Positive Surgical Margins in the 10 Most Common Solid Cancers

Ryan K Orosco,Joseph A Califano,Anne Wallace,Assuntina Sacco,Karen Messer,Viridiana J Tapia,Scott M Lippman,Christopher Kane,Bryan Clary,Kathryn R Tringale,Quyen T Nguyen,Alfredo Molinolo,James D Murphy,John Pang,Ezra E W Cohen

doi:10.1038/s41598-018-23403-5

Ryan K Orosco, Joseph A Califano + Show 13 more

Open Access

https://doi.org/10.1038/s41598-018-23403-5

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Abstract

A positive surgical margin (PSM) following cancer resection oftentimes necessitates adjuvant treatments and carries significant financial and prognostic implications. We sought to compare PSM rates for the ten most common solid cancers in the United States, and to assess trends over time. Over 10 million patients were identified in the National Cancer Data Base from 1998–2012, and 6.5 million had surgical margin data. PSM rates were compared between two time periods, 1998–2002 and 2008–2012. PSM was positively correlated with tumor category and grade. Ovarian and prostate cancers had the highest PSM prevalence in women and men, respectively. The highest PSM rates for cancers affecting both genders were seen for oral cavity tumors. PSM rates for breast cancer and lung and bronchus cancer in both men and women declined over the study period. PSM increases were seen for bladder, colon and rectum, and kidney and renal pelvis cancers. This large-scale analysis appraises the magnitude of PSM in the United States in order to focus future efforts on improving oncologic surgical care with the goal of optimizing value and improving patient outcomes.

Highlights

MethodsThe ten most common solid organ cancers in the United States (US) are: prostate, breast, lung and bronchus, colon and rectal, urinary bladder, thyroid, kidney and renal pelvis, uterine corpus, oral cavity, ovarian[3]
One in four deaths in the United States (US) is due to cancer[1]
Unadjusted positive surgical margin (PSM) rates for breast, and lung and bronchus cancer in both men and women declined over the period of the study (Fig. 1A,B, Table 1)

Summary

Methods

The ten most common solid organ cancers in the US are: prostate, breast, lung and bronchus, colon and rectal, urinary bladder, thyroid, kidney and renal pelvis, uterine corpus, oral cavity, ovarian[3]. We included NCDB data (1998–2012) of patients with these cancers as their only malignancy (n = 10,400,589 Supplemental Table 1), and excluded patients: treated without surgery (n = 3,028,552), who underwent local tumor destruction (n = 98,450), with unknown surgery status (n = 62,071). Tumor (T) categories in the NCDB are based on the American Joint Committee on Cancer (AJCC) 6th and 7th editions. PSM rates were determined for each cancer site by year, T category, gender, age group, and race. Patient-related covariates included: gender, age, race/ethnicity, income, Charlson-Deyo[4] comorbidity index (CI), and insurance type. Tumor-related covariates included: tumor stage (T-stage) and histologic grade (American Joint Committee on Cancer (AJCC) seventh edition guidelines for pathologic staging[5]). Healthcare system covariates included: hospital tumor-specific case volume, facility type, and geographic location. The American College of Surgeons and the CoC have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator

Results and Discussion

Limitations

Conclusion