{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:53:19Z","timestamp":1787032399943,"version":"build-2736575974"},"reference-count":146,"publisher":"Harborside Press, LLC","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"\n Background:<\/jats:bold>\n This study aimed to quantify, for the first time, cumulative burden of morbidity (CBM) scores\u2014including renal function\u2014in long-term testicular cancer survivors (TCS) treated with contemporary NCCN-endorsed regimens of 4 cycles of etoposide\/cisplatin (EPx4) or 3 or 4 cycles of bleomycin\/etoposide\/cisplatin (BEPx3\/BEPx4).\n Patients and Methods:<\/jats:bold>\n A total of 798 TCS underwent baseline clinical examinations and completed follow-up questionnaires. Severity grades for adverse health outcomes (AHOs) and CBM scores were calculated. Adjusted ordinal logistic regression estimated odds ratios (ORs) for AHOs and CBM scores by treatment regimen. Baseline estimated glomerular filtration rate (eGFR) was analyzed for associations with cumulative cisplatin dose and selected follow-up AHOs.\n Results:<\/jats:bold>\n Median age at follow-up was 45 years (median, 11 years postchemotherapy); 516 (65%) TCS survived \u226510 years. Chemotherapy consisted largely of BEPx3 (n=317; 39.7%), EPx4 (n=198; 24.8%), or BEPx4 (n=99; 12.4%); 27 (3.4%) received etoposide\/ifosfamide\/cisplatin (VIPx4). TCS receiving EPx4 (vs BEPx3) had significantly increased odds of worse renal impairment (adjusted OR [aOR], 1.55;\n P<\/jats:italic>\n =.035), ototoxicity (aOR, 1.48;\n P<\/jats:italic>\n =.04), and neuropathy (aOR, 1.77;\n P<\/jats:italic>\n =.002). Reduced eGFR (<90 mL\/min\/1.73 m\n 2<\/jats:sup>\n ), observed in 41% of TCS, was associated with cumulative cisplatin dose (\n r<\/jats:italic>\n = \u22120.149;\n P<\/jats:italic>\n <.0001) and with 2- to 20-fold increased odds of developing hypertension (60\u201389 mL\/min\/1.73 m\n 2<\/jats:sup>\n : OR, 2.01;\n P<\/jats:italic>\n =.001; 45\u201359 mL\/min\/1.73 m\n 2<\/jats:sup>\n : OR, 2.84;\n P<\/jats:italic>\n =.040; 30\u201344 mL\/min\/1.73 m\n 2<\/jats:sup>\n : OR, 20.0;\n P<\/jats:italic>\n =.001). Moderate-to-severe eGFR reductions (30\u201344 mL\/min\/1.73 m\n 2<\/jats:sup>\n ) were also associated with significantly increased odds of developing hyperlipidemia (OR, 6.10;\n P<\/jats:italic>\n =.032) and\/or cardiovascular disease (CVD) (OR, 7.09;\n P<\/jats:italic>\n =.023). Significantly increased odds of Raynaud phenomenon were associated with \u03b2-blocker use (OR, 2.17;\n P<\/jats:italic>\n =.036), peripheral artery disease (OR, 3.14;\n P<\/jats:italic>\n =.002), reduced eGFR (OR per 10 mL\/min\/1.73 m\n 2<\/jats:sup>\n increase in eGFR, 0.90;\n P<\/jats:italic>\n =.027), and BEPx4 (OR vs EPx4, 2.18;\n P<\/jats:italic>\n =.003). CBM scores were similar after EPx4 compared with BEPx3 (aOR, 1.04;\n P<\/jats:italic>\n =.83) but worse after BEPx4 (aOR, 1.77;\n P<\/jats:italic>\n =.016) or VIPx4 (aOR, 2.24;\n P<\/jats:italic>\n =.038). Self-reported global physical health correlated strongly with CBM score (\n P<\/jats:italic>\n <.001) and chemotherapy regimen (\n P<\/jats:italic>\n <.001).\n Conclusions:<\/jats:bold>\n This multicenter, real-world study shows that long-term CBM scores after NCCN-endorsed EPx4 or BEPx3 are comparable, but statistically significant differences in cisplatin-related toxicities exist. Cisplatin dose-dependent reductions in eGFR are followed by significant excesses of hypertension, hyperlipidemia, and CVD.\n <\/jats:p>","DOI":"10.6004\/jnccn.2025.7120","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T15:12:26Z","timestamp":1770995546000},"page":"81-90","source":"Crossref","is-referenced-by-count":3,"title":["Renal Impairment and Late Toxicities Comparing Contemporary Chemotherapy Regimens for Testicular Cancer in a Real-World Setting"],"prefix":"10.6004","volume":"24","author":[{"given":"Sarah L.","family":"Kerns","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul C.","family":"Dinh","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick O.","family":"Monahan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunkit","family":"Fung","sequence":"additional","affiliation":[{"name":"J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard D.","family":"Sesso","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren R.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, New York, NY"},{"name":"Department of Medicine, Weill Cornell Medical College, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Vaughn","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kollmannsberger","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil E.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence H.","family":"Einhorn","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lois B.","family":"Travis","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4047","reference":[{"key":"B1","series-title":"CA Cancer J Clin","first-page":"409","article-title":"Cancer treatment and survivorship statistics, 2022","volume":"72","author":"Miller KD","year":"2022","unstructured":"Miller KD, Nogueira L, Devasia T, Cancer treatment and survivorship statistics, 2022. 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