To identify the prognostic impact of treatment centralization in patients with testicular germ cell tumors (TGCT).
We used a hospital-based cancer registry data in Japan to extract seminoma and non-seminoma cases that were diagnosed in 2013, histologically confirmed, and received the first course of treatment. To compare the 5-years overall survival (OS) rates of patients stratified by institutional care volume, we performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) method to adjust patient backgrounds.
A total of 1767 TGCT patients were identified. The 5-years OS rates for stage II and III TGCT patients treated at low-volume institutions (< 7 cases) were significantly worse than high-volume institutions (≥ 7 cases) (91.2% vs. 83.4%, p = 0.012). Histological stratification revealed that 5-year OS rates for stage II and III seminoma patients in the low-volume group were significantly worse than the high-volume group (93.5% vs. 84.5%, p = 0.041). Multivariate OS analysis using an IPTW-matched cohort showed that institutional care volume was an independent prognostic factor (hazard ratio 2.13 [95% confidence interval: 1.23-3.71], p = 0.0072).
Our results indicate that stage II and III TGCT patients experience lower survival rates at low-volume institutions and would benefit from treatment centralization.
International journal of clinical oncology. 2024 Jan 24 [Epub ahead of print]
Shuhei Suzuki, Yoshiyuki Nagumo, Shuya Kandori, Kousuke Kojo, Satoshi Nitta, Ichiro Chihara, Masanobu Shiga, Atsushi Ikeda, Takashi Kawahara, Akio Hoshi, Hiromitsu Negoro, Mathis J Bryan, Ayako Okuyama, Takahiro Higashi, Hiroyuki Nishiyama
Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan., Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. ., International Medical Center, University of Tsukuba Affiliated Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki, 305-8576, Japan., Center for Cancer Registries, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.