The following is a summary of “Age related differences in primary testicular lymphoma: A population based cohort study,” published in the March 2023 issue of Urologic Oncology by Berjaoui et al.
Primary testicular non-Hodgkin’s lymphoma (PTL) is exceedingly uncommon, accounting for merely 1% of all non-Hodgkin’s lymphoma and less than 5% of all instances of testicular tumors. The most prevalent testicular malignancy in men over 60 is PTL, with a median age of diagnosis at 67 years. Preterm labor (PTL) incidence and outcomes in younger patients have limited published data. This investigation aims to assess and contrast the clinical indicators and survival rates of patients aged 50 and above with those under 50. A retrospective analysis was conducted by querying the Surveillance, Epidemiology, and End Results (SEER) database for all individuals who received a diagnosis of primary thyroid lymphoma (PTL) during the period spanning from 1983 to 2017—the collected data comprised demographic and clinical parameters, encompassing staging, pathological evaluations, and survival statistics. The patients were categorized based on their age and subsequently evaluated for comparison.
A cohort of 1,581 individuals received a diagnosis of preterm labor (PTL) spanning from 2000 to 2017. Among them, 215 (13.6%) were under 50. The patients’ median age at diagnosis was 41, with an interquartile range (IQR) of 1-50. For patients 50 years old or younger, the median age at diagnosis was 72, with an IQR of 51-95 for patients who were older than 50 years of age. The study found no significant differences between younger and older patients regarding disease laterality (92% vs 94%, P = 0.38) and Ann Arbor stage I to II at diagnosis (76% vs 75%, P = 0.59). The prevalence of the predominant subtype of diffuse large B-cell lymphoma (DLBCL) was observed to be higher in the elderly population (87%) as compared to the younger population (61%), with a statistically significant difference (P<0.001). The rates of radical orchiectomy were comparable between the two groups with a P=0.004, while the rates of radiation treatment were also comparable with a P=0.49. Lesser individuals received chemotherapy than older patients (83% vs 72%, P < 0.001). The hazard ratio (HR) for 10-year OS was 0.63 (95% CI: 0.57–0.71) for patients who were 50 years old or younger and 0.34 (95% CI: 0.31–0.37) for those who were older than 50 years.
The median survival time for patients older than 50 was 5.75 years (95% CI: 5.25–6.33), and the statistical significance was P less than 0.001. The study found that patients who were 50 years old or younger had a heart rate (HR) of 0.33 (95% CI: 0.26–0.40), while patients who were older than 50 years had an HR of 0.40 (95% CI: 0.37–0.43) for cumulative disease-specific mortality (DSM, P = 0.0204). The presence of an age greater than 50 years was linked with a poorer DSM, with a hazard ratio of 1.39 (95% confidence interval: 1.05-1.86, P=0.024). The Ann Arbor stage II and higher is correlated with poorer DSM outcomes. However, treatment modalities such as surgery, radiotherapy, and chemotherapy have been linked to enhanced DSM outcomes. Painless testicular lump (PTL) is the predominant neoplasm affecting the testes in males above 60. However, a significant proportion of patients, exceeding 25%, belong to the younger age group, and more than 13% of cases are observed in individuals aged 50 years or less. Chemotherapy and radiation therapy are more frequently administered to younger patients, who tend to exhibit better outcomes in terms of disease-specific mortality. Patients with a lower Ann Arbor stage, younger age, and who receive chemotherapy and radiotherapy have a higher likelihood of survival.