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The Association Of Race And Age On Stage Of Testicular Cancer At Diagnosis: A Contemporary Population Based Seer Data Analysis
Callum Lavoie, MD, MSc
1, Christine Do, DrPH, MPH
1, Yash B. Shah, BSc
2, Siamak Daneshmand, MD
3, Thenappan Chandrasekar, MD
4, Andy Y. Chang, MD
1.
1Children's Hospital Los Angeles, Los Angeles, CA, USA, 2Thomas Jefferson University, Philadelphia, PA, USA, 3University of Southern California, Los Angeles, CA, USA, 4University of California Davis, Sacramento, CA, USA.
BackgroundTesticular cancer is the most common malignancy in males ages 20-40 years, and the 2nd most common for those ages 15-19 years. Germ cell tumors are the most common type of testicular neoplasm, and its incidence is increasing worldwide. In the United States, the incidence is greatest in Non-Hispanic Whites, followed by those of Hispanic, Asian, and Black race/ethnicity. Contemporary analysis has shown increasing rates of metastatic disease at presentation and mortality among Hispanic patients, however, there remains a limited understanding of how both age and race are associated with stage of testicular cancer at diagnosis.
MethodsThe Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify patients diagnosed with testicular cancer from 2004-2020. Only patients aged ≥10 years with primary testicular germ cell tumors were included. Descriptive statistics were conducted using Fisher’s exact tests and Pearson chi-square tests for categorical variables. Multinomial logistic regression models were used to assess the association of testicular cancer T, N, and M staging and historic staging with age, race, and ethnicity while controlling for income and community type. Joint effects of age and ethnicity were also analyzed.
ResultsA total of 28,914 patients with complete data were included. The largest proportion were aged 25-44 years (61.2%, n=17696) while 1.9% (n=535) were 65+ years old. Analysis of race showed most subjects (90.1%, n=26050) identified as White. Most of this population was Non-Hispanic at 75.6% (n=21862) and 24.4% (n=7052) were Hispanic.
Compared to Non-Hispanics, Hispanics were 1.63 times (1.02-2.60) more likely to present with T4 disease, 1.59 times (1.41-1.81) more likely to present with N3 disease, and 1.67 times (1.53-1.82) more likely to present with M1 disease. Compared to patients aged 25-44 years, patients aged 10-17 years were 5.22 times (1.26-21.72) more likely to present with T3 disease, 2.07 times (1.58-2.72) more likely to present with N2 disease, and 2.17 times (1.76-2.67) more likely to present with M1 disease. Compared to Non-Hispanics age 25-44 years, Hispanics aged 10-17 were 1.63 (1.23-2.16) and 3.34 (2.46-4.52) times more likely to present with regional and distant disease, respectively.
ConclusionAlthough testicular cancer is most common among middle-aged white, non-Hispanic men, Hispanic adolescents initially present with more advanced disease. This likely leads to worse prognoses and greater morbidity from treatment. Future efforts should be made to optimize health education and screening of younger, Hispanic populations.
Table 1. Multinomial logistic regression model: T Stage by age, race, and ethnicity
| | | | |
| T1 vs. T0 | T2 vs. T0 | T3 vs. T0 | T4 vs. T0 |
| Age Group | OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) |
| 10-17 years | 2.19 (0.54-8.89) | 2.84 (0.70-11.60) | 5.22 (1.26-21.72) | 3.13 (0.56-17.56) |
| 18-24 years | 0.99 (0.68-1.45) | 1.29 (0.88-1.89) | 1.30 (0.87-1.95) | 1.19 (0.66-2.14) |
| 25-44 years | Ref. | Ref. | Ref. | Ref. |
| 45-64 years | 0.44 (0.33-0.59) | 0.44 (0.33-0.59) | 0.64 (0.46-0.88) | 1.22 (0.77-1.93) |
| 65+ years | 0.22 (0.13-0.37) | 0.19 (0.11-0.32) | 0.28 (0.14-0.53) | 0.69 (0.26-1.84) |
| | | | |
| Race | | | | |
| White | Ref. | Ref. | Ref. | Ref. |
| Black | 0.92 (0.45-1.89) | 1.07 (0.52-2.22) | 1.40 (0.65-3.03) | 2.91 (1.13-7.53) |
| Other | 1.26 (0.64-2.48) | 1.22 (0.62-2.41) | 1.79 (0.88-3.64) | 3.56 (1.51-8.40) |
| Unknown | --- | --- | --- | --- |
| | | | |
| Ethnicity | | | | |
| Hispanic | 0.79 (0.59-1.07) | 0.81 (0.60-1.09) | 1.12 (0.81-1.55) | 1.63 (1.02-2.60) |
| Non-Hispanic | Ref. | Ref. | Ref. | Ref. |
| | | | |
| Income | | | | |
| <$35,000 | 0.25 (0.07-0.90) | 0.32 (0.09-1.17) | 0.34 (0.07-1.51) | 1.02 (0.14-7.44) |
| $35k-<$45k | 0.43 (0.21-0.89) | 0.61 (0.29-1.28) | 1.02 (0.46-2.26) | 0.65 (0.17-2.41) |
| $45k-<$55k | 0.39 (0.26-0.60) | 0.37 (0.24-0.57) | 0.66 (0.41-1.06) | 0.97 (0.49-1.89) |
| $55k-<$65k | 0.66 (0.46-0.94) | 0.65 (0.45-0.93) | 0.85 (0.57-1.25) | 0.90 (0.50-1.60) |
| $65k-<$75k | 0.73 (0.54-1.00) | 0.67 (0.49-0.92) | 0.95 (0.68-1.33) | 0.95 (0.58-1.56) |
| $75k+ | Ref. | Ref. | Ref. | Ref. |
| | | | |
| Community | | | | |
| Rural | 1.31 (0.61-2.81) | 1.41 (0.65-3.05) | 1.47 (0.63-3.42) | 1.43 (0.40-3.42) |
| Suburban | Ref. | Ref. | Ref. | Ref. |
| Urban | 0.90 (0.53-1.52) | 0.98 (0.57-1.68) | 1.18 (0.65-2.14) | 1.22 (0.48-3.14) |
Table 2. Multinomial logistic regression model: N and M Stage by age, race, and ethnicity
| | | | |
| N1 vs. N0 | N2 vs. N0 | N3 vs. N0 | M1 vs. M0 |
| Age Group | OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) |
| 10-17 years | 1.85 (1.47-2.33) | 2.07 (1.58-2.72) | 1.52 (1.09-2.13) | 2.17 (1.76-2.67) |
| 18-24 years | 1.52 (1.37-1.68) | 1.61 (1.42-1.82) | 1.41 (1.22-1.62) | 1.71 (1.55-1.88) |
| 25-44 years | Ref. | Ref. | Ref. | Ref. |
| 45-64 years | 0.89 (0.79-1.00) | 0.89 (0.77-1.03) | 1.22 (1.06-1.42) | 1.06 (0.95-1.19) |
| 65+ years | 0.60 (0.41-0.88) | 0.84 (0.56-1.26) | 1.05 (0.69-1.61) | 0.93 (0.66-1.30) |
| | | | |
| Race | | | | |
| White | Ref. | Ref. | Ref. | Ref. |
| Black | 1.29 (1.03-1.63) | 1.08 (0.79-1.48) | 1.40 (1.02-1.91) | 1.26 (1.00-1.60) |
| Other | 0.89 (0.73-1.08) | 0.80 (0.63-1.02) | 1.12 (0.87-1.43) | 1.09 (0.91-1.31) |
| Unknown | 0.33 (0.21-0.51) | 0.27 (0.15-0.49) | 0.43 (0.25-0.73) | 0.31 (0.19-0.49) |
| | | | |
| Ethnicity | | | | |
| Hispanic | 1.12 (1.02-1.23) | 1.17 (1.04-1.31) | 1.59 (1.41-1.81) | 1.67 (1.53-1.82) |
| Non-Hispanic | Ref. | Ref. | Ref. | Ref. |
| | | | |
| Income | | | | |
| < $35,000 | 0.83 (0.44-1.59) | 1.14 (0.57-2.26) | 1.65 (0.87-3.15) | 1.91 (1.17-3.11) |
| $35k-<$45k | 1.20 (0.92-1.57) | 0.99 (0.67-1.40) | 1.18 (0.82-1.70) | 1.75 (1.37-2.23) |
| $45k-<$55k | 1.14 (0.97-1.35) | 1.13 (0.92-1.38) | 1.28 (1.04-1.59) | 1.45 (1.25-1.70) |
| $55k-<$65k | 1.13 (1.00-1.27) | 0.98 (0.84-1.13) | 1.08 (0.92-1.26) | 1.23 (1.10-1.38) |
| $65k-<$75k | 1.12 (1.01-1.23) | 1.01 (0.89-1.13) | 0.93 (0.81-1.07) | 1.10 (0.99-1.21) |
| $75k+ | Ref. | Ref. | Ref. | Ref. |
| | | | |
| Community | | | | |
| Rural | 0.91 (0.68-1.22) | 1.05 (0.73-1.51) | 1.32 (0.91-1.92) | 0.96 (0.73-1.25) |
| Suburban | Ref. | Ref. | Ref. | Ref. |
| Urban | 1.12 (0.91-1.37) | 1.24 (0.95-1.62) | 1.28 (0.96-1.71) | 1.14 (0.93-1.38) |
Table 3. Multinomial logistic regression model: Historic stage by combined age and ethnicity
| | | | | | | | | |
| | Regional vs. Localized | Distant vs. Localized |
| Variable(s) | Unadjusted | Adjusted* | Unadjusted | Adjusted* |
| Age Group | Ethnicity | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI |
| 10-17 years | Hispanic | 1.63 | 1.23-2.17 | 1.63 | 1.23-2.16 | 3.31 | 2.44-4.48 | 3.34 | 2.46-4.52 |
| 10-17 years | Non-Hispanic | 1.50 | 1.15-1.97 | 1.51 | 1.15-1.98 | 3.02 | 2.26-4.05 | 3.05 | 2.27-4.09 |
| 18-24 years | Hispanic | 1.50 | 1.33-1.69 | 1.49 | 1.32-1.68 | 3.07 | 2.68-3.52 | 3.06 | 2.67-3.51 |
| 18-24 years | Non-Hispanic | 1.31 | 1.19-1.45 | 1.31 | 1.19-1.45 | 1.85 | 1.63-2.10 | 1.83 | 1.61-2.08 |
| 25-44 years | Hispanic | 1.22 | 1.12-1.34 | 1.22 | 1.11-1.33 | 1.80 | 1.61-2.02 | 1.81 | 1.61-2.03 |
| 25-44 years | Non-Hispanic | Ref. | -- | Ref. | -- | Ref. | -- | Ref. | -- |
| 45-64 years | Hispanic | 1.51 | 1.22-1.87 | 1.51 | 1.22-1.87 | 1.64 | 1.22-2.20 | 1.67 | 1.24-2.24 |
| 45-64 years | Non-Hispanic | 1.14 | 1.04-1.24 | 1.14 | 1.05-1.24 | 1.19 | 1.05-1.35 | 1.20 | 1.06-1.36 |
| 65+ years | Hispanic | 1.44 | 0.65-3.21 | 1.42 | 0.64-3.16 | 2.14 | 0.81-5.62 | 2.04 | 0.78-5.38 |
| 65+ years | Non-Hispanic | 1.00 | 0.79-1.27 | 1.01 | 0.79-1.28 | 0.99 | 0.70-1.40 | 1.00 | 0.71-1.42 |
| Income | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI |
| < $35,000 | -- | -- | 1.08 | 0.70-1.66 | -- | -- | 2.18 | 1.35-3.53 |
| $35k-<$45k | -- | -- | 1.28 | 1.05-1.57 | -- | -- | 1.88 | 1.47-2.41 |
| $45k-<$55k | -- | -- | 1.10 | 0.97-1.24 | -- | -- | 1.57 | 1.35-1.84 |
| $55k-<$65k | -- | -- | 1.05 | 0.96-1.15 | -- | -- | 1.29 | 1.15-1.44 |
| $65k-<$75k | -- | -- | 1.04 | 0.97-1.12 | -- | -- | 1.11 | 1.01-1.23 |
| $75k+ | -- | -- | Ref. | -- | -- | -- | Ref. | -- |
| Community | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI |
| Rural | -- | -- | 1.04 | 0.84-1.28 | -- | -- | 0.98 | 0.75-1.29 |
| Suburban | -- | -- | Ref. | -- | -- | -- | Ref. | -- |
| Urban | -- | -- | 1.14 | 0.98-1.33 | -- | -- | 1.20 | 0.98-1.46 |
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