The prognostic impact of treatment centralization in patients with testicular germ cell tumors: analysis of hospital-based cancer registry data in Japan

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发表日期：

2024年1月24日

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Shuhei Suzuki,
Yoshiyuki Nagumo,
Shuya Kandori,
Kousuke Kojo,
Satoshi Nitta,
Ichiro Chihara,
Masanobu Shiga,
Atsushi Ikeda,
Takashi Kawahara,
Akio Hoshi,
Hiromitsu Negoro,
Mathis J. Bryan,
Ayako Okuyama,
Takahiro Higashi,
Hiroyuki Nishiyama

摘要

Background

To identify the prognostic impact of treatment centralization in patients with testicular germ cell tumors (TGCT).

Methods

We used a hospital-based cancer registry data in Japan to extract seminoma and non-seminoma cases that were diagnosed in 2013, histologically confirmed, and received the first course of treatment. To compare the 5-years overall survival (OS) rates of patients stratified by institutional care volume, we performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) method to adjust patient backgrounds.

Results

A total of 1767 TGCT patients were identified. The 5-years OS rates for stage II and III TGCT patients treated at low-volume institutions (< 7 cases) were significantly worse than high-volume institutions (≥ 7 cases) (91.2% vs. 83.4%, p = 0.012). Histological stratification revealed that 5-year OS rates for stage II and III seminoma patients in the low-volume group were significantly worse than the high-volume group (93.5% vs. 84.5%, p = 0.041). Multivariate OS analysis using an IPTW-matched cohort showed that institutional care volume was an independent prognostic factor (hazard ratio 2.13 [95% confidence interval: 1.23–3.71], p = 0.0072).

Conclusion

Our results indicate that stage II and III TGCT patients experience lower survival rates at low-volume institutions and would benefit from treatment centralization.