Though testicular cancer is the most common cancer in young men, there is a paucity of epidemiologic studies examining sociodemographic disparities in adjuvant therapy and outcomes. We examined the associations of sociodemographic factors with retroperitoneal lymph node dissection (RPLND) and survival among patients with nonseminomatous germ cell tumors (NSGCTs).
Within the Surveillance Epidemiology and End Results database (2005-2015), we identified 8,573 patients with nonseminomatous germ cell tumors. Multivariable logistic regression and Fine-Gray competing-risks regression models were constructed to examine the association of sociodemographic factors (neighborhood SES (nSES), race, and insurance) with, respectively, adjuvant RPLND within 1 year of diagnosis and cancer-specific mortality.
Patients in the lowest nSES quintile (OR 0.59, 95% CI = 0.40-0.88, P = 0.01) and Black patients (OR 0.41, 95% CI = 0.15-1.00, P= 0.058) with stage II disease were less likely to receive RPLND compared to those in the highest quintile and White patients, respectively. Stage III patients with Medicaid (OR 0.64, 95% CI = 0.46-0.89, P= 0.009) or without insurance (OR 0.46, 95% CI = 0.27-0.76, P= 0.003) were less likely to receive RPLND compared to patients with private insurance. Lowest quintile nSES patients of all disease stages and Black patients with stage I disease (HR = 2.64, 95% CI = 1.12-6.20, P = 0.026) or stage II disease (HR=4.93, 95% CI = 1.48-16.44, P = 0.009) had higher risks of cancer-specific mortality compared to highest quintile nSES and White patients, respectively.
This national study found multilevel, stage-specific sociodemographic disparities in receipt of RPLND and survival.
Urologic oncology. 2021 Jan 07 [Epub ahead of print]
Hriday P Bhambhvani, Daniel R Greenberg, Alex M Kasman, Mindy C DeRouen, Iona Cheng, Michael L Eisenberg, Sumit A Shah
Department of Urology, Stanford University Medical Center, Stanford, CA. Electronic address: ., Department of Urology, Stanford University Medical Center, Stanford, CA., UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; UCSF Department of Epidemiology and Biostatistics, San Francisco, CA., Division of Oncology, Stanford University Medical Center, Stanford, CA.