Age ≥40 Years Is Associated with Adverse Outcome in Metastatic Germ Cell Cancer Despite Appropriate Intended Chemotherapy

Abstract

BackgroundAge ≥40 yr is associated with poorer testicular cancer outcomes in population-based studies. ObjectiveTo assess the association between age (≥40 yr) and outcomes among men with germ cell tumors (GCTs) in a large hospital registry. Design, setting, and participantsElectronic medical records for 1095 GCT patients treated at Dana-Farber Cancer Institute between 1997 and 2013 were reviewed. Information regarding histology, stage, treatment, and patient characteristics was obtained. Outcome measurements and statistical analysisUsing logistic regression analysis and Cox proportional hazards regression, we investigated the association between age and treatment and risk of relapse and GCT-specific death for men with GCT. Results and limitationsAt diagnosis, 26% of men (n=283/1095) were ≥40 yr. Among the 610 men with clinical stage 1 (CS1) disease, age ≥40 yr was not associated with a higher risk of CS1 relapse (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.74–1.92). There were 603 men with metastatic disease (CS1 at diagnosis with subsequent relapse or metastasis at diagnosis); after adjusting for stage and histology, men ≥40 yr were more likely to receive etoposide and cisplatin chemotherapy compared to bleomycin, etoposide, and cisplatin as their primary treatment (odds ratio 2.40, 95% CI 1.14–5.05). Salvage therapy also differed by age. In the multivariable model, men ≥40 yr with metastatic GCT had a higher risk of relapse (HR 1.58, 95% CI 1.02–2.46) after primary treatment and death from GCT (HR 2.31, 95% CI 1.29–4.15). The study limitations include incomplete data on medical comorbidities and possible subsequent dose modifications. ConclusionsMen aged ≥40 yr with metastatic GCT have poorer outcomes, even after accounting for different intended treatment patterns. Patient summaryIn this study we looked at the outcome for testicular cancer in more than 1000 patients treated at a single institution in the USA. We found that the treatment for metastatic disease differed between older (≥40 yr) and younger patients. Furthermore, outcomes for older patients (≥40 yr) were worse than for younger men.