Trends in Stage I Non-Seminomatous Germ Cell Tumors in the United States
Sources of Funding: None
Introduction
Testicular malignancies are the most common solid tumor in men 15-34 years and affect approximately 8400 men in the United States each year. Almost half can be classified as non-seminomatous germ cell tumors (NSGCT). Treatment options for stage I include surveillance, chemotherapy, or retroperitoneal lymph node dissection (RPLND). Our study aimed to examine demographic and socioeconomic trends around treatment patterns. _x000D_
Methods
Using the National Cancer Database, we retrospectively examined 55,756 patients between January 1, 2004 and December 31, 2013. Data was extracted on 7,657 individuals with ICD histology diagnosis for stage I NSGCT. We obtained data on various demographic and socioeconomic variables including race, education, income, location and health insurance. We used multivariable logistic regression models to estimate odds ratios with 95% confidence intervals._x000D_ _x000D_
Results
Throughout 2004-2013 fewer patients received RPLND (OR 0.65 [0.55-0.76] p<0.01), and more received chemotherapy (OR 1.26 [1.10-1.43] p<0.01). Compared to other treatments, RPLND was less commonly seen in non-academic centers (OR 0.47 [0.33-0.66] p<0.01), more commonly in the highest volume institutions compared to the lowest volume institutions (OR 4.57 [2.47-8.46] p<0.01), and more commonly seen in those with low income (OR 1.24 [1.06-1.46] p<0.01). Patients living in rural counties compared to metro counties were more likely to receive chemotherapy (OR 1.72 [1.08-2.75] p=0.03). As distance from hospital increased, individuals were more likely to receive any form of treatment versus observation for their disease (OR 1.51 for the greatest vs. the lowest quartile [1.31-1.74] p<0.01). Low income and Medicaid predicted greater chance for any treatment (OR 1.17 [1.04-1.32] p=0.01 and OR 1.45 [1.20-1.74] p<0.01, respectively). No trends were seen for race or education status.
Conclusions
Our study illustrates that fewer patients are undergoing RPLND, which may be due to increased surveillance. RPLND is more commonly practiced at higher volume and academic centers. Education and race do not predict choice of treatment, whereas distance, income and insurance type do predict increased likelihood for receiving treatment overall._x000D_
Funding
None
Thomas Seisen
Claire Beard
Christoper Sweeney
Quoc-Dien Trinh
Jennifer Rider
Mark Preston