Racial and socioeconomic disparities in testicular cancer survival outcomes: A SEER database analysis.

Abstract

5028 Background: Testicular cancer, the most common malignancy in men aged 15 to 45 years, has a high cure rate exceeding 95% with early diagnosis and proper treatment. However, these favorable outcomes are not equitably distributed across all racial and socioeconomic groups. This study aims to analyze these disparities in testicular cancer survival outcomes from 2014 to 2021. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients diagnosed with testicular cancer (ICD-O-3 site codes C620-C629) from 2014 to 2021. Variables including stage, treatment, ethnicity, income level, and geographic location (urban/rural) were extracted. Patients with missing data were excluded from the analysis. Statistical methods included chi-square tests, Kaplan-Meier survival curves, and Cox proportional hazards models. Analyses were conducted using R (v4.4.1). Results: A total of 20,508 patients were included in the study. The population was predominantly White (87%), followed by Asian/Pacific Islanders (5%) and African Americans (3%). The majority of patients were aged 20–39 years (60%), with T1 disease (42.89%) and no nodal involvement (N0- 53.93%). Seminomas accounted for 52.7% of cases, followed by mixed germ cell tumors (25.88%) and embryonal carcinoma (7.73%). Primary treatments included surgery (95%) and chemotherapy (38%). Advanced disease stages (T3–T4, M1, Stage II–III) and extensive nodal involvement were significantly associated with poor survival outcomes (p<0.001). Multivariate stratified analyses revealed higher overall mortality (OM) among African Americans (HR = 1.75, p < 0.001) and Asian/Pacific Islanders (HR = 1.25, p = 0.003) compared to White patients. The Hispanic population exhibited an 8.8% higher hazard compared to non-Hispanics (HR = 1.088, p = 0.02). Patients with annual incomes below $40,000 had significantly elevated OM (HR = 2.41, p < 0.001), whereas those with incomes of $120,000 or more demonstrated better survival outcomes (HR = 0.77, p = 0.019) compared to the reference group ($40,000- $120,000). Multivariate analyses of cancer-specific mortality (CSM) revealed similar findings, with African American patients (HR = 1.69, p < 0.001) and individuals in lower-income brackets (HR = 2.12, p < 0.001) experiencing worse outcomes. Conclusions: This study highlights racial and socioeconomic disparities in testicular cancer survival outcomes, with African American patients and individuals in lower-income brackets experiencing significantly worse overall and cancer-specific mortality. It underscores the need for future research to investigate structural inequities and insurance-related barriers contributing to these disparities and develop actionable strategies to achieve equity in cancer outcomes.