Difference in stage and morphology-adjusted survival between young and elderly patients with a testicular germ cell tumor.

OBJECTIVES: To compare the relative survival in men younger and older than 50 years with a testicular germ cell tumor. METHODS: Data on patients with testicular cancer diagnosed between 1973 and 1997 and registered by one of the nine population-based Surveillance, Epidemiology, and End Results (SEER) cancer registries in the United States were obtained from the National Cancer Institute public domain SEER*Stat 3.0 package. Survival rates adjusted for mortality owing to other causes (ie, relative survival) were calculated for men within each category of the American Joint Committee on Cancer staging system. RESULTS: Patients who developed a germ cell tumor before the age of 50 years had better 10-year relative survival (90.8%, 95% confidence interval 90.6% to 91.0%) than those who developed one after the age of 50 years (84.0%, 95% confidence interval 81.9% to 86.1%). This difference remained after stratification by histologic type and stage, except for patients with localized seminomatous disease (97.9% versus 98.0% for men younger and older than 50 years, respectively). The largest difference in 10-year relative survival was found in men with metastasized disease: seminomatous disease, 89.7% versus 69.6%, and nonseminomatous disease, 76.9% versus 57.0%, for men younger and older than 50 years, respectively. CONCLUSIONS: Lower stage and morphology-adjusted relative survival rate was observed among patients older than 50 years of age with testicular cancer. This difference was more evident in metastasized disease. Whether the worse prognosis in testicular cancer can be explained by a lower tolerance to chemotherapy and/or to suboptimal treatment in the elderly has to be established