Adult testicular lymphoma in the United States (1985–2004): Analysis of 3,669 cases from the National Cancer Data Base (NCDB)

Abstract

19503 Background: Because patients with testicular lymphoma are rare and generally excluded from clinical trials, data on clinical features,treatment and survival are limited. Methods: We retrospectively reviewed all cases of adult (age ≥18 years) testicular lymphoma registered with the NCDB from 1985–2004. Survival data were available only for patients diagnosed before 2001. The NCDB, a project of the American College of Surgeons Commission on Cancer, serves as a comprehensive clinical surveillance resource for all forms of cancer and captures approximately 75% of all cancer cases in the US. Results: We identified3669 cases of testicular lymphoma. This comprised 0.6% of all non-Hodgkin lymphoma. Major histological groups included diffuse large B-cell (DLBCL) (77.8%), other B-cell (21.1%), and T/NK/null cell (1.1%). Median age at diagnosis was 70 years (range, 20–101), with 34.9% under age 65. The right testis was as frequently involved as the left (46.4% v 44.2%). Bilateral testicular involvement occurred in 6.1%. Among those with complete staging work-up, the stage distribution was: I (59.1%), II (15.3%), III (6.0%), and IV (19.6%). Majority were cared for in the community(62.4%) and either had surgery plus additional treatment (59.9%) or surgery alone (23.8%). Median overall survival improved over time, 35.5, 37.6, and 49.5 months for those diagnosed in 1985–1989, 1990–1994, and 1995–2000, respectively (P= 0.01). Other significant predictors of better survival were age <65 years, non-black race, stages I/II at diagnosis, multi-modality treatment, and treatment at a non- Veterans Affairs facility. After multivariate analysis, only age, stage, race, and treatment modality remained independent predictors of survival. Conclusions: This is the largest reported clinical series of testicular lymphoma. Testicular lymphoma is rare and usually presents as early stage disease. Even prior to the introduction of rituximab, the prognosis of testicular lymphoma improved over time, perhaps due to the more frequent use of multimodality therapy. Notably, black race predicted for a worse outcome while DLBCL histology unexpectedly did not. No significant financial relationships to disclose.