Department of Urology, University of California, San Francisco, 550 16th Street, 6th Floor, San Francisco, CA, 94158, USA.
Osher Center for Integrative Medicine, University of California, San Francisco, 1545 Divisadero Street, Suite 301, San Francisco, CA, 94143, USA.
BMC Urol. 2020 Apr 17;20(1):40. doi: 10.1186/s12894-020-00609-2.
Testicular sex cord stromal tumors (SCSTs) are managed similarly to germ cell tumors (GCTs); however, few studies have directly compared outcomes between these tumor types. Using the National Cancer Database (NCDB), we sought to compare overall and stage-specific all-cause mortality (ACM) between SCSTs versus GCTs.
NCDB was queried for patients diagnosed with SCSTs and GCTs between 2004 and 2013. Descriptive statistics were used to compare sociodemographic and clinical characteristics between groups. Univariable and multivariable Cox proportional hazards regression analyses were used to assess associations with ACM.
We identified 42,192 patients diagnosed with testicular cancer between 2004 and 2013, with 280 having SCSTs and 41,912 patients having GCTs. Median age for SCSTs and GCTs was 45 (interquartile range [IQR] 34-59) and 34 (IQR 27-43), respectively (p < 0.001). Median follow-up was 39 and 52 months, respectively. Overall, patients with SCSTs had greater risk of ACM compared to those with GCTs (HR 1.69, 95% CI 1.14-2.50). Private insurance, greater education, and fewer comorbidities were associated with reduced risk of ACM (p < 0.05 for all). Among those with stage I disease, tumor type was not associated with ACM on multivariable analysis. Among those with stage II/III disease, patients with SCSTs had increased risk of ACM compared to patients with GCTs (HR 3.29, 95% CI 1.89-5.72).
Patients with advanced SCSTs had worse survival outcomes compared to those with advanced GCTs. These data suggest a need for further investigation to ascertain effective management recommendations for SCSTs.
睾丸性索间质肿瘤（SCST）的治疗与生殖细胞肿瘤（GCT）相似；然而，很少有研究直接比较这两种肿瘤类型的预后。本研究利用国家癌症数据库（NCDB），比较了 SCST 和 GCT 之间的总生存率和特定分期的全因死亡率（ACM）。
检索了 2004 年至 2013 年间诊断为 SCST 和 GCT 的 NCDB 患者。使用描述性统计方法比较两组患者的社会人口统计学和临床特征。采用单变量和多变量 Cox 比例风险回归分析评估与 ACM 相关的因素。
本研究共纳入了 42192 例 2004 年至 2013 年间诊断为睾丸癌的患者，其中 280 例为 SCST，41912 例为 GCT。SCST 和 GCT 的中位年龄分别为 45（四分位距 [IQR] 34-59）和 34（IQR 27-43）（p<0.001）。中位随访时间分别为 39 个月和 52 个月。总体而言，与 GCT 患者相比，SCST 患者的 ACM 风险更高（HR 1.69，95%CI 1.14-2.50）。私人保险、更高的教育程度和更少的合并症与 ACM 风险降低相关（p<0.05）。在 I 期疾病患者中，多变量分析显示肿瘤类型与 ACM 无关。在 II/III 期疾病患者中，与 GCT 患者相比，SCST 患者的 ACM 风险更高（HR 3.29，95%CI 1.89-5.72）。
与晚期 GCT 患者相比，晚期 SCST 患者的生存结局更差。这些数据表明，需要进一步研究以确定 SCST 的有效治疗建议。
