer diagnosis. Using national complex weights, they estimated each group’s outcomes proportions. Furthermore, they used several complex-weighted logistic regression models adjusted for different covariates to evaluate the association between a history of testicular cancer and odds of developing hypertension, high cholesterol, diabetes, BMI >25, angina, myocardial infarction (MI), coronary heart disease (CHD), stroke, and chronic kidney disease (CKD).

The study investigators identified 308 patients with a known history of testicular cancer and 1,169,061 men with no prior history of cancer. The baseline patient characteristics are summarized below. The median patient age was 52.2 among testicular cancer survivors and 50.7 for the controls. The mean age of testicular cancer diagnosis was 35.1 years (mean cancer survival was 17.1 years). Of these 308 patients, 90% had completed treatment and 10% reported that ‘treatment was not necessary’.
Using complex-weighted logistic regression modeling adjusted for age, race, income, education, marital status, reported health status, exercise, smoking status, physical status, and mental health status, Dr. Alkhatib and colleagues demonstrated the following associations between testicular cancer and increased odds of:

• Angina (OR: 3.98, p
• Coronary heart disease or myocardial infarction (OR: 3.01, p

Dr. Alkhatib concluded that these real-world data confirm the results of prior smaller, hospital-based studies demonstrating a significantly increased risk of cardiovascular disease in testicular cancer survivors. These findings support implementing early preventative strategies in testicular cancer survivors. 

Presented by: Khalid Alkhatib, MD, MMSc. Clinical Research Fellow, University of Pennsylvania, Philadelphia, PA

Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, Chicago, IL, May 31^st – June 4^th, 2024