Introduction: Testicular cancer represents 1% of adult neoplasms, with the vast majority being primary germ cell tumors (GCT). On the other hand, while primary testicular non-Hodgkin’s lymphoma (PTL) is a very rare disease, comprising <5% of all cases of testicular tumors, it is considered the most common testicular malignancy in men older than 60 years. To our knowledge, no data have been published comparing survival rates between PTL and GCT. Our aim was to analyze the differences in clinical parameters and survival outcomes between patients with PTL and GCT.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for all patients with testicular tumors from 1980–2013. Data collected consisted of demographic and clinical parameters, including staging, pathological, and survival data. Patients were stratified according to their tumor type and compared.

Results: The cohort included 51 269 patients comprising all testicular tumors managed during a period of 33 years. PTL patients (n=1745) accounted for 3.45% of all testicular tumors, compared to 96.6% (n=49 524) patients with GCT. The median age at GCT was 33 years (interquartile rage [IQR] 26–41), compared to 70 (IQR 59–77) with PTL (p<0.001). In terms of treatment, similar rates of radical orchiectomy and radiation were noted between the two cohorts, while a major difference was noted in chemotherapy rates. Among the GCT patients, 47 632 (96.2%) underwent radical orchiectomy, compared to 1632 (93.5%) patients in the PTL cohort. Furthermore, in terms of radiation, 33 032 (66.7%) of the GCT patients underwent radiation therapy compared to 1106 (63.4%) patients in the PTL cohort (p=0.012). There was a considerable difference with chemotherapy, with 34 905 of the GCT patients (70.5%) receiving chemotherapy compared to 546 patients (31.3%) in the PTL cohort (p<0.001). Twenty-year survival probabilities were 82.3% (95% confidence interval [CI] 81.8–82.9%) for GCT patients and 9.83% (95% CI 7.25–13.3%) for PTL patients (p<0.001), with the adjusted hazard ratio of 2.57 (95% CI 2.16–3.05, p<0.001) (Figure 1)

Conclusions: Lower survival rates are noted among PTL patients when compared to GCT patients. Younger patients are more likely to receive chemotherapy and radiation and have better disease-specific survival outcomes. Reduced rates of chemotherapy in PTL patients may also be attributable to the blood-testis barrier creating sanctuaries for these tumors from systemic chemotherapy.