MP76-09 PREDICTORS OF METASTASIS AT TIME OF DIAGNOSIS AND OVERALL SURVIVAL IN METASTATIC TESTICULAR CANCER

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making IV1 Apr 2017MP76-09 PREDICTORS OF METASTASIS AT TIME OF DIAGNOSIS AND OVERALL SURVIVAL IN METASTATIC TESTICULAR CANCER Marshall Shaw, Andrew Bachman, Alexander Parker, Brian Cross, Kelly Stratton, Michael Cookson, and Sanjay Patel Marshall ShawMarshall Shaw More articles by this author , Andrew BachmanAndrew Bachman More articles by this author , Alexander ParkerAlexander Parker More articles by this author , Brian CrossBrian Cross More articles by this author , Kelly StrattonKelly Stratton More articles by this author , Michael CooksonMichael Cookson More articles by this author , and Sanjay PatelSanjay Patel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2137AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Few large series in the literature examine predictors of metastatic disease at time of testicular cancer diagnosis. We performed an analysis of the National Cancer Database (NCDB) to examine predictors of metastatic disease at the time of diagnosis and overall survival (OS) based on site of metastatic disease. METHODS Utilizing the NCDB, 44,354 patients were identified with data available for metastatic disease at time of diagnosis and tumor histology. Metastases were stratified as either absent, lymph node only, lung, brain, liver or bone metastases. Demographic characteristics, socioeconomic indicators and tumor histology were compared using the chi-squared test. Univariate survival analysis was performed using the Kaplan Meier method. Multivariate survival analysis was performed using cox proportional hazard model. RESULTS Mean age of diagnosis was 35 and mean follow-up was 53 months. On univariate analysis decreased age at diagnosis (p<0.001), non-white race (p=0.002), uninsured status (p=<0.001), <$38,000 annual income (p=<0.001), distance from treating hospital (p<0.001), and pure choriocarcinoma histology (166/202, 82%, p<0.001) were associated with metastases at time of diagnosis. 3,504 (7.9%) patients had metastatic disease at diagnosis. Kaplan Meier survival analysis showed significant differences in OS between metastatic sites at presentation, with 5 yr OS of 87% for lymph node only metastases compared to 48% OS in those with brain metastases (p<0.001). On multivariate analysis while controlling for age, race, insurance status, income, comorbidities, histology, receipt of chemotherapy, and primary tumor size, metastases to any site were associated with worsened survival compared to no metastases (referent): metastasis to lymph nodes (3.4, 95% CI: 2.70-4.50, p<0.001), lung (4.48, 95% CI: 3.69-5.43, p<0.001), liver (10.32, 95% CI: 6.78-15.7), bone (12.99, 95% CI: 7.93-21.29) and brain (14.4, 95% CI: 9.53-21.89). Private insurance status (0.48, 95% CI: 0.40-0.56, p<0.001) and income >$63,000 (0.72, 95% CI: 0.60-0.87, p=0.001) were favorable predictors of OS. CONCLUSIONS There are significant differences in OS dependent on site of metastases at time of testicular cancer diagnosis. Several sociodemographic factors likely contribute to likelihood of metastases at presentation as well. Further prospective studies are warranted to better characterize the impact of sociodemographic factors on metastases at presentation and to improve access to care in high-risk populations. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1016 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Marshall Shaw More articles by this author Andrew Bachman More articles by this author Alexander Parker More articles by this author Brian Cross More articles by this author Kelly Stratton More articles by this author Michael Cookson More articles by this author Sanjay Patel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...