Though testicular cancer is the most common cancer in young men, there is a paucity of epidemiologic studies examining sociodemographic disparities in adjuvant therapy and outcomes. We used a national database to examine the associations of sociodemographic factors with chemotherapy, retroperitoneal lymph node dissection (RPLND), and survival among patients with nonseminomatous germ cell tumors (NSGCTs).

Within the Surveillance Epidemiology and End Results database (2005-2015), we identified 8,573 patients with NSGCTs. Multivariable logistic regression and Cox proportional hazards models were constructed to examine the association of sociodemographic factors (neighborhood SES (nSES), race, insurance, and marital status) with, respectively, adjuvant chemotherapy/RPLND and all-cause mortality.

Low nSES (OR 0.59, 95% CI=0.40-0.88, p=0.01) and Black (OR 0.41, 95% CI=0.15-1.00, p=0.058) patients with stage II disease were less likely to receive RPLND compared to high nSES and white patients, respectively. Stage III patients with Medicaid (OR 0.64, 95% CI=0.46-0.89, p=0.009) or without insurance (OR 0.46, 95% CI=0.27-0.76, p=0.003) were less likely to receive RPLND compared to patients with private insurance. Asian (OR 0.62, 95% CI=0.45-0.86, p=0.005) and uninsured (OR 0.70, 95% CI=0.55- 0.88, p=0.003) patients with stage I disease were less likely to receive chemotherapy compared to white and privately insured patients, respectively. Low nSES patients with stage I disease (HR=2.12, 95% CI=1.23-3.67, p=0.007) or stage II disease (HR=2.97, 95% CI=1.00-8.78, p=0.049) and black patients with stage I disease (HR=1.97, 95% CI=1.01-3.85, p=0.046) had higher risks of all-cause mortality compared to high nSES and white patients, respectively. 

This national study found multilevel sociodemographic disparities in receipt of adjuvant therapy and stage-specific survival among patients with NSGCTs.