Management trends for men with early‐stage nonseminomatous germ cell tumors of the testicle: An analysis of the National Cancer Database. Issue 2 (14th September 2016)

• Record Type: Journal Article
• Authors: Weiner, Adam B.; Pearce, Shane M.; Eggener, Scott E.
• Is Part Of: Cancer. Volume 123:Issue 2(2017)
• Page Start: 245
• Page End: 252
• Publication Date: 2016-09-14
• Subjects: epidemiology -- germ cell and embryonal -- neoplasms -- testicular neoplasms -- therapeutics -- United States; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.30332
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: Surveillance has been recommended more frequently as a postorchiectomy management option for men with early stage nonseminomatous germ cell tumor (NSGCT) of the testicle. It is unknown how contemporary treatment patterns reflect these recommendations. METHODS: Data from the National Cancer Database were extracted on all men who were diagnosed with clinical stage (CS) IA or CSIB NSGCT between 2004 and 2013. Temporal trends in the use of chemotherapy, retroperitoneal lymph node dissection (RPLND), and surveillance were measured; and multivariable logistic regression was used to analyze the association of patient and clinical covariates with use of surveillance. RESULTS: Of the 4080 men with CSIA NSGCT, 70%, 17%, and 13% received surveillance, RPLND, and chemotherapy, respectively. Surveillance increased in this group from 65% (2004‐2005) to 74% (2012‐2013: adjusted odds ratio, 1.50; 95% confidence interval, 1.14‐1.98; P = .004). Of the 2580 men who had CSIB NSGCT, 46%, 20%, and 34% received surveillance, RPLND, and chemotherapy, respectively. In this group, 48% of men underwent surveillance in the years 2004 to 2005 and 2012 to 2013 (adjusted P = .8). Upon multivariable analyses, higher income and the oldest age quartile were associated with increased odds of surveillance among men with CSIA NSGCT (both P < .050). Hispanic men with CSIB NSGCT were more likely to receive surveillance compared with non‐Hispanic white men ( P = .001). CONCLUSIONS: Nearly 75% of men with CSIA NSGCT and nearly 50% of men with CSIB NSGCT received surveillance in 2012 and 2013. The likelihood of receiving surveillance increased from 2004 through 2013 for men with CSIA NSGCT but was unchanged for men with CSIB. Cancer 2017;123:245–252. © 2016 American Cancer Society . Abstract : Postorchiectomy surveillance for early‐stage nonseminomatous germ cell tumor of the testicle may reduce treatment‐related morbidities without compromising cancer‐specific survival. In the United States, nearly 75% of men with clinical stage IA and nearly 50% of men with clinical stage IB disease received surveillance in 2012 and 2013, and recent increases are observed in men with clinical stage IA tumors.