Table 1.
Clinical and other characteristics and AHO in TCS by type of management
| Treatment regimen |
||||||
|---|---|---|---|---|---|---|
| All patients | Surgery | BEPx3 | BEPx4 | Other chemotherapy* | ||
| Characteristic | n = 479 | n = 98 | n = 235 | n = 82 | n = 64 | P † |
| Clinical characteristic | ||||||
| Age at diagnosis, y | ||||||
| Median [range] | 31.0 [10.0, 56.2] | 33.9 [15.4, 56.2] | 30.0 [10.0, 53.0] | 27.0 [16.0, 49.0] | 31.5 [13.0, 55.0] | .0092 |
| Age at clinical evaluation, y | ||||||
| Median [range] | 38.3 [18.3, 74.5] | 39.0 [20.2, 62.3] | 38.4 [18.3, 74.5] | 36.3 [20.1, 71.3] | 40.6 [20.8, 71.1] | .2468 |
| Category | .3384 | |||||
| <20 | 3 (0.6%) | 0 | 3 (1.3%) | 0 | 0 | |
| 20–29 | 101 (21.1%) | 20 (20.4%) | 47 (20.0%) | 21 (25.6%) | 13 (20.3%) | |
| 30–39 | 169 (35.3%) | 35 (35.7%) | 84 (35.7%) | 32 (39.0%) | 18 (28.1%) | |
| 40–49 | 135 (28.2%) | 30 (30.6%) | 65 (27.7%) | 23 (28.0%) | 17 (26.6%) | |
| 50+ | 71 (14.8%) | 13 (13.3%) | 36 (15.3%) | 6 (7.3%) | 16 (25.0%) | |
| Histologic type§ | <.0001 | |||||
| Seminoma | 127 (27.0%) | 55 (56.7%) | 52 (22.4%) | 6 (7.4%) | 14 (23.0%) | |
| Nonseminoma | 344 (73.0%) | 42 (43.3%) | 180 (77.6%) | 75 (92.6%) | 47 (77.0%) | |
| Site‖ | <.0001 | |||||
| Testis | 397 (84.1%) | 98 (100.0%) | 205 (88.4%) | 55 (67.9%) | 39 (63.9%) | |
| Extragonadal | 75 (15.9%) | 0 | 27 (11.6%) | 26 (32.1%) | 22 (36.1%) | |
| Cisplatin-based chemotherapy | <.0001 | |||||
| BEP¶ | 329 (68.7%) | 0 | 235 (100.0%) | 82 (100.0%) | 12 (18.8%) | |
| EP# | 20 (4.2%) | 0 | 0 | 0 | 20 (31.3%) | |
| None | 98 (20.5%) | 98 (100.0%) | 0 | 0 | 0 | |
| Other** | 32 (6.7%) | 0 | 0 | 0 | 32 (50.0%) | |
| Cumulative dose of cisplatin, mg/m2 | ||||||
| Median [range] | 300 [0, 700] | 0 [0, 0] | 300 [276, 334] | 400 [370, 414] | 400 [198, 700] | <.0001 |
| Category | <.0001 | |||||
| 0 | 98 (20.5%) | 98 (100.0%) | 0 | 0 | 0 | |
| <300 | 25 (5.2%) | 0 | 16 (6.8%) | 0 | 9 (14.1%) | |
| 300 | 216 (45.1%) | 0 | 212 (90.2%) | 0 | 4 (6.3%) | |
| 301–399 | 28 (5.8%) | 0 | 7 (3.0%) | 13 (15.9%) | 8 (12.5%) | |
| 400 | 95 (19.8%) | 0 | 0 | 62 (75.6%) | 33 (51.6%) | |
| >400 | 17 (3.5%) | 0 | 0 | 7 (8.5%) | 10 (15.6%) | |
| Cumulative dose of bleomycin, IU | ||||||
| Median [range] | 270 000 [0.0, 630 000] | 0.0 [0.0, 0.0] | 270 000 [90 000, 270 000] | 360 000 [0.0, 360 000] | 0.0 [0.0, 630 000] | <.0001 |
| Category | <.0001 | |||||
| 0 | 143 (29.9%) | 98 (100.0%) | 0 | 2 (2.4%) | 43 (67.2%) | |
| >0–180 000 | 27 (5.6%) | 0 | 8 (3.4%) | 8 (9.8%) | 11 (17.2%) | |
| 181 000–270 000 | 254 (53.0%) | 0 | 227 (96.6%) | 22 (26.8%) | 5 (7.8%) | |
| 271 000–360 000 | 52 (10.9%) | 0 | 0 | 50 (61.0%) | 2 (3.1%) | |
| 360 000+ | 3 (0.6%) | 0 | 0 | 0 | 3 (4.7%) | |
| Retroperitoneal lymph node dissection†† | <.0001 | |||||
| No | 303 (64.3%) | 80 (81.6%) | 157 (68.6%) | 30 (37.0%) | 36 (57.1%) | |
| Yes | 168 (35.7%) | 18 (18.4%) | 72 (31.4%) | 51 (63.0%) | 27 (42.9%) | |
| Time from chemotherapy/surgery to clinical evaluation, y | ||||||
| Median [range] | 4.1 [1.0, 34.9] | 3.8 [1.0, 30.7] | 4.3 [1.0, 25.5] | 4.5 [1.0, 34.9] | 3.8 [1.0, 25.1] | .7518 |
| Category | .0081 | |||||
| <2 | 149 (31.1%) | 24 (24.5%) | 79 (33.6%) | 23 (28.0%) | 23 (35.9%) | |
| 2–5 | 136 (28.4%) | 44 (44.9%) | 55 (23.4%) | 23 (28.0%) | 14 (21.9%) | |
| 6–9 | 70 (14.6%) | 15 (15.3%) | 36 (15.3%) | 13 (15.9%) | 6 (9.4%) | |
| ≥10 | 124 (25.9%) | 15 (15.3%) | 65 (27.7%) | 23 (28.0%) | 21 (32.8%) | |
| Sociodemographic characteristic | ||||||
| Race | .1817 | |||||
| White | 453 (95.0%) | 94 (95.9%) | 225 (96.2%) | 73 (90.1%) | 61 (95.3%) | |
| Non-white | 24 (5.0%) | 4 (4.1%) | 9 (3.8%) | 8 (9.9%) | 3 (4.7%) | |
| Marital status†† | .4641 | |||||
| Not married | 163 (34.2%) | 32 (32.7%) | 78 (33.3%) | 34 (41.5%) | 19 (30.2%) | |
| Married/living as married | 314 (65.8%) | 66 (67.3%) | 156 (66.7%) | 48 (58.5%) | 44 (69.8%) | |
| Education§§ | .2391 | |||||
| High school or less | 85 (17.8%) | 15 (15.3%) | 35 (15.0%) | 17 (20.7%) | 18 (28.1%) | |
| Some college/college graduate | 296 (62.1%) | 62 (63.3%) | 146 (62.7%) | 51 (62.2%) | 37 (57.8%) | |
| Post-graduate level/other | 96 (20.1%) | 21 (21.4%) | 52 (22.3%) | 14 (17.1%) | 9 (14.1%) | |
| Noise exposure‖‖ | .0073 | |||||
| None | 236 (49.9%) | 60 (61.2%) | 119 (51.1%) | 30 (37.5%) | 27 (43.5%) | |
| Work-related only | 111 (23.5%) | 22 (22.4%) | 60 (25.8%) | 17 (21.3%) | 12 (19.4%) | |
| Non-work related only | 41 (8.7%) | 3 (3.1%) | 21 (9.0%) | 10 (12.5%) | 7 (11.3%) | |
| Both | 85 (18.0%) | 13 (13.3%) | 33 (14.2%) | 23 (28.8%) | 16 (25.8%) | |
| Physical examination results | ||||||
| Body mass index, kg/m2¶¶ | ||||||
| Median [range] | 28.3 [18.0, 66.6] | 28.0 [18.0, 54.3] | 28.2 [19.0, 66.6] | 28.2 [20.5, 46.1] | 29.2 [20.0, 42.0] | .6641 |
| Category | .5166 | |||||
| <25 (normal) | 105 (22.2%) | 24 (25.3%) | 54 (23.2%) | 16 (19.8%) | 11 (17.2%) | |
| 25≤30 (overweight) | 194 (41.0%) | 40 (42.1%) | 95 (40.8%) | 33 (40.7%) | 26 (40.6%) | |
| 30≤40 (obese) | 148 (31.3%) | 28 (29.5%) | 66 (28.3%) | 29 (35.8%) | 25 (39.1%) | |
| ≥40 (morbidly obese) | 26 (5.5%) | 3 (3.2%) | 18 (7.7%) | 3 (3.7%) | 2 (3.1%) | |
| Health behavior | ||||||
| Smoking status## | .0938 | |||||
| Never smoker | 284 (59.4%) | 60 (61.2%) | 150 (64.1%) | 45 (54.9%) | 29 (45.3%) | |
| Former smoker | 147 (30.8%) | 31 (31.6%) | 59 (25.2%) | 30 (36.6%) | 27 (42.2%) | |
| Current smoker | 47 (9.8%) | 7 (7.1%) | 25 (10.7%) | 7 (8.5%) | 8 (12.5%) | |
| Average number of alcoholic drinks in past year*** | .3286 | |||||
| Rarely/never | 147 (30.8%) | 30 (30.6%) | 68 (29.1%) | 29 (35.4%) | 20 (31.3%) | |
| ≤4/wk | 182 (38.1%) | 46 (46.9%) | 90 (38.5%) | 23 (28.0%) | 23 (35.9%) | |
| 5/wk–1/d | 92 (19.2%) | 16 (16.3%) | 44 (18.8%) | 20 (24.4%) | 12 (18.8%) | |
| ≥2/d | 57 (11.9%) | 6 (6.1%) | 32 (13.7%) | 10 (12.2%) | 9 (14.1%) | |
| Moderate-intensity exercise††† | .0759 | |||||
| Yes | 450 (94.5%) | 95 (97.9%) | 221 (94.0%) | 79 (96.3%) | 55 (88.7%) | |
| No | 26 (5.5%) | 2 (2.1%) | 14 (6.0%) | 3 (3.7%) | 7 (11.3%) | |
| Vigorous-intensity exercise‡‡‡ | .0664 | |||||
| Yes | 313 (65.8%) | 69 (71.1%) | 159 (67.7%) | 53 (64.6%) | 32 (51.6%) | |
| No | 163 (34.2%) | 28 (28.9%) | 76 (32.3%) | 29 (35.4%) | 30 (48.4%) | |
| AHO | ||||||
| Total number of AHO | ||||||
| Median [range] | 2.0 [0.0, 11.0] | 1.0 [0.0, 11.0] | 2.0 [0.0, 10.0] | 3.0 [0.0, 9.0] | 3.0 [0.0, 9.0] | <.0001 |
| Category | <.0001 | |||||
| 0 | 82 (17.1%) | 33 (33.7%) | 41 (17.4%) | 5 (6.1%) | 3 (4.7%) | |
| 1 | 115 (24.0%) | 39 (39.8%) | 47 (20.0%) | 20 (24.4%) | 9 (14.1%) | |
| 2 | 96 (20.0%) | 14 (14.3%) | 51 (21.7%) | 14 (17.1%) | 17 (26.6%) | |
| 3 | 66 (13.8%) | 7 (7.1%) | 32 (13.6%) | 15 (18.3%) | 12 (18.8%) | |
| 4 | 43 (9.0%) | 2 (2.0%) | 25 (10.6%) | 10 (12.2%) | 6 (9.4%) | |
| 5 or more | 77 (16.1%) | 3 (3.1%) | 39 (16.6%) | 18 (22.0%) | 17 (26.6%) | |
| Type of AHO | ||||||
| Tinnitus§§§ | <.0001 | |||||
| Yes | 176 (36.8%) | 16 (16.3%) | 92 (39.3%) | 36 (43.9%) | 32 (50.0%) | |
| No | 302 (63.2%) | 82 (83.7%) | 142 (60.7%) | 46 (56.1%) | 32 (50.0%) | |
| Hearing impairment‖‖‖ | <.0001 | |||||
| Yes | 152 (33.2%) | 11 (11.5%) | 80 (36.0%) | 33 (41.8%) | 28 (45.9%) | |
| No | 306 (66.8%) | 85 (88.5%) | 142 (64.0%) | 46 (58.2%) | 33 (54.1%) | |
| Peripheral neuropathy¶¶¶ | <.0001 | |||||
| Yes | 126 (26.5%) | 4 (4.1%) | 65 (27.8%) | 27 (33.8%) | 30 (46.9%) | |
| No | 349 (73.5%) | 93 (95.9%) | 169 (72.2%) | 53 (66.3%) | 34 (53.1%) | |
| Ototoxicity and peripheral neuropathy | <.0001 | |||||
| Yes | 80 (16.7%) | 1 (1.0%) | 41 (17.4%) | 16 (19.5%) | 22 (34.4%) | |
| No | 399 (83.3%) | 97 (99.0%) | 194 (82.6%) | 66 (80.5%) | 42 (65.6%) | |
| Raynaud phenomenon### | <.0001 | |||||
| Yes | 86 (18.2%) | 2 (2.0%) | 47 (20.3%) | 24 (29.6%) | 13 (20.6%) | |
| No | 387 (81.8%) | 96 (98.0%) | 184 (79.7%) | 57 (70.4%) | 50 (79.4%) | |
| Hypogonadism with testosterone therapy**** | .3004 | |||||
| Yes | 52 (10.9%) | 8 (8.2%) | 28 (12.0%) | 6 (7.4%) | 10 (15.9%) | |
| No | 423 (89.1%) | 90 (91.8%) | 205 (88.0%) | 75 (92.6%) | 53 (84.1%) | |
| Erectile dysfunction†††† | .0548 | |||||
| Yes | 67 (14.0%) | 8 (8.2%) | 30 (12.8%) | 15 (18.5%) | 14 (21.9%) | |
| No | 410 (86.0%) | 89 (91.8%) | 205 (87.2%) | 66 (81.5%) | 50 (78.1%) | |
| Hypertension and on prescription medication‡‡‡‡ | .0007 | |||||
| Yes | 57 (12.2%) | 0 | 36 (15.7%) | 12 (15.0%) | 9 (15.0%) | |
| No | 410 (87.8%) | 97 (100.0%) | 194 (84.3%) | 68 (85.0%) | 51 (85.0%) | |
| Hypercholesterolemia and on prescription medication§§§§ | .7902 | |||||
| Yes | 58 (12.2%) | 14 (14.3%) | 25 (10.8%) | 10 (12.2%) | 9 (14.1%) | |
| No | 418 (87.8%) | 84 (85.7%) | 207 (89.2%) | 72 (87.8%) | 55 (85.9%) | |
| CVD ‖‖‖‖ | .0648 | |||||
| Yes | 27 (5.7%) | 1 (1.0%) | 13 (5.6%) | 8 (9.9%) | 5 (7.9%) | |
| No | 448 (94.3%) | 97 (99.0%) | 220 (94.4%) | 73 (90.1%) | 58 (92.1%) | |
| Peripheral vascular disease¶¶¶¶ | .1063 | |||||
| Yes | 19 (4.0%) | 1 (1.0%) | 8 (3.4%) | 5 (6.2%) | 5 (8.1%) | |
| No | 455 (96.0%) | 97 (99.0%) | 225 (96.6%) | 76 (93.8%) | 57 (91.9%) | |
| Thromboembolic disease#### | ||||||
| Yes | 0 | 0 | 0 | 0 | 0 | |
| No | 474 (100.0%) | 98 (100.0%) | 233 (100.0%) | 81 (100.0%) | 62 (100.0%) | |
| Renal disease***** | .1983 | |||||
| Yes | 6 (1.3%) | 0 | 4 (1.7%) | 0 | 2 (3.3%) | |
| No | 462 (98.7%) | 97 (100.0%) | 227 (98.3%) | 80 (100.0%) | 58 (96.7%) | |
| Diabetes and on prescription medication††††† | .4671 | |||||
| Yes | 14 (3.0%) | 5 (5.1%) | 6 (2.6%) | 1 (1.2%) | 2 (3.2%) | |
| No | 460 (97.0%) | 93 (94.9%) | 227 (97.4%) | 80 (98.8%) | 60 (96.8%) | |
| Thyroid disease††††† | .6403 | |||||
| Yes | 5 (1.1%) | 2 (2.0%) | 2 (0.9%) | 1 (1.2%) | 0 | |
| No | 469 (98.9%) | 96 (98.0%) | 231 (99.1%) | 80 (98.8%) | 62 (100.0%) | |
| Problems with balance/vertigo/dizziness‡‡‡‡‡ | .0483 | |||||
| Yes | 55 (11.8%) | 6 (6.1%) | 25 (11.0%) | 15 (19.5%) | 9 (14.3%) | |
| No | 410 (88.2%) | 92 (93.9%) | 202 (89.0%) | 62 (80.5%) | 54 (85.7%) | |
| Psychotropic prescription medication for anxiety and/or depression§§§§§ | .1420 | |||||
| Yes | 58 (12.1%) | 9 (9.2%) | 25 (10.6%) | 11 (13.4%) | 13 (20.3%) | |
| No | 421 (87.9%) | 89 (90.8%) | 210 (89.4%) | 71 (86.6%) | 51 (79.7%) | |
Patients in this category received BEP chemotherapy other than three or four cycles (n = 12), EP chemotherapy (n = 20), and other cisplatin-based regimens (n = 32). AHO = adverse health outcome; BEPx3 = three cycles of bleomycin, etoposide, and cisplatin; BEPx4 = four cycles of bleomycin, etoposide, and cisplatin; CVD = cardiovascular disease; EPx4 = four cycles of etoposide and cisplatin; TCS = testicular cancer survivors; VeIP = vinblastine, ifosfamide, cisplatin; VIP = etoposide, cisplatin, ifosfamide.
P value comparisons are based on χ2 test for categorical variables and Kruskal-Wallis test (normal approximation) for continuous variables. Missing values were not used in the calculation of the P values.
Includes eight participants with not-otherwise-specified germ cell tumor or unknown histology.
Includes seven patients with primary site not stated.
The standard BEP chemotherapy cycle that all our patients received consists of bleomycin 30 000 IU days 1, 8, 15; etoposide 100 mg/m2 days 1 through 5; and cisplatin 20 mg/m2 days 1 through 5. Includes 12 patients who received BEP other than three or four cycles.
The standard dosing and standard EP schedule that all of our patients consists of etoposide 100 mg/m2 days 1 through 5 and cisplatin 20 mg/m2 days 1 through 5.
Includes 32 patients with other cisplatin-based regimens: 11 participants with VIP and 1 with VeIP. Each standard VIP chemotherapy cycle that our patients received consists of etoposide 75 mg/m2 days 1 through 5, cisplatin 100 mg/m2 days 1through 5, and ifosfamide 1200 mg/m2 days 1 through 5.
Includes eight patients for whom retroperitoneal lymph node dissection status was not available.
Includes two participants with marital status not available.
Includes two patients for whom education level was not available.
Noise exposure data were not available for six patients.
Includes six patients with body mass index information not available.
Reported health behavior was not available for one patient.
Reported health behavior was not available for one patient.
Reported health behavior was not available for three patients.
Reported health behavior was not available for three patients.
Category includes one patient for whom this outcome was not available.
Category includes 21 patients for whom this outcome was not available.
Category includes four patients for whom this outcome was not available.
Category includes six patients for whom this outcome was not available.
Category includes four patients who received bilateral orchiectomy that were not included in the comparison of hypogonadism, but were included elsewhere if the data was available.
Category includes two patients for whom this outcome was not available.
Category includes 12 patients for whom this outcome was not available.
Category includes three patients for whom this outcome was not available.
Category includes four patients for whom this outcome was not available. Includes coronary artery disease, heart failure, and cerebrovascular disease (categories not mutually exclusive and each category was counted as one AHO).
Category includes five patients for whom this outcome was not available.
Category includes five patients for whom this outcome was not available.
Category includes 11 patients for whom this outcome was not available.
Category includes five patients for whom this outcome was not available.
Category includes five patients for whom this outcome was not available.
Category includes 14 patients for whom this outcome was not available.
Participants could report more than one psychotropic medication.