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Orchiopexy and the Risk of Testicular Cancer: An Analysis of 206,421 Patients in the TriNetX Global Collaborative Network
Jacob W. Greenberg, MD1, Garrett Brinkley, MD, PhD1, William Fuell, MD1, Hailey Silverii, MD2, Jorge Caso, MD1, Amanda Raines, MD2.
1Tulane University School of Medicine, New Orleans, LA, USA, 2Louisiana State University School of Medicine, New Orleans, LA, USA.
BACKGROUND: Cryptorchidism is the most consistently identified risk factor for testicular cancer later in life for children. Given a protective effect of orchiopexy, guidelines recommend early intervention at less than 18 months of age. However, the landmark publication linking the risk of testicular cancer for these patients was published ~20 years ago, prior to the implementation of the AUA guidelines. To further validate these effects in a modern cohort, the aim of this study was to utilize the TriNetX database containing a global network of 173 healthcare organizations to quantify the risk of testicular cancer in patients with cryptorchidism, and to compare risk among treated patients.
METHODS: Using the TriNetX Global Collaborative Network, we identified all patients with an ICD-10 Q53.1 - .9 diagnosis. The primary outcome was a subsequent diagnosis of malignant neoplasm of the testis (ICD-10-CM C62.0 - .9). Analysis was performed utilizing different cohorts: (1) Overall testicular cancer risk in the cryptorchidism cohort; (2) risk among patients undergoing orchiopexy (CPT 54640, 54650, 54692) at 0-2 years vs 18-3 years of age. Given the TriNetX database only permits filtering by year rather than by month of age, the cohort was defined as 0-2 years instead of the guideline-recommended ≤18-months. Odds ratios (OR), and 95% confidence intervals (CI) were computed.
RESULTS: A total of 206,421 patients with cryptorchidism were identified. The absolute risk of testicular cancer in this cohort was 0.28% (n = 578). Comparing age at treatment, patients who underwent orchiopexy at 18 to 3 years old showed an OR 3.62 (CI 2.01-6.49; p<0.001) for subsequent development of testicular cancer compared to those treated at ≤2 years.
CONCLUSIONS: In the largest contemporary cohort assembled to date, cryptorchidism conferred a measurable risk of subsequent testicular cancer that was approximately 3.6-fold higher when orchiopexy was performed at ≥3 years compared with ≤2 years of age. These findings reinforce current AUA recommendations for early surgical correction and continued long-term surveillance.
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