title: Effect of the time from the presentation of symptoms to medical consultation on primary tumor size and survival in patients with testicular cancer: Shift in the last 2 decades.
abstract: OBJECTIVE
  To clarify the effect of the time from the presentation of symptoms to medical consultation (time to consultation) on oncological outcomes in men with testicular cancer and to examine whether the recent improvement of delays in consultation has led to better outcomes.
  
  
  METHODS
  We reviewed 175 consecutive patients registered for testicular cancer (124 men with seminoma and 51 men with nonseminoma) at a single institution between 1991 and 2010.
  
  
  RESULTS
  Men with the time to consultation of>6 months (n = 56) had a poorer overall survival than those with the time to consultation of ≤ 6 months (log-rank test, P = 0.028), despite similar disease stage between them (P = 0.897) and less prevalent nonseminoma in the former (P = 0.032). Although the negative effect of consultation delay on overall survival was significant only in nonseminoma histology (log-rank test, P = 0.004), the time to consultation of>6 months was an independent risk factor associated with poorer overall survival (hazard ratio [HR] = 18.0, 95% confidence interval [CI]: 1.78-182, P = 0.014), in addition to nonseminoma histology (HR = 17.4, 95% CI: 1.38-219, P = 0.027) and stage II or higher disease (HR = 12.9, 95% CI: 1.36-123, P = 0.026) in all the patients. The time to consultation was positively correlated with the primary tumor size (P<0.001). The time to consultation was shorter and the primary tumor size was seemingly smaller in patients registered between 2001 and 2010 (n = 104) than in those registered between 1991 and 2000 (median 74 d vs. 109 d, P = 0.042 and 5.8 ± 2.6 cm vs. 6.7 ± 3.3 cm, P = 0.068, respectively), although disease stage and overall survival were not different between the 2 periods (P = 0.233 and log-rank test, P = 0.719, respectively).
  
  
  CONCLUSIONS
  The time to consultation and primary tumor size showed a strong positive correlation in men with testicular cancer. Delays in consultation had a negative effect on their survival, particularly in those with nonseminoma. The time to consultation significantly shortened and the primary tumor size was reduced with a borderline significance in men registered between 2001 and 2010 compared with those between 1991 and 2000, although stage migration or survival improvement in recent years was not observed.
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kitamura
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nobushita
authors.affiliation: Department of Pathology, Niigata Cancer Center Hospital, Niigata, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawasaki
authors.affiliation: Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan; Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan; Division of Molecular Oncology, Department of Signal Transduction Research, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. Electronic address: harasho@med.niigata-u.ac.jp.
authors.forename: Noboru
authors.initials: N
authors.lastname: Hara
authors.affiliation: Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D018570:Risk Assessment / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D012307:Risk Factors; D018239:Seminoma / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
keywords: Primary tumor size; Symptoms; Testicular cancer; Time to consultation; Treatment outcome