ABSTRACT
OBJECTIVES: To characterize changes in body composition following cytotoxic chemotherapy for germ cell carcinoma of the testis (GCT) and quantify associations between body composition metrics and chemotherapy-associated adverse events (AEs) and post-retroperitoneal lymph node dissection (RPLND) complications. MATERIALS AND METHODS: This retrospective multi-center study included 216 men with GCT treated with cytotoxic chemotherapy and/or RPLND (2005-2020). We measured body composition including skeletal muscle (SMI), visceral adipose (VAI,), subcutaneous adipose (SAI), and fat mass (FMI) indices on computed tomography. We quantified chemotherapy-associated changes in body composition and evaluated associations between body composition and incidence of grade 3+ AEs and post-RPLND complications on multivariable logistic regression analyses. RESULTS: 182 men received a median of 3 cycles of cisplatin-based chemotherapy. Following chemotherapy, median change in SMI was -6% (p=<0.0001), while VAI, SAI, and FMI increased by +13% (p=<0.0001), +11% (p=<0.0001), and +6% (p=<0.0001), respectively. 79 patients (43%) experienced at least one grade 3+ AE. A decrease in SMI following chemotherapy was associated with increased risk of grade 3+ AEs (p=0.047). 103 men with a median age of 28.5 years (IQR 23-35.5) underwent RPLND of whom 22 (21.3%) experienced at least one grade 3+ post-RPLND complication. No baseline body composition metrics were associated with post-RPLND complications. CONCLUSIONS: In men with GCT of the testis, chemotherapy was associated with 6% loss of lean muscle mass and gains in adiposity. Lower skeletal muscle was associated with a higher incidence of chemotherapy-associated AEs. Body composition was not associated with the incidence of post-RPLND complications.