Presentation Authors: Rashed Ghandour*, Caleb Ashbrook, Yuval Freifeld, Nirmish Singla, Yair Lotan, Vitaly Margulis, Solomon Woldu, Aditya Bagrodia, Dallas, TX
Introduction: Management of advanced testicular cancer is mostly performed in a few, high-volume clinical centers whose practice patterns may not be generalizable. We review a nationwide, cancer registry to discern treatment patterns of patients with retroperitoneal involvement of non-seminomatous germ cell tumor (NSGCT).
Methods: The NCDB was queried for patients with AJCC stage II NSGCT from 2004-2014. Patients were excluded if all treatment decisions were made outside of the reporting facility, or if treatment was unknown. Hospital volumes were stratified according to GCT case volume: low (bottom 25%), low-intermediate (25-75%), intermediate (75-95%), high-intermediate (95-99%), and high volume (top 99%). Patients were stratified by clinical nodal status and corresponding AJCC sub-staging: cN0/AJCC Stage IIA, cN2/AJCC Stage IIB, and cN3/AJCC Stage IIIC. Logistic regression was performed to determine factors independently associated with primary RPLND and post- chemotherapy RPLND.
Results: A total of 2,408 patients met the inclusion criteria: Stage IIA (n=1,060), IIB (n=869), IIC (n=274). The mean patient age was 29.5 (SD 9.4) years. Racial breakdown was: white (non-Hispanic): 83.1%, Hispanic: 10.7%, black 2.1%, other 2.7%, and unknown 1.4%. Overall, 82.6% of patients underwent primary chemotherapy, while 17.4% underwent upfront RPLND. Stratified by stage, use of primary chemotherapy was 77.5%, 87.7%, and 86.1% for stages IIA, IIB, and IIC, respectively. Overall, 24.4% of patients underwent PC-RPLND. Longitudinal data, stratified by stage, is provided in Figures 1-2. Factors independently associated with a lower likelihood of undergoing primary RPLND were more recent diagnosis and high clinical nodal stage. Conversely, patients treated at high-volume facilities were more likely to receive primary RPLND. Factors associated with higher likelihood of undergoing PC-RPLND included higher clinical nodal stage, treatment at a high-volume center, and the distance a patient traveled to seek care.
Conclusions: The nationwide utilization of primary chemotherapy is increasing compared to RPLND for stage II NSGCT, and is the preferred therapy for more advanced nodal disease. PC-RPLND is driven by the nodal stage as well as the accessibility of a high-volume center.