Survival differences in non-seminoma testis cancer patients according to race/ethnicity

Background: Historic evidence suggests that non -Caucasian race/ethnicity predisposes to higher testis cancerspecific mortality (CSM) in non-seminoma. However, it is unknown, whether higher CSM in non -Caucasians applies to Hispanics or Asians or African -Americans, or all of the above groups. In contemporary patients, we tested whether CSM is higher in these select non -Caucasian groups than in Caucasians, in overall and in stagespecific comparisons: stage I vs. stage II vs. stage III. Methods: The Surveillance, Epidemiology, and End Results (SEER) database (2004 -2019) was used. KaplanMeier plots and multivariable Cox regression models tested the effect of race/ethnicity on CSM after stratification for stage (I vs. II vs. III) and adjustment for prognosis groups in stage III. Results: In all 13,515 non-seminoma patients, CSM in non -Caucasians was invariably higher than in Caucasians. In stage -specific analyses, race/ethnicity represented an independent predictor of CSM in Hispanics in stage I (HR 1.8, p = 0.004), stage II (HR 2.2, p = 0.007) and stage III (HR 1.4, p < 0.001); in African -Americans in stage I (HR 3.2; p = 0.007) and stage III (HR 1.5; p = 0.042); and in Asians in only stage III (HR 1.6, p = 0.01). Conclusions: In general, CSM is higher in non -Caucasian non-seminoma patients. However, the CSM increase differs according to non -Caucasian race/ethnicity groups. Specifically, higher CSM applies to all stages of nonseminoma in Hispanics, to stages I and III in African -Americans and only to stage III in Asians. These differences are important for individual patient management, as well as for design of prospective trials.