Impact and Risk Factors of Diagnostic Delay in Patients With Testicular Cancer: A Multicenter Retrospective Study

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Abstract
Background: Testicular cancer progresses rapidly, and delays in diagnosis after symptom onset may lead to disease progression and increased treatment resistance. In this study, we aimed to evaluate the impact of diagnostic delay on various clinical outcomes and identify risk factors associated with delayed diagnosis in patients with testicular cancer. Methods: A retrospective observational study was conducted on 254 patients diagnosed with testicular cancer who underwent high orchiectomy at three university hospitals between March 2005 and October 2020. The clinicopathological characteristics associated with diagnostic delay and its risk factors were analyzed. Results: Among all patients, 228 (89.8%) presented with testis related symptoms, including testicular swelling or mass in 202 (79.5%), testicular pain in 34 (13.4%), and discomfort in 13 (5.1%). A delayed diagnosis, defined as an interval exceeding 53 days from symptom onset to orchiectomy, was significantly associated with a pathological tumor size ≥ 60 mm (odds ratio [OR]: 2.77, p < 0.001), elevated postoperative serum tumor markers (OR: 2.90, p < 0.001), presence of metastases (OR: 2.12, p = 0.006), clinical stage III disease (OR: 3.20, p = 0.002), and second‐line chemotherapy administration (OR: 3.36, p = 0.008). Additionally, age ≥ 36 years (OR: 1.88, p = 0.017) and absence of testicular pain (OR: 2.29, p = 0.033) were identified as independent risk factors for delayed diagnosis. Conclusion: Early medical consultation and prompt initiation of treatment following symptom onset are crucial for improving clinical outcomes in patients with testicular cancer.

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