The National Cancer Data Base report on lung cancer

Lung cancer management challenges amidst COVID-19 pandemic: hope lives here.

Previous Commission on Cancer data from the National Cancer Data Base (NCDB) examined time trends in disease stage, treatment patterns, and survival for patients with selected cancers. The most current (1992) data for prostate cancer are described in this Communication. Calls for data yielded a total of 52,597 prostate cancer reports for 1986/1987 and 101,903 for 1992 from hospital cancer registries across the United States. Data were received for 154,500 patients with prostate cancer. Prostate cancer is detected increasingly at localized stages and among younger men. African American men have a continuing pattern of more advanced disease at diagnosis. Selection of prostatectomy as the primary treatment has increased, and its use varies by region and several patient and hospital characteristics. Selection of radiation treatment has increased to a lesser degree. The 5-year survival for patients diagnosed in 1986/1987 was 60%. Outcomes varied by stage, age, and race. The NCDB provides valuable information concerning patterns and trends in prostate cancer care in the United States. The data show that prostate cancer detection and treatment have changed markedly in recent years. These changes appear to be related to the increased use of early detection measures. The improvements in prostate cancer detection and trends in treatment have not affected the population evenly, with African American men having more advanced disease and lower survival. Continued monitoring of these important trends is needed.

Stigma May Exacerbate Disproportionately Low Guideline-Concordant Treatment Rates for Patients With Advanced-Stage Lung Cancer in the United States

Previous Commission on Cancer data from the National Cancer Data Base (NCDB) have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1992) data for endometrial cancer are described here. Four calls for data have yielded a total of 560,455 cancer cases diagnosed in 1986-1987, and 599,597 cancer cases diagnosed in 1992, from hospital cancer registries across the United States. Data were received for 36,341 endometrial cancer patients. No significant change in stage distribution for patients who were staged was noted with time, however, markedly fewer patients were reported with unknown stage in 1992 (15.6%) compared with 1986-1987 (45.1%). Blacks and low income groups were more likely to present with advanced stage disease. A 12.6% increase in patients undergoing nodal dissection as part of their surgical treatment occurred during this time period. More patients received surgery only as part of their treatment in 1992 (53.8%) vs. 42.6%). Advancing age, minority status, low income, and increasing grade all had a negative impact on survival. Blacks experienced a 25% reduction in survival compared to non-Hispanic Whites and Hispanics. Lack of improvement in detecting early disease indicates the lack of acceptable screening methodology for this disease. Blacks present with more advanced disease and subsequently have a decreased survival compared to non-Hispanic Whites. Time trends indicate that nodal dissection is becoming a more common surgical practice in this disease, and that radiation therapy is utilized less often. The current American Joint Committee on Cancer staging accurately reflects differences in prognosis by stage.

Previous Commission on Cancer data from the National Cancer Data Base (NCDB) have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1993) data are described here. Five calls for data have yielded a total of 3,700,000 cases for the years 1985 through 1993, including 477,679 cases for 1988, and 608,593 cases for 1993, from hospital cancer registries across the U.S. The most recent call for data for 1993 comprised 52% of the estimated new cases of cancer in the U.S. The country was comprised of 6 regions, with the Mountain and Southeast regions having the highest regional reporting of new cases of cancer (69% and 55%, respectively) and the Northeast and Pacific regions having the lowest (47% each). Approximately 96% of patients received their treatment at the reporting hospital. The 4 most common carcinomas were breast (15.7%), lung (14.6%), prostate (14.2%), and colon (7.5%) and comprised the majority of new cases. Trends in patterns of care for breast carcinoma were analyzed for possible bias in the 1988 and 1993 periods. When hospitals reporting only in 1988 or in 1993 were compared with hospitals reporting at both time points, the only differences were small differences in ethnic participation. These differences were less than 1.5% in the proportion of African Americans reported in the different time periods. There were no significant differences in the downstaging of breast carcinoma, or the role of conservative surgery or adjuvant radiation therapy. The NCDB is a cancer management and outcomes data base for health care organizations that presently comprises 52% of the estimated new cases in the U.S. This will increase to 80% as the approved hospitals of the Commission on Cancer are required to report to the NCDB. Comparison of breast carcinoma findings at two time periods appeared similar regardless of hospital reporting set (i.e., set of hospitals reporting for one period versus both periods).

Previous Commission on Cancer data from the National Cancer Data Base (NCDB) have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. In the current study data relating to patients diagnosed with testicular carcinoma in 1985, 1986, 1990, 1991, 1995, and 1996 are described. The data reported in this review were collected from hospital cancer registries from across the U.S. Case information is submitted to the NCDB following guidelines established by the North American Association of Central Registries. Data items include patient demographics, tumor characteristics, initial course of therapy, and follow-up status. Eight calls for data have yielded a total of 6.9 million cases for the years 1985-1996, including 2280 testicular carcinoma cases in 1985-1986, 5677 cases in 1990-1991, and 7452 cases in 1995-1996. These data represent approximately 22.6%, 47.3%, and 51.4%, respectively, of the estimated cases of testicular carcinoma diagnosed in the U.S. in each of these 3 respective time periods. Cases diagnosed and reported to the NCDB between 1985-1991 and that had been staged according to the 4th edition of the American Joint Committee on Cancer (AJCC) manual for the staging of cancer (1567) were used in the analysis of survival outcomes. Four principle findings are reported. First, young men (age < 25 years) are diagnosed with advanced stage nonseminomatous germ cell tumors more frequently than are older men (age >/= 30 years). Second, although surgery and concomitant radiation are the standard therapy for early stage seminomas, surgery alone increasingly is being used. In the treatment of patients with advanced stage seminomas the use of surgery and radiation has declined slightly whereas surgery with concomitant chemotherapy appears to be employed with greater frequency. Third, surgery alone is the treatment of choice for patients with early stage nonseminomatous germ cell tumors and has been employed with increasing frequency over the three time periods studied. The use of surgery and concomitant chemotherapy has remained relatively stable over time in the treatment of patients with advanced stage nonseminomas. And fourth, survival rates decrease with increasing AJCC stage of disease. The NCDB data regarding testicular carcinoma highlight a number of important trends in the presentation and management of testicular tumors. These trends not only evaluate new protocols of treatment but also can be used to direct new strategies toward achieving earlier patient presentation.

Previous Commission on Cancer Data from the National Cancer Data Base (NCDB) have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1993) data relating to patients with bladder carcinoma are described here. Five calls for data have yielded a total of 3,700,000 cases for the years 1985 through 1993, including 447,679 cases for 1988 and 608,593 cases for 1993, from hospital cancer registries across the U.S. Data were received on 18,053 bladder carcinoma cases in 1988 and 22,606 cases in 1993. Interesting trends are 1) younger patients (49 years of age and younger) present with earlier stages of disease than do older patients; 2) women are slightly more likely to be diagnosed with later stages (II, III, and IV) of bladder carcinoma than men; 3) African Americans are less likely to be diagnosed with Stage 0 or Stage I disease than either Hispanic or non-Hispanic whites; and 4) National Cancer Institute designated centers treat more patients with advanced disease than do other types of hospitals. The NCDB data are important for analyzing what cancer treatments and outcomes are used and occurring in the country. The data suggest that African Americans are diagnosed at later stages of disease progression. The relative survival rates among African Americans are lower than among Hispanics or non-Hispanic whites. Also, the decreasing utility of adjuvant chemotherapy is being recognized.

Commission on Cancer data from the National Cancer Data Base (NCDB) report time trends in stage of disease, treatment patterns, and survival for patients with selected cancers. The most current data (1993) for patients with colon cancer are described. Five calls for data yielded 3,700,000 cases of cancer for the years 1985 through 1993 from hospital cancer registeries across the U.S., including 36,937 cases of colon cancer from 1988 and 44,812 from 1993. Interesting trends are as follows: (1) the elderly ( > 80 years) present with earlier stage disease than younger patients; (2) the National Cancer Institute recognized cancer centers have more patients with advanced disease than other types of hospitals; (3) all ethnic groups have generally similar stages of disease at presentation, except for African-Americans who have a slightly higher incidence of Stage IV disease; (4) the proximal migration of the primary cancer continues with 54.7% of primary colon cancer arising in the right colon in 1993 compared with 50.9% in 1988; (5) an interaction between grade and stage of cancer seems present; and (6) patients with Stage III colon cancer who received adjuvant chemotherapy had a 5% improvement in 5-year relative survival. The NCDB data are useful for reporting what cancer treatments are being administered and what outcomes are occurring in the U.S. The data suggest an important biologic role for grade of cancer. They also suggest that African-Americans and other ethnic groups have the same outcome as non-Hispanic whites but that access to medical care may still be less. Finally, the utility of adjuvant therapy for Stage III colon cancer may just be beginning to be appreciated.

Previous Commission on Cancer studies from the National Cancer Data Base (NCDB) have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1991) data for gastric cancer are described here. Three Calls for Data have yielded a total of 16,992 case reports of gastric cancer for 1985, 1986, and 1991, from hospital cancer registries across the U.S. Gastric cancer was the 15th most frequent cancer reported to the NCDB. The proportion of all reported cancers that were gastric in the two time intervals studied were essentially the same. In 1991, 20.8% of the cases were reported in minorities. Only 46% of gastric cancer cases were staged by the American Joint Committee on Cancer (AJCC) system in 1985 to 86, compared with 77% in 1991. More advanced stages were reported for younger patients, but less advanced stages were noted in the Asian population. Of all patients reported, 41.4% had no reported cancer-directed surgery, 41.1% had partial or hemigastrectomy, and 6.7% had total gastrectomy. More extensive surgery was associated with patients with Stage III disease than with Stages I and II, as might be expected. Survival after treatment remained poor (5-year relative survival; 43% for Stage I, 37% for Stage II, 18% for Stage III, and 20% for Stage IV). Improvements in treatment will emerge allowing survival to serve as a better guide for the quality of care in the future. In the interim, the frequency of American Joint Committee on Cancer staging in patient charts and the fraction of patients with Stages I and II as opposed to Stages III and IV disease (as a measure of prompt diagnosis) may serve as measure of how quickly these cancers are being diagnosed.

The Commission on Cancer data from the National Cancer Data Base (NCDB) has previously reported data evaluating time trends in various cancers, including such elements as stage of disease at diagnosis, treatment, and survival for multiple tumor sites. In this report, data collected from 1985, 1986, 1990, 1991, 1995, and 1996 for primary hepatocellular carcinoma (HCC) tumors are presented. The data presented in this review were collected from hospital cancer registries from across the U.S. Eight calls for data have yielded a total 6.9 million cases for the years 1985-1996, including 1158 HCC cases in 1985-1986, 3319 cases in 1990-1991, and 5683 cases in 1994-1995 from hospital cancer registries across the U. S. These data represent approximately 4.3%, 11.2%, and 14.8% of the estimated cases of carcinomas of the liver and biliary tract diagnosed in the U.S. in each of the three respective time periods. The outcome for patients diagnosed with HCC remains poor, with only 10% of patients with American Joint Committee on Cancer Stage I disease surviving 5 years. Approximately 50% of patients received no therapy for their HCC, even those with early stage disease. Over these three time periods, the use of chemotherapy appears to have decreased. Among patients diagnosed with Stage II and III disease a difference in survival was noted between those treated with surgery only and those treated with chemotherapy only. Women appear to have a limited survival advantage over men. In spite of an overall poor prognosis, subsets of patients with HCC appear to benefit from surgical resection/ablation of their tumor. The decreasing use of chemotherapy and the early reports of newer ablative techniques (e.g., cryotherapy) suggest that other treatment modalities are emerging. These NCDB data provide a baseline for HCC treatment from which prospective studies are being developed to assess the newer treatments as well as the underlying causes.

The National Cancer Data Base (NCDB) of the Commission on Cancer gathers data on time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1991) data for pancreatic cancer are described here. The NCDB data contain important reference information regarding patient and hospital demographics associated with the diagnosis and treatment of pancreatic cancer. Three Calls for Data have yielded a total of 17,490 cases for 1985, 1986, and 1991, from 937 hospital cancer registries across the United States. The data for 1991 represent 32% of all pancreas cancer cases for U.S. A higher incidence of more advanced disease was reported for the youngest group of patients, Hispanics, African Americans, Asians, males and patients seen at smaller hospitals. For all patients combined, only 14.2% were reported to have had a pancreatectomy. Older patients, patients from lower income zip codes, and African Americans were somewhat less likely to have received a pancreatectomy. Cancer of the body of the pancreas was the anatomic subsite for which patients with pancreatic cancer were least likely to receive a pancreatectomy. Patients seen at hospitals with larger case-loads and at teaching hospitals were more frequently reported as having had a pancreatectomy. Between 1985-1986 and 1991, there was a trend from treatment with surgery only or radiation only toward more frequent use of combined chemoradiation without surgery. There was less radiation reported as received by patients at hospitals with fewer than 150 annual cancer caseloads compared with hospitals with larger caseload. For patients with resectable tumors, a moderate survival advantage was reported compared with nonresectable tumors: 1-year, 48% versus 23%; 2-year, 24% versus 9%; 3-year, 17% versus 6% respectively. The NCDB provides a powerful tool for examining practice patterns and outcome of cancer care in the U.S. The present report, covering one-third of all patients treated in the U.S. in 1991, confirms the advanced disease status of patients with pancreatic cancer. Minority groups present with more advanced disease and are less likely to undergo resection, currently the only potentially curative therapy. Resectability rates appear to be higher in large caseload hospitals.

Liquid biopsy is a rapidly emerging tool of precision oncology enabling minimally invasive molecular diagnostics and longitudinal monitoring of treatment response. For the clinical management of advanced stage lung cancer patients, detection and quantification of circulating tumor DNA (ctDNA) is now widely adopted into clinical practice. Still, interpretation of results and validation of ctDNA-based treatment decisions remain challenging. We report here our experience implementing liquid biopsies into the clinical management of lung cancer. We discuss advantages and limitations of distinct ctDNA assay techniques and highlight our approach to the analysis of recurrent molecular alterations found in lung cancer. Moreover, we report three exemplary clinical cases illustrating the complexity of interpreting liquid biopsy results in clinical practice. These cases underscore the potential and current limitations of liquid biopsy, focusing on the difficulty of interpreting discordant findings. In our view, despite all current limitations, the analysis of ctDNA in lung cancer patients is an essential and highly versatile complementary diagnostic tool for the clinical management of lung cancer patients in the era of precision oncology.

Lung cancers are ranked third among the cancer incidence in France in the year 2020, with adenocarcinomas being the commonest sub-type out of ~85% of non-small cell lung carcinomas. The constant evolution of molecular genotyping, which is used for the management of lung adenocarcinomas, has led to the current focus on tumor suppressor genes, specifically the loss of function mutation in the SMARCA4 gene. SMARCA4-deficient adenocarcinomas are preponderant in younger aged male smokers with a predominant solid morphology. The importance of identifying SMARCA4-deficient adenocarcinomas has gained interest for lung cancer management due to its aggressive behavior at diagnosis with vascular invasion and metastasis to the pleura seen upon presentation in most cases. These patients have poor clinical outcome with short overall survival rates, regardless of the stage of disease. The detection of SMARCA4 deficiency is possible in most pathology labs with the advent of sensitive and specific immunohistochemical antibodies. The gene mutations can be detected together with other established lung cancer molecular markers based on the current next generation sequencing panels. Sequencing will also allow the identification of associated gene mutations, notably KRAS, KEAP1, and STK11, which have an impact on the overall survival and progression-free survival of the patients. Predictive data on the treatment with anti-PD-L1 are currently uncertain in this high tumor mutational burden cancer, which warrants more groundwork. Identification of target drugs is also still in pre-clinical testing. Thus, it is paramount to identify the SMARCA4-deficient adenocarcinoma, as it carries worse repercussions on patient survival, despite having an exceptionally low prevalence. Herein, we discuss the pathophysiology of SMARCA4, the clinicopathological consequences, and different detection methods, highlighting the perspectives and challenges in the assessment of SMARCA4 deficiency for the management of non-small cell lung cancer patients. This is imperative, as the contemporary shift on identifying biomarkers associated with tumor suppressor genes such as SMARCA4 are trending; hence, awareness of pathologists and clinicians is needed for the SMARCA4-dNSCLC entity with close follow-up on new management strategies to overcome the poor possibilities of survival in such patients.

Commentary: Thoracic surgery during the COVID-19 pandemic: Recommendations from China

The following highlights summarize the principle findings of the NCDB, which are presented in more detail in other reports, some of which have been published and others of which are in press or submitted awaiting review. Collectively, these findings present a broad pattern of NCDB assessment of cancer patterns of care. In addition to the resulting journal publications, 1,600 NCDB participating hospitals receive a customized summary of similar patterns of care and outcome at their facility compared with national norms, which is then used for quality assurance purposes.