Background
Methods
Data source
Patient selection
Objectives and statistical analysis
Results
Sociodemographic and clinical characteristics between groups
Factor | Overall cohort | SCSTs | GCTs | p-value |
---|---|---|---|---|
N | 42,192 | 280 | 41,912 | |
Age at diagnosis, median (IQR) | 34 (27, 43) | 45 (34, 59) | 34 (27, 43) | < 0.001 |
Diagnosis year | 0.002 | |||
2004–2005 | 8215 (20%) | 48 (17%) | 8167 (20%) | |
2006–2007 | 8329 (20%) | 39 (14%) | 8290 (20%) | |
2008–2009 | 8520 (20%) | 50 (18%) | 8470 (20%) | |
2010–2011 | 8561 (20%) | 81 (29%) | 8480 (20%) | |
2012–2013 | 8567 (20%) | 62 (22%) | 8505 (20%) | |
Race/ethnicity | < 0.001 | |||
Non-Hispanic White | 32,565 (77%) | 174 (62%) | 32,391 (77%) | |
Non-Hispanic Black | 1168 (3%) | 48 (17%) | 1120 (3%) | |
Hispanic/Other | 7727 (18%) | 55 (20%) | 7672 (18%) | |
Unknown | 732 (2%) | 3 (1%) | 729 (2%) | |
Insurance | < 0.001 | |||
Uninsured | 4786 (11%) | 24 (9%) | 4762 (11%) | |
Private insurance | 31,092 (74%) | 178 (64%) | 30,914 (74%) | |
Medicaid/Medicare/other government insurance | 5487 (13%) | 70 (25%) | 5417 (13%) | |
Unknown | 827 (2%) | 8 (3%) | 819 (2%) | |
Income (per year) | 0.42 | |||
Less than $38 k | 5533 (13%) | 45 (16%) | 5488 (13%) | |
$38 k-62,999 | 20,324 (48%) | 125 (45%) | 20,199 (48%) | |
$63 k or greater | 15,769 (37%) | 106 (38%) | 15,663 (37%) | |
Unknown | 566 (1%) | 4 (1%) | 562 (1%) | |
Percent in ZIP code without a high school degree | 0.81 | |||
21% or greater | 6203 (15%) | 42 (15%) | 6161 (15%) | |
7–20.9% | 23,172 (55%) | 159 (57%) | 23,013 (55%) | |
Less than 7% | 12,287 (29%) | 75 (27%) | 12,212 (29%) | |
Unknown | 530 (1%) | 4 (1%) | 526 (1%) | |
Residence | 0.48 | |||
Metropolitan | 35,048 (83%) | 237 (85%) | 34,811 (83%) | |
Urban/rural | 7144 (17%) | 43 (15%) | 7101 (17%) | |
Charlson-Deyo comorbidity score | 0.001 | |||
0 | 39,825 (94%) | 252 (90%) | 39,573 (94%) | |
1 or more | 2367 (6%) | 28 (10%) | 2339 (6%) | |
Stage | < 0.001 | |||
Stage I | 32,463 (77%) | 259 (93%) | 32,204 (77%) | |
Stage II | 5478 (13%) | 9 (3%) | 5469 (13%) | |
Stage III | 4251 (10%) | 12 (4%) | 4239 (10%) | |
Treatment received | < 0.001 | |||
No orchiectomy | 666 (2%) | 2 (0.7%) | 664 (2%) | |
Orchiectomy alone | 17,885 (42%) | 260 (93%) | 17,625 (42%) | |
Orchiectomy + adjuvant therapy | 23,585 (56%) | 18 (6%) | 23,567 (56%) | |
Other/unknown | 56 (0.1%) | 0 (0%) | 56 (0.1%) | |
Last contact or death, months from diagnosis, median (IQR) | N = 37,716 | N = 249 | N = 37,467 | |
52 (28, 79) | 39 (20, 61) | 52 (28, 79) | < 0.001 | |
Time from diagnosis to death in months, median (IQR) | N = 1640 | N = 27 | N = 1613 | |
20 (7, 43) | 18 (7, 37) | 20 (7, 43) | 0.88 |
Factor | Stage I | Stage II/III | ||||
---|---|---|---|---|---|---|
SCSTs | GCTs | p-value | SCSTs | GCTs | p-value | |
N | 259 | 32,204 | 21 | 9708 | ||
Age at diagnosis, median (IQR) | 43 (34, 57) | 34 (28, 43) | < 0.001 | 55 (42, 64) | 33 (26, 42) | < 0.001 |
Diagnosis year | < 0.001 | 0.38 | ||||
2004–2005 | 46 (18%) | 6387 (20%) | 2 (10%) | 1780 (18%) | ||
2006–2007 | 33 (13%) | 6416 (20%) | 6 (29%) | 1874 (19%) | ||
2008–2009 | 45 (17%) | 6528 (20%) | 5 (24%) | 1942 (20%) | ||
2010–2011 | 75 (29%) | 6487 (20%) | 6 (29%) | 1993 (21%) | ||
2012–2013 | 60 (23%) | 6386 (20%) | 2 (10%) | 2119 (22%) | ||
Race/ethnicity | < 0.001 | 0.62 | ||||
Non-Hispanic White | 157 (61%) | 25,125 (78%) | 17 (81%) | 7266 (75%) | ||
Non-Hispanic Black | 47 (18%) | 809 (3%) | 1 (5%) | 311 (3%) | ||
Hispanic/Other | 52 (20%) | 5672 (18%) | 3 (14%) | 2000 (21%) | ||
Unknown | 3 (1%) | 598 (2%) | 0 (0%) | 131 (1%) | ||
Insurance | < 0.001 | 0.087 | ||||
Uninsured | 169 (65%) | 3411 (11%) | 4 (19%) | 1351 (14%) | ||
Private insurance | 20 (8%) | 24,575 (76%) | 9 (43%) | 6339 (65%) | ||
Medicaid/Medicare/other government insurance | 62 (24%) | 3605 (11%) | 8 (38%) | 1812 (19%) | ||
Unknown | 8 (3%) | 613 (2%) | 0 (0%) | 206 (2%) | ||
Income (per year) | 0.38 | 0.68 | ||||
Less than $38 k | 40 (15%) | 3981 (12%) | 5 (24%) | 1507 (16%) | ||
$38 k-62,999 | 115 (44%) | 15,408 (48%) | 10 (48%) | 4791 (49%) | ||
$63 k or greater | 100 (39%) | 12,407 (39%) | 6 (29%) | 3256 (34%) | ||
Unknown | 4 (2%) | 408 (1%) | 0 (0%) | 154 (2%) | ||
Percent in ZIP code without a high school degree | 0.69 | 0.75 | ||||
21% or greater | 37 (14%) | 4450 (14%) | 5 (24%) | 1711 (18%) | ||
7–20.9% | 147 (57%) | 17,658 (55%) | 12 (57%) | 5355 (55%) | ||
Less than 7% | 71 (27%) | 9716 (30%) | 4 (19%) | 2496 (26%) | ||
Unknown | 4 (2%) | 380 (1%) | 0 (0%) | 146 (2%) | ||
Residence | 0.42 | 0.51 | ||||
Metropolitan | 221 (85%) | 26,877 (84%) | 16 (76%) | 7934 (82%) | ||
Urban/rural | 38 (15%) | 5327 (17%) | 5 (24%) | 1774 (18%) | ||
Charlson-Deyo comorbidity score | 0.016 | < 0.001 | ||||
0 | 237 (92%) | 30,544 (95%) | 15 (71%) | 9029 (93%) | ||
1 or more | 22 (9%) | 1660 (5%) | 6 (29%) | 679 (7%) | ||
Stage | 0.21 | |||||
Stage I | 259 (100%) | 32,204 (100%) | – | – | ||
Stage II | – | – | 9 (43%) | 5469 (56%) | ||
Stage III | – | – | 12 (57%) | 4239 (44%) | ||
Treatment | < 0.001 | < 0.001 | ||||
No orchiectomy | 0 (0%) | 30 (0.1%) | 2 (10%) | 634 (7%) | ||
Orchiectomy alone | 250 (97%) | 16,519 (51%) | 10 (48%) | 1106 (11%) | ||
Orchiectomy + adjuvant therapy | 9 (4%) | 15,626 (49%) | 9 (43%) | 7941 (82%) | ||
Other/unknown | 0 (0%) | 29 (0.1%) | 0 (0%) | 27 (0.3%) | ||
Last contact or death, months from diagnosis, median (IQR) | N = 229 | N = 28,855 | < 0.001 | N = 20 | N = 8612 | 0.002 |
41 (22, 62) | 53 (29, 80) | 19 (8, 55) | 47 (24, 75) | |||
Time from diagnosis to death, median (IQR) | N = 13 | N = 747 | N = 14 | N = 866 | ||
23 (18, 43) | 31 (14, 58) | 0.78 | 11 (7, 21) | 13 (4, 28) | 0.96 |
Survival analysis
Univariable HR (95% CI) | Multivariablea HR (95% CI) – Overall | |
---|---|---|
Tumor type | ||
GCTs | Ref. | Ref. |
SCSTs | 2.96 (2.03–4.33)*** | 1.68 (1.13–2.49)* |
Age (per 5-year increase) | 1.21 (1.19–1.23)*** | 1.18 (1.16–1.20)*** |
Race/ethnicity | ||
Non-Hispanic White | Ref. | Ref. |
Non-Hispanic Black | 1.80 (1.41–2.29)*** | 1.13 (0.89–1.45) |
Hispanic/other | 1.27 (1.13–1.43)*** | 1.14 (1.01–1.30)* |
Insurance | ||
Private insurance | Ref. | Ref. |
Uninsured | 2.63 (2.29–3.01)*** | 2.32 (2.01–2.66)*** |
Medicaid/Medicare/other government insurance | 4.33 (3.88–4.83)*** | 2.72 (2.42–3.05)*** |
Income (per year) | ||
< $38,000 | Ref. | Ref. |
$38,000–$62,999 | 0.71 (0.62–0.81)*** | 0.94 (0.82–1.09) |
> $63,000 | 0.44 (0.38–0.50)*** | 0.76 (0.63–0.92)** |
Percent in ZIP code without a high school diploma | ||
> 21% | Ref. | Ref. |
7–20.9% | 0.63 (0.56–0.71)*** | 0.83 (0.73–0.96)* |
< 7% | 0.43 (0.37–0.49)*** | 0.74 (0.61–0.90)** |
Residence | ||
Metropolitan | Ref. | Ref. |
Urban/rural | 1.49 (1.33–1.67)*** | 1.13 (1.00–1.28) |
Charlson-Deyo comorbidity score | ||
0 | Ref. | Ref. |
≥ 1 | 3.23 (2.82–3.70)*** | 2.06 (1.79–2.37)*** |
Multivariablea HR (95% CI) – Stage I | Multivariablea HR (95% CI) – Stage II/III | |
---|---|---|
Tumor type | ||
GCTs | Ref. | Ref. |
SCSTs | 1.06 (0.60–1.86) | 3.28 (1.88–5.73)*** |
Age (per 5-year increase) | 1.23 (1.20–1.26)*** | 1.13 (1.10–1.16)*** |
Race/ethnicity | ||
Non-Hispanic White | Ref. | Ref. |
Non-Hispanic Black | 1.18 (0.80–1.72) | 1.13 (0.81–1.56) |
Hispanic/other | 1.14 (0.95–1.38) | 1.12 (0.94–1.32) |
Insurance | ||
Private insurance | Ref. | Ref. |
Uninsured | 2.58 (2.08–3.21)*** | 2.07 (1.72–2.50)*** |
Medicaid/Medicare/other government insurance | 3.15 (2.64–3.75)*** | 2.31 (1.97–2.70)*** |
Income (per year) | ||
< $38,000 | Ref. | Ref. |
$38,000–$62,999 | 0.92 (0.74–1.15) | 0.96 (0.79–1.16) |
> $63,000 | 0.74 (0.56–0.98)* | 0.77 (0.61–1.02) |
Percent in ZIP code without a high school diploma | ||
> 21% | Ref. | Ref. |
7–20.9% | 0.87 (0.70–1.07) | 0.80 (0.67–0.97)* |
< 7% | 0.80 (0.61–1.06) | 0.68 (0.52–0.88)** |
Residence | ||
Metropolitan | Ref. | Ref. |
Urban/rural | 1.18 (0.98–1.42) | 1.09 (0.91–1.29) |
Charlson-Deyo comorbidity score | ||
0 | Ref. | Ref. |
≥ 1 | 2.03 (1.64–2.51)*** | 2.03 (1.68–2.45)*** |