Article Figures & Tables
Figures
- Figure 1:
Changes in 3-month incidence of testicular cancer overall, by stage and for stage III before and during the COVID-19 pandemic in Alberta. The black dotted line represents the first 3-month period of the COVID-19 pandemic in our study. (A) Incidence of testicular cancer overall and by stage for each 3-month time period. (B) Proportion of stage III testicular cancers diagnosed for each 3-month period. Note: the first and last periods have been standardized to a 3-month incidence.
- Figure 2:
Changes in 3-month incidence of pure seminoma and nonseminoma testicular cancers by stage and for stage III, before and during the COVID-19 pandemic in Alberta. The first black dotted line represents the first 3-month period of the COVID-19 pandemic in our study. The second black dotted line indicates the period with the 6-month lag time for seminomas. (A) Incidence of pure seminoma testicular cancer by stage for each 3-month period. (B) Proportion of stage III pure seminoma testicular cancers diagnosed for each 3-month period. (C) Incidence of nonseminoma testicular cancer by stage for each 3-month period. (D) Proportion of stage III nonseminoma testicular cancers diagnosed for each 3-month period. Note: the first and last periods have been standardized to a 3-month incidence.
- Figure 3:
Monthly proportion of testicular germ cell tumours by stage. (A) All cases; time 0 (solid line) represents Apr. 1, 2020, the beginning of the pandemic in Alberta in our study; the dashed line represents the 3-month lag time for nonseminomas and the dotted line represents the 6-month lag time for seminomas. (B) Seminomas; time 0 (solid line) incorporates a 6-month lag time (Oct. 1, 2020). (C) Nonseminomas; time 0 (solid line) incorporates a 3-month lag time (July 1, 2020).
Tables
Characteristic No. (%)* Seminoma
n = 192Nonseminoma
n = 143Age, yr, mean ± SD 38.5 ± 14.5 32.5 ± 11.9 Histology Seminoma 192 (100.0) 55 (38.5) Embryonal – 102 (71.3) Yolk sac – 69 (48.3) Choriocarcinoma – 20 (14.0) Teratoma – 74 (51.7) Other – 20 (14.0) pT stage 1 122 (63.5) 70 (48.9) 2+ 66 (34.4) 52 (36.4) 0 or unknown 4 (2.1) 21 (14.7) cN stage 0 159 (82.8) 92 (64.3) 1 11 (5.7) 11 (7.7) 2 11 (5.7) 19 (13.3) 3 11 (5.7) 21 (14.7) M stage 0 185 (96.4) 120 (83.9) 1 7 (3.6) 23 (16.1) Cancer stage I 159 (82.8) 88 (61.5) II 26 (13.5) 28 (19.6) III 7 (3.7) 27 (18.9) Treatment location Tom Baker Cancer Centre 68 (35.4) 53 (37.1) Cross Cancer Institute 80 (41.7) 60 (41.9) Other 44 (22.9) 30 (21.0) Orchiectomy 188 (97.9) 130 (90.9) Radiation therapy 10 (5.2) 1 (0.7) Systemic therapy 22 (11.5) 51 (35.7) Note: cN = node (clinical), M = metastasis, pT = tumour (pathological), SD = standard deviation, TGCT = testicular germ cell tumour.
↵* Unless otherwise indicated.
- Table 2:
Differences in staging, systemic therapy setting, largest tumour dimension and pre-orchiectomy markers before and during the COVID-19 pandemic
Variable No. (%)* p value Before pandemic†
n = 231During pandemic
n = 104Cancer stage 0.002¶ I 166 (71.9) 81 (77.9) II 47 (20.3) 7 (6.7) III 18 (7.8) 16 (15.4) IGCCC risk category‡ 0.07** Good 52 (80.0) 13 (56.5) Intermediate 6 (9.2) 5 (21.7) Poor 7 (10.7) 5 (21.7) Systemic therapy setting§ 0.1** Outpatient 44 (78.5) 13 (61.9) Inpatient or ICU 12 (21.4) 8 (38.1) Largest tumour dimension, cm 0.06†† Mean ± SD 4.5 ± 3.6 5.1 ± 4.1 Median (IQR) 3.6 (2.4–5.5) 4.2 (3.1–6) No. missing records 1 (0.4) 0 (0) Pre-orchiectomy LDH, U/L 0.1†† Mean ± SD 288 ± 358 278 ± 476 Median (25th–75th percentiles) 198 (170–279) 192 (167–237) No. missing records 49 (21.2) 20 (19.2) Pre-orchiectomy β-HCG, IU/L 0.4†† Median (25th–75th percentiles) 5 (1.0–13.8) 5 (0.5–20.0) No. missing records 17 (7.4) 9 (8.7) Pre-orchiectomy AFP, ng/mL 0.1†† Median (25th–75th percentiles) 3.6 (2.0–6.4) 3 (2.0–6.0) No. missing records 18 (7.8) 7 (6.7) Note: AFP = α fetoprotein, HCG = human chorionic gonadotropin, ICU = intensive care unit, IGCCC = International Germ Cell Consensus Classification, IQR = interquartile range, LDH = lactate dehydrogenase, SD = standard deviation, TGCT = testicular germ cell tumour.
↵* Unless otherwise indicated.
↵† Includes a 6-month lag period for seminomas and a 3-month lag period for nonseminomas.
↵‡ IGCCC risk category was applicable only to stage II and stage III patients before (n = 65) and during (n = 23) the pandemic.
↵§ Systemic therapy setting was applicable only to patients who received systemic treatment before (n = 56) and during (n = 21) the pandemic.
↵¶ χ2 test.
↵** Fisher exact test.
↵†† Wilcoxon rank sum test.
Variable Monthly incidence Rate ratio (95% CI) Before pandemic During pandemic Overall 11.69 10.43 0.89 (0.72–1.11) Stage I 8.13 8.21 1.01 (0.79–1.30) Stage II 2.5 1.00 0.40 (0.21–0.72) Stage III 1.06 1.21 1.14 (0.58–2.26) Nonseminoma 5.56 3.79 0.68 (0.48–0.95) Stage I 3.25 2.50 0.77 (0.50–1.18) Stage II 1.38 0.43 0.32 (0.12–0.74) Stage III 0.94 0.86 0.92 (0.52–1.97) Seminoma 6.13 6.64 1.08 (0.82–1.44) Stage I 4.88 5.71 1.17 (0.86–1.60) Stage II 1.13 0.57 0.51 (0.21–1.15) Stage III 0.13 0.36 2.74 (0.56–21.26) Note: CI = confidence interval, TGCT = testicular germ cell tumour.
↵* Using Apr. 1, 2020, as the pandemic cut-off (without lag time).
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