Shah Yash B, Goldberg Hanan, Hu Brian, Daneshmand Siamak, Chandrasekar Thenappan
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
Department of Urology, State University of New York Upstate, Syracuse, NY.
Urology. 2023 Oct;180:182-189. doi: 10.1016/j.urology.2023.07.007. Epub 2023 Jul 17.
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 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 to 2016. Descriptive statistics were analyzed using Fisher 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, 1877 (11.39%) had distant metastases at diagnosis. These patients more commonly featured disease-specific and demographic variables associated with worse health outcomes (all P < .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. Nearly one-fourth of patients with metastases died. Poor CSM was predicted by histology, age, insurance status, and socioeconomic status. 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 social determinants of health in TC mortality. These findings can facilitate a risk-stratified approach to staging and management while supporting new approaches to target disparities.
阐明初诊时转移性睾丸癌（TC）的临床和人口统计学预测因素，并研究这些因素对预后的影响。转移性TC患者的预后比局限性或局部区域性疾病患者更差。健康的社会决定因素可能会加剧这一趋势。
查询监测、流行病学和最终结果（SEER）数据库，以识别2010年至2016年诊断出的16528例年龄≥18岁的TC患者。使用Fisher精确检验和Pearson卡方检验对连续变量和分类变量进行描述性统计分析。分别使用多因素逻辑回归分析和竞争风险回归评估特定转移的预测因素和影响癌症特异性死亡率（CSM）的因素。
在16474例有完整数据的患者中，1877例（11.39%）在诊断时出现远处转移。这些患者更常出现与较差健康结果相关的疾病特异性和人口统计学变量（所有P <.001）。肺转移是同步和孤立转移瘤的主要部位。转移的疾病特异性预测因素包括T分期、组织学、肿瘤大小、淋巴管侵犯和隐睾症。患者特异性预测因素包括年龄、地理位置、种族、民族、婚姻状况和社会经济地位。近四分之一的转移患者死亡。组织学、年龄、保险状况和社会经济地位可预测较差的CSM。除骨转移外，所有转移部位均与较差的CSM相关，肺转移的风险最大。
这项横断面研究确定了与TC转移和生存相关的变量，特别强调了健康的社会决定因素在TC死亡率中的重要性。这些发现有助于采用风险分层方法进行分期和管理，同时支持针对差异的新方法。
