Assessing racial disparities in testicular cancer survival: Evidence from a nationwide cohort.

Abstract

621 Background: Testicular cancer is one of the most common and curable malignancies in young men, with a 5 year survival rate of 95%. Limited research has explored long-term survival outcomes among Black men, given rarity of disease among this demographic. Our study aims to assess potential racial differences in overall survival (OS) and cancer-specific mortality (CSM) among testicular cancer patients using a large, equal access nationwide Veterans Affairs (VA) database, focusing on self-identified Black and White race. Methods: This retrospective study analyzed Black and White testicular cancer patients from the VA database utilizing Veterans Informatics and Computing Infrastructure (VINCI). Self-identified race was obtained from the VA Cancer Registry, with OS and CSM as the primary outcomes. CSM was identified using the National Death Index (NDI). NDI data is available through 12/31/2020, after which date all patients with continued follow-up were censored. Cox proportional hazard models were applied to examine the associations of race on OS and CSM, adjusting for relevant clinical factors such as cancer staging, Charlson Comorbidity Index (CCI), and receipt of adjuvant chemotherapy or radiation. All time to event analyses were done from time of testicular cancer diagnosis to outcome of interest. Results: We compared 1799 White patients to 118 Black patients. A total of 431 (22.49%) patients died, of whom 405 were White and 26 were Black. There was no statistically significant difference in survival at 10 years between Black and White individuals (80.4% vs 81.6%, p = 0.68). The multivariable cox-regression analysis showed no statistically significant difference between Black and White men. Of the 431 deaths, 72 were identified as CSM (71 White, 1 Black). There was no significant difference in 10-year cumulative incidence of CSM in Black and White individuals (0% vs 4.1%, p=0.12). Similarly, no significant differences were found for CSM between Black and White men in the multivariable analysis. Conclusions: Our study found no significant racial disparities in OS or CSM between Black and White testicular cancer patients in the VA healthcare system. As the VA represents an equal access to care setting, these findings may not be generalizable to the broader U.S. population, where disparities in care are more notable. Conversely, access to care may overcome known sociodemographic disparities that drive worse clinical outcomes. The analysis is limited by the small number of patients experiencing the event of interest. Future research should be conducted to validate the association between self-identified race and survival outcomes in more diverse healthcare settings.