Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Goethe University Frankfurt, Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Clin Genitourin Cancer. 2024 Oct;22(5):102161. doi: 10.1016/j.clgc.2024.102161. Epub 2024 Jul 14.
We investigated regional differences in patients with stage III nonseminoma germ cell tumor (NSGCT). Specifically, we investigated differences in baseline patient, tumor characteristics and treatment characteristics, as well as cancer-specific mortality (CSM) across different regions of the United States.
Using the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018), patient (age, race/ethnicity), tumor (International Germ Cell Cancer Collaborative Group [IGCCCG] prognostic groups) and treatment (systemic therapy and retroperitoneal lymph dissection [RPLND] status) characteristics were tabulated for stage III NSGCT patients, according to 12 SEER registries representing different geographic regions. Multinomial regression models and multivariable Cox regression models testing for cancer-specific mortality (CSM) were used.
In 3,174 stage III NSGCT patients, registry-specific patient counts ranged from 51 (1.5%) to 1630 (51.3%). Differences across registries existed for age (12%-31% for age 40+), race/ethnicity (5%-73% for others than non-Hispanic whites), IGCCCG prognostic groups (24%-43% vs. 14-24% vs. 3%-20%, in respectively poor vs. intermediate vs. good prognosis), systemic therapy (87%-96%) and RPLND status (12%-35%). After adjustment, clinically meaningful inter-registry differences remained for systemic therapy (84%-97%) and RPLND (11%-32%). Unadjusted 5-year CSM rates ranged from 7.1% to 23.3%. Finally in multivariable analyses addressing CSM, 2 registries exhibited more favorable outcomes than SEER registry of reference (SEER Registry 12): SEER Registry 4 (Hazard Ratio (HR): 0.36) and SEER Registry 9 (HR: 0.64; both P = .004).
We identified important regional differences in patient, tumor and treatment characteristics, as well as CSM which may be indicative of regional differences in quality of care or expertise in stage III NGSCT management.
我们研究了 III 期非精原细胞瘤生殖细胞肿瘤（NSGCT）患者的区域差异。具体来说，我们研究了美国不同地区患者基线特征、肿瘤特征和治疗特征以及癌症特异性死亡率（CSM）的差异。
使用监测、流行病学和最终结果（SEER）数据库（2004-2018 年），根据代表不同地理区域的 12 个 SEER 登记处，对 III 期 NSGCT 患者的患者（年龄、种族/族裔）、肿瘤（国际生殖细胞癌协作组 [IGCCCG] 预后组）和治疗（全身治疗和腹膜后淋巴结清扫术 [RPLND] 状态）特征进行了分类。使用多项回归模型和多变量 Cox 回归模型检验癌症特异性死亡率（CSM）。
在 3174 例 III 期 NSGCT 患者中，登记处特定的患者计数范围为 51（1.5%）至 1630（51.3%）。各登记处之间存在年龄差异（40+岁占 12%-31%）、种族/族裔差异（非西班牙裔白人以外的占 5%-73%）、IGCCCG 预后组差异（分别为预后差、预后中等和预后良好的占 24%-43%、24%-43%和 3%-20%）、全身治疗差异（87%-96%）和 RPLND 状态差异（12%-35%）。调整后，全身治疗（84%-97%）和 RPLND（11%-32%）仍存在有临床意义的登记处间差异。未经调整的 5 年 CSM 率范围为 7.1%至 23.3%。最后，在多变量分析中，2 个登记处的 CSM 结果优于 SEER 参考登记处（SEER 登记处 12）：SEER 登记处 4（风险比（HR）：0.36）和 SEER 登记处 9（HR：0.64；均 P=0.004）。
我们发现患者、肿瘤和治疗特征以及 CSM 存在重要的区域差异，这可能表明在 III 期 NGSCT 管理方面存在区域间护理质量或专业知识的差异。
