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Does Cryptorchidism Influence Oncologic Outcomes in Testicular Germ Cell Tumors? A SEER Population-based Study
Oguzhan Yildiz1, Sami Sekkeli2, Mucahit Gelmis3
1Department of Urology, İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi, Istanbul, Turkey. opdroguzhanyildiz@gmail.com.
Objective:
Our objective was to investigate whether cryptorchidism independently influenced cancer-specific survival (CSS) and overall survival in patients with testicular germ cell tumors (TGCTs).
Materials And Methods:
We conducted a cohort study using the Surveillance Epidemiology and End Results (SEER) database (2000-2022; 21 registries). Patients with TGCTs who underwent orchiectomy were identified and classified by primary site code as having descended (C62.1) or undescended (C62.0) testis. The final analytical cohort comprised 10,353 patients (10,103 descended, 250 undescended). Survival outcomes were evaluated using Kaplan-Meier analysis and multivariable Cox proportional hazards regression adjusting for age, histology, stage, tumor size, race/ethnicity, and chemotherapy receipt. PSM (1:4 nearest neighbor) was performed as a sensitivity analysis to account for baseline differences between groups.
Results:
Seminoma was significantly more prevalent in the undescended group (65.2% vs 51.4%; p < 0.001). Kaplan-Meier analysis demonstrated no significant difference in CSS between descended and undescended groups (log-rank p = 0.876). On multivariable Cox regression, cryptorchidism was not an independent predictor of CSS (hazard ratio [HR] 1.14; 95% confidence interval [CI] 0.50-2.57; p = 0.762). Independent predictors of worse CSS included distant stage (HR 21.89; p < 0.001), nonseminoma histology (HR 3.11; p < 0.001), regional stage (HR 3.27; p < 0.001), older age (HR 1.04; p < 0.001), and Hispanic (HR 1.96; p < 0.001) and non-Hispanic Black race/ethnicity (HR 2.91; p < 0.001). Subgroup analyses by histology and stage consistently showed no survival difference. In the PSM cohort (249 vs 988), cryptorchidism remained non-significant (HR 1.55, 95% CI 0.60-3.95; p = 0.365; log-rank p = 0.62).
Conclusions:
Cryptorchidism was not independently associated with CSS or overall survival in patients with TGCTs. Prognosis and management should remain guided by established tumor-related prognostic and risk-stratification factors.
