Age-adjusted Survival Research Articles

Sex and 30-day survival following out-of-hospital cardiac arrest in Scotland 2011–2020

BackgroundDifferences in 30-day survival between males and females following out-of-hospital cardiac arrest (OHCA) are well documented. Biological sex does not appear to be responsible for this survival gap independently of potential mediating factors. We investigated the role of potential mediating factors in the association between sex and 30-day survival after OHCA in Scotland.MethodsA retrospective cohort study of adult non-emergency medical services (EMS)-witnessed OHCA cases was conducted. We included incidents from the whole of Scotland where resuscitation was attempted by the Scottish Ambulance Service (SAS) between April 1, 2011 and March 1, 2020. Logistic regression was used to assess the contribution of age, socioeconomic status, urban–rural location of the incident, initial cardiac rhythm, bystander cardiopulmonary resuscitation (CPR) and location of the arrest (home or away from home).ResultsThe cohort consisted of 20,585 OHCA cases (13,130 males and 7,455 females). Median (IQR) age was 69 years (22) for males versus 72 years (23) for females. A higher proportion of males presented with initial shockable rhythm (29.4% versus 12.4%) and received bystander CPR (56.7% versus 53.2%) compared with females. A higher proportion of females experienced OHCA at home (78.8% versus 66.8%). Thirty-day survival after OHCA was higher for males compared with females (8.2% versus 6.2%). Males had higher age-adjusted odds for 30-day survival after OHCA than females (OR, 1.26; (95% CI), 1.12–1.41). Mediation analyses suggested a role for initial cardiac rhythm and location of the arrest (home or away from home).ConclusionMales had higher age-adjusted 30-day survival after OHCA than females. However, after adjusting for confounding/mediating variables, sex was not associated with 30-day survival after OHCA. Our findings suggest that initial cardiac rhythm and location of the arrest are potential mediators of higher 30-day OHCA survival in males than females. Improving proportions of females who present with initial shockable rhythm may reduce sex differences in survival after OHCA.

Abstract A046: Disparities in cancer burden and survival rates in persistent poverty communities in Los Angeles County

Abstract Objective: Persistent poverty census tracts (PPT) are those with socioeconomic challenges where prolonged economic disadvantages may significantly influence health outcomes. This study examined the cancer burden and survival patterns in PPTs compared to non-PPTs in Los Angeles County (LAC) considering disparities by race/ethnicity and stage at diagnosis. Methods: A comprehensive analysis of 2012-2021 Cancer Registry data examined age-adjusted incidence rates (AAIRs) and survival rates for lung, colorectal, liver, stomach, breast, and prostate cancers, which are the Norris Comprehensive Cancer Center priority cancers. Cancer-specific data were further stratified by racial/ethnic group and stage at diagnosis, and compared across residents in PPTs, non-PPTs, and LAC overall. Survival rates were calculated using the Kaplan-Meier method and differences between groups were assessed by log-rank tests. Results: PPTs in LAC were characterized by a higher proportion of racial/ethnic minorities, lower education levels, and higher unemployment compared to non-PPTs. In all racial/ethnic groups combined, AAIRs for lung, breast, and prostate cancers were lower in PPTs than non-PPTs, whereas AAIRS for liver and stomach cancers were higher in PPTs, with no differences for colorectal cancer. Disparities emerged when considering race and ethnicity, with higher lung cancer AAIRs among Non-Hispanic White (NHW) and Black/African American (B/AA) PPT residents compared to non-PPT, while AAIRs for lung and colorectal cancers were lower among Hispanic/Latino (H/L) PPT residents compared to non-PPTs. Breast and prostate cancer AAIRs remained lower in PPTs than in non-PPTS regardless of racial/ethnic group. Patients in PPTs exhibit significantly lower five-year survival rates across all studied cancers, except stomach, compared to non-PPTs. B/AA patients showed the lowest five-year survival rates for lung and colorectal cancer, with patients in PPTs experiencing significantly lower rates than patients in non-PPTs regardless of disease stage (p < 0.01 for early- or late-stage). Liver cancer survival rates were notably low, especially for H/L and Asian/Pacific Islander patients in PPTs, with five-year survival for late-stage cancer at 4.9% (95%CI: 2.8-8.5) and 5.4% (95%CI: 2.1-14.0), respectively. Patients in PPTs with late-stage breast or prostate cancer exhibited significantly lower 5-year survival (compared to non-PPTs) across all race/ethnicities, with B/AA patients experiencing the lowest survival rates for breast cancer and NHW patients experiencing the lowest survival rates for prostate cancer. Conclusions: Cancer outcomes for patients in PPTs were significantly poorer compared to those in non-PPT communities. The notably lower AAIRs in PPTs versus non-PPTs for more screen-able cancers, such as breast, prostate, and early-stage colorectal cancer, suggest a need for greater efforts to provide access to routine screening in areas affected by persistent poverty, though other causes cannot be ruled out. Citation Format: Miriam L Gorbatov, Joel S. Mendez, Myles Cockburn, Laura K. Thompson, Lihua Liu, Jennifer Tsui, Kali Zhou, V. Wendy Setiawan, Chanita Hughes-Halbert, Mariana C. Stern. Disparities in cancer burden and survival rates in persistent poverty communities in Los Angeles County [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A046.

Epidemiology, survival and new treatment modalities for intrahepatic cholangiocarcinoma.

Intrahepatic cholangiocarcinoma (iCCA) is a rare biliary tract cancer with increasing incidence and poor survival rates. This study aims to evaluate the incidence and survival trends of iCCA patients over 20 years using a national cancer database, and assess the temporal association between survival and landmark clinical trials. Data was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Age-adjusted incidence rates (AAIRs) were calculated from 2000 to 2020. Overall survival was analyzed based on diagnosis time and disease stage. Subgroup analysis was performed for patients diagnosed between 2015 and 2020. Landmark clinical trials were reviewed to determine temporal changes in survival. In this analysis of 28,918 iCCA patients, the AAIR increased from 0.49 per 100,000 in 2000 to 1.38 in 2020 [annual percent change (APC) 6.94, 95% confidence interval (CI): 6.32 to 7.56], with a notable decline from 2019 to 2020. Incidence rates overall displayed an uptrend course across subgroups divided by sex, race, age, and disease stage. The age-adjusted median overall survival (mOS) improved from 5.28 months in 2000 to 9.3 months in 2013, then stabilized between 8.0-9.0 months after 2013. Using 2010 as a cutoff, when the ABC-02 trial was published, the decade-based mOS increased from 6.55 months in 2000-2010 to 9.06 months in 2010-2020. During 2015-2020, the overall mOS was 8.8 months, with mOS of 24.3, 12.1, and 5.4 months for local, regional, and distant stages, respectively. The study indicates a steady rise in iCCA incidence since 2000 across all subgroups. Survival rates improved since 2000 but stabilized after 2013, following the ABC-02 trial publication in 2010. The impact of more recent clinical trials on survival rates requires further analysis in the coming years.

Survival shifts in multiple myeloma: Evaluating the impact of therapeutic advances and racial disparities after a decade of change.

e19509 Background: Multiple myeloma (MM) is the second most common hematologic malignancy and is considered an incurable disease. However, the last two decades have witnessed the emergence of new therapies that have improved overall survival by several folds. In the current study, we are examining the evolving trends in age-adjusted incidence and relative survival among myeloma patients over the last 20 years, specifically focusing on discerning disparities in these trends based on racial classifications. Methods: We performed a retrospective cohort study using the SEER Plus Data, 12 registries, Nov 2022 Sub (1992-2020) to calculate the age-adjusted incidence and relative survival rate (RSR) of MM in the US in two specific time intervals 2001-2010 & 2011-2020 consistent with changes in MM treatment during 2011-2020 including the emergence of immunomodulatory drugs (IMiDs). The year of diagnosis, sex, and race data were available for each case. We excluded cases diagnosed before 2001 and after 2020. Patients were stratified by sex and categorized into two racial groups: White and Black. The 60-month (5-year) and 116-month (used as a 10-year estimate) RSR and age-adjusted incidence rate were calculated for the cohort and each racial group. We calculated survival utilizing the Kaplan-Meier method. Using the log-rank test, we also found hazard ratios (HR), with the corresponding CI for each racial group stratified by sex. Results: We investigated MM incidence and survival rate trends over two decades while considering gender and race. The age-adjusted incidence rate showed a significant overall increase from 6.5 to 7.4 per 100,000, with changes in gender-specific rates. Higher incidence rates among Black populations were noted. Cohort relative survival analysis revealed improved median survival (53 to 83 months) and increased relative survival rate both at five years (46.4% to 56.3%) and at ten years (28.8% to 40.8%). An investigation based on race revealed substantial improvements among both White and Black populations. The HR (Table) emphasized the improved survival outcomes for patients diagnosed in period two across genders and races. Conclusions: The study highlights the changes in the incidence and survival rates of MM. Notably, MM incidence has seen a significant rise in the last decade, particularly among the Black population. The survival of patients diagnosed between 2011 and 2020 revealed statistically significant improvement at both the 5- and 10-year mark compared to patients diagnosed between 2001 and 2010. [Table: see text]

Hepatocellular carcinoma etiology drives survival outcomes: A population-based analysis.

e16142 Background: Previous studies on survival differences according to etiology of hepatocellular carcinoma (HCC) (5-year observed survival of 23%) are limited to hospital-based series and restricted cohorts. We performed a population-based survival analysis by major HCC etiologies, inclusive of hepatitis-C virus (HCV), hepatitis-B virus (HBV), alcohol-related liver disease (ALD), and non-alcoholic fatty liver disease (NAFLD) as singular causes, in addition to unexplored dual etiological groups, (HCV&HBV, HCV&ALD, and HBV&ALD), and accounting for age at diagnosis, tumor characteristics, and socio-demographics. Methods: All 19,956 cases of HCC diagnosed in Florida during 2005–2018 from the Florida cancer registry were linked for HCC etiology using Agency for Healthcare Administration and Florida Department of Health viral hepatitis data. Survival analysis was performed for the 15,759 linked HCC cases, comparing HCC etiologic groups (4 single and 3 dual). Results included age-adjusted 5-year survival, Kaplan-Meier curves, and adjusted hazard ratios from Cox regression models. Results: The leading single etiology was ‘HCV only’ (n=4,983; 31.6%); the leading dual etiology was ‘HCV&ALD’ (n=2,694; 17.1%). The age-adjusted 5-year survival was low (<22%) across all HCC etiologies; however, non-ALD causes showed higher survival [‘HCV only’ (21.5%; 95%CI:20.2%–22.8%), ‘HBV only’ (20.2%; 95%CI:16.6%–23.9%), ‘NAFLD only’ (19.9%; 95%CI:18.7%–21.2%)] than ALD-related etiologies [‘ALD only’ (14.4%; 95%CI:12.7%–16.0%), ‘HCV&ALD’ (10.4%; 95%CI:9.0%–11.9%), ‘HBV&ALD’ (8.1%; 95%CI:2.2%–14.1%)]. Compared to the reference category ‘HCV only,’ age-adjusted hazard ratios were 1.69 (95%CI: 1.41–2.03; p-value<0.0001) for ‘HBV&ALD,’ 1.33 (95%CI:1.26–1.40; p-value<0.0001) for ‘HCV&ALD,’ and 1.35 (95%CI:1.28–1.43; p-value<0.0001) for ‘ALD only.’ Multivariable analysis including additional factors showed minimal variation from these results. Conclusions: Significant differences in survival based on HCC etiology are important for prevention, surveillance, and targeted treatments based on etiologic-specific biomarkers. Specific pathophysiological mechanisms for ALD in addition to viral hepatitis could be responsible for poorer outcomes for dual etiologies involving alcohol use, compared to viral etiology alone. To increase overall survival, improved screening is needed for patients with multiple HCC risk factors. [Table: see text]

Uterine cancer incidence trends and 5-year relative survival by race/ethnicity and histology among women under 50 years

BackgroundUterine cancers diagnosed before age 50 years are increasing in the U.S., but changes in clinical characteristics and survival over time across racial/ethnic groups have not been previously described. ObjectivesTo investigate age-adjusted, hysterectomy corrected incidence rates and trends, and five-year relative survival rates of uterine cancer in women aged <50 years, overall and stratified by race/ethnicity and histology. Study DesignWe included microscopically confirmed uterine cancer cases (diagnosed 2000-2019) in women aged 20-49 years from the Surveillance, Epidemiology, and End Results Program (SEER 22). Age-adjusted incidence and 5-year relative survival rates, and 95% confidence intervals were computed using SEER*Stat and compared across time periods (2000-2009 and 2010-2019). Incidence rates were adjusted for hysterectomy prevalence using Behavioral Risk Factor Surveillance System data, and trends were computed using the Joinpoint regression program. ResultsWe included 57,128 uterine cancer cases. The incidence of uterine cancer increased from 10.1 per 100,000 in 2000-2009 to 12.0 per 100,000 in 2010-2019, increasing at an annual rate of 1.7%/year for the entire period. Rising trends were more pronounced among women <40 years (3.0%/year and 3.3%/year in 20-29 and 30-39 years, respectively) than in those 40-49 years (1.3%/year), and among underrepresented racial/ethnic groups (Hispanic 2.8%/year, Non-Hispanic, [NH]-Black 2.7%, NH-Asian/Pacific Islander [PI] 2.1%) than in NH-White (0.9%/ year). Recent (2010-2019) incidence rates were highest for endometrioid (9.6 per 100,000), followed by sarcomas (1.2), and non-endometrioid subtypes (0.9). Rates increased significantly for endometrioid subtypes at 1.9%/year from 2000-2019. Recent endometrioid and non-endometrioid rates were highest in NH-Native American/Alaska Native [NA/AN] (15.2 and 1.4 per 100,000), followed by Hispanic (10.9 and 1.0), NH-Asian/PI (10.2 and 0.9), NH-White (9.4 and 0.8), and lowest in NH-Black women (6.4 and 0.8). Sarcoma rates were highest in NH-Black women (1.8 per 100,000). The five-year relative survival remained unchanged over time for women with endometrioid (from 93.4% in 2000-2009 to 93.9% in 2010-2019, p≥0.05) and non-endometrioid subtypes (from 73.2% to 73.2%, p≥0.05) but decreased for women with sarcoma from 69.8% (2000-2009) to 66.4% (2010-2019, p<0.05). ConclusionsUterine cancer incidence rates in women <50 years have increased from 2000 to 2019 while survival has remained relatively unchanged. Incidence trends can be primarily attributed to increasing rates of cancers with endometrioid histology, with the greatest increases observed among NH-Black, Hispanic, and NH-Asian/PI. Sarcomas, while much rarer, were the second most common type of uterine cancer among women <50 years and have poor prognosis and apparent decreasing survival over time. Rising rates of uterine cancer and the distinct epidemiologic patterns among women <50 years highlight the need for effective prevention and early detection strategies for uterine cancer in this age group.

Epidemiology, survival and new treatment modalities for intrahepatic cholangiocarcinoma (IHCC).

e16217 Background: Intrahepatic cholangiocarcinoma (IHCC), a rare biliary tract cancer, has been rising in incidence and is associated with poor survival. With the advent of new treatment modalities and various ongoing research, population-based perspective can be helpful to reflect the progress in managing this deadly disease and provide updated outcome information as a reference for comparison during upcoming clinical studies. We would like to provide a 20-year update on incidence and survival with reference to landmark trials, with a focus on survival outcomes of the recent 5 years for future insights. Recent and ongoing clinical trials will be discussed. Methods: This study extracted population data from the Surveillance, Epidemiology, and End Results (SEER) database. Age-adjusted incidence rate (AAIRs) and survival rate (SR) trends were calculated from January 2000 to December 2020 using 22 registries for the US population. Incidence and survival rates were collected from the SEER database, reported per 100,000 population and age adjusted to the 2020 US standard population. The annual percent change (APC) was used to report long term trends. Results: In this analysis of 19,948 IHCC patients, the AAIR increased from 0.49 per 100,000 in 2000 to 1.38 in 2020 (APC 6.94, 95% CI 6.32 to 7.56), with a notable decline from 2019 to 2020. Incidence rates overall displayed an uptrend course across subgroups divided by sex, race, age, and disease stage. The age-adjusted mOS climbed from 5.28 months in 2000 to 9.3 months in 2013, maintaining between 8.0-9.0 months after 2013. Using 2010 as a cutoff, when the ABC-02 trial was published, the decade-based mOS increased from 6.55 in 2000-2010 to 9.06 in 2010-2020, which remained statistically significant at 1-year, 3-year, and 5-year OS. During 2015-2020, the overall mOS was 8.8 months, with mOS of 24.3 months, 12.1 months, and 5.4 months for local, regional, and distant stages, respectively. Conclusions: These results indicate a steady rise in IHCC incidence since 2000, consistent across all subgroups. Survival rates have improved since 2000 but stabilized after 2013, following the publication of the ABC-02 trial published in 2010, which used systemic gemcitabine and cisplatin for unresectable iHCC. Updated survival data from 2015 onwards will serve as a reference of comparison for forthcoming clinical trials.

Charting the Course: Insights into Neuroendocrine Tumor Dynamics in the United States.

To explore changing trends and characteristics in neuroendocrine tumors (NETs) epidemiology, focusing on demographics, clinical aspects, and survival, including the impact of social determinants of health (SDOH) on outcomes. The escalating incidence and prevalence of NETs underscore the pressing need for updated epidemiologic data to reveal the evolving landscape of this condition. Access to current information is imperative for informing clinical strategies and public health initiatives targeting NETs. A retrospective, population-based study analyzed NET patient data from 1975 to 2020, using the Surveillance, Epidemiology, and End Results (SEER 8, 12, 18) program. We calculated annual age-adjusted incidence, prevalence, and 5-year overall survival (OS) rates. Survival trends from 2000 to 2019 were examined, employing the Fine-Gray model to evaluate cancer-specific mortality. NETs' age-adjusted incidence rate quadrupled from 1.5 per 100,000 in 1975 to 6.0 per 100,000 in 2020. A decline in incidence occurred from 6.8 per 100,000 in 2019 to 6.0 per 100,000 in 2020. All-cause survival multivariable analysis demonstrated high grade (HR: 2.95, 95% CI: 2.63-3.09, P<0.001), single patients (HR: 1.49, 95% CI: 1.45-1.54, P<0.001), and Black patients (HR: 1.17, 95% CI:1.13-1.22, P<0.001) all had worse survival than their controls. In conclusion, our study shows a steady increase in NETs incidence until 2019, with a decline in 2020. Understanding the reasons behind this trend is vital for improved management and public health planning. Further research should focus on the factors driving these changes to enhance our understanding of NET epidemiology.

Persistent poverty disparities in incidence and outcomes among oral and pharynx cancer patients

PurposeDisparities in oral cavity and pharyngeal cancer based on race/ethnicity and socioeconomic status have been reported, but the impact of living within areas that are persistently poor at the time of diagnosis and outcome is unknown. This study aimed to investigate whether the incidence, 5-year relative survival, stage at diagnosis, and mortality among patients with oral cavity and pharyngeal cancers varied by persistent poverty.MethodsData were drawn from the SEER database (2006–2017) and included individuals diagnosed with oral cavity and pharyngeal cancers. Persistent poverty (at census tract) is defined as areas where ≥ 20% of the population has lived below the poverty level for ~ 30 years. Age-adjusted incidence and 5-year survival rates were calculated. Multivariable logistic regression was used to estimate the association between persistent poverty and advanced stage cancer. Cumulative incidence and multivariable subdistribution hazard models were used to evaluate mortality risk. In addition, results were stratified by cancer primary site, sex, race/ethnicity, and rurality.ResultsOf the 90,631 patients included in the analysis (61.7% < 65 years old, 71.6% males), 8.8% lived in persistent poverty. Compared to non-persistent poverty, patients in persistent poverty had higher incidence and lower 5-year survival rates. Throughout 10 years, the cumulative incidence of cancer death was greater in patients from persistent poverty and were more likely to present with advanced-stage cancer and higher mortality risk. In the stratified analysis by primary site, patients in persistent poverty with oropharyngeal, oral cavity, and nasopharyngeal cancers had an increased risk of mortality compared to the patients in non-persistent poverty.ConclusionThis study found an association between oral cavity and pharyngeal cancer outcomes among patients in persistent poverty indicating a multidimensional strategy to improve survival.

Thyroid Cancer Survival in the Multiethnic Cohort Study.

The US 5-year survival rate after thyroid cancer (TC) diagnosis is over 95%. Our aim was to investigate survival differences by sex and race and ethnicity in a multiethnic US population. In the Multiethnic Cohort (MEC) study, a total of 605 incident TC cases were identified by linkage to HI and CA statewide cancer registries. Cox models were performed to compare the risk of all-cause mortality among TC cases by sex and race and ethnicity, with adjustment for age, first course of treatment, baseline body mass index, smoking status, alcohol intake, and neighborhood socioeconomic status. Survival among cases was also compared to matched MEC controls with no thyroid cancer. After a mean follow-up of 10.1 years, 250 deaths occurred among TC cases, including 63 deaths attributed to thyroid cancer. The median survival was 14.7 years, and the 5-year age-adjusted overall survival was 84.4% for female cases and 68.7% for male cases (p < 0.0001, HR 2.28 (95% CI: 1.72, 3.01)). Age-adjusted survival was lower among African American, Native Hawaiian, and Filipino cases, compared to Japanese American cases, with Whites and Latinos being intermediate. Men and Filipinos were found to have excess mortality due to thyroid cancer compared to controls (adjusted HR 1.39, 95% CI: 1.11, 1.74; HR 1.62, 95% CI: 1.04, 2.53, respectively). Sex and racial and ethnic disparities in survival among TC cases were similar to those found in the general population. However, cases with TC had an excess risk of death among males and for Filipinos.

Current status of head and neck sarcomas in Japan in 2016–2019: an analysis using the national cancer registry

BackgroundHead and neck sarcomas are especially rare in Asia, leading to limited clinical evidence. This study aimed to investigate the incidence, clinical features, treatment status, and outcome of these sarcomas using data from the National Cancer Registry in Japan.MethodsAll head and neck sarcomas diagnosed between 2016 and 2019 and recorded in the National Cancer Registry were analyzed. Data on sex, age, primary site, histological type, stage, treatment modality, and prognostic information were collected. Age-adjusted incidence and 3-year survival rates of patients with head and neck sarcomas were calculated.ResultsOverall, 635 head and neck sarcoma patients were identified. Head and neck sarcoma occurred more frequently in men and patients in their 70 s. The age-adjusted annual incidence rate was 0.125 per 100,000 patients in the 2015 Japanese model or 0.089 per 100,000 patients in the world population model. The nasal cavity and paranasal sinuses were the most frequent primary sites, with rhabdomyosarcoma as the most common histologic type. Treatment typically involved chemotherapy and/or radiation therapy for rhabdomyosarcoma and Ewing’s sarcoma, whereas surgical approaches for other types. Three-year survival rate of head and neck sarcoma patients was 64.8%.ConclusionsHead and neck sarcomas occurred rarely, but most frequently in the nasal cavity and paranasal sinuses in Japan. Poor outcomes were observed for sarcoma patients than for non-sarcoma head and neck cancer patients.

SERUM METABOLOMICS SIGNATURES OF EXTREME OLD AGE AND LONGEVITY

Abstract A total of 1,495 chemicals including 1,213 compounds of known identity and 282 compounds of unknown structural identity were profiled in serum samples collected at enrollment at Metabolon, Inc. from the blood serum of 213 subjects, including centenarians (n=80), offspring (n=70), and controls (n=63), mean ages of 105, 70, and 70, respectively, enrolled in the New England Centenarian Study (NECS). We performed metabolite- and metabolite module-based regression analyses on age, differential analyses comparing centenarian to offspring and control, and Cox proportional hazard-based survival analyses. We annotated the derived signatures by enrichment analysis using metabolite sets curated by Metabolon, RefMet, and Pathbank, among others. We identified 323 (436) metabolites that change with age at an FDR-corrected q-value of 0.01 (0.05), and 298 (407) metabolites differentially abundant between centenarians, their younger offspring, and controls. Our results confirm and expand upon previous metabolomics-based studies of aging, including decreased abundance with age of Tryptophan, DHEA-S, Pregnenolone, Glutathione, and Androgen, among others, and increased abundance of Amino acids (Tyrosines), Phenylacetylglutamine, Ornithine, Urea, Kynurenine, and Creatine, among others. To distinguish metabolites associated with longevity from those associated with extreme old age, we performed age-adjusted survival analysis, and rank-based enrichment analysis identified several metabolites significantly associated with survival independent of age, including secondary and primary (C 24) bile acids, and multiple classes of steroids (androgens, pregnenolone, progestin), among others. Additional analyses are ongoing to further annotate and characterize these findings. If validated, these results could contribute to the identification of novel healthy aging therapeutics.

Abstract C051: Deciphering the role of stress-survival pathway genes and mutations in Hispanic colorectal cancer disparities

Abstract This study aims to determine the role of stress-survival pathway (SSP) genes and the associated mutations in Hispanic colorectal cancer (CRC) disparities, particularly in young and late-stage Hispanic CRC. CRC is the second most-deadliest among all cancers and the third leading cause of cancer in the United States (US). An overall reduction in CRC cases among individuals aged 50 and older has been reported, albeit there is an alarming rise in the incidence of early-onset (patients under the age of 50) CRC. The increase in the early onset of CRC is concerning as these cases tend to appear with higher pathologic grades and have a higher risk of recurrence and metastasis. The incidence of early-onset CRC is almost two times in Hispanics (16.5%) when compared to that in non-Hispanic White (NHWs; 8.7%). Access to health care for Hispanics is limited, as a result, they also tend to present with later-stage CRC when compared to NHWs (32% versus 19% of Stage IV), which likely accounts for their inferior age-adjusted survival after CRC diagnosis. Since Hispanics have the highest percentage of young people and comprise ~18% of the US population, the rising incidence of early-onset and late-stage detection of CRC among Hispanics coupled with the rapid growth in this segment of the population makes it imperative to correctly assess the causes behind the observed disparities in Hispanics with early-onset and late-stage CRC. Our previous study, using in-silico analyses of CRC datasets, helped us identify twenty-eight oxidative stress-response and apoptosis-associated genes that are expressed differently in CRC when compared to normal colon tissues. Expressions of these SSP genes (mRNA and protein levels) were validated in CRC cell lines, cDNA arrays, and human colon cancer tissue microarrays (TMAs). Finally, we have confirmed the differential expression of all twenty-eight transcripts in Hispanic and NHW CRC, and corresponding normal adjacent to the tumor (NAT) tissues. Interestingly, we have identified distinct transcripts that are differentially expressed in Hispanics with early-onset (PDCD2L, CDK1, and PRDX4) and late-stage (CCNB1, CDK4, CHEK1, and MCM10) CRC. We have also identified the mutations associated with the SSP genes by analyzing the ClinVar and NHGRI-EBI GWAS databases. These findings have laid the foundation to characterize further, the roles played by these genes in the molecular basis for Hispanic CRC disparities at early-onset and late stages. Differential Expression of mRNAs in CRC tissues between the two ethnic groups (Hispanics and NHW) and corresponding NATs has been determined by RNA-seq. Ingenuity Pathway Analysis (IPA) has been performed to correlate SSP genes with the canonical CRC pathways to better understand the roles played by these genes, their effects on the downstream cancer-related pathways, and on the early-onset and late-stage Hispanic CRC. These putative ethnicity-specific biomarkers or targets could be used for developing novel prognostic tools or therapeutic interventions for Hispanic CRC patients in the future. Citation Format: Sourav Roy, Brian I. Grajeda, Md Zahirul Islam Khan, Urbashi Basnet, Soumya Nair. Deciphering the role of stress-survival pathway genes and mutations in Hispanic colorectal cancer disparities [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C051.

Twenty years' experience of type B aortic dissections: a population-based national registry study from Finland.

The objective of this study was to investigate the incidence, treatment and survival of Stanford type B aortic dissection (BTAD) during 20 years in the Finnish population. Data collection was made from the Nationwide Care Register for Health Care, Finnish National Institute for Health and Welfare. All patients over 15 years of age with BTAD from 2000 to 2019 were included in the study. A data search of the Registry of Death Cause (Statistic Finland) was carried out to identify the date and cause of death. There were 1742 cases of BTAD during the study period. BTAD represented 45.6% of all aortic dissections leading to hospital admission. Incidence for BTAD was 1.62 per 100 000 inhabitants per year. The median survival was 12.7 years [95% confidence interval (CI) 9.63-14.7], 12.4 years (95% CI 10.5-14.4) and 8.6 years (95% CI 7.5-9.7) for patients treated with thoracic endovascular aortic repair (TEVAR), surgery and medical treatment (MT), respectively. Survival was significantly better after TEVAR and surgery, compared to MT only (P < 0.001). Age-adjusted survival was significantly better after TEVAR compared to patients treated with MT or surgery (hazard ratio 0.578, 95% CI 0.420-0.794, P < 0.001). Aortic-related death was the most common cause of death in all groups (41%). The incidence of BTAD seems to be similar in the Finnish population compared to other populational studies. Patients treated with TEVAR had significantly better survival compared to other patients. A high risk for late aortic-related death should be recognized in patients with BTAD.

From Option B+ to Universal "Test and Treat" in Cameroon: Identification and Evaluation of District-level Factors Associated with Retention in Care.

Retaining women in Option B+ services is crucial for eliminating new pediatric HIV infections. However, there are few studies on factors influencing retention at the district level. This study evaluates the factors associated with retention in two health districts of Cameroon. From September 1, 2015, to February 29, 2016, we reviewed the records of pregnant and breastfeeding women initiating Option B+, a lifelong approach to preventing mother-to-child transmission (PMTCT) of HIV, between October 2013 and July 2014. We abstracted sociodemographic and clinical data from registers in 22 health facilities in the Bamenda urban and Kumba rural districts into spreadsheets. Cox regression age-adjusted survival curves were used to compare retention probabilities at 6 and 12 months post-antiretroviral therapy (ART) initiation. Multivariable modified Poisson regressions were run to estimate adjusted relative risk (aRR) of factors associated with retention in PMTCT care at 12 months post-ART initiation. STATA software was used for the analyses. Of the 560 files reviewed, majority, 62.7% (n=351), were above 24 years of age and married, 68.9% (n=386). From the multivariable analysis, enrolling early in antenatal care (ANC) (aRR: 1.50, 95% CIL: 1.17-1.93) and knowing the male partner's HIV-negative status (aRR: 1.16, 95% CI: 1.00-1.34) were significantly associated with higher retention in care, adjusting for maternal age, marital status, and distance from the health facility. By health district, knowing the male partner's HIV-negative status (aRR: 1.30, 95% CI: 1.13-1.50) in the Bamenda urban and enrolling early in ANC (aRR: 2.03, 95% CI" 1.21-3.41) in the Kumba rural district, had significantly higher retention rates after adjusting for the same covariates. Overall, factors influencing retention varied by urban or rural district. Therefore, tailored district-level interventions are needed to enhance early ANC enrollment in the rural and partner HIV status disclosure in the urban districts to improve retention in PMTCT care.

Epidemiology of cholangiocarcinoma in Florida, and differences in risk factors between intra- and extra-hepatic cholangiocarcinoma.

e16329 Background: Albeit rare, cholangiocarcinoma (CC) is a poorly understood, highly fatal cancer with an incidence rate of less than 2.5 per 100,000 people. For most cases of CC, causes are not known. Here, we use population-based data from the diverse state of Florida to study the most recent incidence rates and trends for intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC) and measure the prevalence of potential risk factors and preexisting conditions associated with liver cancer including biliary conditions, diabetes, obesity and dyslipidemia, hypertension, smoking, chronic hepatitis C (HCV) and hepatitis B (HBV) infections, alcohol-related disease, and auto-immunes diseases. Methods: We used the Florida Cancer Registry Data on all cases of cholangiocarcinoma (N = 5,096) diagnosed during 2010–2018 (2,930 intra-hepatic, 2,166 extra-hepatic). Data were linked with two other data sources: the Agency for Healthcare Administration and the Department of Viral Hepatitis. Age-adjusted rates by sex were computed, incidence trends using Joinpoint regression and 5-year age-adjusted survival, using lifetable methods, were estimated. Differences in prevalence of risk factors were tested using chi-square tests. Results: Both ICC rates, 1.7 (per 100,000) for males and 1.3 for females, and ECC rates, 1.0 in males and 0.7 in females are relatively low. ICC is currently the fastest increasing cancer at a rate of +7.2% per year in males and +6.5% in females, while ECC trends remain stable. The 5-year survival was 11.0% for ICC (95%CI: 9.2-12.8) and 12.9% (95%CI: 10.5-15.3) for ECC. Overall, conditions such as diabetes type 2 (29%), obesity and dyslipidemia (41%), and hypertension (61%) were highly but equally prevalent in both ICC and ECC. The presence of non-alcohol related cirrhosis (6.0% vs 2.8% for ICC and ECC, respectively), chronic HCV infection (6.6%, 2.0%), and smoking (52.7%, 48.5%) were significantly more prevalent in ICC, while cholangitis of any type (13.5%,26.0%), chronic pancreatitis, auto-immune diseases (all. Conclusions: Currently, ICC is the most rapidly increasing cancer in the US; though, the extent to which better recognition of ICC plays a role in this trend is unknown. ICC and ECC show similarities, but also, differences in the prevalence of specific risk factors and preexisting conditions. The commonly held perception that the increase in metabolic causes (diabetes and obesity), similarly present in both ICC and ECC, are responsible for the current trends is partially challenged by the stable trends in ECC. Given its dismal prognosis, cholangiocarcinoma, especially ICC, requires further research. Funding: This work was supported by Bankhead Coley Grant #20B16 from the Biomedical Research Program of the Department of Health State of Florida.

Long-term outcomes of patients with single ventricle who do not undergo Fontan palliation

BackgroundPatients with single ventricle (SV) without Fontan palliation are uncommon, and their long-term outcomes remain unclear. MethodsRetrospective study of 35 adult patients with SV without Fontan from two tertiary centers. Primary outcome was mortality. ResultsMedian age at first follow-up was 31 years (IQR: 20–40). Most common defect was double inlet left ventricle (34%), and 69% had left ventricular morphology. Patients were unoperated (46%), had systemic-to-pulmonary artery shunt (31%) or bidirectional cavopulmonary shunt (23%) as final palliation. Most common reasons for not progressing to Fontan palliation were pulmonary vascular disease (54%), patient refusal (17%), Fontan takedown (14%), and hypoplastic pulmonary arteries (11%). Baseline mean hemoglobin was 195 ± 29 g/L, mean O2 saturation 83 ± 6.9%, and 4 patients in NYHA Class III‒IV. After a mean follow-up of 10 ± 8.3 years, there were 9 deaths with heart failure being the leading cause (n = 6). Age-adjusted survival of these adult SV survivors was 73% and 53% at 40 and 50 years of age, respectively. Deceased patients more frequently had renal impairment (50% vs 0%) and QRS prolongation (75% vs 16%) at baseline (all p < 0.05). During follow-up, 40% had a new arrhythmia (atrial: n = 14, ventricular: n = 3), 34% had one or more hospitalizations for heart failure, and 17% had a stroke. A greater proportion of patients with pre-existing or new atrial/ventricular arrhythmia died compared to those without (42% vs 6%, p = 0.02). ConclusionsPatients with SV without Fontan have high mortality and a substantial burden of cardiovascular complications, particularly arrhythmia. QRS prolongation and renal impairment were associated with mortality.

Covid-19 vaccine acceptance among individuals incarcerated in Connecticut state jails

BackgroundVaccine hesitancy is common among incarcerated populations and, despite vaccination programs, vaccine acceptance within residents remains low, especially within jails. With the goal of assessing the Connecticut DOC’s COVID-19 vaccine program within jails we examined if residents of DOC operated jails were more likely to become vaccinated following incarceration than in the community. Specifically, we conducted a retrospective cohort analysis among people who spent at least one night in a DOC-operated jail between February 2 and November 8, 2021, and were eligible for vaccination at the time of incarceration (intake). We compared the vaccination rates before and after incarceration using an age-adjusted survival analysis with a time-varying exposure of incarceration and an outcome of vaccination.ResultsDuring the study period, 3,716 people spent at least one night in jail and were eligible for vaccination at intake. Of these residents, 136 were vaccinated prior to incarceration, 2,265 had a recorded vaccine offer, and 479 were vaccinated while incarcerated. The age-adjusted hazard of vaccination following incarceration was significantly higher than prior to incarceration (12.5; 95% Confidence Intervals: 10.2–15.3).ConclusionsWe found that residents were more likely to become vaccinated in jail than in the community. Though these findings highlight the utility of vaccination programs within jails, the low level of vaccination in this population speaks to the need for additional program development within jails and the community.

96P Age-adjusted trends and survival analysis of alveolar soft part sarcoma

96P Age-adjusted trends and survival analysis of alveolar soft part sarcoma

Whole Body Retrograde Perfusion Combined With Central Aortic Perfusion Strategy in the Repair of Distal Arch Pathology Through a Lateral Thoracotomy

ObjectiveTo compare the results of the hypothermic circulatory arrest (HCA) + retrograde whole-body perfusion (RBP) technique with those of deep hypothermic circulatory arrest (DHCA-only) approach. MethodsLimited data are available on cerebral protection techniques when distal arch repairs are performed through a lateral thoracotomy. In 2012, the RBP technique was introduced as adjunct to HCA during open distal arch repair via thoracotomy. We reviewed the results of the HCA + RBP technique compared with those of the DHCA-only approach. From February 2000 to November 2019, 189 patients (median age, 59 [IQR, 46 to 71] years; 30.7% female) underwent open distal arch repair via lateral thoracotomy to treat aortic aneurysms. The DHCA technique was used in 117 patients (62%, median age 53 [IQR, 41 to 60] years), whereas HCA + RBP was used in 72 patients (38%, median age 65 [IQR, 51 to 74] years). In HCA + RBP patients, cardiopulmonary bypass was interrupted when systemic cooling achieved isoelectric electroencephalogram; once the distal arch had been opened, RBP was then initiated via the venous cannula (flow of 700 to 1000 mL/min, central venous pressure <15 to 20 mm Hg). ResultsThe stroke rate was significantly lower in the HCA + RBP group (3%, n=2) compared with the DHCA-only (12%, n=14) (P=.031), despite longer circulatory arrest times in HCA + RBP compared with the DHCA-only (31 [IQR, 25 to 40] minutes vs 22 [IQR, 17 to 30] minutes, respectively; P<.001). Operative mortality for patients undergoing HCA + RBP was 6.7% (n=4), whereas for those undergoing DHCA-only it was 10.4% (n=12) (P=.410). The 1-, 3-, and 5-year age-adjusted survival rates for the DHCA group are 86%, 81%, and 75%, respectively. The 1-, 3-, and 5-year age-adjusted survival rates for the HCA + RBP group are 88%, 88%, and 76%, respectively. ConclusionThe addition of RBP to HCA in the treatment of distal open arch repair via a lateral thoracotomy is safe and provides excellent neurological protection.