目的:我们研究了III期非精原细胞瘤生殖细胞肿瘤(NSGCT)患者的区域差异。具体来说,我们调查了基线患者的差异,肿瘤特点和治疗特点,以及美国不同地区的癌症特异性死亡率(CSM)。
方法:使用监视,流行病学,和最终结果(SEER)数据库(2004-2018年),患者(年龄,种族/种族),将III期NSGCT患者的肿瘤(国际生殖细胞癌协作组[IGCCCG]预后组)和治疗(全身治疗和腹膜后淋巴结清扫[RPLND]状态)特征制成表格,根据代表不同地理区域的12个SEER登记册。使用多项回归模型和多变量Cox回归模型测试癌症特异性死亡率(CSM)。
结果:在3,174个III期NSGCT患者中,登记特异性患者计数范围为51例(1.5%)至1630例(51.3%).不同年龄的登记册存在差异(40岁以上的登记册为12%-31%),种族/民族(5%-73%的其他人比非西班牙裔白人),IGCCCG预后组(24%-43%vs.14-24%vs.3%-20%,分别在穷人与中间vs.预后良好),系统治疗(87%-96%)和RPLND状态(12%-35%)。调整后,对于全身治疗(84%-97%)和RPLND(11%-32%),临床上仍存在有意义的登记间差异.未调整的5年CSM率从7.1%到23.3%不等。最后,在解决CSM的多变量分析中,2个注册表比SEER参考注册表(SEER注册表12)表现出更有利的结果:SEER注册表4(危险比(HR):0.36)和SEER注册表9(HR:0.64;两者P=.004)。
结论:我们确定了患者的重要区域差异,肿瘤和治疗特点,以及CSM,这可能表明III期NGSCT管理中护理质量或专业知识的区域差异。
OBJECTIVE: We investigated regional differences in patients with stage III nonseminoma germ cell tumor (NSGCT). Specifically, we investigated differences in baseline patient, tumor characteristics and treatment characteristics, as well as cancer-specific mortality (CSM) across different regions of the United States.
METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018), patient (age, race/ethnicity), tumor (International Germ Cell Cancer Collaborative Group [IGCCCG] prognostic groups) and treatment (systemic therapy and retroperitoneal lymph dissection [RPLND] status) characteristics were tabulated for stage III NSGCT patients, according to 12 SEER registries representing different geographic regions. Multinomial regression models and multivariable Cox regression models testing for cancer-specific mortality (CSM) were used.
RESULTS: In 3,174 stage III NSGCT patients, registry-specific patient counts ranged from 51 (1.5%) to 1630 (51.3%). Differences across registries existed for age (12%-31% for age 40+), race/ethnicity (5%-73% for others than non-Hispanic whites), IGCCCG prognostic groups (24%-43% vs. 14-24% vs. 3%-20%, in respectively poor vs. intermediate vs. good prognosis), systemic therapy (87%-96%) and RPLND status (12%-35%). After adjustment, clinically meaningful inter-registry differences remained for systemic therapy (84%-97%) and RPLND (11%-32%). Unadjusted 5-year CSM rates ranged from 7.1% to 23.3%. Finally in multivariable analyses addressing CSM, 2 registries exhibited more favorable outcomes than SEER registry of reference (SEER Registry 12): SEER Registry 4 (Hazard Ratio (HR): 0.36) and SEER Registry 9 (HR: 0.64; both P = .004).
CONCLUSIONS: We identified important regional differences in patient, tumor and treatment characteristics, as well as CSM which may be indicative of regional differences in quality of care or expertise in stage III NGSCT management.