1. Association between Abdominal Adiposity, Muscle Mass, and Metabolic Syndrome in Survivors of Testicular Germ Cell Cancer Kyaw Z. Thein, MD 1,3, William Osai, NP-C 1, Shi-Ming Tu, MD 1, Lance C. Pagliaro, MD 2, Jeri Kim, MD 1, Sai-Ching J Yeung, MD, PhD 1   1The University of Texas MD Anderson Cancer Center, 2Mayo Clinic, 3Texas Tech University Health Sciences Center
BACKGROUND
Effective therapies have resulted in an increased number of cancer survivors, and it is estimated that cancer survivors will approach 20 million by 2020.
Cancer and cancer therapy effects linger long after treatment.
In the United States, testicular germ cell tumor (TGCT) is the predominate type of germ cell tumors, and it has a high incidence in men 19 to 39 years old.
Cisplatin-based chemotherapy and radiation therapy offer an excellent cure rate approaching 100% for early stage disease.
Because of their relative young age at diagnosis, TGCT survivors contend with treatment effects for decades after treatment.
Several studies have documented the long-term adverse effects of testicular cancer treatment, including increased risk of cardiac disease and mortality after chemotherapy, radiation, or a combination of both; abnormal lipid metabolism; risk of excessive body mass index (BMI) increase; and increased risk of metabolic syndrome (MTS).
Because reliably predicting MTS could prompt intervention reducing risk, we analyzed clinical data and body composition in computed tomography (CT) scans to identify associations.
METHODS
This retrospective study was submitted to the institutional review board of The University of Texas MD Anderson Cancer Center in accordance with institutional policies, and no informed consent was required for this chart review study.
In a retrospective review of the charts of 196 TGCT survivors treated at a single institution from 1970 to 2007, we collected patient demographics, clinical data, body fat composition measures, and evidence from CT scans from baseline through posttreatment.
NIH Image J was used to analyze cross-sectional CT images and measure subcutaneous adipose tissue, visceral adipose tissue, and skeletal muscle. Visceral fat-to-muscle ratio (VMR), visceral-to-subcutaneous fat ratio (VSR), and change in VMR and VSR from baseline to 3 to 5 years posttreatment (ΔVMR and ΔVSR) were calculated. 
We also gathered measures of posttreatment glucose, blood pressure, lipid data, and body weight and height at time of scans. 
The 2001 U.S. National Cholesterol Education Program Adult Treatment Panel III guideline defined MTS.
Using univariate and multivariate logistic regression analyses, we identified associations.  
Excluded were patients who were treated with orchiectomy only without chemotherapy or radiation therapy; patients with incomplete records; and patients who expired.
RESULTS/DISCUSSION
Of the 167 patients included in the final analysis, 37.7% had MTS, 76.6% were white, and 68.9% had chemotherapy. 
Patients with MTS had significantly higher VMRs (p = .007) and VSRs (p = .021) than those without. 
Patients who received chemotherapy and radiotherapy were significantly more likely to have MTS (p = .044 and p = .037) than others.  
A multinomial logistic regression model that included year of cancer diagnosis, age, race, tumor histology, treatment types, VSR, and VMR confirmed the association of high VMR and VSR with future development of MTS.
In a similar regression model, ΔVMR and ΔVSR were not statistically significant predictors.  
Exercise and physical activity aimed at decreasing VMR and VSR may help lower incidence of MTS in patients with TGCT.
Figure 1. Analyzing VMR, VSR from total fat area, subcutaneous fat area, visceral fat area, and total muscle area using NIH image J.
Table 2. Demographics and other characteristics of patients
Characteristics
Total number (n)
Metabolic syndrome 76
Seminoma 58
Nonseminoma
129
Others 9
REFERENCES
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OBJECTIVES
The objectives of this retrospective study are:
To determine the prevalence of MTS in patients with testicular germ cell tumors after treatment with a cisplatin-based chemotherapy
To identify characteristics prognostic of development of MTS in patients who have been treated with a cisplatin-based chemotherapy for testicular germ cell tumors
To determine association between abdominal adiposity, chemotherapy, and MTS in patients with testicular germ cell tumors after undergoing cisplatin-based chemotherapy
Characteristics
P value
Age
0.361
Race
0.509
Chemotherapy
0.046
Radiation therapy
0.031
Visceral fat-to-muscle ratio (VMR)
0.007
Visceral-to-subcutaneous fat ratio (VSR)
0.021
Change in VMR (ΔVMR) NS
Change in VSR (ΔVSR)
Table 1. Chemotherapy regimens used for testicular cancer at MD Anderson Cancer Center
CISCA
Dose in mg/m2/day
Cyclophosphamide days 1 and 2
Doxorubicin days 1 and 2
Cisplatin day 3 VB
Vinblastine days 22 to 26
Bleomycin days 22 to 26
400
  35
100
  2.5
25 U/day
BEP
Bleomycin days 1, 8, and 15
Etoposide days 1-5
Cisplatin days 1-5
30 U/day
  20
Corresponding Author : Presented at ASCO Palliative Care in Oncology Symposium, 2016.