Rowan E Miller1, Sarah C Markt2, Elizabeth O'Donnell3, Brandon Bernard3, Laurence K Albiges3, Clair Beard3, Christopher J Sweeney4. 1. University College London Hospital, London, UK; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. 2. Harvard T.H. Chan School of Public Health, Boston, MA, USA. 3. Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. 4. Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: christopher_sweeney@dfci.harvard.edu.
Abstract
BACKGROUND: Age ≥40 yr is associated with poorer testicular cancer outcomes in population-based studies. OBJECTIVE: To assess the association between age (≥40 yr) and outcomes among men with germ cell tumors (GCTs) in a large hospital registry. DESIGN, SETTING, AND PARTICIPANTS: Electronic medical records for 1095 GCT patients treated at Dana-Farber Cancer Institute between 1997 and 2013 were reviewed. Information regarding histology, stage, treatment, and patient characteristics was obtained. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Using logistic regression analysis and Cox proportional hazards regression, we investigated the association between age and treatment and risk of relapse and GCT-specific death for men with GCT. RESULTS AND LIMITATIONS: At diagnosis, 26% of men (n=283/1095) were ≥40 yr. Among the 610 men with clinical stage 1 (CS1) disease, age ≥40 yr was not associated with a higher risk of CS1 relapse (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.74-1.92). There were 603 men with metastatic disease (CS1 at diagnosis with subsequent relapse or metastasis at diagnosis); after adjusting for stage and histology, men ≥40 yr were more likely to receive etoposide and cisplatin chemotherapy compared to bleomycin, etoposide, and cisplatin as their primary treatment (odds ratio 2.40, 95% CI 1.14-5.05). Salvage therapy also differed by age. In the multivariable model, men ≥40 yr with metastatic GCT had a higher risk of relapse (HR 1.58, 95% CI 1.02-2.46) after primary treatment and death from GCT (HR 2.31, 95% CI 1.29-4.15). The study limitations include incomplete data on medical comorbidities and possible subsequent dose modifications. CONCLUSIONS: Men aged ≥40 yr with metastatic GCT have poorer outcomes, even after accounting for different intended treatment patterns. PATIENT SUMMARY: In this study we looked at the outcome for testicular cancer in more than 1000 patients treated at a single institution in the USA. We found that the treatment for metastatic disease differed between older (≥40 yr) and younger patients. Furthermore, outcomes for older patients (≥40 yr) were worse than for younger men.
BACKGROUND: Age ≥40 yr is associated with poorer testicular cancer outcomes in population-based studies. OBJECTIVE: To assess the association between age (≥40 yr) and outcomes among men with germ cell tumors (GCTs) in a large hospital registry. DESIGN, SETTING, AND PARTICIPANTS: Electronic medical records for 1095 GCT patients treated at Dana-Farber Cancer Institute between 1997 and 2013 were reviewed. Information regarding histology, stage, treatment, and patient characteristics was obtained. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Using logistic regression analysis and Cox proportional hazards regression, we investigated the association between age and treatment and risk of relapse and GCT-specific death for men with GCT. RESULTS AND LIMITATIONS: At diagnosis, 26% of men (n=283/1095) were ≥40 yr. Among the 610 men with clinical stage 1 (CS1) disease, age ≥40 yr was not associated with a higher risk of CS1 relapse (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.74-1.92). There were 603 men with metastatic disease (CS1 at diagnosis with subsequent relapse or metastasis at diagnosis); after adjusting for stage and histology, men ≥40 yr were more likely to receive etoposide and cisplatin chemotherapy compared to bleomycin, etoposide, and cisplatin as their primary treatment (odds ratio 2.40, 95% CI 1.14-5.05). Salvage therapy also differed by age. In the multivariable model, men ≥40 yr with metastatic GCT had a higher risk of relapse (HR 1.58, 95% CI 1.02-2.46) after primary treatment and death from GCT (HR 2.31, 95% CI 1.29-4.15). The study limitations include incomplete data on medical comorbidities and possible subsequent dose modifications. CONCLUSIONS:Men aged ≥40 yr with metastatic GCT have poorer outcomes, even after accounting for different intended treatment patterns. PATIENT SUMMARY: In this study we looked at the outcome for testicular cancer in more than 1000 patients treated at a single institution in the USA. We found that the treatment for metastatic disease differed between older (≥40 yr) and younger patients. Furthermore, outcomes for older patients (≥40 yr) were worse than for younger men.
Authors: A Necchi; S Lo Vullo; G Rosti; M Badoglio; P Giannatempo; D Raggi; S Secondino; L Mariani; F Lanza; P Pedrazzoli Journal: Bone Marrow Transplant Date: 2017-06-05 Impact factor: 5.483
Authors: Alexander I Rolevich; Denis M Borodin; Anton N Rabcheuski; Tatsiana A Ivanitskaya; Sviataslau A Semenov; Liudmila V Artsiushkevich; Alena V Sukalinskaya; Edvard A Zhavrid; Sergei A Krasny; Natalia E Konoplya; Sergey L Polyakov Journal: JCO Glob Oncol Date: 2021-01