Ethnic disparities and variations in testicular germ cell tumours: A retrospective real-world analysis in a single tertiary cancer centre.

Abstract

595 Background: Testicular germ cell tumours (TGCTs) are the most common malignancy in young men. Ethnic disparities and variations are increasingly recognised as influencing the continuum of clinical care, with a growing emphasis to address the needs of patients from under-represented ethnic backgrounds 1 . Deeper insight into this could validate population trends, identify inequities in presentation and inform strategies to achieve equitable care. However, there remains a paucity of real-world data examining ethnic impact in TGCT, warranting further elucidation. Methods: We retrospectively analysed demographics (age, ethnicity), time to presentation, clinico-pathological characteristics, adverse events on treatment and compliance with follow-up. Inclusion criteria were pts with TGCT diagnosed between January 2021 to December 2023 and managed at Mount Vernon Cancer Centre. Results: We identified 397 pts of which 69.5% (n=276) were White British, 19.1% (n=76) Asian and 11.3% (n=45) Eastern European. Across all ethnicities, incidence peaked in ages 25-45. In Eastern Europeans, 71% were in the 25-45 age range. Asian pts had the youngest age distribution with 21% aged 18-24, while White British pts showed a broader distribution with 29% aged over 45. The histological subtypes across ethnicities showed that Seminoma was the most common, affecting 42.2% of Eastern European, 23.7% of Asian and 56.5% of White British pts. Non-seminomatous germ cell tumours (NSGCT) accounted for 24.4%, 35.5% and 38% of cases respectively. Delayed presentation (>3 months) occurred in 33% of Asian, 26% of Eastern European and 20% of White British pts. The most common reason for delay cited was the belief that symptoms would resolve spontaneously reported by 14% (n=56). Treatment-related adverse events, including thrombocytopaenia and neutropaenia, were analysed for ethnic variation. Retroperitoneal lymph node dissection was performed in 23 patients (6%) whilst stem cell transplantation was undertaken in 19 patients (4.8%) with no significant variation between ethnic groups. Compliance with follow-up was lowest among Asian (48%) and Eastern European (68%) pts, compared with 89% the White British cohort. Conclusions: Ethnic disparities were observed among pts with TGCT, reflected in delayed presentation and poorer compliance with follow-up among Asian and Eastern European groups. In tandem, ethnic variation was evident in disease characteristics - Asian pts presented at a younger age with a higher relative proportion of NSGCT. These findings align with emerging evidence of biological and epidemiological differences, with a rising incidence of NSGCT among Asian pts. This highlights the need for targeted interventions within under-represented populations. Further research is needed to identify factors contributing to the rising incidence of NSGCT observed in Asian pts.