Mortality In Cancer Patients Research Articles

Lower Thyroid Cancer Mortality in Patients Detected by Screening: A Meta-Analysis.

Thyroid cancer screening has contributed to the skyrocketing prevalence of thyroid cancer. However, the true benefit of thyroid cancer screening is not fully understood. This study aimed to evaluate the impact of screening on the clinical outcomes of thyroid cancer by comparing incidental thyroid cancer (ITC) with non-incidental thyroid cancer (NITC) through a meta-analysis. PubMed and Embase were searched from inception to September 2022. We estimated and compared the prevalence of high-risk features (aggressive histology of thyroid cancer, extrathyroidal extension, metastasis to regional lymph nodes or distant organs, and advanced tumor-node-metastasis [TNM] stage), thyroid cancer-specific death, and recurrence in the ITC and NITC groups. We also calculated pooled risks and 95% confidence intervals (CIs) of the outcomes derived from these two groups. From 1,078 studies screened, 14 were included. In comparison to NITC, the ITC group had a lower incidence of aggressive histology (odds ratio [OR], 0.46; 95% CI, 0.31 to 0.7), smaller tumors (mean difference, -7.9 mm; 95% CI, -10.2 to -5.6), lymph node metastasis (OR, 0.64; 95% CI, 0.48 to 0.86), and distant metastasis (OR, 0.42; 95% CI, 0.23 to 0.77). The risks of recurrence and thyroid cancer-specific mortality were also lower in the ITC group (OR, 0.42; 95% CI, 0.25 to 0.71 and OR, 0.46; 95% CI, 0.28 to 0.74) than in the NITC group. Our findings provide important evidence of a survival benefit from the early detection of thyroid cancer compared to symptomatic thyroid cancer.

Estrogen therapy after breast cancer diagnosis and breast cancer mortality risk

PurposeThe safety of local estrogen therapy in patients on adjuvant endocrine treatment is questioned, but evidence on the issue is scarce. This nested case–control registry-based study aimed to investigate whether estrogen therapy affects breast cancer mortality risk in women on adjuvant endocrine treatment.MethodsIn a cohort of 15,198 women diagnosed with early hormone receptor (HR)-positive breast cancer and adjuvant endocrine treatment, 1262 women died due to breast cancer and were identified as cases. Each case was matched with 10 controls. Exposure to estrogen therapy with concurrent use of aromatase inhibitors (AIs), tamoxifen, or both sequentially, was compared between cases and controls.ResultsNo statistically significant difference in breast cancer mortality risk was seen in patients with exposure to estrogen therapy concurrent to endocrine treatment, neither in short-term or in long-term estrogen therapy use.ConclusionsThe study strengthens current evidence on local estrogen therapy use in breast cancer survivors, showing no increased risk for breast cancer mortality in patients on adjuvant AIs or tamoxifen.

Hallmarks of Cancer Affected by the MIF Cytokine Family.

New diagnostic methods and treatments have significantly decreased the mortality rates of cancer patients, but further improvements are warranted based on the identification of novel tumor-promoting molecules that can serve as therapeutic targets. The macrophage migration inhibitory factor (MIF) family of cytokines, comprising MIF and DDT (also known as MIF2), are overexpressed in almost all cancer types, and their high expressions are related to a worse prognosis for the patients. MIF is involved in 9 of the 10 hallmarks of cancer, and its inhibition by antibodies, nanobodies, or small synthetic molecules has shown promising results. Even though DDT is also proposed to be involved in several of the hallmarks of cancer, the available information about its pro-tumoral role and mechanism of action is more limited. Here, we provide an overview of the involvement of both MIF and DDT in cancer, and we propose that blocking both cytokines is needed to obtain the maximum anti-tumor response.

Characteristics and 6-Month Mortality of Medical Oncology Patients With Incidental and Symptomatic Pulmonary Embolism: A Single-Institutional Retrospective Longitudinal Analysis.

This study aimed to identify clinical characteristics of cancer patients with incidental pulmonary embolism (IPE) and assess the variables associated with 30-day mortality in cancer patients with PE including symptomatic pulmonary embolism (SPE) and IPE. 6-Month mortality rate in cancer patients with SPE and IPE were also compared. We retrospectively analyzed electronic medical records of cancer patients with newly diagnosed PE between January 2016 and June 2021. We compared clinical and radiological characteristics in cancer patients with IPE and SPE and identified variables associated with the overall 30-day mortality on multivariate analysis. All patients were followed up for 6 months and survival analysis was performed by use of Kaplan-Meier. Five hundred and nine eligible cancer patients with pulmonary embolism were identified during the study period. IPE is associated with lower BMI, colorectal and pancreas cancers, stage III/IV of cancer, recent antiangiogenic therapy, central venous catheter (CVC) and chronic cardiac or respiratory disease compared to SPE. The factors associated with 30-day mortality included poor performance status, lung/pleura or upper gastrointestinal cancers, stage III/IV of cancer, previous VTE, oxygen saturation < 95%, lactic acid > 2 mmol/l and bilateral PE. The overall survival in patients with IPE at 6-month follow-up was similar to those diagnosed with SPE. The present study has allowed the identification of factors associated with 30-day mortality in cancer patients with IPE and SPE. We also found similar mortality rate in cancer patients with IPE compared with patients with SPE at 6-month follow-up.

In-Hospital Mortality and Morbidity in Cancer Patients with COVID-19: A Nationwide Analysis from the United States.

Background: Coronavirus disease 2019 (COVID-19) caused significant mortality and mortality worldwide. There is limited information describing the outcomes of COVID-19 in cancer patients. Methods: We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) 2020 database to collect information on cancer patients hospitalized for COVID-19 in the United States. Using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system, adult (≥18 years) patients with COVID-19 were identified. Adjusted analyses were performed to assess for mortality, morbidity, and resource utilization among cancer patients. Results: A total of 1,050,045 patients were included. Of them, 27,760 had underlying cancer. Cancer patients were older and had more comorbidities. The all-cause in-hospital mortality rate in cancer patients was 17.58% vs. 11% in non-cancer. After adjusted logistic regression, cancer patients had a 21% increase in the odds of all-cause in-hospital mortality compared with those without cancer (adjusted odds ratio (aOR) 1.21, 95%CI 1.12−1.31, p-value < 0.001). Additionally, an increased odds in acute respiratory failure rate was found (aOR 1.14, 95%CI 1.06−1.22, p-value < 0.001). However, no significant differences were found in the odds of septic shock, acute respiratory distress syndrome, and mechanical ventilation between the two groups. Additionally, no significant differences in the mean length of hospital stay and the total hospitalization charges between cancer and non-cancer patients. Conclusion: Cancer patients hospitalized for COVID-19 had increased odds of all-cause in hospital mortality and acute respiratory failure compared with non-cancer patients.

Cardio-Protection Against Cancer Treatment-Related Cardiac Dysfunction: Who is at Risk?

Long-term survival of cancer patients has improved, and the sequelae of treatment have become more evident. Mortality rates of cancer patients, adjusted for age, have decreased globally, with a reduction by 17% from 1990 to 2019. The prevention of left ventricular dysfunction secondary to cancer treatment is still a medical challenge. Drug-induced cardiotoxicity is the main limiting factor for the administration of higher doses of anthracyclines. Addressing the anthracycline-induced cardiotoxicity is particularly important for pediatric cancer survivors, as it remains [...]

Abstract 11852: Impact of Heart Failure on New Cancer Diagnosis and Cancer Mortality in Patients With Ischemic Heart Disease Who Underwent Percutaneous Coronary Intervention

Background: Recently, it has been reported that heart failure may be associated with high risk for development of cancer. However, this theory is not definitive and more epidemiological data are needed. Here we investigated the impact of heart failure on the incidence of new cancer diagnosis and cancer mortality in patients with ischemic heart disease who underwent percutaneous coronary intervention (PCI). Methods and Results: Consecutive 1787 patients with ischemic heart disease who underwent PCI were enrolled. Patients were divided into two groups according to the presence or absence of heart failure, and followed up for incidence of new cancer diagnosis and mortality due to cancer. Patients with heart failure (n = 434) were older (73.4 vs. 68.0 years, P &amp;lt; 0.001) and had higher prevalence of comorbidities such as anemia (63.2 vs. 40.2%, P &amp;lt; 0.001), chronic kidney disease (61.4 vs. 40.3%, P &amp;lt; 0.001), atrial fibrillation (20.7 vs. 14.0%, P = 0.001) and stroke (21.8 vs. 15.8%, P = 0.004) than those without heart failure (n = 1353). The percentage of smokers did not differ between two groups (P = 0.374). During follow up period (mean of 1528 days), there were 142 new cancer diagnoses and 60 cancer deaths. Of 142 new cancers, gastrointestinal cancer was the leading site (39.4%), followed by lung cancer (14.1%), prostate cancer (11.3%), liver or biliary tract cancer (10.6%), hematologic cancer (9.9%) and others. The incidence of new cancer diagnosis and cancer mortality were significantly higher in patients with heart failure than in those without heart failure (P &amp;lt; 0.001 and P = 0.001, respectively). In the multivariate analyses after adjusting for confounding factors including smoking, heart failure was an independent predictor of new cancer diagnosis and cancer death (hazard ratio 2.22, P &amp;lt; 0.001 and hazard ratio 1.78, P = 0.036, respectively). Conclusion: Heart failure was associated with incidence of new cancer and cancer death in patient with ischemic heart disease.

PMON230 Pancreatic Exocrine Cells are Altered during the Progression of Ovarian Cancer-Driven Cachexia in Female Mice

Abstract Cancer-associated cachexia (CAC) is a progressive debilitating syndrome that frequently complicates metabolic function in body vital organs and subsequently causes a high mortality rate in cancer patients. However, the underlying mechanisms and the functional consequences of organs dysfunction during CAC are not fully elucidated. Recently, we have developed a preclinical model characterized by oocyte-specific knockin for constitutively active Pi3k (Pik3ca*) which induces ovarian granulosa cell tumor (GCT) and mimics the stagewise progression of CAC in humans. Here, we aim to characterize the pathophysiological effect of cachexia on pancreatic dysfunction and investigate the potential role of the pancreas in the development and complication of cachexia in transgenic female mice with ovarian cancer. Notably, we found that cachectic mice showed a drastic loss in the pancreatic volume (PV) before death. Histological and morphometric assays revealed that exocrine pancreatic acinar atrophy (PAA) is drastic in the pancreas of cachectic PIK3CA* mice. The pancreas appeared to have an increased number of pancreatic stellate-shaped cells between acini. No significant changes were observed in the morphology of endocrine islets. Immunohistochemical assay confirmed a high level of TNF-a in atrophied pancreatic tissue and decreased intensity of pancreatic amylase in the cytoplasm of atrophied pancreatic acinar cells. Additionally, moderate fibrosis was also observed in the wall of pancreatic ducts and blood vessels, but not between the pancreatic acini. Masson trichrome and histochemical staining confirmed expression of extracellular matrix proteins including collagen I, II, IV, and a -smooth muscle actin in ducts and vessel walls. Overall, our preliminary findings in this novel CAC mouse model strongly suggest potential signs of exhausted exocrine pancreatic cells during the progression of ovarian cancer-driven cachexia. This mouse line could be an ideal preclinical model to aid in clarifying molecular mediators of pancreatic pathophysiology and metabolic dysfunction during CAC. Keywords: Ovarian cancer-driven cachexia, pancreas, atrophy, amylase. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Comparing the COVID-19 Mortality Rate in Cancer Patients with and Without a History of Chemotherapy

Background: Patients with cancer are potentially vulnerable to COVID-19 infection due to the immune-compromised state of cancer or its treatment complications. Objectives: This study compared the COVID-19 mortality rate in cancer patients with and without a history of chemotherapy. Methods: This registry-based cohort study launched from March 2020 to March 2021 contains 2350 records in which 64 COVID-19 patients with cancer were included, of which 27 patients underwent the chemotherapy plan within eight weeks before confirmed COVID-19. In addition, age and sex were matched in patients without a history of cancer as a control group. Two groups of cancer patients with and without a history of chemotherapy compared to the control group using cox proportional hazard regression models in Stata.10 software. Results: Patients with cancer had a higher hazard for in-hospital mortality from COVID-19 infection (adjusted HR; 2.27, 95% CI: 1.25 - 4.13, P = 0.007) after adjusting for age, sex, body mass index (BMI), and co-morbidities. Our result showed no significant association between chemotherapy and control groups (adjusted HR; 1.65, 95% CI: 0.60 - 4.56, P = 0.33). Conclusions: Patients with cancer faced a risk of mortality from COVID-19 two times higher than those without cancer. However, chemotherapy did not increase the mortality following COVID-19 infection.

Electrostatic potential difference between tumor and paratumor regulates cancer stem cell behavior and prognose tumor spread.

Tumor spread is responsible for most deaths related to cancer. Increasing the accuracy of cancer prognosis is critical to reducing the high mortality rates in cancer patients. Here, we report that the electrostatic potential difference (EPD) between tumor and its paratumor tissue is a prognostic marker for tumor spread. This finding is concluded from the patient-specific EPD values and clinical observation. The electrostatic potential values were measured on tissue cryosections from 51 patients using Kelvin probe force microscopy (KPFM). A total of ~44% (15/34) patients of Vtumor-paratumor > 0 were featured with tumor spread, whereas only ~18% (2/11) patients of Vtumor-paratumor < 0 had tumor spread. Next, we found the increased enrichment of cancer stem cells in paratumors with lower electrostatic potentials using immunofluorescence imaging, which suggested the attribution of tumor spread to the galvanotaxis of cancer stem cells (CSCs) toward lower potential. The findings were finally validated in breast and lung spheroid models composed of differentiated cancer cells and cancer stem cells at the ratio of 1:1 and embedded in Matrigel dopped with negative-, neutral- and positive-charged polymers and CSCs prefer to spread out of spheroids to lower electrostatic potential sites. This work may inspire the development of diagnostic and prognostic strategies targeting at tissue EPDs and CSCs for tumor therapy.

A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs.

OBJECTIVES:The reported mortality rates of cancer patients admitted to ICUs vary widely. In addition, there are no studies that examined the outcomes of critically ill cancer patients based on the geographical regions. Therefore, we aimed to evaluate the mortality rates among critically ill cancer patients and provide a comparison based on geography.DATA SOURCES:PubMed, EMBASE, and Web of Science.STUDY SELECTION:We included observational studies evaluating adult patients with cancer treated in ICUs. We excluded non-English studies, those with greater than 30% hematopoietic stem cell transplant or postsurgical patients, and those that evaluated a specific type of critical illness, stage of malignancy, or age group.DATA EXTRACTION:Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. Studies were classified based on the continent in which they were conducted. Primary outcomes were ICU and hospital mortality. We pooled effect sizes by geographical region.DATA SYNTHESIS:Forty-six studies were included (n = 110,366). The overall quality of studies was moderate. Most of the published literature was from Europe (n = 22), followed by North America (n = 9), Asia (n = 8), South America (n = 5), and Oceania (n = 2). Pooled ICU mortality rate was 38% (95% CI, 33–43%); the lowest mortality rate was in Oceania (26%; 95% CI, 22–30%) and highest in Asia (51%; 95% CI, 44–57%). Pooled hospital mortality rate was 45% (95% CI, 41–49%), with the lowest in North America (37%; 95% CI, 31–43%) and highest in Asia (54%; 95% CI, 37–71%).CONCLUSIONS:More than half of cancer patients admitted to ICUs survived hospitalization. However, there was wide variability in the mortality rates, as well as the number of available studies among geographical regions. This variability suggests an opportunity to improve outcomes worldwide, through optimizing practice and research.

PD-1, PD-L1 and cAMP immunohistochemical expressions are associated with worse oncological outcome in patients with bladder cancer

PurposeIn this study, we aimed to identify prognostic factors of cancer mortality in patients who received radical cystectomy and to identify genomic alterations in a sub-cohort of patients with locally advanced (pT3-4) and/or positive lymph nodes bladder cancer (BC).MethodsWe collected 101 BC samples from 2010 to 2018 who previously received radical cystectomy. Immunohistochemical slides were evaluated for PPAR, cAMP, IMP3, Ki67, CDK4, POU5F1, Cyclin E and MDM2, p65, CD3, CD4, CD8, CD20, CD68, CD163, FOXP3, PD-1 and PD-L1 expression. We calculated a prognostic score (PS) based on the positivity to PD-1, PD-L1 and of cAMP (final score ranging from 0 to 3). DNA of each sample have been used for sequencing by NGS in a sub-cohort of 6 patients with locally advanced (pT3-4) and/or positive lymph nodes BC.ResultsPD-1 + (HR [hazard ratio] 2.59; p = 0.04), PD-L1+ (HR = 6.46; p < 0.01) and cAMP+ (HR 3.04; p = 0.02) were independent predictors of cancer-specific mortality (CSM). Increase of PS (score = 0 as reference) was associated with CSM, 0.81 (p = 0.80), 4.72 (p = 0.01) and 10.51 (p < 0.0) for PS 1, 2 and 3, respectively. ERBB2 was the gene most frequently mutated.ConclusionBC exhibited heterogenous protein expression and variable genomic features. Identification of expression of PD-1, PD-L1 and cAMP could help in predicting oncological outcomes.

The effect of malignancy on prognosis in ICU patients with COVID-19

Background: It is known that COVID-19 has a worse and poorer progression, which often might lead to death in those with comorbidities. Multiple studies have recently examined the clinical course of cancer patients with COVID-19 and new guidelines have been developed to manage this group of patients. This study aimed to evaluate the clinical course and mortality rate of cancer patients admitted to the intensive care unit (ICU) for COVID-19.&#x0D; Material and Method: The demographic characteristics, detailed medical history and laboratory findings of 140 patients with malignancy, who were treated in the COVID-19 Intensive Care Unit of Ankara City Hospital, were evaluated retrospectively. Gender, age, comorbidity, length of stay in the ICU, mortality rates, length of stay on a mechanical ventilator, cytokine storm scores, ferritin, interleukin 6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH), lymphocyte count and treatment options were compared. The patients were divided into two groups: solid and hematological malignancies.&#x0D; Results: One hundred eight of 140 patients were diagnosed with solid organ malignancy and 32 with hematological malignancy. The most common comorbidity was found to be hypertension. A total of 94 patients died during their ICU stay. While the most common solid organ malignancies were malignancies of the lower gastrointestinal tract and lung cancers, multiple myeloma (MM) was the most common hematological malignancy. There was no significant difference between the two groups in terms of cytokine storm scores , duration of hospitalization and mechanical ventilation. Levels of Ferritin and LDH were found to be significantly higher in patients with hematological malignancies, while D-dimer was significantly higher in solid organ malignancies. A high level of CRP and IL-6 was associated with COVID-19 mortality. Lymphopenia was associated with increased mortality in patients with solid organ malignancy. However, there was no difference in mortality rate among both groups. Although the mortality was significantly higher in the patient group receiving chemotherapy, there were no significant differences in mortality for the duration of receiving chemotherapy.&#x0D; Conclusion: The results of this study suggested that cancer was associated with severe clinical outcomes and a 67% mortality rate among patients with COVID-19. However, despite the changes in patients’ demographic, clinical and laboratory characteristics, no difference in mortality rate was detected in patients with hematological and solid organ malignancies due to COVID-19 infection.

The impacts of exosomes on bone metastatic progression and their potential clinical utility

Bone is one of the most common sites of cancer metastasis. Once cancer metastasizes to the bone, the mortality rate of cancer patients dramatically increases. Although the exact mechanisms for this observation remain elusive, recent studies have revealed that the complex crosstalk between bone marrow microenvironment and bone metastatic cancer cells is responsible for the induction of treatment resistance. Consequently, bone metastasis is currently considered incurable. Bone metastasis not only impairs the patients' survival, but also negatively affects their quality of life by causing painful complications. It has recently been implicated the regulatory role of exosomes in cancer development and/or progression as a delivery biomaterial between cancer cells and tumor microenvironment. However, little is known as to how exosomes contribute to the progression of bone metastasis by impaction on the crosstalk between bone metastatic cancer cells and bone marrow microenvironment. Here, we highlighted the emerging roles of cancer-derived exosomes in (i) the process of dissemination and bone colonization of bone metastatic cancer cells, (ii) the enhancement of crosstalk between bone marrow microenvironment and bone metastatic cancer cells, (iii) the development of its resultant painful complications, and (iv) the clinical applications of exosomes in the bone metastatic setting.

Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy.

Whether continuous renal replacement therapy (CRRT) should be applied to critically ill patients with both acute kidney injury (AKI) and cancer remains controversial because of poor expected outcomes. The present study determined prognostic factors for all-cause in-hospital mortality in patients with AKI and cancer undergoing CRRT. We included 471 patients with AKI and cancer who underwent CRRT at the intensive care unit of a Korean tertiary hospital from 2013 to 2020, and classified them by malignancy type. The primary outcomes were 28-day all-cause mortality rate and prognostic factors for in-hospital mortality. The secondary outcome was renal replacement therapy (RRT) dependency at hospital discharge. The 28-day mortality rates were 58.8% and 82% in the solid and hematologic malignancy groups, respectively. Body mass index (BMI), presence of oliguria, Sequential Organ Failure Assessment (SOFA) score, and albumin level were common predictors of 28-day mortality in the solid and hematologic malignancy groups. A high heart rate and the presence of severe acidosis were prognostic factors only in the solid malignancy group. Among the survivors, the proportion with RRT dependency was 25.0% and 33.3% in the solid and hematologic malignancy groups, respectively. The 28-day mortality rate of cancer patients with AKI undergoing CRRT was high in both the solid and hematologic malignancy groups. BMI, presence of oliguria, SOFA score, and albumin level were common predictors of 28-day mortality in the solid and hematologic malignancy groups, but a high heart rate and severe acidosis were prognostic factors only in the solid malignancy group.

Low apolipoprotein A1 was associated with increased risk of cancer mortality in patients following percutaneous coronary intervention: A 10-year follow-up study.

Previous studies showed that elevated apolipoprotein A1 (ApoA1) and high‐density lipoprotein cholesterol (HDL‐C) predicted reduced risk of cardiovascular‐related (CV) mortality in patients following percutaneous coronary intervention (PCI). Nevertheless, as the association between ApoA1 and cancer mortality in this population has been rarely addressed, our study aimed to evaluate prognostic impact of ApoA1 on multiple types of cancer mortality after PCI. This is a retrospective analysis of a single‐center prospective registry database of patients who underwent PCI between 2000 and 2018. The present study enrolled 3835 patients whose data of serum ApoA1 were available and they were divided into three groups according to the tertiles of the preprocedural level of ApoA1. The outcome measures were total, gastrointestinal, and lung cancer mortalities. The median and range of the follow‐up period between the index PCI and latest follow‐up were 5.9 and 0‐17.8 years, respectively. Consequently, Kaplan‐Meier analyses showed significantly higher rates of the cumulative incidences of total, gastrointestinal, and lung cancer mortality in the lowest ApoA1 tertile group compared to those in the highest. In contrast, there were no significant differences in all types of cancer mortality rates in the groups divided by the tertiles of HDL‐C. Multivariable Cox proportional hazard regression analysis adjusted by cancer‐related prognostic factors, such as smoking status, identified the elevated ApoA1 as an independent predictor of decreased risk of total and gastrointestinal cancer mortalities. Our study demonstrates the prognostic implication of preprocedural ApoA1 for predicting future risk of cancer mortality in patients undergoing PCI.

Mortality prediction models after radical cystectomy for bladder tumour: A systematic review and critical appraisal.

To identify risk-predictive models for bladder-specific cancer mortality in patients undergoing radical cystectomy and assess their clinical utility and risk of bias. Systematic review (CRD42021224626:PROSPERO) in Medline and EMBASE (from their creation until 31/10/2021) was screened to include articles focused on the development and internal validation of a predictive model of specific cancer mortality in patients undergoing radical cystectomy. CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) and Prediction model Risk Of Bias ASsessment Tool (PROBAST) were applied. Nineteen observational studies were included. The main predictors were sociodemographic variables, such as age (18 studies, 94.7%) and sex (17, 89.5% studies), tumour characteristics (TNM stage (18 studies, 94.7%), histological subtype/grade (15 studies, 78.9%), lymphovascular invasion (10 studies, 52.6%) and treatment with chemotherapy (13 studies, 68.4%). C-index values were presented in 14 studies. The overall risk of bias assessed using PROBAST led to 100% of studies being classified as high risk (the analysis domain was rated to be at high risk of bias in all the studies), and 52.6% showed low applicability. Only 5 studies (26.3%) included an external validation and 2 (10.5%) included a prospective study design. Using clinical predictors to assess the risk of bladder-specific cancer mortality is a feasibility alternative. However, the studies showed a high risk of bias and their applicability is uncertain. Studies should improve the conducting and reporting, and subsequent external validation studies should be developed.

Outcome of cancer patients affected by COVID-19 in different settings.

e18709 Background: The mortality rate of cancer patients diagnosed with COVID-19 infection has reached 25%. The time from symptom onset to admission to the intensive care unit (ICU) was on average 10 days, with approximately 26% of patients requiring ICU admission. A higher mortality attributed to COVID-19 was seen in older patients, patients with certain cancer types, and patients with a higher Charslon comorbidity score. Moreover, male sex and leukopenia at diagnosis were associated with an increased risk of worse clinical outcomes. Furthermore, a study done at Memorial Sloan Kettering showed that patients with hematological malignancies had a worse prognosis than those with solid tumors. Our aim is to identify the predictive factors for ICU admission in the setting of positive COVID-19 infection in cancer patients. Differences in prognosis were compared between cancer and non-cancer patients admitted to the ICU due to COVID-19 infection. We also compared the overall outcome between patients with solid cancers and hematologic malignancies. Methods: This is a single institution retrospective study based on chart review analysis conducted at the American University of Beirut Medical Center (AUBMC). 248 patients were diagnosed with COVID-19 from 1 January 2020 to 31 December 2021. The patient groups were (1) all cancer patients admitted to the COVID unit, (2) all cancer patients admitted to ICU, and (3) all other patients without cancer admitted to the ICU. The main outcomes were ICU admission and mortality. Results: 173 cancer patients were admitted to our institution for the management of COVID-19 with a mean age of 63 years. 52 patients (30%) required ICU admission and 50 patients (29%) died during hospital stay or 1 month following discharge. The time from symptom onset to ICU admission and death were 12.8 and 35 days, respectively. Patients admitted to the ICU were more likely to have anemia (Hb &lt; 8 g/dL) and thrombocytopenia (&lt; 50,000/mm3) on admission (p = 0.001). Age, male sex and history of smoking, diabetes or cardiopulmonary diseases were not associated with greater risk of ICU admission or death. Among cancer patients, those with uncontrolled disease at the onset of COVID-19 had greater risk of death from COVID-19 (p = 0.001). Cancer type, number of lines of treatment, history of radiation to the chest, recent cytotoxic therapy, and neutropenia were not associated with ICU admission or death from COVID-19. There was no statistical significance in mortality or disease progression between patients with solid or hematologic malignancies. Conclusions: Our data reaffirms previously reported findings of high mortality in cancer patients who contract COVID-19. In particular, patients with anemia, thrombocytopenia, and uncontrolled disease at diagnosis had unfavorable outcomes. Contrary to the literature, age, male sex, cancer type, and neutropenia were not predictive factors for mortality in cancer patients in the setting of COVID-19 infections.

Trends in ethnic-specific colorectal cancer mortality in patients with and without diabetes in the United States: A CDC database population-based study 2011-2019.

3545 Background: Colorectal cancer (CRC) is the third most frequent type of cancer and the second most lethal in both sexes combined. CRC is strongly associated with both environmental and genetic risk factors. Previous studies reported an increased mortality in CRC patients with diabetes mellitus, however, the interplay between ethnicity and diabetes mellitus was not explored. This study analyzes trends in mortality across ethnic groups and assess the impact of diabetes mellitus. Methods: We queried the Multiple Cause of Death database (International Classification of Diseases, 10th revision) between 2011 and 2019, we identified all patients (Hispanic and non-Hispanic origin) who died of a malignant neoplasm of the colon, rectosigmoid junction, and rectum {Codes C18.x to C20.x reported as the underlying cause of death (UCD)}. Then we identified the same group (UCD) among individuals with diabetes (Insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus) (Codes E10.x to E11.x reported as multiple causes of death). Age-adjusted mortality rates per million persons (PMP) were estimated, standardized to US census data from 2000, and stratified by Hispanic origin. Results: In the general population, a total of 464,058 deaths from CRC were identified, with an overall age- adjusted mortality rate of 137.9 PMP (Hispanic: 109.3, Non-Hispanic: 141.1). Overall, age-adjusted mortality declined by 13% among Hispanic, from 118.1 PMP in 2011 to 102.9 PMP in 2019, and by 8% among non-Hispanic, from 153.3 PMP in 2011 to 141.1 PMP in 2019. In the diabetic population, a total of 8679 CRC death were identified, with an overall age-adjusted mortality rate of 2.6 PMP (Hispanic: 3.6, Non-Hispanic: 2.5). Age-adjusted mortality increased by 32% in Hispanic from 3.1 PMP in 2011 to 4.1 PMP in 2019 and by 13% in non-Hispanic from 2.4 PMP in 2011 to 2.7 PMP in 2019. Conclusions: This study concludes that between 2011 and 2019, the CRC mortality was reduced in both Hispanic and non-Hispanic in the general population. Notably, this tendency was not observed in the diabetic population, where mortality increased, particularly among Hispanic. Additional studies are warranted to determine the causes of the rise among diabetics and strategies for minimizing the disparity between Hispanic and non-Hispanic. [Table: see text]

Barriers and facilitators to lung cancer screening and follow-up

Two randomized trials have shown that lung cancer screening (LCS) with low dose computed tomography (LDCT) reduces lung cancer mortality in patients at high-risk for lung malignancy by identifying early-stage cancers, when local cure and control is achievable. The implementation of LCS in the United States has revealed multiple barriers to preventive cancer care. Rates of LCS are disappointingly low with estimates between 5%-18% of eligible patients screened. Equally concerning, follow-up after baseline screening is far lower than that of clinical trials (44-66% v >90%). To optimize the benefits of LCS, programs must identify and address factors related to LCS participation and follow-up while concurrently recognizing and mitigating barriers. As a relatively new screening test, the most effective processes for LCS are uncertain. Therefore, LCS programs have adopted a wide range of approaches without clearly established best practices to guide them, particularly in rural and resource-limited settings. In this narrative review, we identify barriers and facilitators to LCS, focusing on those studies in non-clinical trial settings - reflecting "real world" challenges. Our goal is to identify effective and scalable LCS practices that will increase LCS participation, improve adherence to follow-up, inform strategies for quality improvement, and support new research approaches.