No survival differences among germ-cell cancer patients from urban and rural areas

Introduction: Germ-cell cancer (GCC) is curable in the majority of men. However, previous reports have described inferior outcomes in men living in rural as compared to urban residential areas.Methods: We identified all GCC patients treated at two large university hospitals in Zurich and Bern, both Switzerland, between 2010 and 2020 by retrospective chart review. In 400 patients from Zurich and 274 patients from Bern, details on presentation, diagnosis, treatment and outcomes were abstracted from medical records. For follow-up, we contacted referring centers or private physicians. Residential region was allocated according to the Federal Statistical Office of Switzerland.Results: We found no differences in initial presentation [clinical stage I (CSI) versus de-novo metastatic], relapse rate in clinical stage I patients, response in metastatic patients (favorable versus unfavorable), progression-free survival (PFS) or overall survival (OS) between patients from urban as compared to suburban or rural residential areas. PFS at 3 years for CSI patients was 78% (95% confidence interval 72% - 82%) and OS at 5 years was 98% (95% confidence interval 96% - 99%). PFS at 3 years for de-novo metastatic patients was 74% (95% confidence interval 68% - 79%) and OS at 5 years was 86% (95% confidence interval 80% - 90%).Conclusion: Treatment outcomes in GCC patients were excellent and comparable to international standards at both centers irrespective of the residential area of patients documenting equal access to high-level oncological care at both centers.