Epidemiological patterns, temporal trends in management and long-term outcomes in testicular cancer: a 30-year single center experience.
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PURPOSE: Recent studies have suggested a change in the epidemiologic pattern of testicular germ-cell tumors (TGCTs) and advances in therapeutic strategies have led to significant changes in their treatment over the last decades. Treatment guidelines for early-stage testicular cancer recommend de-escalation of therapy by the adoption of surveillance strategies. This study aimed to describe trends in TGCTs diagnosed over the last 30 years at our center and evaluate the impact of evolving treatment strategies. METHODS: We retrospectively analyzed 277 TGCT patients treated from 1994 to 2023. Clinical characteristics, treatment patterns, and outcomes were assessed across three 10-year periods. Survival and relapse rates were estimated using Kaplan-Meier methods; significance was set at p < 0.05. RESULTS: A significant increase in incidence was observed (p < 0.05), along more stage I diagnoses (p < 0.05) and older age at diagnosis, including a higher proportion aged ≥ 40 years (p < 0.001). Seminoma incidence doubled, while non-seminoma remained stable. In stage I disease, the use of active surveillance increased significantly, while adjuvant chemotherapy declined (p < 0.0005). Recurrence rates slightly decreased but were not statistically significant. Cause-specific 10-year survival improved from 95% to 97.2%, with overall survival stable at ~ 94%. The risk of second primary malignancies was notable, including contralateral testicular cancer (2.9%) and second malignant neoplasms (SMNs) (5.0%). A substantial burden of non-cancer-related causes of death were also observed. CONCLUSIONS: A real increase in the incidence of TGCTs and age at diagnosis was confirmed. These trends highlight a shift toward less aggressive treatment while maintaining excellent outcomes. However, the notable occurrence of SMNs and non-cancer mortality underscores the need for long-term follow-up that includes survivorship care beyond oncological monitoring.