Metabolic Syndrome Among Testicular Cancer Survivors: Long-Term Follow-Up of the Veterans Affairs Health System

BACKGROUND: The 5-year survival rate for patients with testicular germ cell tumors (TC) is excellent. However, these survivors are at an increased risk for metabolic syndrome (MetS), a significant source of morbidity and precursor to cardiovascular disease. This study investigates the incidence of MetS in TC survivors compared to matched controls. METHODS: A retrospective analysis was conducted using the Veterans Affairs national database. The incidence of MetS was compared between 2021 TC survivors and 7595 matched controls. MetS was identified via diagnostic codes and medication use, requiring at least three of five criteria: insulin resistance, dyslipidemia, central obesity, and hypertension. Statistical analysis included chi-squared and t-tests for demographic comparisons, and Cox regression for outcome associations. RESULTS: TC survivors exhibited a greater prevalence of MetS components than controls, specifically hyperglycemia (28.4%), low HDL levels (59.8%), hypertriglyceridemia (8.0%), and abdominal obesity (27.3%), except for hypertension. Over 5 and 10 years, the cumulative incidence of MetS in TC survivors was 17.0% and 27.8%, compared to 1.9% and 2.8% in controls. Multivariate regression showed an increased incidence of MetS in TC survivors (HR = 19.02, 95% confidence interval [CI]: 16.31-22.19, p < 0.001). Chemotherapy (HR = 1.28, 95% CI: 1.04-1.57, p = 0.017) and increasing age (HR = 1.04, 95% CI: 1.04-1.06, p < 0.001) were associated with a higher risk. CONCLUSIONS: TC survivors have a substantial risk of MetS with a higher occurrence of most MetS components, barring hypertension. Comprehensive metabolic health monitoring is crucial in TC survivorship care. Integrating vigilant screening and preventive strategies can mitigate MetS development in this population.