To elucidate clinical and demographic predictors of metastatic testicular cancer (TC) at presentation and study the impact of these factors on prognosis. Patients with metastatic TC experience poorer outcomes than those with localized or locoregional disease. Social determinants of health (SDOH) may compound this trend.
The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify 16,528 patients aged ≥18 with TC diagnosed from 2010-2016. Descriptive statistics were analyzed using Fisher's exact test and Pearson chi-square test for continuous and categorical variables. Predictors of specific metastases and factors impacting cancer-specific mortality (CSM) were evaluated using multivariate logistic regression analysis and competing risks regression, respectively.
Of 16,474 patients with complete data, 1,877 (11.39%) had distant metastases at diagnosis. These patients more commonly featured disease-specific and demographic variables associated with worse health outcomes (all p<0.001). Lung metastases were the predominant site of synchronous and solitary metastases. Disease-specific predictors of metastasis included T stage, histology, tumor size, lymphovascular invasion, and cryptorchidism. Patient-specific predictors included age, geography, ethnicity, race, marital status, and socioeconomic status (SES). Nearly one-fourth of patients with metastases died. Poor CSM was predicted by histology, age, insurance status, and SES. All metastatic sites except bone were associated with worse CSM, with lung metastases conferring the greatest risk.
This cross-sectional study identifies variables associated with TC metastasis and survival, particularly highlighting the importance of SDOH in TC mortality. These findings can facilitate a risk-stratified approach to staging and management while supporting new approaches to target disparities.
Urology. 2023 Jul 17 [Epub ahead of print]
Yash B Shah, Hanan Goldberg, Brian Hu, Siamak Daneshmand, Thenappan Chandrasekar
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA., Department of Urology, State University of New York Upstate, Syracuse, NY, USA., Department of Urology, Loma Linda University, Loma Linda, California., Aresty Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA, United States., Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA; Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA; Department of Urology, University of California, Davis, Sacramento, CA, USA. Electronic address: .