Affiliation:
1. University of Tsukuba: Tsukuba Daigaku
2. University of Tsukuba Hospital: Tsukuba Daigaku Fuzoku Byoin
3. Saint Luke University
4. National Cancer Center
Abstract
Abstract
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-year 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-year 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.
Publisher
Research Square Platform LLC