Black Pts Research Articles

47982 Reversing the resistance to chemotherapy in White and Black patients with triple negative breast cancer (TNBC).

ABSTRACT IMPACT: Reversing tumor microenvironment (TME) immunosuppression will help to increase the overall efficacy of treatment of chemo-resistant triple negative breast cancer (TNBC) and mitigate racial disparities in treatment response. OBJECTIVES/GOALS: We have developed an ex-vivo whole tissue culture model to test the feasibility of reversing local immunosuppression in TME by chemokine modulatory (CKM) regimen. Our current objective is to analyze the molecular changes in CKM-treated chemoresistant TNBC from White and Black women and identify factors determining response to CKM. METHODS/STUDY POPULATION: Freshly resected residual TNBC from 20 White and 20 Black women ≥18 yrs old treated with neoadjuvant chemotherapy (NAC) will be procured. Tumor explants will be prepared & cultured in the absence and presence of CKM (Interferon-ð 〉1/4, TLR3 agonist rintatolimod and COX-2 inhibitor celecoxib). Chemokines implicated in cytotoxic T-lymphocyte (CTL)- & MDSC/ Treg attraction will be analyzed using Taqman & ELISA. We will have 80% power to detect a 0.7 standard deviation difference in chemokines between untreated & treated samples within and between cohorts using ANCOVA. Bulk RNA sequencing will be performed on both untreated & treated samples from CKM responding (highest aggregate increase in CTL- and highest decrease in Treg/MDSC-favoring chemokines in the top quartile) and non-responding (bottom quartile) tissues. RESULTS/ANTICIPATED RESULTS: Our preliminary data show that Black patients (pts) with breast cancer (BC) have an immunosuppressive TME associated with poor outcomes. This is similar to other existing literature showing that Black pts with BC have less favorable and more unfavorable chemokines in the TME. We anticipate the chemokine changes with CKM treatment will be larger in the Black cohort given their ability to elicit a robust inflammatory response. Therefore, we expect that CKM treatment will result in favorable TME in both groups and improve outcomes in TNBC, which has the worst prognosis of all subtypes, eliminating a key area of disparity in BC. The proposed transcriptome analysis will help identify key gene networks involved in response to CKM treatment and guide modulating the targets for non-responsiveness to improve efficacy of CKM. DISCUSSION/SIGNIFICANCE OF FINDINGS: Pts with residual disease (RD) after NAC have a 3-yr overall survival 68% vs. 94% for pts with complete response. Blacks have a higher incidence of TNBC with more likelihood of RD & mortality. We anticipate that the existing TME differences can be abrogated by our current CKM regimen or via developing an alternative CKM regimen optimized for Black pts.

Abstract PS7-29: Racial disparities in breast cancer outcomes: A SEER population based study

Abstract Introduction: Breast cancer (BC) is the second leading cause of female cancer-related mortality in the United States. Despite advances in therapies which have significantly lowered BC mortality rates over the years, the decline in mortality in African American/Black women continues to lag behind. Black women with BC continue to do poorly compared to non-Hispanic White women. The etiologies underlying this disparity are multifactorial and still remain unclear. Our study aims to investigate the differences in clinical and socioeconomic characteristics (cts) between Blacks and Whites and evaluate their prognostic value on long-term outcomes. Methods: We conducted a retrospective, population-based analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) database, and studied BC pts from 1975-2017. Different demographic and clinical cts were analyzed by race. Univariate (UV) and multivariable (MV) analyses were performed to evaluate the associations of race with disease-specific survival (DSS), overall survival (OS) using Cox regression models. Results: A total of 816,763 pts were analyzed (n=720,144 White, n=966,19 Black). As compared to White BC patients (pts), Black pts were younger in age (median age 57 years vs. 62 years), with a higher tumor stage (III/IV; 25% vs. 16.3%) and a higher tumor grade (III/IV; 52.2% vs. 35.3%) at disease presentation (p<0.001). Furthermore, Black pts were more likely to present with triple-negative (23.9% vs. 11.1%) and Her-2+ BC (20.6% vs. 16.3%) than White pts (p<0.001). Black pts were also more likely to be uninsured (3.4% vs.1.1%), single (64.3% vs. 42.5%), and less likely to receive breast surgery (90.7% vs. 95.4%) as compared to White pts (p<0.001). A higher proportion of Black pts lived in urban areas (93.9% vs. 87.9%) and had a higher county-level availability of hospitals with oncology services per million population (median 126 vs. 120.6) than White pts (p<0.001). Black pts had a worse DSS (Hazard Ratio (HR) 1.68, 95% CI 1.66-1.71)) and OS (HR 1.30, 95% CI 1.29-1.31) compared to White pts (p<0.001). The racial differences in DSS and OS remained significant on both UV and MV analyses while controlling for each demographic and clinical variable. Conclusions: Our study confirms that Black pts with BC have a worse OS and DSS as compared to White pts. These disparities could be partially explained by observed differences in underlying aggressive tumor biology (stage, grade, hormone receptor status, age at diagnosis), lower access to health care (insurance status and % receiving breast surgery) and weaker social support systems (% single). However, the fact that the survival disparity persisted even after controlling for these factors suggests that there are potentially more variables driving these racial differences in breast cancer outcomes. We note that more Black pts resided in UA and had access to hospitals with oncology services reflecting that there could be disparities in health care utilization patterns. Further studies investigating these variables would be of paramount importance in order to identify underlying causes for poorer outcomes in Black pts and help eliminate this survival gap. Citation Format: Medhavi Gupta, Rohit Gosain, Maithreyi Sarma, Stuthi Perimbeti, Kristopher Attwood, Wenyan Ji, Shipra Gandhi, Yara Abdou. Racial disparities in breast cancer outcomes: A SEER population based study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-29.

Impact of socioeconomic status (SES) on colorectal cancer patient survival: An analysis of 890,867 patients in the National Cancer Database (NCDB).

19 Background: SES has been associated with outcomes in cancer patients (pts). We examined associations between SES and survival of pts with colorectal cancers (CRC). Methods: The NCDB was used to examine the association of SES status with clinicopathological features and outcomes of colorectal cancer pts, categorized by the income and education level of their area of residence. Logistic regression, Cox proportional hazard model, and chi-square test were used to examine the differences between groups. Results: A retrospective analysis of 890,867 pts with CRC (right-sided 34.1%, transverse 11.9%, left-sided 46.2%, and rectal 7.8%) diagnosed between 2004 and 2016, was conducted. About half the pts were male (51.4%); 84.3% were white, 11.2% black, and 4.5% of other races. Overall, 30.8% of pts lived in the highest and 18.4% in the lowest income areas. Twenty-three percent lived in areas comprising the highest high school graduation rate areas (>93%), while 17.4% lived in the lowest (< 79%). Compared to pts living in high-income areas, pts living in the lowest income areas were more likely to be black (OR 6.2, 6.1-6.3), present at a younger age (18-30 yrs vs. >70 yrs; OR 1.28, 1.18-1.39), have T3/T4 disease at presentation (OR 1.03, 95%CI 1.02-1.04), left-sided tumors (OR 1.05, 1.04-1.06), higher Charlson-Deyo score (OR 1.34, 1.33-1.36), and have Medicaid (OR: 3.9, 3.8-4.0) or no health insurance (OR: 2.9, 2.8-3.0). Tumor location and grade, stage, age, sex, race, ethnicity, income, education, insurance status, Charlson-Deyo score, and type of treatment center were independent predictors for survival in the multivariate analysis. Pts living in the lowest income and lowest education areas had a 13% and 4% higher risk of death, respectively, compared to pts in the highest income areas and education areas. Black pts had a 7% increased risk of death. Pts with Medicaid and no insurance coverage had a 44% and 29% increased risk of death, respectively, compared to pts with private insurance. Conclusions: CRC pts living in areas of low income and low education had worse survival. Insurance status and type of treatment center also have a strong impact on survival. Sociodemographic characteristics need to be taken into account and studied further, with the aim of improving outcomes for all pts. [Table: see text]

Socioeconomic status (SES) and survival outcomes in patients with gastrointestinal (GI) cancers: An analysis of 1.4 million patients in the National Cancer Database (NCDB).

458 Background: SES and access to care are factors that may impact patient outcomes. We examined the impact of SES on survival in patients (pts) with GI cancers. Methods: Data obtained from the NCDB were used to examine the association between SES and outcomes of GI cancer pts. Pts were categorized by income and education levels. Logistic regression, Cox proportional hazards models, and chi-square tests were used to examine the differences between the groups. Results: A total of 1,409,177 pts diagnosed with GI cancers between 2004 and 2016 were retrospectively studied (table). The majority of pts were male (54.3%), and 83.7% were white, 11.5% black, and 4.7% of other races. Of the entire cohort, 31% of pts lived in the highest income areas, whereas 18.3% were in the lowest and 50.6% in middle-income areas; 23% lived in the highest high school graduation rate (>93%) areas, whereas 17.4% lived in the lowest graduation rate (< 79%) areas; and 82.4% resided in metropolitan areas. Pts in the lowest compared to highest income areas were more likely to be black (OR: 6.5, 6.4-6.6), uninsured (2.9, 2.8-3.0), or have Medicaid (4.13, 4.04-4.22), and have a Charlson-Deyo score ≥ 1 (1.35, 1.33-1.36). In the multivariate analysis, cancer type, stage, tumor differentiation, income, education, insurance status, gender, race, Charlson-Deyo score, and type of treatment center were independent predictors for survival. After controlling for other factors, black pts had a 3% increased risk of death (HRadj = 1.03; 1.02-1.03; p < 0.001). Pts from lowest vs highest education areas had a 2% increased risk of death (HRadj = 1.02; 1.01-1.03; p < 0.001). Pts from the lowest income vs highest income areas had a 13% increased risk of death (HRadj = 1.13; 1.12-1.14; p < 0.001). Pts with Medicaid insurance had a 33% (HRadj: 1.33, CI 1.32-1.34, p < 0.001) and uninsured pts had 22% (HRadj: 1.22 (1.20-1.23, p < 0.001) increased risk of death compared to pts with private insurance. Pts from urban or rural areas vs metropolitan areas had a 1% increased risk of death (HRadj = 1.01; 1.00-1.02; p < 0.001). Conclusions: Low SES is associated with worse survival in pts with any GI cancer. Pts with low-income status and Medicaid or no health insurance had the highest risk of mortality. These stark inequities must be addressed with renewed efforts to identify, treat, and better support pts at highest risk for poor outcomes. [Table: see text]

Abstract 14591: Persistent Racial Disparities in Risks of Readmission and Mortality After Percutaneous Coronary Intervention in the Contemporary Era: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Introduction: Racial disparities in the management and outcomes following acute myocardial infarction are well-established. However, there remains conflicting data on whether such disparities exist between black and non-black patients (pts) after percutaneous coronary intervention (PCI) in contemporary practice. Hypothesis: We hypothesize that compared with non-black race, black race is associated with increased risks of post-PCI readmission and mortality. Methods: We linked clinical registry data from PCIs performed between 1/2013 and 3/2018 at 48 Michigan hospitals to Medicare Fee-for-service claims. Patient race as recorded in the registry was dichotomized as black and non-black. The date of death was obtained from the Medicare beneficiary file. We used a logistic regression model to estimate the odds of 90-day readmission and a Cox model to estimate the association between race and post-discharge mortality after adjusting for important clinical characteristics. Results: A total of 30,206 pts (10.0% black, 59.9% men) were included. Black pts tended to be younger (68.9 vs 72.2 yrs), were more likely to smoke (27.7% vs. 19.5%), and had a higher burden of cardiovascular comorbidities. Compared with non-black pts, black pts had an increased risk of 90-day readmission (26.5% vs. 18.2%; adjusted OR 1.34; 95% CI 1.22-1.47; p<0.001) and long-term mortality after PCI (HR 1.13; 95% CI 1.05-1.21; p=0.001) (Figure). Conclusions: Even after accounting for clinical comorbidities, in contemporary practice black pts are at an increased risk of readmission and long-term mortality after PCI discharge. Future studies investigating differences in care and social determinants of health are needed to elucidate the mechanisms behind these disparate outcomes and identify potential opportunities to reduce these dramatic and persistent health care disparities.

Clinical Features and Survival Outcomes in Diabetic Patients with Newly Diagnosed Multiple Myeloma (NDMM) Enrolled in the Connect® MM Registry

Clinical Features and Survival Outcomes in Diabetic Patients with Newly Diagnosed Multiple Myeloma (NDMM) Enrolled in the Connect® MM Registry

MM-350: Daratumumab (DARA) + Lenalidomide/Bortezomib/Dexamethasone (RVd) in African American/Black Patients (Pts) with Transplant-Eligible Newly Diagnosed Multiple Myeloma (NDMM): Subgroup Analysis of GRIFFIN

Context: To optimize treatment of Black pts with multiple myeloma, a greater understanding of differences in outcomes in Black pts vs. White pts is needed. In GRIFFIN, DARA plus RVd (D-RVd) improved rates and depth of response in autologous stem cell transplant (ASCT)-eligible NDMM pts. Here, we report a subgroup analysis of Black pts from GRIFFIN. Design: Between 2016 and 2018, pts in the United States were randomized 1:1 to RVd ± DARA and received 4 induction cycles, high-dose therapy, ASCT, 2 consolidation cycles, and maintenance with R ± DARA for 24 mo. The pre-specified primary endpoint was stringent complete response (sCR) rate by end of consolidation, which occurred at a median follow-up of 13.5 mo. Results below are based on longer follow-up (22.1 mo). Results: Two hundred seven pts (D-RVd, n=104; RVd, n=103) were randomized; 32 (15%) pts were Black (D-RVd, n=14; RVd, n=18), and 161 (78%) pts were White (D-RVd, n=85; RVd, n=76). Baseline demographics were generally similar between treatment arms in Black and White pts. D-RVd vs RVd improved the sCR rate by end of consolidation in Black (10 [71%]; 6 [33%]) and White pts (35 [43%]; 24 [34%]). Including post-consolidation data, sCR with D-RVd vs. RVd was achieved by 12 (86%) and 7 (39%) Black pts and 50 (61%) and 33 (46%) White pts. ORR by end of consolidation was improved for D-RVd vs. RVd in Black pts (14 [100%] vs. 17 [94%]), as were rates of ≥CR (12 [86%] vs. 7 [39%]) and minimal residual disease at 10−5 (5 [36%] vs. 3 [17%]). Grade 3/4 TEAEs (≥25%) with D-RVd/RVd included neutropenia (Black pts, 50%/22%; White pts, 41%/16%), lymphopenia (29%/39%; 23%/16%), and thrombocytopenia (29%/11%; 14%/8%). Grade 3/4 infections for D-RVd/RVd occurred in 36%/17% of Black and 20%/23% of White pts. IRRs occurred in 29% of Black and 45% of White pts. Conclusions: GRIFFIN demonstrated that D-RVd improved responses in the Black NDMM pt subgroup, but larger studies are needed to better define the magnitude of DARA benefit in Black pts. Improved recruitment of Black pts in clinical trials is needed to understand disease biology and response to therapy among racial groups. To optimize treatment of Black pts with multiple myeloma, a greater understanding of differences in outcomes in Black pts vs. White pts is needed. In GRIFFIN, DARA plus RVd (D-RVd) improved rates and depth of response in autologous stem cell transplant (ASCT)-eligible NDMM pts. Here, we report a subgroup analysis of Black pts from GRIFFIN. Between 2016 and 2018, pts in the United States were randomized 1:1 to RVd ± DARA and received 4 induction cycles, high-dose therapy, ASCT, 2 consolidation cycles, and maintenance with R ± DARA for 24 mo. The pre-specified primary endpoint was stringent complete response (sCR) rate by end of consolidation, which occurred at a median follow-up of 13.5 mo. Results below are based on longer follow-up (22.1 mo). Two hundred seven pts (D-RVd, n=104; RVd, n=103) were randomized; 32 (15%) pts were Black (D-RVd, n=14; RVd, n=18), and 161 (78%) pts were White (D-RVd, n=85; RVd, n=76). Baseline demographics were generally similar between treatment arms in Black and White pts. D-RVd vs RVd improved the sCR rate by end of consolidation in Black (10 [71%]; 6 [33%]) and White pts (35 [43%]; 24 [34%]). Including post-consolidation data, sCR with D-RVd vs. RVd was achieved by 12 (86%) and 7 (39%) Black pts and 50 (61%) and 33 (46%) White pts. ORR by end of consolidation was improved for D-RVd vs. RVd in Black pts (14 [100%] vs. 17 [94%]), as were rates of ≥CR (12 [86%] vs. 7 [39%]) and minimal residual disease at 10−5 (5 [36%] vs. 3 [17%]). Grade 3/4 TEAEs (≥25%) with D-RVd/RVd included neutropenia (Black pts, 50%/22%; White pts, 41%/16%), lymphopenia (29%/39%; 23%/16%), and thrombocytopenia (29%/11%; 14%/8%). Grade 3/4 infections for D-RVd/RVd occurred in 36%/17% of Black and 20%/23% of White pts. IRRs occurred in 29% of Black and 45% of White pts. GRIFFIN demonstrated that D-RVd improved responses in the Black NDMM pt subgroup, but larger studies are needed to better define the magnitude of DARA benefit in Black pts. Improved recruitment of Black pts in clinical trials is needed to understand disease biology and response to therapy among racial groups.

Single-institutional analysis of clinicopathologic features and overall survival (OS) in melanoma patients (pts).

e14023 Background: Melanoma is ranked 5th commonest malignancy in United States and SEER has projected 3,290 new skin melanoma cases in Michigan in 2020. Diagnosis of recurrent & metastatic melanoma has associated with poor prognosis and survival. Henry Ford Cancer Institute (HFCI) is a tertiary cancer care facility serves cancer patients from communities throughout metropolitan Detroit tri-county areas where a higher melanoma presentation (1.56%) in black pts than this group at national database (0.6%). A subgroup of white Michiganders travel to Southern sunshine states in winter months known as “snowbirds” have contributed to melanoma incidences in Michigan. We aim to review our institute tumor registry data to analyze the clinicopathological features, care pattern and correlated survival outcomes. Methods: We have identified adult melanoma pts through institute tumor registry between 2007 – 2017, who had demographics, initial diagnosis, recurrence, then death or last follow-up for overall survival (OS) outcome. Data were analyzed using IBM SPSS, R-statistical and log-rank test. Results: Of 1327 eligible pts, median age was 63, and 874 (65.86%) pts were invasive at onset diagnosis. 1298 (97.81%) pts were white, 23 (1.73%) pts were black. Slightly more females (55.54%) over males and overall 301 deaths (22.68%) were observed. 1277 pts with cutaneous melanoma had better 5- and 10-year (yr) OS at 78.14%, and 68.32% compared to 50 (3.77%) non-cutaneous pts at 13.31% and 8.87%, respectively. Black pts carried a poor 5-yr OS at 34.68% vs white at 76.4%. 116 (17.9%) pts presented with recurrences, had 5-yr OS at 34.58%. Of 121 (9.1%) pts who never had been disease-free, showed worse 5-yr OS at 15.87%, with trend of improvement since FDA-approval of immune checkpoint inhibitor therapies. Conclusions: We have analyzed our melanoma care pattern, experience and survival outcomes at 5-yr and/or 10-yr from a tertiary community cancer care facility. We have assessed our current practice benchmarks with plan to improve our care delivery by having built a multidisciplinary team, and launched Melanoma & Skin Cancer Clinical Care Pathway through Tumor Board to improve care access, to decrease care disparity, then to standardize quality of care including encouraging clinical trial enrollments which will enhance quality of melanoma care and survival outcomes of advanced and metastatic cases.

Treatment patterns and outcomes of patients with penile squamous-cell carcinoma (PSCC) undergoing inguinal lymph node dissection (ILND): An analysis of a multicenter contemporary database.

5585 Background: PSCC is a rare tumor and the administration of guidelines-based therapies is still problematic in real-world practice. Survival outcomes remain suboptimal in patients (pts) with ILN involvement. Multinational analyses of real-world patterns are needed. Methods: Within an international, multicenter database of 965 PSCC pts who received ILND from 1980-2019, 630 had complete information for the variables of interest, from USA (N=81), Europe (EU, N=355), South America (SA, N=90), and China (Ch, N=104). Descriptive analyses according to geographical and ethnicity/race distribution were made. Comparisons of outcomes were made with Kaplan-Meier analyses and corresponding logrank tests. Results: Median age at diagnosis was 59 yrs, with no differences worldwide and according to ethnicity/race. Pts from SA presented with more advanced cT-stage (cT3-4: 26.7% vs. 17.3% USA vs. 7.6% EU) while EU pts presented with more advanced cN-stage (cN3: 14.9% vs. 11% USA vs. 7.8% SA vs. 5.8% Ch) as well as pathological (p)N-stage: pN3 pts were 53% in EU, 33.3% in USA, 20% in SA, and 18.3% in Ch. Perioperative chemotherapy (pCT) was more frequently administered in EU (53.8%) vs. USA (34.6%) SA (5.6%) Ch (7.7%). cT-stage was more frequently advanced in black pts (cT3-4: 33.3% vs. 12% Caucasian, 6.2% Hispanic/latino, 0% Asian) and the same was for cN-stage (cN3: 25% in black, 13% in Caucasian, 6.2% in Hispanic/latino, 6% in Asian). Conversely, pN3 pts were more frequently Caucasian (45.6%) vs. black (25%), Hispanic/latino (19%), and Asian (18%). pCT was more frequently administered in Caucasian pts (45%) vs. black (8.3%), Hispanic/latino (0), and Asian (8%). No significant differences in overall survival (OS) were observed according to geographical region or ethnicity/race, in the total pts and in the subgroups according to cT, cN, pN-stages and pCT. Median OS after pCT and ILND was 95 months. Bilateral ILN involvement was equally observed regardless of geographical region and ethnicity/race. In the total population, pCT significantly prolonged OS in pts with bilateral ILN (p=0.04), but not in pts with pelvic LN. Conclusions: Treatment patterns for PSCC undergoing ILND remain heterogeneous worldwide, and adherence to guidelines is seemingly poor. However, long-term outcomes with pCT remain uniformly suboptimal with <50% pts alive at 10 yrs. Further collaborative efforts are needed in this orphan disease to harmonize the therapeutic paradigm.

Abstract 332: Racial Differences in Prescribing of Sodium Glucose Cotransporter-2 Inhibitors and Glucagon-like Peptide-1 Receptor Agonists Among Veterans With Type 2 Diabetes and Coronary Artery Disease: Findings From the Veteran’s Administration Clinical Assessment, Reporting, and Tracking Program

Background: Recent trials have shown improved cardiovascular benefit associated outcomes with sodium glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) treatment in patients (pts) with type 2 diabetes (T2D) and high cardiovascular (CV) risk. We examined the extent to which this new evidence has been applied in routine clinical care and whether race influenced differences in prescription rates between patients. Methods and results: We used data from the US Department of Veterans Affairs’ Clinical Assessment, Reporting, and Tracking (CART) Program (2015-2017 inclusive). Pts were deemed SGLT2i- or GLP-1RA-eligible based on EMPA-REG OUTCOME and LEADER trial criteria. Rates of use were examined among eligible pts by race/ethnicity in unadjusted and multivariable logistic regression models adjusted for age, insurance type, service connection, and clinical site. From 84 sites, 21,053 patients were eligible for an SGLT2i and 1,520 (7.2%) had one prescribed. Recipients of SGLT2i were younger (65.59 years vs 68.29 years) had a higher mean HbA1c (8.27% vs 8.02%) and were more likely white (86.0 % vs 82.6%). Compared to black pts, whites had higher odds of receiving the medication, OR = 1.38; 95% CI 1.05,1.85; p < 0.01. Among 11,913 Veterans eligible for an GLP-1RA, 477 (4.0%) had one prescribed. Recipients were younger (65.84 years vs 68.96 years), had a higher mean HbA1c (8.55% vs 8.09%) and were more likely white (83.6% vs 81.8%). Compared to black pts, whites had higher odds of receiving the medication, OR = 1.43; 95% CI 1.09, 1.92; p = 0.013. Representation of other racial/ethnic groups was insufficient for comparison. Conclusion: Appropriate prescription of SGLT2i or GLP-1RA was less likely among black than white US Veterans at high CV risk. Our results suggest that while overall uptake of these medications has been slow, there are substantial racial differences that exist concerning the prescribing of these medications. In view of these findings, additional research is needed to further investigate both institutional and clinical factors which may adversely affect the prescribing of SGLT2i and GLP-1RA in African American Veterans.

An Assessment of Race As a Risk Factor for Doxorubicin-Related Cardiotoxicity in Diffuse Large B Cell Lymphoma

Introduction Doxorubicin carries a risk of heart failure (HF). Black race has been suggested as a risk factor for doxorubicin-related HF or asymptomatic LVEF decline, but studies were limited by small sample size, unknown racial composition of the comparison group, or lack of assessment of potential confounders. We aimed to assess whether HF occurs at higher rates in black patients (pts) compared to non-Hispanic white pts who receive doxorubicin for DLBCL, and to evaluate race as an independent risk factor for the development of HF after adjusting for known risk factors. Methods We used the Surveillance, Epidemiology, End Results - Medicare (SEER-Medicare) database to identify pts >65 years who were diagnosed with DLBCL (ICD-O: 9680, 9684) between 1997-2015 and who received doxorubicin (HCPCS/NDC codes) within 30 days of diagnosis. We excluded pts with HF (ICD-9: 428, ICD-10: I50) documented prior to diagnosis with DLBCL. We recorded age at diagnosis, Ann Arbor stage, and race. We assessed pts for hypertension (HTN) and coronary artery disease (CAD) documented in the year prior to lymphoma diagnosis. The primary outcome was documented HF at any point following DLBCL diagnosis. Descriptive statistics were performed for demographic and clinical variables. The proportion of pts who developed HF was calculated in both racial groups and compared with the chi-square test. A multivariable logistic regression model was formulated using race, age at diagnosis, Ann Arbor stage and comorbidities, as covariates. Adjusted odds ratios and 95% confidence intervals for racial group status and demographic/clinical variables of interest were estimated from the multivariable model. The Kaplan-Meier method was used to generate time-to-event curves for the onset of HF in each racial group. A multivariable Cox proportional hazards model was used to estimate the hazard ratio for the diagnosis of HF in black vs. white pts after adjusting for age at diagnosis, stage, HTN and CAD. All p-values were two-sided with statistical significance evaluated at the 0.05 alpha level. Results We identified 71,072 pts with DLBCL (white 82.2%, black 5.7%). We excluded 13,651 (19%) pts with HF prior to lymphoma diagnosis (white 84.4%, black 5.7%). We identified 6630 pts (white 88.8%, black 3%) with DLBCL who had received doxorubicin within 30 days of diagnosis. We excluded 797 pts <65 years and 802 pts with unknown stage at diagnosis. Of the remaining 4555 pts (white 97.7%, black 2.3%), 3398 (74.6%) had a history of HTN (white 74.3%, black 88.7%) and 1841 (40.4%) had a history of CAD (white 40.5%, black 37.7%). A total of 1607 (35%) pts developed HF (white 35%, black 33%). By univariate analysis, factors associated with development of HF included history of HTN (OR 1.27; 95% CI 1.10-1.47; p=0.001), CAD (OR 1.39; 95% CI 1.23-1.57); p<0.001), age at diagnosis of DLCBL (median 72.5 vs. 74; p=<0.001) and stage (OR 0.87; 95% CI 0.77-0.98; p=0.02). Race was not associated with risk of HF (OR 1.11; 95% CI 0.74-1.68; p=0.70). Our multivariable logistic regression model showed that older age at diagnosis (OR 1.03; 95% CI 1.02-1.04) and CAD (OR, 1.28; 95% CI 1.12-1.46) were associated with HF. Stage III/IV (OR 0.86; 95% CI 0.76-0.97) was associated with a lower risk of HF compared to stage I/II. Race (OR 1.05; 95% CI 0.70-1.60) and prior history of HTN (OR 1.12; 95% CI 0.96-1.30) were not significantly associated with development of HF. The median overall CHF-free survival time was 10.28 years after diagnosis (95% CI 9.75-11.13; Figure 1). Log-rank testing showed no difference in probability of developing HF between black and white pts (p=0.80), and the Cox model showed that after accounting for age at diagnosis, stage, HTN, and CAD, there was no statistically significant association between race and HF (HR, 0.92; 95% CI 0.66-1.30; p=0.62). Discussion HF is a common condition in older individuals following use of anthracycline for DLBCL, and it is associated with worse survival. No association was observed between black race and the onset of heart failure following treatment with doxorubicin for DLBCL. However, there was a greater proportion of black pts excluded for pre-existing HF than in the final study population. This highlights the importance of rigorous screening for pre-existing HF or LV dysfunction as a means of mitigating the risk of worsening cardiac function in this population. Figure 1 Disclosures Martin: I-MAB: Consultancy; Sandoz: Consultancy; Karyopharm: Consultancy; Teneobio: Consultancy; Celgene: Consultancy; Janssen: Consultancy.

Billed palliative care services and end-of-life care in patients with hematologic malignancies.

43 Background: Patients (pts) with hematologic malignancies (HMs) often receive aggressive care at the end of life (EOL), leading to lower quality of life. Early palliative care (PC) may improve EOL care, but its benefits are less established in HMs than in solid tumors. We sought to describe the use of billed PC services (BPCS) among Medicare beneficiaries with HMs and associated EOL quality measures. Methods: Using the linked SEER-Medicare registry, we studied Medicare beneficiaries diagnosed with leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm who died from 2001-2015. We described trends in the use of BPCS (identified by codes in clinician encounter claims). Among pts surviving >30 days from diagnosis, we compared baseline characteristics and EOL care quality metrics for pts with and without “early BPCS” (initiated >30 days before death). Results: The proportion of pts ( N=139,191, median age 81 years) with any BPCS increased from 0.4% in 2001 to 13.3% in 2015. Median time from first BPCS encounter to death was 10 days and 84.3% occurred during hospital admissions. Use of early BPCS was rare (from 0.2% in 2001 to 4.3% in 2015, with 28% of all first BPCS occurring early) and more frequent in acute leukemia, among black pts, those with higher comorbidity indices or poor performance statuses, and those receiving chemotherapy. Receipt of early BPCS was associated with improved EOL care quality metrics (see Table). Conclusions: Use of BPCS among Medicare beneficiaries with HMs has steeply increased in recent years, but most encounters still occur within days of death. Early BPCS are associated with better EOL care quality metrics similar to those observed in solid tumors. Our results support the need for prospective trials of early PC for pts with HMs. [Table: see text]

Sacubitril/Valsartan Initiated in Black Patients Admitted for Acute Decompensated Heart Failure Reduced NT-proBNP, was Safe and Led to Improved Clinical Outcomes- A Secondary Analysis of the PIONEER-HF Trial

Introduction There is a disproportionate burden and severity of heart failure (HF) among black patients (pts) who may be less responsive to treatment with an ACEi/ARB than other racial/ethnic groups. How black pts with HF respond to sacubitril/valsartan (S/V), an angiotensin receptor neprilysin inhibitor, has not been fully explored. Methods The PIONEER-HF trial was a prospective, multicenter, double-blind, active-controlled, randomized trial which enrolled 881 pts at 129 sites in the United States. Pts with or without a history of prior HF and an EF ≤40% and an NT-proBNP ≥1600 pg/mL or BNP ≥400 pg/mL were eligible for participation no earlier than 24 hours and after hemodynamic stabilization while hospitalized for acute decompensated HF (ADHF). Pts were randomly assigned 1:1 to in-hospital initiation of S/V (N = 440) vs. enalapril (E, N = 441) for 8 weeks. We performed a pre-specified subgroup analysis by self-reported race (i.e., black vs. other). Results The study population was 316 (35.9%) black, 515 (58.5%) white, and 50 (5.7%) other. Black pts (Ratio of change [ROC] 0.72, 95% CI 0.57-0.89) experienced a similar improvement in NT-proBNP with S/V vs. E compared to white pts (ROC 0.68, 95% CI 0.58-0.80; p-value for interaction = 0.13). There was no statistical interaction between race and the effect of S/V on the composite of CV death or rehospitalization for HF (black: HR 0.47, 95% CI 0.24-0.94 vs. white: HR 0.60, 95% CI 0.35-1.01) (Figure). The incidence of worsening renal function, hyperkalemia, and symptomatic hypotension was comparable with S/V vs. E regardless of race. There was one confirmed angioedema event in the S/V arm (in a white pt), while there were six in the enalapril arm (all in black pts) (p-value = NS). Conclusion Among black pts admitted for ADHF, in-hospital initiation of S/V resulted in a greater reduction in natriuretic peptide levels, was safe and well-tolerated, and led to a significant improvement in clinical outcomes compared to enalapril. The effect of S/V vs. E on these outcomes did not differ by race. No angioedema event with S/V was observed in a black patient.

Does ethnicity affect the relationship between body mass index (BMI) and overall survival (OS) in non-small cell lung cancer (NSCLC)? A pooled analysis of 17,326 International Lung Cancer Consortium (ILCCO) patients (pts).

1562 Background: In Caucasian-predominant populations, overweight or obese NSCLC pts (BMI≥25-kg/m2) have better prognosis while underweight (BMI≤18.5-kg/m2) pts have a worse prognosis. A large pooled sample allowed us to evaluate the role of ethnicity in this BMI-NSCLC OS relationship. Methods: Using individual data, survival analysis was performed on 15 ILCCO studies, assessing the interactions between ethnicity and BMI on overall survival (OS). Adjusted Hazard Ratios (aHR) from Cox models and adjusted penalized smoothing spline plots were generated. Results: Among 13416 (77%) Caucasian, 2975 (17%) Asian, and 935 (5%) Black NSCLC pts analyzed, we confirmed that for all pts, being underweight at NSCLC diagnosis was associated with worse OS (aHR=1.68, CI 1.5-1.8, p<0.001), while overweight/obese pts had improved survival (aHR 0.89, CI 0.8-0.9, p<0.001), when compared to pts with normal BMI. In general, Black pts had poorer OS than Caucasian pts (aHR 1.26 CI 1.1-1.4, p<0.001). However, the BMI-OS relationship differed according to ethnicity (BMI-ethnicity interaction, p=0.009): Caucasian underweight pts had poorer OS (aHR 1.67, CI 1.5-1.8, P<0.001) while overweight/obese pts had improved OS (aHR 0.89, CI 0.8-0.9, P<0.001). In Asian pts, these two associations were aHR 1.15, CI 0.8-1.5, P=0.33, and aHR 0.91, CI 0.7-1.1, P=0.32, respectively. In Black pts, these two associations were aHR 1.06, CI 0.7-1.5, p=0.73 and 0.75, CI 0.6-0.8 p<0.001, respectively. For overweight/obese patients, as BMI rises from 25-kg/m2 through 45-kg/m2, the prognosis worsens for Caucasian pts, remains stable for Asian pts, but improves for Black pts. Conclusions: InCaucasian pts, being underweight had a greater negative impact on OS than for Asian or Black pts, while being obese had a greater beneficial impact in Blacks than in other ethnic groups. These ethnic differences likely reflect genetically-informed muscle/adipose tissue distributions, where Black pts may have less sarcopenic obesity than other ethnicities. In future prognostic studies, BMI relationships must account for ethnic differences.

Comparable survival of African-Americans and Caucasian patients with multiple myeloma: A hospital-based study including 117,926 patients.

e18170 Background: Multiple Myeloma (MM) counts the most common hematologic malignance among African-Americans with twice the incidence of whites. The outcomes have greatly improved during the last 15 years, however with changing demographics there is an increasing focus on how various subgroups, based on race and ethnicity may be benefiting from survival improvement in MM. Previous studies showed that if access to care is assured, racial disparity-driven differences in outcome may be mitigated. Here, we conducted a study using the National Cancer Data Base (NCDB), which covers more than 70% of cancer pts in the USA, to evaluate survival patterns by race. Methods: MM patients (pts) diagnosed between years 2005 and 2014 and reported to the NCDB were analyzed (n = 117926). Pts were divided in three groups based on the year (y) of diagnosis (2005-07, 2008-10 and 2011-14). Kaplan-Meier method and log-rank test were used for overall survival analysis (OS). The effect size, hazard ratio (HR), of race on OS was estimated by Cox model adjusted by confounders. Results: Median age at diagnosis was 67 y (19 - 90); 55% were males. Median follow up was 30 months (m) (0 - 145). Median OS for white and black pts was 46 m (95% CI: 45.4 - 46.6) and 50.6 m (95% CI: 49.1 - 52.3), respectively (p < 0.0001). Black had longer OS compared to white pts by univariable analysis in all three study periods, noticeably with a trend toward higher survival benefit in most recent years. After adjusting for a variety of factors there was no statistically significant difference between the two racial groups (Table). Conclusions: This large study confirmed that after adjusting for confounding factors survival is similar for white and black MM pts. [Table: see text]

Characterizing the gut microbiome of patients with triple-negative breast cancer.

e14186 Background: The human microbiome has been postulated to play a role in carcinogenesis, and there is evidence that commensal intestinal bacteria are capable of promoting tumor immunosurveillance and controlling the immune system’s response to therapy by modulating the tumor microenvironment. Methods: We characterized the stool microbiome of 30 patients (pts) with triple-negative breast cancer (TNBC) using 16S rRNA gene sequencing. Analysis of composition of microbiomes (ANCOM) was used to identify differential abundant exact-sequence-variants (ESVs) with p-values adjusted using Benjamini-Hochberg False Discovery Rate (pFDR) correction. We correlated the stool microbiome with clinicopathologic features and response to treatment. Results: The cohort included 7 pts with metastatic breast cancer and 23 pts with early-stage disease. 19 pts were treated with neoadjuvant chemotherapy (NACT). Bacteroides ovatus ESV was enriched (pFDR < 0.05) in black pts (n = 14), whereas ESV from Prevotella copri was abundant (pFDR < 0.05) in white pts (n = 13). ESVs from Clostridium and family Ruminococcaceae were enriched (pFDR < 0.05) in pts with distant metastatic recurrence (n = 6) compared to pts without metastatic disease. Notably, we identified specific taxa that differentiated between pts with a pathological complete response to NACT (pCR, n = 6) and those with residual disease (n = 13). ESVs from Bacteroides and Ruminococcaceae were relatively more abundant in pts with a pCR (pFDR < 0.05). Furthermore, among pts with residual disease after NACT, Bacteroides caccae was significantly enriched in pts with a partial response (n = 4) compared to pts with no response (n = 9). Conclusions: To our knowledge, this is the first time that 16S rRNA amplicon sequencing has been used to identify microbial signatures correlating with clinical phenotypes and response to treatment in pts with TNBC. This small study provides insight into the potential role of microbes in novel therapeutic interventions to correct dysbiosis and shift towards a gut microbial ecosystem that enhances the body’s immune response to TNBC.

Abstract P1-08-30: Triple negative breast cancer: Does ethnicity impact survival?

Abstract Background: Triple negative breast cancer (TNBC) is a heterogeneous disease with poor outcomes relative to hormone positive breast cancer. Observations in the clinical setting lead to the hypothesis that there may be phenotypic differences among ethnic groups. Previous studies have conflicting results; some suggesting no differences, others showing inferior outcomes for black patients (pts). The purpose of this study was to use a population-based approach to examine survival amongst different ethnicities in triple negative breast cancer (TNBC). Methods Retrospective population-based study using data from the surveillance epidemiology and end results (SEER) database to identify TNBC cases diagnosed 2010 - 2014. We divided pts into 6 ethnic groups: White, Black, American Indian/Alaskan Native (AIAN), Pacific Islander (PI), Asian and Asian Indian (AI). Primary outcome: overall survival (OS); secondary outcome: breast-cancer specific survival (BCSS). Survival analysis was performed using Cox proportional hazards and Kaplan-Meier models. Results 31482 pts were included; 22752 (72.3%) were white, 6319 (20.4%) black, 1720 (5.5%) Asian, 262 (0.8%) AI, 179 (0.6%) AIAN, and 150 (0.5%) PI. Asian pts had the best OS (HR 0.82, 95% CI 0.72-0.94), while Black pts had the worst (HR 1.21 95% CI 1.13-1.29) when compared with White pts. Differences between other ethnicities were not statistically significant for OS. Black pts had significantly worse BCSS (HR 1.20, 95% CI 1.12 -1.29); no other ethnicity had statistically significant differences compared to Whites. Comparing Asian with Black pts in multivariate analysis the HR was 0.68 (95% CI 0.59 – 0.79) for OS and 0.71 (95% 0.61 – 0.84) for BCSS. Older age, advanced stage, male sex, and lack of chemotherapy, radiation or surgery were also found to be statistically significant variables in multivariate analysis. Conclusions In this large population study, we found Asian pts had significantly better OS and Black pts had significantly worse OS and BCSS. These findings confirm the clinical observation and warrant closer molecular analysis of TNBC phenotypes based on patient's ethnicity. Findings may offer insight into the biology of TNBC and lead to development of innovative treatment options. Citation Format: Rushton-Marovac M, Zhang T, Song X. Triple negative breast cancer: Does ethnicity impact survival? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-30.

Abstract P4-10-18: Patterns of failure in a predominately black, inner city cohort of triple negative breast cancer patients at a single institution

Abstract Introduction: Triple negative breast cancer (TNBC) accounts for 12-17% of breast cancer (BC) in the US, but behaves much more aggressively. It occurs more commonly in younger, black women and death within two years of diagnosis is more common in this subset of BC compared to hormone receptor positive BC. At the University of Maryland Greenebaum Comprehensive Cancer Center, we see a higher proportion of TNBC and present our comprehensive evaluation of the patterns of failure in women with TNBC treated at our urban breast center. Materials/Methods: A retrospective review of TNBC patients treated from 2005-2017 identified 198 patients with Stage I (33%), Stage II (47%), Stage III (16%) and Stage IV (4%) TNBC. The patients were all female, median age of 54 years (range 22-86 years), 64% black, 40% married, 7% BRCA mutated, and 3% HIV positive. Tumor characteristics revealed 93% infiltrating ductal carcinoma, 68% grade 3, and 18% with lymphovascular space invasion. Self-palpation of the lesion occurred in 76% of women, and the lesion was in the upper outer quadrant 62% of the time. Thirty percent of pts had neoadjuvant and 67% adjuvant chemotherapy. Ninety-eight percent of pts underwent surgical resection, 55% had lumpectomy and 61% sentinel lymph node biopsy. Adjuvant radiation was given in 56% of patients with a median dose of 60 Gy (range 16-70 Gy). Chi-square testing was used to compare variables, while logistic regression with Kaplan-Meier estimate was used to calculate overall survival (OS) and freedom from recurrence (FFR). Results: With a median follow up of 45 months, 33 (17%) documented failures occurred. At time of first documented failure, 30% were local (L), 6% regional (R), 22% distant (D), 6% combination of L/R, 12% combination of L/R/D, 9% L/D, and 15% R/D, with a total combined failure pattern in 42% of pts. There was no significant difference in failure patterns between white and black pts (p=0.50, Table 1). The 2 and 5 year OS was 88% and 80%, respectively. Median survival was not reached in our cohort. The 2 and 5-year FFR was 90% and 84%, respectively with a median time to any failure of 16 months after initiation of therapy and median OS of 29 months for these pts. Conclusion: Our work shows that with modern BC therapies treatment outcomes for pts with TNBC are improved and 84% are free of disease at 5 yrs after the initial diagnosis. The patterns of failure in TNBC are complex, did not vary by race, and showed the largest proportion of our pts (58%) failing in distant and locoregional sites simultaneously, while an additional 30% of pts fail locally only. These failure patterns did not differ significantly based on race. Future efforts will identify pts most at risk for treatment failure for consideration of treatment intensification, as salvage options are limited when treatment failure occurs. Comparison of Failure Patterns Between White and Black PatientsFailure PatternWhite (n,%)Black (n,%)p-valueLocal only2 (22.5)8 (33) Regional only1 (11)1 (4) Distant only2 (22.5)5 (21)p=0.496Local and Regional0 (0)2 (8) Local and Distant0 (0)3 (13) Regional and Distant3 (33)2 (8) Local, Regional and Distant1 (11)3 (13) Citation Format: Rice SR, Cherng H-R, Hamza M, Murali S, Rosenblatt P, Bellavance E, Cheston S, Amin N, Nichols EM. Patterns of failure in a predominately black, inner city cohort of triple negative breast cancer patients at a single institution [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-18.

Interaction of race and pathology for neuroendocrine tumors: Epidemiology, natural history, or racial disparity?

376 Background: The prognostic value of pathologic variables is not consistent for gastroenteropancreatic neuroendocrine tumors (GEP-NETs). We previously demonstrated a limited prognostic role of lymph node (LN) positivity in small bowel NETs (SBNET) compared to pancreatic NETs (panNET). Although minority race is often associated with worse cancer outcomes, the interaction of race with pathologic and oncologic outcomes of pts with GEP-NETS is not known. Methods: Pts with GEP-NETs who underwent curative intent resection at eight institutions of the US NET Study Group from 2000-16 were included. Given few pts of other races, only Black and White race pts were analyzed. Results: Of 2,182 pts, 1,143 met inclusion criteria. Median age was 58 yrs, median follow up was 3 yrs, 48% were male, 14% (n = 157) were Black, and 86% (n = 986) were White. Black pts were more likely uninsured (7 vs 2%, p = 0.005), had symptomatic bleeding (13 vs 7%, p = 0.006), required emergency surgery (7 vs 3%, p = 0.003), and had LN positive disease (47 vs 36%, p = 0.016). Despite this, Black pts had improved 5 yr recurrence free survival (RFS) compared to White pts (90 vs 80%, p = 0.008). The quality of care received was comparable between both groups, demonstrated by similar LN yield at surgery, neg margin resection rate, post-op complications, and need for reoperation or readmission (all p > 0.05). Black pts were more likely to have SBNET (22 vs 13%) and less likely to have panNET (43 vs 68%) compared to White pts (p < 0.001). Consistent with prior data, pts with LN pos panNET had decreased 5yr RFS (67 vs 83%, p = 0.001); however, for SBNET, LN involvement was not prognostic (77 vs 96%, p = 0.08). The prognostic value of LN pos disease was similar between Black and White pts in both SBNET (p = 0.34) and panNET (p = 0.95). Conclusions: Black pts with GEP-NET present with more advanced disease, including higher LN positivity. Despite this, Black pts have improved RFS compared to White pts. Although there may be delays in seeking or reaching care, Black pts received similar quality of care compared to White pts. The improved RFS seen in Black pts may be attributed to the epidemiologic differences in the site of presentation of GEP-NETs and variable prognostic value of LN pos disease.

MP84-16 FACTORS ASSOCIATED WITH EARLY MORTALITY AND SURVIVAL OUTCOMES AMONG PATIENTS WITH TESTICULAR NEOPLASMS: A POPULATION-LEVEL ANALYSIS

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease II1 Apr 2018MP84-16 FACTORS ASSOCIATED WITH EARLY MORTALITY AND SURVIVAL OUTCOMES AMONG PATIENTS WITH TESTICULAR NEOPLASMS: A POPULATION-LEVEL ANALYSIS Zachary Klaassen, Thenappan Chandrasekar, Hanan Goldberg, Karan Arora, Rashid K. Sayyid, J. Charles Victor, Neil E. Fleshner, Robert J. Hamilton, and Girish S. Kulkarni Zachary KlaassenZachary Klaassen More articles by this author , Thenappan ChandrasekarThenappan Chandrasekar More articles by this author , Hanan GoldbergHanan Goldberg More articles by this author , Karan AroraKaran Arora More articles by this author , Rashid K. SayyidRashid K. Sayyid More articles by this author , J. Charles VictorJ. Charles Victor More articles by this author , Neil E. FleshnerNeil E. Fleshner More articles by this author , Robert J. HamiltonRobert J. Hamilton More articles by this author , and Girish S. KulkarniGirish S. Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2784AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite remarkable survival outcomes for testicular cancer (TC) patients (pts) in the post-chemotherapy (chemo) era, there is a paucity of data assessing factors associated with ′early′ mortality of any cause after diagnosis. The objectives of this study were to assess predictors of early mortality and factors associated with overall survival (OS) among pts with TC. METHODS Pts with a testicular neoplasm were identified in the SEER database from 1973-2011 (n=42,004). All pts had at »2 years of follow-up. The primary outcome was mortality within two years of TC diagnosis. A multivariable log binomial regression model was used to generate prevalence ratios (PR) for predictors of early mortality (« 2 years). A multivariable Cox-proportional hazards model was used to generated hazard ratios (HR) for identifying factors associated with OS. RESULTS The mean age was 35.4 (SD 12.4) years and 92% of pts were white. More than 95% of pts had germ cell tumors (42% NSGCT, 54% seminoma), 35% had radiation (rads), and 30% had chemo. 6% of pts had cancer specific death and 8% suffered other-cause mortality. Compared to white pts, black men had a higher likelihood of early mortality (PR 1.96; p=0.02). Men with NSGCT, lymphoma and variant histology were 1.59, 4.01, and 6.36 times, respectively, more likely to suffer early mortality compared to pts with seminoma (all p<0.001). Protective factors for early mortality included: marriage (PR 0.72, p<0.001), later year of diagnosis (vs 1973-1992: 2003-2011 PR 0.31, p<0.001) and surgical management (vs none: radical orchiectomy (RO) with RPLND PR 0.27, p=0.001). The model AUC was 0.875. Predictors for OS were distant disease (HR 4.49, 95%CI 4.07-4.95), testicular lymphoma (HR 2.32, 95%CI 1.77-3.05), and variant histology (HR 2.18, 95%CI 1.75-2.72). Black men also had inferior OS compared to white men (HR 1.55, 95%CI 1.29-1.88). Factors associated with improved OS included being married (HR 0.59, 95%CI 0.55-0.64) and surgical management (RO with RPLND HR 0.42, 95%CI 0.31-0.59). Rads and chemo as time-varying covariates were not significant in the final model (HR 1.48, 95%CI 0.89-2.47; HR 0.92, 95%CI 0.55-1.52). CONCLUSIONS Although pts with TC have excellent long-term survival, there are a subset of patients that suffer mortality within 2 years of diagnosis. Unmarried and black pts are more likely to suffer early mortality, raising the question of appropriate access to initial and follow-up care. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1131 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Zachary Klaassen More articles by this author Thenappan Chandrasekar More articles by this author Hanan Goldberg More articles by this author Karan Arora More articles by this author Rashid K. Sayyid More articles by this author J. Charles Victor More articles by this author Neil E. Fleshner More articles by this author Robert J. Hamilton More articles by this author Girish S. Kulkarni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...