Association of age 40 and older with adverse outcome in metastatic testicular cancer (TC).

Abstract

386 Background: We sought to determine factors associated with poorer outcome in older patients (≥ 40) with TC in a large institutional dataset. Methods: A retrospective review of a 1095 patient, IRB approved database, of men treated for TC between 1997 and 2012 at the Dana-Farber Cancer Institute was performed. Information regarding histology, stage, treatment and patient characteristics was obtained from electronic medical records. Using logistic regression analysis and Cox proportional hazard regression we investigated the association between age and outcome for (a) men with clinical stage 1 (CS1) TC and (b) men with metastatic TC, either at diagnosis or following CS1 relapse. Results: 26% of the TC patients were ≥ 40 at diagnosis. Amongst the 616 men with CS1 disease 150 (24%) were age ≥ 40, there was an association with increased likelihood of seminoma (OR 2.46, 95%CI 1.68-3.60) and larger tumour size (> 4cm, OR 1.81, 95%CI 1.23-2.66). Age ≥ 40 was not associated with an increased risk of relapse (HR 0.931, 95%CI 0.575-1.505, p=0.77). 605 men (159, 26% ≥ 40) with metastatic disease were identified. Men ≥ 40 were more likely to have seminoma (OR 3.07 95%CI 2.07-4.54). Distribution of IGCCC prognostic stage was similar in men < 40 and ≥ 40. After adjusting for stage and histology, men ≥ 40 were more likely to receive chemotherapy other than BEP as their primary treatment (OR 1.87 95%CI 1.17-3.00, p=0.009) and men ≥ 40 were also more likely to receive non-optimal chemotherapy than men < 40 (OR 2.91 95%CI 1.12-7.60, p=0.03). When adjusted for confounding variables, age ≥ 40 was associated with a non-significant increased risk of relapse (HR 1.467 95%CI 0.94-2.29, p=0.09) post primary treatment and a significant increased risk of death from TC (HR 2.41 95%CI 1.41-4.11, p=0.0013), which was greater for those with non-seminoma (HR 2.54 95%CI 1.45-4.44, p=0.0011) than seminoma (HR 1.53, 95%CI 0.33-7.2, p=0.56). Conclusions: Men ≥ 40 years diagnosed with metastatic TC were less likely to be cured with therapy for metastatic disease compared to men < 40.