Patients with testicular cancer (TC) who received chemotherapy, but not surgery, were more likely to die from cardiovascular disease (CVD) and cerebrovascular disease, according to a study published online ahead of print in the Journal of Clinical Oncology.

Few population-based studies had quantified CVD mortality shortly, after and 2 decades after diagnosis in the era of cisplatin-based chemotherapy.

“This is the first population-based study, to our knowledge, to quantify short- and long-term CVD mortality after TC diagnosis,” the authors wrote.

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Researchers calculated standardized mortality ratios for CVD and absolute excess risks (AERs; number of excess deaths per 10,000 person-years) for 15,006 patients with testicular nonseminoma reported to the population-based Surveillance, Epidemiology, and End Results program from 1980 to 2010.

Patients who initially received chemotherapy (n = 6,909) or surgery (n = 8,097) without radiotherapy were included. The median person-years of follow-up was 60,065 for the chemotherapy group and 81, 227 for the surgical group. Age, treatment, disease extent, and other factors were considered when evaluating CVD mortality.

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Results showed significantly increased CVD mortality after chemotherapy (standardized mortality ratio [SMR] 1.36; 95% CI, 1.03 to 1.78; n = 54), but not for surgery (SMR, 0.81; 95% CI, 0.60 to 1.07; n = 50).

Excess deaths following chemotherapy were restricted for the first year following TC diagnosis and included cerebrovascular disease and heart disease. Distant disease and older age at diagnosis were independent risk factors.


  1. Cardiovascular disease mortality after chemotherapy or surgery for testicular nonseminoma: a population-based study. J Clin Oncol. 2015. [epub ahead of print]. doi: 10.1200/JCO.2014.60.3654.