title: Adverse prognostic factors for testicular cancer-specific survival: a population-based study of 27,948 patients.
abstract: OBJECTIVE
  The prognostic significance of age at testicular cancer (TC) diagnosis, socioeconomic status (SES), race, and marital status on TC-specific mortality is not well-characterized. In a cancer that is so curable, it is important to identify any influence that confers an increased risk of TC-specific mortality.
  
  
  METHODS
  Using multivariate cause-specific Cox regression models that accounted for competing risks, hazard ratios (HRs) were calculated for 10-year TC-specific mortality among 27,948 patients with TC reported to the Surveillance, Epidemiology and End Results program (1978 to 2006). Independent predictors were age at diagnosis, SES, race, marital status, extent of disease (EOD), calendar year of diagnosis, radiotherapy, and retroperitoneal lymph node dissection (RPLND).
  
  
  RESULTS
  Compared with younger patients, diagnostic age 40+ was associated with increased mortality (seminoma, HR, 2.00, P < .001; nonseminoma, HR, 2.09; P < .001; most evident in metastatic disease, HR, 8.62; P < .001; HR, 6.35; P < .001, respectively). Unmarried men had two-to three-fold excess mortality compared to married men (HR, 2.97; P < .001; HR, 1.54; P < .001, respectively). Among nonseminoma patients, decreasing SES (P trend < .001) and nonwhite race (HR, 2.11; P < .001) increased mortality. Diagnosis after 1987 resulted in reduced mortality compared to earlier calendar years (HR, 0.58; P = .001; HR, 0.74; P = .001, respectively). Lack of RPLND was associated with seven-fold increase in death (P < .001).
  
  
  CONCLUSIONS
  TC-specific mortality is doubled among US patients diagnosed with seminoma or nonseminoma after age 40, even when initial treatment and EOD are taken into account. Among men with nonseminoma, nonwhite race and lower SES also significantly increase TC-specific mortality. Additional research is needed, enabling the development of interventional strategies and preventive approaches, as applicable.
authors.affiliation: Oslo University Hospital, University of Oslo, Norway.
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
authors.forename: Milada
authors.initials: M
authors.lastname: Cvancarova
authors.forename: Linlin
authors.initials: L
authors.lastname: Chen
authors.forename: Annie L
authors.initials: AL
authors.lastname: Allan
authors.forename: Jan
authors.initials: J
authors.lastname: Oldenburg
authors.forename: Derick R
authors.initials: DR
authors.lastname: Peterson
authors.forename: Lois B
authors.initials: LB
authors.lastname: Travis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D018239:Seminoma / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult