Adverse Prognostic Factors for Testicular Cancer-Specific Survival: A Population-Based Study of 27,948 Patients
Adverse Prognostic Factors for Testicular Cancer-Specific Survival: A Population-Based Study of 27,948 Patients
复制标题
DOI：
10.1200/jco.2010.32.3204
复制
发表时间：
2011-03-01
影响因子：
45.3
通讯作者：
Travis, Lois B.
中科院分区：
文献类型：
--
作者：
Fossa, Sophie D.;Cvancarova, Milada;Travis, Lois B.
目的：睾丸癌（TC）诊断年龄、社会经济地位（SES）、种族和婚姻状况对TC特异性死亡率的预后意义尚不明确。患者和方法使用多变量原因特异性考克斯回归模型，考虑竞争风险，计算27，948例报告给监测的TC患者10年TC特异性死亡率的风险比（HR），流行病学和最终结果方案（1978年至2006年）。独立的预测因子是诊断时的年龄、SES、种族、婚姻状况、疾病范围（EOD）、诊断日历年、放射治疗和腹膜后淋巴结清扫（RPLND）。（腺瘤，HR，2.00，P < .001;非腺瘤，HR，2.09; P < .001;转移性疾病最明显，HR，8.62; P < .001; HR，6.35; P < .001）。未婚男性的死亡率是已婚男性的2 ~ 3倍（HR分别为2.97; P <0.001; HR为1.54; P <0.001）。在非恶性肿瘤患者中，SES降低（P趋势<0.001）和非白人（HR，2.11; P <0.001）增加了死亡率。1987年以后确诊的患者死亡率较前几年有所下降（分别为HR，0.58; P <0.001; HR，0.74; P <0.001）。缺乏RPLND与死亡率增加7倍相关（P <0.001）。结论TC特异性死亡率在40岁后被诊断为乳腺癌或非乳腺癌的美国患者中翻了一番，即使考虑到初始治疗和EOD。在非精原细胞瘤男性中，非白人种族和较低的SES也显着增加了TC特异性死亡率。需要进行更多的研究，以便酌情制定干预战略和预防办法。
PurposeThe prognostic significance of age at testicular cancer (TC) diagnosis, socioeconomic status (SES), race, and marital status on TC-specific mortality is not well-characterized. In a cancer that is so curable, it is important to identify any influence that confers an increased risk of TC-specific mortality.Patients and MethodsUsing multivariate cause-specific Cox regression models that accounted for competing risks, hazard ratios (HRs) were calculated for 10-year TC-specific mortality among 27,948 patients with TC reported to the Surveillance, Epidemiology and End Results program (1978 to 2006). Independent predictors were age at diagnosis, SES, race, marital status, extent of disease (EOD), calendar year of diagnosis, radiotherapy, and retroperitoneal lymph node dissection (RPLND).ResultsCompared with younger patients, diagnostic age 40+ was associated with increased mortality (seminoma, HR, 2.00, P < .001; nonseminoma, HR, 2.09; P < .001; most evident in metastatic disease, HR, 8.62; P < .001; HR, 6.35; P < .001, respectively). Unmarried men had two-to three-fold excess mortality compared to married men (HR, 2.97; P < .001; HR, 1.54; P < .001, respectively). Among nonseminoma patients, decreasing SES (P trend < .001) and nonwhite race (HR, 2.11; P < .001) increased mortality. Diagnosis after 1987 resulted in reduced mortality compared to earlier calendar years (HR, 0.58; P < .001; HR, 0.74; P < .001, respectively). Lack of RPLND was associated with seven-fold increase in death (P < .001).ConclusionTC-specific mortality is doubled among US patients diagnosed with seminoma or nonseminoma after age 40, even when initial treatment and EOD are taken into account. Among men with nonseminoma, nonwhite race and lower SES also significantly increase TC-specific mortality. Additional research is needed, enabling the development of interventional strategies and preventive approaches, as applicable.