Age ≥40 Years Is Associated with Adverse Outcome in Metastatic Germ Cell Cancer Despite Appropriate Intended Chemotherapy

Background: Age ≥40 yr is associated with poorer testicular cancer outcomes in population-based studies. Objective: To assess the association between age (≥40 yr) and outcomes among men with germ cell tumors (GCTs) in a large hospital registry. Design, setting, and participants: Electronic medical records for 1095 GCT patients treated at Dana-Farber Cancer Institute between 1997 and 2013 were reviewed. Information regarding histology, stage, treatment, and patient characteristics was obtained. Outcome measurements and statistical analysis: Using logistic regression analysis and Cox proportional hazards regression, we investigated the association between age and treatment and risk of relapse and GCT-specific death for men with GCT. Results and limitations: At diagnosis, 26% of men (n = 283/1095) were ≥40 yr. Among the 610 men with clinical stage 1 (CS1) disease, age ≥40 yr was not associated with a higher risk of CS1 relapse (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.74–1.92). There were 603 men with metastatic disease (CS1 at diagnosis with subsequent relapse or metastasis at diagnosis); after adjusting for stage and histology, men ≥40 yr were more likely to receive etoposide and cisplatin chemotherapy compared to bleomycin, etoposide, and cisplatin as their primary treatment (odds ratio 2.40, 95% CI 1.14–5.05). Salvage therapy also differed by age. In the multivariable model, men ≥40 yr with metastatic GCT had a higher risk of relapse (HR 1.58, 95% CI 1.02–2.46) after primary treatment and death from GCT (HR 2.31, 95% CI 1.29–4.15). The study limitations include incomplete data on medical comorbidities and possible subsequent dose modifications. Conclusions: Men aged ≥40 yr with metastatic GCT have poorer outcomes, even after accounting for different intended treatment patterns. Patient summary: In this study we looked at the outcome for testicular cancer in more than 1000 patients treated at a single institution in the USA. We found that the treatment for metastatic disease differed between older (≥40 yr) and younger patients. Furthermore, outcomes for older patients (≥40 yr) were worse than for younger men. Using a large single-institution database including more than 1000 men with detailed treatment information, we show that older age (≥40 yr) is associated with a higher risk of relapse and death from metastatic germ cell tumors, despite intent to give guideline-directed optimal therapy.