Urologic Oncology: Seminars and Original Investigations
Original articleClinical—testisMarital status independently predicts testis cancer survival—an analysis of the SEER database
Introduction
Testis cancer remains the most common malignancy in males ages 20 to 34 in the United States, and there were an estimated 8,600 new cases diagnosed in 2009. The incidence of testis cancer continues to increase, while the disease-specific mortality continues to decrease. The overall testis cancer-specific 5 year survival is 95% according to the Surveillance, Epidemiology, and End Results (SEER) cases reported between 1999 and 2005, indicative of the overall success in diagnosing and treating this disease [1]. There still exist significant differences, however, in survival of men based on race, tumor histology, and stage at diagnosis [2]. Other socioeconomic and demographic variables also likely play a role in survival in men with testis cancer, as have been demonstrated in other malignancies.
The impact of marital status on testicular cancer survival has not been previously studied to our knowledge. Data does exist to suggest that married men with testis cancer present at an earlier stage than unmarried men [3], however this has not been published in the peer-reviewed literature and the analysis has not been extended to cancer outcome.
The effect of marital status in particular has been studied extensively in a variety of urologic and nonurologic malignancies. A recent article showed that separated patients have decreased cancer survival across a range of malignancies, perhaps due to psychosocial stress [4]. Patients with transitional cell carcinoma of the bladder who are married when diagnosed have been shown to enjoy increased disease-specific survival [5]. Another study failed to show this relationship, however, did demonstrate that widowed men with bladder cancer had significantly decreased survival [6].
The goal of this study was to examine the impact of marital status on overall and testis cancer-specific survival using the SEER registry, a U.S. population based sample.
Section snippets
Data
The data for this study come from the Surveillance, Epidemiology, and End Results (SEER) 17 cancer public use database (1973–2005). The SEER cancer registry identifies patients from 17 representative geographic regions encompassing 26% of the general U.S. population. [Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs Limited-Use + Hurricane Katrina Impacted Louisiana Cases, Nov 2007 Sub (1973–2005) - Linked To County
Results
Table 1a, Table 1b indicates summary statistics for the analysis sample, stratified by marital status. Patients married at the time of diagnosis were also older at the time of diagnosis, more likely to be of white ethnicity, and presented at earlier stages. These characteristics are also true for the stages I or II NSGCT subgroup.
Total overall mortality was low: 89.1% of the 20,245 total patients were still alive at 10 years following diagnosis. Of the 2,201 who died at 10 years, 962 of these
Discussion
This study is the first to show an independent beneficial effect of marriage on survival in testis cancer. This is likely a multifactorial psychosocial effect on various stages of the disease process, including detection, presentation for treatment, compliance with treatment, treatment decisions, and compliance with surveillance or follow-up after treatment.
Conclusion
Patients who are married at the time of testis cancer diagnosis have better 10 year overall and cancer-specific survival than unmarried patients. Targeting single men with screening and disease awareness programs, maintaining vigilance during surveillance, and offering social support resources such as those provided by the American Cancer Society are possible interventions that may mitigate this phenomenon.
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