Prognostic indicators and socioeconomic disparities in teratoma with malignant transformation: An NCDB analysis.

Abstract

e22613 Background: Teratomas with malignant transformation (TMT) are rare germ cell tumors in which a typically benign mature teratoma undergoes transformation into a non-germ cell malignancy such as squamous cell carcinoma, adenocarcinoma, or sarcoma. TMT has a median age of diagnosis of 38 years of age. Given the rarity of TMT, current literature relies on small institutional case series and focuses primarily on tumor characteristics and clinical outcomes. This study leveraged the National Cancer Database (NCDB) to explore demographic and socioeconomic factors of TMT. Methods: A retrospective cohort study using data from the National Cancer Database (NCDB) from (2004-2020) analyzed patients diagnosed with TMT (ICD-O-3 code: 9084). The study examined demographic factors such as age, sex, race, primary site of occurrence, insurance coverage and Charlson- Deyo score. Demographic factors were analyzed by descriptive statistics, and incidence trends were interpreted by regression analysis. Results: We identified 212 patients with a confirmed diagnosis of TMT from 2004-2020. Most patients in the cohort were women at (62.7%). Most patients were White (79.2%) and 13.7% were Hispanic. Of the 122 patients with facility data, most were treated in academic/research programs (37.7%), and comprehensive community center cancer programs (35.2%). The majority resided in metropolitan areas with populations over 1 million (49.5%) and had household incomes between $57,857-$74,062 (27.4%). Most patients were privately insured (60.8%), while 17.9% and 12.3% had Medicaid and Medicare respectively. Most patients (86.3%) had no comorbidity burden, with a Charlson-Deyo score of 0. Treatment consisted largely of surgical excision (93.8%). The most common site of occurrence was in the ovaries (58.5%), followed by the testicles (22.7%). Most patients presented with Stage I (35.8%), and pairwise analysis showed significant differences in survival between Stage I compared to Stages 2-4, and Stage 2 compared to Stage 4 (p = 0.001). Mean overall survival time was 140 months with survival rates of 76.2% at 2 years, 69.3% at 5 years, and 65.1% at 10 years. Conclusions: To the best of our knowledge, this study represents one of the first studies to analyze the influence of socioeconomic and demographic factors on TMT, thereby addressing a gap in literature. Most TMT patients were White and resided in high income metropolitan areas. The majority were treated in academic centers with surgery as the primary treatment. Most patients were privately insured. These findings emphasize the need for research on the impact of socioeconomic factors on diagnosis, treatment access and long-term survival outcomes Future studies should focus on addressing the need for further data collection to better understand the incidence of TMT originating in different sites.