Risk and survival outcomes of Hispanic patients with germ cell tumors at a multihospital academic center.

Abstract

e17007 Background: Testicular germ cell tumors (TGCTs) are the leading solid-organ malignancy of adolescent/young adult males. National data has noted a rising incidence in all racial/ethnic groups, most rapidly in Hispanics who also have worse prognosis and advanced disease at diagnosis. We sought to explore differences between Hispanic white (HW) and non-Hispanic white (NHW) patients with TGCTs. Methods: We identified patients with pathologically confirmed TGCT treated from 2015 to 2022 at two major referral centers in southern California with a large HW population. Demographic, clinical, treatment, and outcome data was collected, including race/ethnicity, age, location of initial presentation to care, insurance type, TNMS stage, histology, location of metastases, and IGCCCG risk score. Differences between HW and NHW patients were evaluated using Kruskal-Wallis rank sum for numeric variables and Chi-square tests for categorical variables. Cox proportional hazards model was utilized for univariate analyses of OS, PFS, and RFS, which were censored at last follow-up or event of interest. Results: Among 124 NHW and 176 HW patients, 5-year OS was 94.1%, PFS was 75.4%, and RFS was 73.2%. HW patients were younger at diagnosis (29 vs 31 years, P = 0.026), more likely to initially present to acute services (68% vs 42%, P <0.001) and have public insurance (77% vs 21%, P <0.001). No difference in risk prevalence was found in HW patients with seminoma; however, HW patients with nonseminoma had higher prevalence of intermediate/poor risk disease (40% vs 22%, P = 0.014), had higher prevalence of non-retroperitoneal lymph node metastases (21% vs 7%, P = 0.012), and were more likely to require chemotherapy initiation before orchiectomy (16% vs 3%, P = 0.032). Stage III disease was associated with worse OS (HR = 4.96, 95%CI 1.03-23.9, P = 0.046) and PFS (HR = 2.76, 95%CI 1.48-5.14, P = 0.001). Poor risk disease was associated with worse OS (HR = 30.1, 95%CI 6.37-142, P < 0.001), RFS (HR = 3.29, 95%CI 1.72-6.32, P < 0.001), and PFS (HR = 6.29, 95%CI 3.61 -10.9, P < 0.001). HW ethnicity was not associated with worse survival in stage III or poor risk cohorts. Conclusions: In a multihospital cohort with significant HW representation, HW patients with nonseminoma had more prevalent advanced stage and poor risk disease. Poor risk and stage III disease was found to be associated with worse survival and prognostic outcomes, independent of ethnicity. Hispanic N=176 Non-Hispanic White (N=124) Total (N=300) P-value Presented to Clinic (vs Acute) 30 (17.0%) 42 (33.9%) 72 (24.0%) <0.001 Private (vs Public) Insurance 36 (20.5%) 89 (71.8%) 125 (41.7%) <0.001 Good Risk 128 (72.7%) 96 (77.4%) 224 (74.7%) 0.197 Intermediate Risk 27 (15.3%) 13 (7.4%) 40 (13.3%) Poor Risk 21 (11.9%) 12 (9.7%) 33 (11.0%) Nonseminoma 105 (59.7%) 73 (58.9%) 178 (59.3%) 0.834 Seminoma 67 (38.1%) 49 (39.5%) 116 (38.7%) Teratoma 64 (36.4%) 38 (30.6%) 102 (34.0%) 0.238