Presentation Authors: Alexandr Pinkhasov*, Ruben Pinkhasov, Garrett Smith, Michael Daneshvar, Stephanie Gleicher, Jeffrey Johnson, Oleg Shapiro, Elizabeth Ferry, Gennady Bratslavsky, Joseph Jacob, Syracuse, NY
Introduction: Racial disparities among black and white men have been established in several urological malignancies including prostate and renal cancer. The purpose of this study is to compare socio-demographic factors and survival outcomes among black and white men with testicular cancer.
Methods: The National Cancer Database was queried to identify black and white men with testicular cancer diagnosed between 2004 and 2015. Baseline demographic characteristics included age at diagnosis, Charlson Comorbidity Index (CCI), insurance status, median household income by residence, education level, distance to facility, facility type, and stage at diagnosis. Frequencies and relative frequencies were compared using Chi-squared test. Kaplan-Meier method and Cox proportional hazards modeling were used to analyze survival and comparisons, respectively.
Results: A total of 62,705 men were included in our analysis, of which 60,566 (96.6%) were white and 2,139 (3.4%) were black. When compared to whites, blacks had significantly higher CCI (8.4% vs 6.2%; p < 0.001), were less likely to be insured (17.6% vs 10.8%; p < 0.001), and more likely to have stage III disease (16.6% vs 12.6%; p < 0.001). Blacks had a lower median household income and education level. Blacks were more likely to be treated at an Academic/Research/ Integrated Network center (20.0% vs 13.9%; p < 0.001), whereas whites were more likely to be treated at Community/Comprehensive Community centers (19.0% vs 14.6%; p < 0.001). Blacks were more likely to live within a 10-mile radius of their treatment facility (62.3% vs 51.2%; p < 0.001). Black men had a twofold increase in 30-day mortality (0.6% vs 0.3%; p < 0.001) and 90-day mortality (1.3% vs 0.6%; p < 0.001) when compared to white men. When compared to whites, blacks have a significantly lower 10-year overall survival (p < 0.001). After controlling for insurance status, income, CCI, and stage, race continued to be a predictor of mortality (HR 1.122, p < 0.001).
Conclusions: Our analysis reinforces previously identified conclusions on racial disparities in testicular cancer using a larger and more current data set. After surveying the largest cohort of cancer patients nationwide to date, race continues to be an independent predictor of mortality in testis cancer.