To characterize post-orchiectomy treatment trends in prepubescent and adolescent patients with nonseminomatous germ cell tumors (NSGCT) and identify patient and hospital factors associated with receiving surveillance or treatment (chemotherapy or RPLND) after orchiectomy.
Patients <18 years old diagnosed with NSGCT from 2006-2016 were extracted from the National Cancer Database. Patients were stratified into prepubescent (<12 years old) and adolescent (age 13 to 17) cohorts. National trends and multivariable logistic regression for odds of undergoing treatment were identified.
Documentation of use of post-orchiectomy treatment or surveillance was available for 1006 patients. This population was divided into a prepubescent cohort (≤12 years of age, n=153) and an adolescent cohort (13-17 years of age, n=853). 545 (54.4%) patients proceeded with treatment. The proportion of patients undergoing treatment in each cohort remained similar over time, but there was a shift in the adolescent cohort away from RPLND towards chemotherapy. In the prepubescent cohort, pathologic stage group III was associated with undergoing treatment. Older age, >50 miles travel to treatment facility, and higher pathologic stage group were associated with treatment in the adolescent cohort. Black race was associated with decreased odds of undergoing treatment amongst adolescents.
National treatment trends regarding NSGCT remained similar over a decade. Higher disease stage in prepubescent patients lead to additional post-orchiectomy treatment. Adolescents with NSGCT were more likely to undergo post-orchiectomy treatment if they were older, traveled farther to a treatment center, and had a higher disease stage.
Urology. 2021 Feb 27 [Epub ahead of print]
Elizabeth L Koehne, Parth M Patel, Hiten D Patel, Arnav Srivastava, Hannah Slovacek, Gopal N Gupta, Michael E Woods, Diana K Bowen
Department of Urology, Loyola University Medical Center, Maywood, IL, USA. Electronic address: ., Department of Urology, Loyola University Medical Center, Maywood, IL, USA., Department of Surgery, Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA., Department of Urology, Loyola University Medical Center, Maywood, IL, USA; Department of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.