Sociodemographic Factors Associated With Later Stage at Diagnosis of Pediatric Germ Cell Tumors: A Report From Children's Oncology Group Registries ACCRN07 and APEC14B1.
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BACKGROUND: Germ cell tumors (GCTs) often arise in the ovaries and testes (extracranial) but can also develop in the brain (intracranial). We examined the relationship of individual, family, and community-level socioeconomic status (SES) with stage of disease at diagnosis in a cohort of pediatric patients with GCT from Children's Oncology Group (COG) registries. METHODS: We obtained COG data from participants enrolled in 2003-2021, including summary stage (operationalized as local, regional, distant for extracranial tumors, and as early vs. late stages for intracranial tumors), tumor subtype, demographics, and ZIP code at diagnosis. We linked ZIP codes to county-level redlining scores (C,D = greatest redlining), Child Opportunity Index (COI), and racial dissimilarity indices. Logistic regressions calculated odds ratios (ORs) and 95% confidence intervals (CIs) for late-stage diagnosis; sex-stratified models were also fit. RESULTS: Of 1850 patients with GCT, n = 1316 had extracranial and n = 534 intracranial tumors. In multivariable models, females had lower odds of distant stage disease diagnosis (extracranial: OR, 0.40; 95% CI, 0.28-0.58 vs. local/regional; intracranial OR, 0.44; 95% CI, 0.24-0.83) than males. Participants diagnosed between 1998-2009 (OR, 0.52; 95% CI, 0.29-0.68) and 2010-2014 (OR, 0.51; 95% CI, 0.39-0.68) had lower odds of local stage disease than regional or distant stage disease versus 2015-2021. For males, residence in a micropolitan residence was associated with lower odds of regional/distant/late-stage disease (OR, 0.55; 95% CI, 0.31-0.95) while being uninsured was associated with higher odds of late-stage disease (OR, 1.81; 95% CI, 1.16-2.81). No family/area factors were significant for females. CONCLUSIONS: Individual SES factors potentially explain more stages of disease disparities than area-level factors for young patients with GCT.