Charlson-Deyo Comorbidity Index Score Research Articles

A National Cancer Database Analysis of Demographics, Treatment Patterns and Survival Trends of Patients with Plasmablastic Lymphoma in US: Does Ethnicity Predict Enhanced Outcomes?

Background: Plasmablastic lymphoma (PbL) is an exceedingly rare, aggressive non-Hodgkin lymphoma with overlapping features of myeloma and lymphoma diagnosed most commonly in immunocompromised individuals, especially in the setting of human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) infection ( Int J Lab Hematol PMID 36074710). Pathologically, it is characterized by lacking CD20 and PAX5 expression with the presence of CD38, CD138, MUM1/IRF4, Blimp1, and XBP1 expression ( Blood Lymphat Cancer PMID 31360094). There is no established standard of care ( Blood PMID 25636338). Due to the disease's rarity, limited information is available on PbL, especially when focusing on underrepresented minorities. This study aims to describe the demographics, treatment patterns, and survival outcome differences in Hispanic (HI) versus non-Hispanic (NH) patients in the United States with PbL. Methods: Data was analyzed on patients with PbL in the US reported to the NCDB between 2010 and 2019. Sociodemographic and treatment characteristics were compared between ethnic groups. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) between HI and NH populations. Multivariate analysis and propensity score matching were performed with adjustment for age, stage, co-morbidity score, insurance status, type of facility and great circle distance. Results: Between 2010 and 2019, 1624 patients were diagnosed with PbL with 16% identified as HI. HI were diagnosed at a younger median age of 48 years as compared to NH at 58 years. Diagnosis was made predominately in males (78%) with no statistical difference between HI and NH. Most HI and NH were white (92% and 74% in HI and NH, respectively) with increased racial diversity among NH. 17% of all patients identified as black with 1% HI and 21% NH. Regarding income, 32% HI had an income less than $38,000 versus 23% NH; whereas, 31% NH had an income greater than $63,000 versus 20% HI [p=0.017]. 38% HI had a Charlson-Deyo Comorbidity Index score ≥ 2 as compared to 27% NH [p<0.001]. Table 1 provides additional information on demographics. 45% of all patients had stage IV disease at the time of diagnosis. 86% of all patients received treatment with no statistical difference among HI and NH [p=0.246]. 67% of HI were treated at academic/research programs compared to 50% of NH [p=0.004]. The median distance between the patient's residence and treatment facility was 6.9 miles for HI versus 9.8 miles for NH [p=0.001]. The survival probability at 2, 5, and 10 years for HI was 59%, 52%, and 42%, respectively as compared to NH was 47%, 37%, and 31%, respectively. The median survival time (MS) was 9.4 years in HI versus 1.4 years in NH [p <0.001]. Figure 1 shows the Kaplan Meier curve comparing overall survival (OS) between HI versus NH.When adjusted on multivariate analysis, there were no independent variables associated with better or worse OS; moreover, propensity matched analysis showed no MS difference between HI vs NH (1.79 years versus 1.17 years). Conclusion: This hospital-based analysis noted that HI presented with PbL at a younger age than NH; however, HI more frequently had a higher Charlson-Deyo Comorbidity Index score than NH. There was no statistical difference in the stage at diagnosis between HI and NH. Additionally, HI had a lower income and no medical insurance as compared to NH suggesting HI possibly had inferior access to medical resources. Paradoxically, HI had significantly higher OS rates. Further insight into the disease's intrinsic characteristics, as well as biological factors, is needed to gain a better understanding of these poor outcomes.

Treatment at Twilight: An Analysis of Therapy Patterns and Outcomes in Adults 80 Years and Older With Advanced or Metastatic NSCLC

IntroductionThe aim of this study is to evaluate treatment patterns, survival outcomes, and factors influencing systemic treatment decisions in adults 80 years and older with NSCLC. MethodsThis was a retrospective National Cancer Database study evaluating outcomes in adults aged 80 years and older with advanced NSCLC. Patients were analyzed on the basis of systemic therapy, including none, chemotherapy or immunotherapy (IO) alone, and chemotherapy plus IO (chemotherapy + IO). Median overall survival (OS) was compared using Kaplan-Meier methodology. Hazard ratio with 95% confidence interval (CI) was used to assess differences in outcomes, and OR with 95% CI was used to assess factors contributing to systemic therapy provision. ResultsPatients 80 years and older (OR = 1.135 [95% CI: 1.127–1.142], p = 0.000), females (OR = 1.129 [95% CI: 1.085–1.175], p < 0.001), blacks (OR = 1.272 [95% CI: 1.179–1.372], p < 0.001), non-Hispanic whites (OR = 1.210 [95% CI: 1.075–1.362], p = 0.002), and those with increasing Charlson-Deyo Comorbidity Index score (p < 0.001) were less likely to receive systemic therapy. Median OS for no therapy, IO alone, chemotherapy alone, and chemotherapy plus IO was 2.63 (95% CI: 2.57–2.69), 10.68 (95% CI: 9.96–11.39), 12.35 (95% CI: 11.98–12.72), and 14.03 (95% CI: 13.87–14.88) months, respectively. In chemotherapy alone, mean OS was 1.12 months (95% CI: 0.55–1.70) (p < 0.001) longer with multiagent versus single agent. There was no difference between IO plus single agent versus IO plus multiagent chemotherapy (0.67 mo [95% CI −1.18 to 2.54], p = 1.00). ConclusionsAge, comorbidities, patient race, and sex affected systemic therapy provision. Multiagent chemotherapy and chemotherapy plus IO significantly improved survival; with the latter, survival was similar with IO plus single or multiagent chemotherapy.

Systemic Adverse Events Among Patients With Diabetes Treated With Intravitreal Anti–Vascular Endothelial Growth Factor Injections

Anti-vascular endothelial growth factor (VEGF) agents are currently the mainstay of treatment for diabetic retinopathy (DR). Although effective, data on their systemic safety remains inconclusive, particularly in high-risk patient groups. To explore the systemic safety of intravitreal anti-VEGF agents among patients with diabetes. This was a retrospective, longitudinal population-based analysis of the Corporate Data Warehouse, a large-scale database of patients within the US Veteran Health Affairs. All patients 18 years and older with type 2 diabetes who were seen at any Veterans Affairs health care facility in the US between January 1, 2011, and December 31, 2012, were identified. Data were then extracted on incident systemic adverse events among this patient cohort from January 1, 2013, to December 31, 2017. All individuals with diabetes who did and did not receive anti-VEGF injections were included. Patients with a history of prior systemic adverse events and those who received an intravitreal injection between January 1, 2011, and December 31, 2012, were excluded. Data were analyzed from October 2019 to March 2023. Anti-VEGF injection. Proportion of patients with any incident systemic adverse event, acute myocardial infarction, cardiovascular disease, or kidney disease at 1-, 3-, and 5-year follow-up. A total of 1 731 782 patients (mean [SD] age, 63.8 [12.3] years; 1 656 589 [95.7%] male) with type 2 diabetes were included. DR was present in 476 013 (27.5%), and 14 022 (0.8%) received anti-VEGF injections. Of the total number of patients with type 2 diabetes, 321 940 (18.6%) developed systemic adverse events between 2013 and 2017. The 5-year cumulative incidence of any systemic adverse event was 37.0% (5187/14 022) in the injection group vs 18.4% (316 753/1 717 760) in the noninjection group (P < .001). Anti-VEGF injections were independently associated with a higher likelihood of developing any systemic adverse event (odds ratio, 1.8; 95% CI, 1.7-1.9) when controlling for age, race, sex, ethnicity, tobacco use, severity of DR, Deyo-Charlson Comorbidity Index score, mean hemoglobin A1c, total number of injections, and statin use. In this study, intravitreal anti-VEGF injections were independently associated with a higher likelihood of systemic adverse events among patients with diabetes.

EE333 Assessment of Medically-Attended COVID-19 Patient Risk Profiles and Health Care Resource Utilization (HCRU) and Costs in the U.S.

To assess healthcare costs for medically attended COVID-19 (MAC) patients vs. matched controls not presenting with COVID-19, to serve as a baseline for the value of potential therapeutics. This study was a retrospective analysis of administrative claims from multiple payer channels spanning 4/1/2020 to 6/30/2022 (Wuhan strain through omicron clinical variants). Inclusion criteria: 1) ICD-10-CM diagnosis code of COVID-19 (U07.1; index date), 2) 18+ years of age on index, and 3) at least -365/+30 days of continuous enrollment surrounding index. Baseline comorbid conditions were assessed, along with the proportion of patients presenting as high-risk for developing severe COVID-19 per CDC guidelines. HCRU and costs were assessed during the 180-day period following index, and were compared between a subset of MAC and non-MAC controls matched directly on age, gender, and baseline Deyo-Charlson Comorbidity Index (DCI). Descriptive statistics were presented for all outcomes, and bivariate tests of significance were used to assess differences between cohorts. A total of 5,746,432 COVID-19 patients met all study inclusion criteria. Patients with MAC had a mean DCI score of 1.79±2.69, with 26.0% of patients presenting a DCI score ≥ 3, and with 49.7% qualifying as at high-risk for complications per the CDC guidelines. MAC patients also presented significantly greater ER visits (0.62±1.42 vs. 0.24±0.85), hospitalizations (0.28±0.66 vs. 0.09±0.38), and total medical costs ($13,011±$28,382 vs. $5,083±$15,061; ps < 0.001) compared to non-MAC controls. A key feature of COVID-19 is higher costs and HCRU related to complications for patients with comorbidities. This study demonstrated that patients with comorbidities are more likely to experience complications and incur greater costs associated with ER visits, hospitalization, and other medical services. These data serve as a baseline for assessing the value of therapeutics that lower the risk of mild COVID-19 progressing to more severe disease.

Does Chemo-Radiotherapy Improve Survival Outcomes vs. Radiotherapy Alone for High-Grade cT1 Urothelial Carcinoma of the Bladder?

<h3>Purpose/Objective(s)</h3> High-grade cT1 (HGT1) urothelial carcinoma of the bladder (UC) is an aggressive disease with a 4-year cancer-specific mortality of 36% in a large cystectomy series. NCCN guidelines recommend radical cystectomy as the preferred treatment for patients with (1) BCG-naive HGT1 with high-risk features or (2) for HGT1 disease that is BCG unresponsive or intolerant. Definitive concurrent chemoradiotherapy (CRT) has emerged as a promising bladder-sparing alternative treatment for HGT1 with the recent presentation of the single-arm RTOG 0926 trial. However, while there is level 1 evidence that CRT is superior to radiotherapy (RT) alone for muscle-invasive bladder cancer (MIBC), there is limited data on the comparative effectiveness of RT vs. CRT for HGT1 non-MIBC. We hypothesized that CRT would be associated with improved overall survival (OS) vs. RT for patients with HGT1 bladder cancer. <h3>Materials/Methods</h3> Patients with cT1N0M0, high-grade urothelial carcinoma diagnosed between 2004-2017 and treated with transurethral resection of the bladder tumor followed by RT alone or concurrent CRT were identified in the National Cancer Database (NCDB). All patient received a cumulative RT dose ≥ 50 Gy. Patients with a Charlson-Deyo comorbidity index (CDCI) score > 1 or missing key information were excluded. Propensity-weighted multivariable analysis (MVA) using Cox regression modeling was used to compare overall survival (OS) between groups. Covariables included age, race, ethnicity, gender, year of diagnosis, CDCI score, insurance status, educational and socioeconomic metrics, and treatment at an academic center. <h3>Results</h3> A total of 192 patients with HGT1 UC were treated with: (<i>i</i>) RT alone (n = 78) or (<i>ii</i>) CRT (n = 114). Median age was 81 (range: 50-90), and 70% were male. The median tumor size was 4.0 cm (range: 0.4-10.5 cm). The median follow-up time was 46 months (range: 10-168 months). The mean radiation dose was 62.4 Gy (SD: ±5 Gy) and 63.2 Gy (SD: ±12 Gy) in the RT and CRT cohorts, respectively. Propensity-weighted MVA showed that combined modality treatment with CRT was associated with improved OS relative to radiation alone [Hazard Ratio (HR): 0.56, 95% Confidence Interval (95% CI): 0.36-0.89, <i>p</i> = 0.012]. Female gender was associated with worse OS (HR: 1.75, 95% CI 1.16-2.66, p = .008). 4-year OS for the RT alone versus CRT arm was 22% and 38%, respectively. <h3>Conclusion</h3> For patients with HGT1 bladder cancer, concurrent CRT was associated with improved OS compared with radiation alone. These results complement the findings of RTOG 0926 showing the promise of CRT for the treatment of HGT1 disease and support the decision by NRG Oncology investigators to omit RT alone as a treatment arm in the successor trial to RTOG 0926 for HGT1 disease.

Quality of end-of-life care for women with gynecologic malignancies in Ontario, Canada: A 14-year population-based retrospective analysis (132)

Objectives: Tracking population-based quality indicators of supportive and aggressive end of life (EOL) care may provide insight into the success of EOL interventions and health resource utilization. We examined patterns of EOL care in patients with gynecologic cancers over 14 years in Ontario, Canada. Methods: We conducted a population-based, retrospective cohort study of gynecologic cancer decedents in Ontario from 2005 to 2018 using linked administrative healthcare data (Ontario Cancer Registry, Discharge Abstract Database, Ontario Health Insurance Plan physician billing claims, homecare databases). Quality indices included emergency department (ED) use, admissions to hospital or intensive care unit (ICU), chemotherapy in the last 14 days of life, physician or palliative care home visits, and death in hospital, as well as previously defined aggregate measures of aggressive or supportive care. Descriptive statistics and crude incidence rates of each indicator were calculated. A multivariable logistic regression model was created to examine the relationship between sociodemographic and patient factors and receipt of aggressive and supportive care. Results: The cohort included 1 7,405 women; 51% died of ovarian cancer, 30% uterine cancer, 12% cervical cancer, and 6.5% vulvar or vaginal cancers (VVC). During the study period, death rates in hospitals decreased from 48% to 39%, while supportive care indices increased from 47% to 71%, and aggressive care indices remained stable (18%). Within the last 30 days of life, 53% were hospitalized, 5.6% were admitted to ICU, and 64% accessed palliative homecare, while within the last 14 days of life, 33% visited the ED, and 4.5% received chemotherapy. Patients with VVC demonstrated lower rates of both aggressive (11%) and supportive care (58%) compared to other cancer subtypes. On multivariable analyses, patients were significantly more likely to receive aggressive EOL care if they were <50 years of age, had a modified Deyo-Charlson Comorbidity Index score of 0, had uterine or ovarian cancer, or lived in a smaller community (<100,000) or a neighborhood in the lowest three income quintiles. Patients were less likely to receive supportive EOL care if they were ≥70 years of age, had a non-ovarian gynecologic malignancy, or lived in the lowest two income quintiles. Objectives: Tracking population-based quality indicators of supportive and aggressive end of life (EOL) care may provide insight into the success of EOL interventions and health resource utilization. We examined patterns of EOL care in patients with gynecologic cancers over 14 years in Ontario, Canada. Methods: We conducted a population-based, retrospective cohort study of gynecologic cancer decedents in Ontario from 2005 to 2018 using linked administrative healthcare data (Ontario Cancer Registry, Discharge Abstract Database, Ontario Health Insurance Plan physician billing claims, homecare databases). Quality indices included emergency department (ED) use, admissions to hospital or intensive care unit (ICU), chemotherapy in the last 14 days of life, physician or palliative care home visits, and death in hospital, as well as previously defined aggregate measures of aggressive or supportive care. Descriptive statistics and crude incidence rates of each indicator were calculated. A multivariable logistic regression model was created to examine the relationship between sociodemographic and patient factors and receipt of aggressive and supportive care. Results: The cohort included 1 7,405 women; 51% died of ovarian cancer, 30% uterine cancer, 12% cervical cancer, and 6.5% vulvar or vaginal cancers (VVC). During the study period, death rates in hospitals decreased from 48% to 39%, while supportive care indices increased from 47% to 71%, and aggressive care indices remained stable (18%). Within the last 30 days of life, 53% were hospitalized, 5.6% were admitted to ICU, and 64% accessed palliative homecare, while within the last 14 days of life, 33% visited the ED, and 4.5% received chemotherapy. Patients with VVC demonstrated lower rates of both aggressive (11%) and supportive care (58%) compared to other cancer subtypes. On multivariable analyses, patients were significantly more likely to receive aggressive EOL care if they were <50 years of age, had a modified Deyo-Charlson Comorbidity Index score of 0, had uterine or ovarian cancer, or lived in a smaller community (<100,000) or a neighborhood in the lowest three income quintiles. Patients were less likely to receive supportive EOL care if they were ≥70 years of age, had a non-ovarian gynecologic malignancy, or lived in the lowest two income quintiles.

Can EBRT Dose-Escalation Above 80 Gy Yield Comparable Survival Rates Relative to EBRT Plus Brachytherapy Boost in Men With Unfavorable Intermediate-Risk Prostate Cancer?

<h3>Purpose/Objective(s)</h3> Current recommendations regarding radiotherapy treatment for unfavorable intermediate-risk prostate cancer (UIR-PCa) include external beam radiotherapy (EBRT) ± brachytherapy boost (BT) ± androgen deprivation therapy (ADT). Dose-escalated EBRT ± ADT is associated with excellent long-term outcomes, but ERBT+BT ± ADT can achieve higher dose escalation beyond what can be achieved with EBRT alone. Prior studies have shown improved biochemical control and reduced distant metastasis with EBRT+BT vs. EBRT in men with intermediate-risk disease, but it is unclear if this translates into a survival benefit. <h3>Materials/Methods</h3> Men with UIR-PCa diagnosed between 2004 and 2015 and treated with EBRT ± ADT or EBRT+BT ± ADT were identified in the National Cancer Database (NCDB). EBRT was delivered with conventional fractionation (≥ 72 Gy in 1.8-2.0 Gy per fraction), while EBRT+BT was defined as patients receiving EBRT to a total dose of 40-50.4 Gy plus high-dose rate or low-dose rate brachytherapy. Patients with a Charlson-Deyo comorbidity index (CDCI) score > 1, who received systemic therapy other than ADT, or missing key information were excluded. Propensity-weighted multivariable analysis (MVA) using Cox regression modeling was used to compare overall survival (OS) hazard ratios. Covariables included age, race, ethnicity, year of diagnosis, CDCI score, insurance status, educational and socioeconomic metrics, treatment at an academic center, PSA at diagnosis, Gleason score, clinical T-stage, and receipt of ADT. <h3>Results</h3> The study cohort included 32,246 unfavorable intermediate-risk prostate cancer patients treated with: (<b>i</b>) EBRT (n = 13,265), (<b>ii</b>) EBRT+ADT (n = 13,123), (<b>iii</b>) EBRT+BT (n = 3,440), or (<b>iv</b>) EBRT+BT+ADT (n = 2,418). Cumulative doses of EBRT ± ADT are summarized in Table 1. The average time to follow-up was 62 months (standard deviation ± 39 months). Propensity-weighted MVA showed that EBRT+BT ± ADT was associated with improved OS relative to increasing doses of EBRT ± ADT. However, the OS benefit associated with EBRT+BT ± ADT diminished as the cumulative dose of radiation in the EBRT ± ADT cohort increased (Table 1). <h3>Conclusion</h3> The addition of brachytherapy to EBRT correlated with reduced mortality in men with UIR prostate cancer, including patients treated with EBRT ± ADT to ≥80 Gy. The relative OS benefit associated with EBRT+BT declined as the radiation dose increased in the EBRT ± ADT cohort.

Treatment of PRIME II Eligible Women With Early-Stage Breast Cancer: A National Cancer Database Analysis

For patients with early-stage breast cancer (ESBC) who undergo lumpectomy, adjuvant radiation therapy (RT) and hormone therapy (HT) have been shown to decrease the risk of local recurrence. Subsequent studies evaluating omission of RT for women over the age of 65-70 years old with ESBC, such as CALGB 9343 and PRIME II, compared HT with or without RT. In the population of older women with ESBC, RT alone has not been widely studied. We aim to describe patterns of care and outcomes for this population treated with RT alone.We queried the National Cancer Database for treatments between 2004 and 2016 and identified 179,309 women who met the PRIME II eligibility criteria. All included patients were females age ≥ 65 years with Charlson-Deyo Comorbidity Index score 0-1 who underwent segmental mastectomy for invasive ductal or lobular carcinoma, were ER positive and Her2 negative, clinically and pathologically node negative, and had no distant metastases. Tumors were ≤ 3 cm and any grade and could have LVSI (tumors that were both grade 3 and had LVSI were excluded). We used Kaplan-Meier estimates and Cox regression analysis to analyze overall survival (OS) among the cohorts.Most women in the cohort were white, had a median income in the highest quartile, and lived within 15 miles of a treatment facility. When evaluating overall rates of adjuvant therapy, 59% of patients underwent RT + HT, 16.5% HT alone, 12.1% RT alone, and 12.4% no adjuvant therapy. On multivariate analysis using Cox proportional hazards modeling, patients receiving RT and HT had a decreased risk of death compared to patients receiving RT alone (HR 0.77, 95% CI 0.74-0.79, P < 0.001). However, patients receiving HT alone or no adjuvant therapy had an increased risk of death compared to patients receiving RT alone (HT alone: HR 1.31, 95% CI 1.26-1.35, P < 0.001; no adjuvant therapy: HR 1.6, 95% CI 1.55-1.66, P < 0.001).Compared to adjuvant RT alone, OS was better with combined adjuvant RT and HT but worse with HT alone or no adjuvant therapy. Negative predictors for OS included increasing age, lower median income, higher tumor grade, and larger tumor size on multivariate analysis. These findings may prompt further prospective study of RT alone versus other adjuvant therapy options.

Epidemiology, Time Trends, and Outcomes of Serious Infections in Patients With Vasculitis: A Nineteen-Year National Study.

To examine the epidemiology, time trends, and outcomes and types of serious infections in people with vasculitis in the US. We identified people with vasculitis who were hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections, or opportunistic infections in the 1998-2016 US National Inpatient Sample. We used adjusted logistic regression to examine the predictors of a hospital stay >3 days, total hospital charges greater than the median, discharge to a non-home setting, and in-hospital mortality. We noted 111,345 serious infections in patients with vasculitis (14% of all vasculitis hospitalizations). Among the patients, the mean age was 67.3 years, the Deyo-Charlson comorbidity index score was ≥2 in 54%, 37% were male, and 67% were White. The serious infection hospitalization rate per 100,000 US National Inpatient Sample claims in 1998-2000 versus 2015-2016 (and rates of increase) in patients with vasculitis was as follows: overall, 12.14 versus 25.15 (2.1-fold); opportunistic infections, 0.78 versus 0.83 (1.1-fold); skin and soft tissue infections, 1.38 versus 2.52 (1.8-fold); UTI, 0.35 versus 1.48 (4.2-fold); pneumonia, 7.10 versus 6.23 (0.9-fold); and sepsis, 2.53 versus 14.10 (5.6-fold). Pneumonia was the most common serious infection in 1998-2000 (58%) versus sepsis in 2015-2016 (56%). Sepsis, older age, Deyo-Charlson comorbidity index score of ≥2, urban hospital, or medium/large hospital (by number of beds) were associated with higher health care utilization and in-hospital mortality rates; Northeast region and Medicare and Medicaid payer type were associated with higher rates of health care utilization. Serious infection hospitalization rates are increasing in patients with vasculitis except among those with pneumonia. Sepsis was the most common serious infection in 2015-2016. Several patient and hospital factors are associated with health care utilization and mortality in serious infection hospitalization in vasculitis.

Demographic Factors Associated With Non-Guideline–Based Treatment of Kidney Cancer in the United States

Significant demographic disparities have been found to exist in the delivery of health care. Demographic factors associated with clinical decision-making in kidney cancer have not been thoroughly studied. To determine whether demographic factors, including sex and race/ethnicity, are associated with receipt of non-guideline-based treatment for kidney cancer. This retrospective cohort study was conducted using data from the National Cancer Database for the years 2010 through 2017. Included patients were individuals aged 30 to 70 years with localized (ie, cT1-2, N0, M0) kidney cancer and no major medical comorbidities (ie, Charlson-Deyo Comorbidity Index score of 0 or 1) treated at Commission on Cancer-accredited health care institutions in the United States. Data were analyzed from November 2020 through March 2021. Demographic factors, including sex, race/ethnicity, and insurance status. Receipt of non-guideline-based treatment (undertreatment or overtreatment) for kidney cancer, as defined by accepted clinical guidelines, was determined. Among 158 445 patients treated for localized kidney cancer, 99 563 (62.8%) were men, 120 001 individuals (75.7%) were White, and 91 218 individuals (57.6%) had private insurance. The median (interquartile range) age was 58 (50-64) years. Of the study population, 48 544 individuals (30.6%) received non-guideline-based treatment. Female sex was associated with lower adjusted odds of undertreatment (odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P < .001) and higher adjusted odds of overtreatment (OR, 1.27; 95% CI, 1.24-1.30; P < .001) compared with male sex. Compared with White patients, Black and Hispanic patients had higher adjusted odds of undertreatment (Black patients: OR, 1.42; 95% CI, 1.29-1.55; P < .001; Hispanic patients: OR, 1.20; 95% CI, 1.06-1.36; P = .004) and overtreatment (Black patients: OR, 1.09; 95% CI, 1.05-1.13; P < .001; Hispanic patients: OR, 1.06; 95% CI, 1.01-1.11, P = .01). Individuals who were uninsured, compared with those who had insurance, had statistically significantly higher adjusted odds of undertreatment (OR, 2.63; 95% CI, 2.29-3.01; P < .001) and lower adjusted odds of overtreatment (OR, 0.72; 95% CI, 0.67-0.77; P < .001). This study found that there were significant disparities in treatment decision-making for patients with kidney cancer, with increased rates of non-guideline-based treatment for women and Black and Hispanic patients. These findings suggest that further research into the mechanisms underlying these disparities is warranted and that clinical and policy decision-making should take these disparities into account.

Serious Infections in Patients With Gout in the US: ANational Study of Incidence, Time Trends, and Outcomes.

To study the epidemiology of serious infections in patients hospitalized with gout. We identified patients with gout hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections (SSTIs), or opportunistic infections (OIs) in a US National Inpatient Sample from 1998 to 2016 and examined factors associated with utilization and mortality. We noted 1,140,085 hospitalizations of patients with serious infections and gout (11% of all hospitalizations of patients with gout; 1998-2000 [8.9%], 2015-2016 [14.5%]). Compared to patients without gout, patients with gout hospitalized with serious infections were older (median age 65 versus 74 years), more of them had a Charlson-Deyo comorbidity index score ≥2 (42% versus 65%), and fewer were female (53% versus 35%) or non-White (40% versus 35%), respectively. The most common infection was pneumonia (52%) in 1998-2000 and sepsis (52%) in 2015-2016. Median hospital charges and hospital stays were higher for patients with sepsis and OIs in 2015-2016 ($41,000-$42,000; 5.1-5.5 days) versus those with UTI, pneumonia, or SSTIs ($15,000-$17,000; 3.0-3.9 days). Compared to patients with sepsis, the multivariable-adjusted odds of health care utilization and in-hospital mortality were significantly lower for patients with UTI, SSTIs, and pneumonia, and non-home discharge or in-hospital mortality were lower in patients with OIs. Among patients hospitalized with infections, older age, Medicaid coverage, a higher Charlson-Deyo comorbidity index score, Black race, and Northeast and nonrural hospital location were associated with significantly higher health care utilization and mortality, while female sex, Medicare insurance, and lower income were associated with higher utilization. Given an increasing rate of serious infections, especially sepsis and pneumonia, in individuals with gout, development of effective interventions targeting factors associated with health care utilization and mortality will improve outcomes and reduce burden.

Survival trends of older adult patients with diffuse large B-cell lymphoma: A National Cancer Database analysis.

7542 Background: 60-70% of patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) can be cured with R-CHOP or R-CHOP-like immunochemotherapy. However, patients ≥80 years of age were either excluded or underrepresented in modern DLBCL trials, and their outcomes are understudied. The aim of this study is to define the survival trends and risk factors for inferior survival in older adult patients with DLBCL. Methods: Patients with newly diagnosed DLBCL were identified from the National Cancer Database (2004-2017, representing the rituximab era). Clinical characteristics, treatment, and outcomes were compared between patients ages ≥ 80, 65-79, and &lt; 65 years. The Kaplan-Meier method and Cox proportional hazards model were used for survival analysis. Results: A total of 231,756 patients with newly diagnosed DLBCL were identified; 46,250 (20%) were ≥80 years, 87,702 (38%) were 65-79 years, and 97,904 (42%) were &lt; 65 years. Patients ≥80 years were more likely to have a higher Charlson-Deyo Comorbidity Index score (CDS) (CDS ≥2, 12% vs 11% vs 8%, p = 0.001), less likely to receive systemic chemotherapy (63% vs 83% vs 89%, p &lt; 0.001), and more likely to receive treatment at a non-academic center (71% vs 65% vs 48%, p &lt; 0.001), compared to patients 65-79 and &lt; 65 years, respectively. Median overall survival (OS) was significantly worse for patients ≥80 years compared to patients 65-79 years (11.6 vs 61.0 months, p = 0.001) and patients &lt; 65 years (11.6 vs 178.1 months, p = 0.001). During the study period, the median OS had only minimally improved for patients ≥80 years (10.6 months in 2004-2007 vs 11.5 months in 2008-2011 vs 12.3 months in 2012-2016, p = 0.006). In contrast, the OS improvement appears more meaningful in patients 65-79 years (median in months: 51 vs 61.2 vs 65.9, p = &lt; 0.001) and patients &lt; 65 years (median in years: 14.6 vs 11.3 vs not reached, p &lt; 0.001) in the prespecified intervals (2004-07, 2008-11, and 2012-16). In multivariate analysis, the most substantial risk factor for worse survival in patients ≥80 years was not receiving systemic therapy (hazard ratio [HR] = 3.26, 95%CI = 3.01-3.54, p = 0.001). Other risk factors associated with worse survival included high-risk IPI score (HR = 2.16, 95%CI = 1.96-2.39, p = 0.001), CDS score ≥2 (HR = 1.56, 95%CI = 1.40-1.73, p = 0.001), male sex (HR = 1.16, 95%CI = 1.09-1.24, p = 0.001), B symptoms at diagnosis (HR = 1.16, 95%CI = 1.08-1.25, p = 0.001), and treatment at a non-academic center (HR = 1.1, 95%CI = 1.01-1.20, p = 0.001). Conclusions: Patients ≥ 80 years of age with DLBCL have a significantly inferior survival which has not meaningfully improved in recent years. More than 1/3 of patients ≥ 80 years did not receive systemic therapy. Older adult patients with DLBCL should be assessed for fitness for chemotherapy using validated geriatric assessment tools. Novel therapeutic strategies with favorable safety profiles are urgently needed for this expanding patient population.

Ethnicity, Ethnic Language, and Fracture Risk Conditions in Women Initiating Osteoporosis Therapy

Introduction: The ethnic diversity of women with osteoporosis has increased, but data on acculturation and health remain limited. Having a primary language (PL) other than English may reflect acculturation level and/or immigration as an adult. We used electronic health record (EHR) data from a large US health plan to examine the association of baseline clinical risk conditions and PL among US Chinese and US Hispanic women who initiated osteoporosis therapy. Methods: We identified women age 65-74y who initiated osteoporosis therapy in 2002–2014, excluding those with skeletal disorders, advanced kidney disease and metastatic cancer. PL was ascertained from the EHR. The study included 1676 Chinese women with English-PL (50%) vs Chinese-PL (50%); 3453 Hispanic women with English-PL (72%) vs Spanish-PL (28%); and 20,289 non-Hispanic White (White) women with English-PL. Clinical conditions assessed included: current smoking; BMI <19 kg/m2; Charlson-Deyo Comorbidity Index (CCI); diabetes (DM) based on diagnosis with treatment; rheumatoid arthritis (RA) based on 2 diagnoses; and fracture diagnosis in the prior 5 years. Language subgroups (* denotes significant difference by PL, p<.05) and ethnic groups (all ethnic differences cited are significant at p<.05) were compared using chi-square tests. Results: Mean age was (69±3y) for Chinese, Hispanics, Whites, and PL subgroups. Prior fracture was lower in Chinese (12.8%) and Hispanics (25.6%) vs Whites (29.7%), with Chinese lower than Hispanics. Smoking was lower in Chinese (1.6%) and Hispanics (6.7%) vs Whites (11.3%). CCI score ≥3 was lower in Chinese (5.2%) and higher in Hispanics (13.0%) vs Whites (10.4%). RA was low overall and lowest in Chinese, especially Chinese-PL. More Chinese (4.2%) and fewer Hispanics (0.8%) had a BMI <19 vs Whites (2.2%). DM was higher in Hispanics (14.8%) and Chinese (8.2%) compared to Whites (5.7%). Significant and non-significant differences by PL were observed for current smoking (0.8%* vs 2.4% for Chinese-PL vs English-PL; 4.0% vs 7.8% for Spanish-PL vs English-PL), prior fracture (11.4%* vs 14.2% for Chinese-PL vs English-PL; 24.3% vs 26.1% for Spanish-PL vs English-PL) and DM (10.5%* vs 5.8% for Chinese-PL vs English-PL; 24.3% vs 26.1% for Spanish-PL vs English-PL) in Chinese and Hispanic women. Conclusion: Among older women initiating osteoporosis therapy, US Chinese women have lower comorbidity but a higher DM prevalence compared to white women, especially those with Chinese-PL. Hispanic women have higher comorbidity and higher DM prevalence than White women, with no differences by PL. Variation in prior fracture, low BMI, RA, and smoking were also seen. These findings highlight ethnic differences in women receiving osteoporosis care, including differences by primary language in Chinese women. Future studies should examine fracture risk factors and outcomes in US immigrant populations, especially Asians.

Association of survival and local radiotherapy to the bladder versus chemotherapy alone for patients with metastatic urothelial carcinoma (mUC).

413 Background: Limited data exists on the role of local therapy for metastatic urothelial carcinoma of the bladder (mUC). Large database analysis have inherent limitations but can shed light on survival outcomes in a real-world population and in scenarios not easily studied in a randomized fashion. We hypothesized that in the NCDB, radiotherapy (RT) to the bladder plus chemotherapy (CT) would be associated with improved overall survival (OS) vs CT alone. Methods: We queried the NCDB for newly diagnosed mUC cases (cT1-4 N0-3 M1) from 2004-2015 treated with CT alone vs CT plus RT to ≥ 45 Gy to the bladder. Cystectomy patients were excluded. To account for lead time bias, we excluded patients with &lt; 2 months of follow-up. Variables for multivariable analysis (MVA) and matching included: age, sex, Charlson-Deyo comorbidity index (CCI), cT/N stage, facility type/location, insurance, year of diagnosis, and number of CT agents. Overall survival (OS) was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazards analyses was performed. Propensity score matching (all variables) and exact matching (CCI score, age +/- 5 years, cT stage) was performed. Results: 4,459 patients with newly diagnosed mUC received either CT+ RT (n = 337) or CT alone (n = 4,122). Median follow-up was 10.7 months (range 2-144). Median RT dose was 57.6 Gy (IQR, 50.0– 63.0 Gy). Median OS for CT+RT was 13.8 (95% CI, 12.1-15.5) vs. 8.4 months (95% CI, 7.5-9.4) for CT (P &lt; 0.0001). In MVA, RT was associated with improved OS (HR, 0.70; 95% CI, 0.62-0.79; P &lt; 0.0001). Increasing age, comorbidity score, and cT-stage were associated with worse OS (P &lt; 0.001). In subgroup analysis of patients without other comorbidities (CCI of 0), median OS for CT+RT was 14.4 (95% CI, 12.1-16.7) vs 11.1 months (95% CI, 10.7-11.5) for CT (P = 0.001). For patients with cT2-3N0 disease, median OS for CT+RT was 14.0 months (95% CI, 6.8-21.3) vs 10.9 months (95% CI, 10.1-11.7) for CT (P = 0.001). On propensity matched analysis (337 CT+RT and 337 CT patients), CT+RT was associated with improved OS (median 13.8 vs 8.5 months; P &lt; 0.0001; MVA HR 0.59, 95% CI 0.50-0.69, P &lt; 0.0001). On exact matched analysis (205 CT+RT and 205 CT patients), CT+RT was associated with improved OS (median 13.5 vs 9.9 months; P = 0.002; MVA HR 0.67, 95% CI 0.57-0.79, P = 0.002). Landmark analysis for patients living ≥6 months (median OS 16.3 vs 13.6 months, P = 0.004) and ≥12 months (median OS 22.2 vs 19.1 months, P = 0.029) demonstrated improved OS for CT+RT. Conclusions: In this large contemporary series, mUC patients treated with local RT plus CT had improved OS compared to CT alone. The magnitude of the effect persisted with matching and landmark analysis to try to mitigate the effect of selection bias, though we could not control for extent of metastatic disease. These findings are hypothesis-generating; a prospective trial evaluating the impact of bladder RT in mUC is warranted.

Burden of Illness and Outcomes in the 2nd Line Treatment of Large B-Cell Lymphoma: A Real-World Comparison of Medicare Beneficiaries with and without Stem Cell Transplants

Introduction: Standard first line therapy (LOT) for patients (pts) with large B-cell lymphoma (LBCL) involves chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) or a similar regimen, e.g. R-CHOP with the addition of etoposide (R-EPOCH). While most pts respond, 30-40% of pts relapse or fail to achieve remission with 1st LOT. For those pts, the goal of curative 2nd LOT is typically platinum-based salvage chemotherapy in preparation for autologous stem cell transplant (ASCT). However, many pts (50% or more) do not qualify for intensive therapy, either due to age or comorbidities, or because they do not respond to or cannot tolerate salvage chemotherapy. For those further treatment options are limited. Objectives: In a sample of U.S. LBCL pts 65 and older, who have progressed to 2nd LOT and are eligible for ASCT, to compare the patient characteristics, treatments, costs and overall survival between pts who received SCT with those who did not. Methods: This retrospective cohort study used 100% Medicare Fee-for-Service Parts A/B claims data and Part D Prescription Drug Event data to identify pts ≥ 65 years of age, newly diagnosed with LBCL in 2012-2017, and who had ≥ 6 months continuous enrollment pre-diagnosis (baseline) and ≥ 12 months post-diagnosis, or who died after initiation of 2nd LOT. All were treated with a CHOP-like regimen 1st LOT and progressed to 2nd LOT. Eligible pts who received a 2nd LOT with a SCT-preparative regimen per NCCN guidelines were stratified into the "ASCT-intended" cohort, and the remainder into the "ASCT-not-intended" cohort. The ASCT-intended group was further subset into those who received a SCT and those who did not (Non-SCT). These 2 subsets formed the primary comparison groups. Baseline characteristics were age, gender, race, dual eligibility status (i.e. Medicare plus Medicaid), and Charlson-Deyo Comorbidity Index (CCI). Measures of utilization during follow-up (from initiation of 2nd LOT to loss to follow-up) were hospitalizations, outpatient and emergency department (ED) visits, and post-acute care. Costs during follow-up reflected standardized, inflation-adjusted, all-cause paid amounts. Utilization and cost metrics were standardized to per-patient-per-month (PPPM). Overall survival (OS) was measured from the start of 2nd LOT until death, disenrollment or the end of the study period. Results: 4,758 pts met all inclusion criteria. 3,713 (78%) did not receive a SCT-preparative regimen after 1st LOT. 1,045 pts (22%) received a SCT-preparative regimen and constituted the ASCT-intended group. Of these, 244 (23.3%) received a SCT and 801 (76.7%) did not. The remainder of this report focuses on a comparison of the SCT and non-SCT cohorts. Baseline characteristics, treatments, utilization and cost are summarized in Table 1. Both groups were predominantly white, but SCT pts were, on average, 5 years younger, slightly more likely to be male, and had slightly lower mean CCI scores. 13.1% of non-SCT pts were dual eligible vs. 4.5% of SCT (all p &amp;lt; .01 except Race). 93.9% of SCT procedures were autologous, and no pts had more than 1 SCT during follow-up. Non-SCT pts had higher all-cause utilization for all categories except for acute hospitalizations. The higher inpatient utilization for the SCT group may reflect the SCT procedure itself (94% of SCT were inpatient). A similar pattern was observed in the cost data, where Non-SCT pts incurred higher costs except for acute hospitalizations. Results for OS are summarized in Figure 1. Non-SCT pts had significantly lower rates of survival than SCT pts. 94.7% of SCT pts were still alive 6 months after initiation of 2nd LOT, whereas only 66.9% of non-SCT pts were. At two years post-2nd LOT, survival rates were 69.7% vs. 36.3%. Conclusions: In this study, only 23.3% of SCT-intended pts ultimately received it. The remaining 76.7% were SCT-intended but never received a transplant. Compared to the SCT pts, the non-SCT pts were older, had more comorbidities, had higher rates of healthcare utilization and costs post-2nd line therapy in all categories (except acute inpatient), and lower OS. 38.7% of non-SCT pts proceeded to additional lines of lymphoma-directed therapies beyond 2nd line, which may suggest that their clinicians felt that there was potential benefit to further treatment. These data suggest there may be unmet need for elderly pts with LBCL who are eligible for ASCT, but do not ultimately receive it. Disclosures Kilgore: Kite, A Gilead Company: Research Funding. Wong:Kite, A Gilead Company: Research Funding. Thornton Snider:Precision Medicine Group: Ended employment in the past 24 months, Research Funding; Gilead Sciences: Current equity holder in publicly-traded company, Research Funding; Kite, A Gilead Company: Current Employment. Cheng:Kite, A Gilead Company: Current Employment; Gilead Sciences: Current equity holder in publicly-traded company. Schroeder:Kite, A Gilead Company: Research Funding. Mohammadi:Kite, A Gilead Company: Research Funding.

Trends And Disparities In The Diagnosis And Initial Management Of High-Risk Prostate Cancer In The United States

An increasing proportion of men are being diagnosed with high-risk prostate cancer. Standard of care for initial treatment of high-risk prostate cancer includes prostatectomy or radiotherapy with no randomized evidence comparing the modalities to guide decision-making. This study characterized US national trends associated with undergoing prostatectomy or radiotherapy for high-risk prostate cancer. This retrospective cohort study used data collected by the National Cancer Database (NCDB) to assess demographic, clinical and socioeconomic factors among 215,313 men diagnosed with high-risk prostate cancer from 2004 to 2016 and the trends in diagnosis rate and the use of prostatectomy or radiotherapy. Cochran-Armitage test was used to identify trends in prostatectomy or radiotherapy with time. Multivariable logistic regression was used to examine demographic and clinical factors associated with undergoing prostatectomy or radiotherapy. All tests were 2-sided and considered significant at an α level of .05. The rate of high-risk prostate cancer increased from 11.9% in 2004 to 20.4% in 2016. In total, 215,313 men diagnosed as having localized high-risk prostate cancer between 2004 and 2016 were identified. White men composed 81.2% of this cohort, whereas black men composed 16.1%. Government-issued insurance was used by 59.2% of men. More than 81.7% of men had a Charlson-Deyo Comorbidity Index score of 0 (range, 0 to ≥3, with lower numbers indicating fewer comorbidities). The proportion of men who underwent prostatectomy (a total of 76,606 men) compared to radiation therapy, androgen deprivation (ADT) alone, or no treatment, increased from 23.1% in 2004 to 40.9% in 2016 (p < .0001). The proportion of men who underwent radiotherapy as the first treatment (a total of 104,783 men) decreased from 59.7% in 2004 to 43.3% in 2016 (p < .0001). Men treated at an academic center, living in an urban area, or possessing higher incomes and those who were younger, healthier, white, or were diagnosed as having lower grade prostate cancer had higher odds of undergoing prostatectomy. This study found that rates of high-risk prostate cancer diagnosis have increased from 11.9% in 2004 to 20.4% in 2016. Prostatectomy rates for the initial treatment of high-risk prostate cancer increased by 17.8% from 2004 to 2016 and radiotherapy rates decreased by 16.4% in the same study period. Demographic, clinical and socioeconomic factors of high-risk cancer diagnosis and undergoing prostatectomy included age, race, income, Charlson-Deyo Comorbidity Index score, clinical stage and grade of disease, facility type and location, and year of diagnosis. These results are hypothesis generating; further studies evaluating potential disparities in the initial diagnosis and management of localized high-risk prostate cancer are warranted.

Healthcare Resource Utilization and Costs in Celiac Disease: A US Claims Analysis.

INTRODUCTION:Celiac disease (CeD) is a lifelong immune-mediated enteropathy in which dietary gluten triggers an inflammatory reaction in the small intestine. This retrospective cohort study examines healthcare resource utilization (HRU) and costs between patients with CeD and matched controls.METHODS:Patients with CeD (cases) with an endoscopic biopsy and ≥2 medical encounters with a CeD diagnosis between January 1, 2010, and October 1, 2015, were identified in the MarketScan databases. The date of the first claim with a CeD diagnosis on or after the endoscopic biopsy was the index date. Cases were matched 1:1 to patients without CeD (controls) on demographic characteristics and Deyo-Charlson Comorbidity Index score. Clinical characteristics, all-cause, and CeD-related HRU and costs (adjusted to 2017 US dollars) were compared between cases and controls during the 12 months before (baseline) and 24 months after (follow-up) the index date.RESULTS:A total of 11,008 cases (mean age 40.6 years, 71.3% women) were matched to 11,008 controls. During the follow-up, a higher proportion of cases had all-cause and CeD-related HRU including inpatient admissions, emergency department visits, gastroenterologist visits, dietician visits, endoscopic biopsies, and gastroenterology imaging (all P ≤ 0.002). Incremental all-cause and CeD-related costs were in the first ($7,921 and $2,894) and second ($3,777 and $935) year of follow-up, driven by outpatient services costs.DISCUSSION:In this US national claims database analysis, there was evidence of an increase in both all-cause and CeD-related HRU and related costs in patients with CeD compared with matched patients without CeD, suggesting a significant economic burden associated with CeD.

Comorbidity burden on receipt of adjuvant immunotherapy and survival in patients with stage III melanoma: an analysis of the National Cancer Database.

Comorbidity burden is associated with development of cancer, stage at diagnosis, and treatment outcomes. We evaluated the association between comorbidity burden, receipt of adjuvant immunotherapy, and survival in patients with stage III melanoma. Using the National Cancer Database, we identified 16,906 patients with stage III melanoma who underwent surgery of the primary site. Outcomes included receipt of adjuvant immunotherapy and overall survival; independent variables included Charlson/Deyo comorbidity index (CDI) and receipt of adjuvant immunotherapy. Patients with CDI scores of two or more averaged 30.0% and 30.9% lower adjusted odds of receiving adjuvant immunotherapy relative to patients with a CDI score of zero or one, respectively (P=0.001 and 0.002, respectively). Longer survival was associated with lower CDI scores (all P<0.001) and receipt of adjuvant immunotherapy (P<0.001). Patients who received adjuvant immunotherapy averaged 16.0% lower adjusted risk of death compared to patients who did not (P<0.001), which was constant within all CDI cohorts. Patients with a CDI score of two or more averaged 53.4% and 39.1% higher adjusted risk of death relative to patients with a CDI score of zero or one (both P<0.001). Greater comorbidity burden was associated with lower receipt of adjuvant immunotherapy; however, adjuvant immunotherapy provided similar survival benefit for patients' irrespective comorbidity burden. Our findings suggest that patients with stage III melanoma who have a greater comorbidity burden may benefit from adjuvant immunotherapy but should not replace careful patient selection by the clinician.

Primary anatomical site as a prognostic factor for pleomorphic liposarcoma.

Pleomorphic liposarcomas (PLS) is an aggressive, high-grade subtype of soft tissue sarcoma representing < 15% of liposarcomas. It most commonly arises in the retroperitoneum and proximal upper extremities. Current prognostic factors are centered around staging, which accounts for the grade, size, and location of the tumor in relation to the superficial fascia. 750 patients diagnosed with pleomorphic liposarcoma from the National Cancer Database were analyzed. Kaplan-Meier survival tables, log-rank tests, and Cox proportional hazards analysis were utilized to compare survival between groups within variables. The most common primary anatomical site was the lower limb/hip. The head/neck primary anatomical site demonstrated the highest 10-year overall survival probability, while the retroperitoneum/abdomen had the lowest (50% and 18.4%). Compared to the thorax/lung site, the following sites demonstrated a decreased risk of death: lower limb/hip (HR = 0.54; 95% CI: 0.35-0.82, p = 0.004), pelvis (HR = 0.49; 95% CI: 0.28-0.84, p = 0.010), and the retroperitoneum/abdomen (HR = 0.54; 95% CI: 0.33-0.89, p = 0.015). Both adjuvant radiation (HR = 0.64; 95% CI: 0.48-0.85, p = 0.002) and neoadjuvant radiation (HR = 0.70; 95% CI: 0.49-1.00, p = 0.049) provided a survival benefit to patients. There was an increased risk of death for every 10-year increment in age (HR = 1.31; 95% CI: 1.12-1.45, p < 0.001). Statistically significant prognostic factors for PLS include primary anatomical site, age, Charlson-Deyo Comorbidity Index Scores and the use of neoadjuvant and adjuvant radiation.

Trends in the Use of Stereotactic Body Radiotherapy for Treatment of Prostate Cancer in the United States

Stereotactic body radiotherapy is a hypofractionated, cost-effective treatment option for localized prostate cancer. To characterize US national trends and the clinical and socioeconomic factors associated with the use of stereotactic body radiotherapy in prostate cancer. This retrospective cohort study used data collected by the National Cancer Database to assess the clinical and socioeconomic factors among 106 926 men diagnosed as having prostate cancer from 2010 to 2015 who underwent definitive radiotherapy and the trends in the use of this therapy. The initial analysis was performed between January and February 2018, with final updates performed August 2019. Stereotactic body radiotherapy, defined as 5 fractions of radiotherapy. Temporal trends and clinical and sociodemographic factors associated with stereotactic body radiotherapy use. In total, 106 926 patients diagnosed as having localized prostate cancer between 2010 and 2015 and receiving definitive radiotherapy were identified. White patients composed 77.3% of this cohort, whereas black patients composed 18.7%. Government-issued insurance was used by 61.2% of patients. More than 80% of patients had a Charlson-Deyo Comorbidity Index score of 0 (range, 0 to ≥3, with lower numbers indicating fewer comorbidities). In the study population, 25.7% had low-risk disease; 26.3%, favorable intermediate-risk disease; 23.3%, unfavorable intermediate-risk disease; and 24.7%, high-risk disease. The proportion of patients who underwent radiotherapy and received stereotactic body radiotherapy (a total of 5395 patients) increased from 3.1% in 2010 to 7.2% in 2015 (odds ratio, 0.36; 95% CI, 0.33-0.40; P < .001). Among the entire cohort, patients received a median dose of 36.25 Gy (range, 30.00-50.00 Gy). Androgen deprivation therapy use increased significantly as disease risk level increased among all patients receiving radiotherapy (9.5% with low risk to 76.6% with high risk; P = .02) and among those receiving stereotactic body radiotherapy (4.1% with low risk to 33.2% with high risk; P = .04) or not receiving stereotactic body radiotherapy (9.9% with low risk to 77.6% with high risk; P = .04). Patients treated at an academic center, living in an urban area, or possessing higher incomes and those who were healthier, white individuals, or were diagnosed as having lower-risk prostate cancer had higher odds of receiving stereotactic body radiotherapy. This study found that stereotactic body radiotherapy use in prostate cancer more than doubled from 2010 to 2015 but accounted for less than 10% of all patients undergoing radiotherapy. Androgen deprivation therapy use increased with disease risk among patients overall, regardless of receiving stereotactic body radiotherapy. Socioeconomic and clinical determinants of stereotactic body radiotherapy included risk category, Charlson-Deyo Comorbidity Index score, facility type and location, income, race/ethnicity, and year of diagnosis. These results are hypothesis generating; further studies evaluating potential disparities in stereotactic body radiotherapy use in localized prostate cancer are warranted.