Testis cancer: A 20-year epidemiological review of the experience at a regional military medical facility

Purpose: Testis cancer is the most common solid malignancy in the young adult population and the incidence in this population is increasing. We present a 20-year epidemiological review of testis cancers treated at our institution. Materials and Methods: The records of testis cancer cases diagnosed between January 1988 and June 2007 were reviewed. Patient demographics, cancer histology and stage, adjuvant therapy, temporal trends and survival data are presented. Our experience was compared to trends published in the SEER (Surveillance, Epidemiology and End Results) database and the National Cancer Database. Results: A total of 338 testis cancers (330 germ cell tumors) were diagnosed during the study period. Median patient age at diagnosis was 26.6 years vs 34 in the SEER database. We observed a temporal increase in stage I tumors (57% to 75%) and a decrease in the proportion of seminomas (52% to 43%) during the study period. In terms of adjuvant therapy for stage I seminoma the use of radiotherapy decreased (91% to 75%), while the use of chemotherapy increased (1.5% to 7.5%). For stage I nonseminomatous germ cell tumors the use of adjuvant chemotherapy increased (12% to 20%), while the use of staging retroperitoneal lymph node dissection decreased (88% to 63%). Five-year cancer specific survival was 97.7%. Conclusions: We are seeing an increase in localized disease at diagnosis, an increase in surveillance for stage I disease and 5-year survival in excess of 95%, similar to data in SEER and the National Cancer Database. However, unlike in SEER and the National Cancer Database, our patients are younger, we are seeing less seminoma and we are performing significantly more staging retroperitoneal lymph node dissection.