Hispanic ethnicity is associated with worse outcomes among pediatric and young adult patients with non-seminomatous germ cell tumor
Iftach Chaplin, MS1, Levi Holland, MD1, Solomon Woldu, MD1, Niccolo Passoni, MD2.
1UT Southwestern Medical Center, Dallas, TX, USA, 2Texas Children's Hospital, Houston, TX, USA.
BACKGROUND: Prior studies have shown that adolescents and young adult patients with testicular non-seminomatous germ cell tumor (NSGCT) have overall better outcomes than adult patient. Other data points to an increase of younger Hispanic patients with more aggressive disease. The goal of our study is to assess if pediatric and young adult Hispanic patients with NSGCT have worse oncologic outcomes.
Methods: We queried the 2020 National Cancer Data Base for patients with NSGCT who underwent primary orchiectomy. We stratified patients by age into pediatric (≤18 yo) and young adults (YA) (19-26 yo). Stage at presentation as well as treatment patterns were stratified by age as well as by ethnicity (Hispanic vs non-Hispanic). A multivariable Cox predicting mortality assessing for the impact of ethnicity was corrected for age, stage and insurance status (none, private, government-based).
Results: We identified 7456 patients with NSGCT who underwent radical orchiectomy and had complete stage and ethnicity data. Of these, 1153 (15.5%) were pediatric and 6303 (84.5%%) were YA. Overall, 1488 (20%) patients were Hispanic. Rates of Hispanic ethnicity were higher in pediatric (24.4%) than young adult patients (19.2%). Pediatric patients had lower stage disease at diagnosis (stage I 55.9%, II 18.3%, III 25.8%) than young adults (I 50.9%, II 19.9%, III 29.2%, p=0.007). When stratifying by age group, Hispanic children had significantly higher rates of stage III disease than non-Hispanic (31.7% vs 24%, p=0.037). This difference was confirmed in young adults (Hispanic 39.1% vs non-Hispanic 26.9%, P<0.001). With regards to insurance status, there was a higher proportion of young adults who were not insured 14.4% vs 5.3%) and not on government-based insurance (18.4% vs 27%) with similar rates of privately insured patients (65.1% vs 65.6%, all p<0.0001). Hispanic patients had higher rates of uninsured patients (11.7% pediatric, 28.2% YA) and on government plans (51.3% pediatric, 31.4% YA), while non-Hispanic patients had higher rates of private insurance (pediatric 75.8%, 71.7% YA, all p<000.1). Median follow up was 89 months (IQR 60-126 mo). Overall, 518 patients died (7%), with no difference between age groups (pediatric 5.6%, YA 7.2% p=0.057). However, more Hispanic patients died (9.3% vs 6.4%, p<0.0001). The difference in mortality by ethnicity was only recorded in YA (Hispanic 10.3% vs non-Hispanic 6.5%, p<0.0001) and not in children (5.7% vs 5.3%, p=0.8).Overall 5-year survival was 76%, and it was worse for Hispanic than non-Hispanic patients (71.1% vs 77.1%, p<0.0001). On multivariable Cox regression analysis, after correcting for age, stage and insurance status, ethnicity was a significant risk factor for mortality (HR 1.2, 95% CI 1.1-1.26, p<0.0001). CONCLUSIONS:
After correcting for confounding variables, pediatric and young adult Hispanic patients with NSGCT present with higher stage and more aggressive disease, fairing a worse survival. Further studies are required to assess for genetic differences in cancer biology in this population as well as to improve detection and therapies.
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