Higher Mortality Rates in Testicular Cancers in Low-Middle Income Countries—Is It True for All Low-Middle Income Countries? Comment on Majdalany et al. Challenges of Urologic Oncology in Low-to-Middle-Income Countries. Soc. Int. Urol. J. 2024, 5, 303–311

We read the review entitled ‘Challenges of Urologic Oncology in Low-to-Middle Income Countries’ by Majdalany et al. published in the October issue of your journal. We congratulate the authors for this informative review on the challenges faced by Low-Middle Income Countries (LMICs) in managing urological malignancies. They have commented that the incidence of testicular cancers is higher in High-Income Countries, but the mortality is higher in LMICs [1]. They have cited our article to support their statement. But, in reality, the Overall Survival reported in our study was on par with other international reports. After a median follow-up of 81 months, the estimated 4-year Overall Survival was 87.1%. The 4-year OS was 93.6%, 87.5% and 52.6% for good, intermediate and poor risk groups, respectively [2]. The landmark paper from the International Germ Cell Cancer Collaborative Group (IGCCCG) also reported similar survival figures for the good, intermediate and poor risk groups [3]. The updated results from the IGCCC consortium in 2021 showed 5-year Overall Survival rates of 96%, 89% and 67% for good, intermediate and poor risk, respectively. The 5-year OS across all prognostic groups was 87% in the updated IGCCCG publication [4]. Hence, it is quite unfortunate that the authors quoted our publication to support the higher mortality rates observed in LMICs.

We would like to reiterate that the statement about higher mortality rates is not generalizable to all LMICs. Our survival figures are comparable to the internationally published literature.