Charlson-Deyo Score Research Articles

Prognostic Significance of Lymph Node Ratio in Intrahepatic and Extrahepatic Cholangiocarcinomas

Background/Objectives. Lymph Node Ratio (LNR) is increasingly recognized as an important prognostic factor in various cancer types, with the potential to enhance patient stratification for intrahepatic (ICC) and extrahepatic (ECC) cholangiocarcinoma. The study aimed to assess the impact of LNR on survival in surgically resected patients with ICC and ECC. Methods. This was a retrospective analysis of National Cancer Database (2004–2020) included ICC and ECC (excluding distal bile duct) patients who underwent primary site resection with adequate lymphadenectomy (≥4 LNs excised). Exclusions comprised age < 18 years, distant metastasis, or incomplete key data. LNR was calculated as the ratio of positive LNs to total examined LNs. Survival probabilities were estimated using Kaplan–Meier analysis and Cox regression. Results. The inclusion criteria were met by 954 patients with ICC and 1607 patients with ECC. In patients with ICC, the median OS time was 62.7 months in LNR0 group, 40.8 months in LNR < 30%, and 25.2 months in LNR ≥ 30% (p < 0.001). In ICC, 3-year OS was 69.3%, 54.6%, and 34% for LNR 0, LNR < 30%, and LNR ≥ 30%, respectively (p < 0.05). When adjusted for age, sex, Charlson–Deyo score, histology, surgical margins, chemo- and radiotherapy using Cox regression, LNR < 30% and LNR ≥ 30% were associated with worse OS in patients with ICC (HR 2.1 (95% CI 1.6–2.7) and HR 2.94 (95% CI 2.3–3.8)) and ECC (HR 2.1 (95% CI 1.8–2.5) and HR 3 (95% CI 2.4–3.7)). Conclusions. It is well-known that LN-negative patients have significantly better survival than LN-positive patients with ICC and ECC. This study strongly demonstrates that survival prognosis can be further stratified based on LNR for ICC and ECC patients and that it is not simply a binary factor.

Conditional Survival of Patients With Early-Stage Non-Small Cell Lung Cancer Who Undergo Lobectomy, Segmentectomy, or Wedge Resection Using the NCDB.

Randomized clinical trials have shown that sub-lobar resection for clinical stage (cStage) IA non-small cell lung cancer (NSCLC) is non-inferior to lobar resection. We evaluated traditional and conditional survival differences between lobectomy, wedge resection, and segmentectomy in patients with cStage IA NSCLC. The National Cancer Database (2004-2019) was queried for patients with cStage IA (≤ 2 cm) NSCLC who underwent upfront lobectomy, segmentectomy, or wedge resection. Patients were stratified by extent of resection. Propensity-matched traditional (TSA) and conditional (CSA) survival analyses were performed. Propensity score included age, gender, histology, tumor grade, and Charlson-Deyo score. Number of lymph nodes (LN) harvested was also compared between groups. There were 46 395 patients who met the inclusion criteria, of whom 32 599 (70.3%) received lobectomy, 11 181 (24.1%) wedge resection, and 2615 (5.6%) segmentectomy. Following propensity matching, all groups contained 2615 patients. In the TSA, segmentectomy (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.08-1.32) and wedge resection (HR: 1.41, CI: 1.28-1.56) were associated with worse 5-year survival. This remained significant in CSA at 3- and 5-years post-resection in patients who underwent segmentectomy (HR: 1.24, CI: 1.08-1.43 and HR: 1.23, CI: 1.02-1.49, respectively) and wedge resection (HR: 1.42, CI: 1.24-1.63 and HR: 1.33, CI: 1.11-1.59, respectively). Wedge resection and segmentectomy were associated with a lower number of harvested LN (median = 4 and 6, respectively) compared to lobectomy (8, p < 0.001). Analysis of real-world data suggests that lobectomy is associated with improved traditional and conditional 5-year survival as well as LN harvest.

Clinical Outcomes of Early Phenotype-Desirable Antimicrobial Therapy for Enterobacterales Bacteremia

Initiating effective therapy early is associated with improved survival among patients hospitalized with gram-negative bloodstream infections; furthermore, providing early phenotype-desirable antimicrobial therapy (PDAT; defined as receipt of a β-lactam antibiotic with the narrowest spectrum of activity to effectively treat the pathogen's phenotype) is crucial for antimicrobial stewardship. However, the timing of targeted therapy among patients hospitalized with gram-negative bloodstream infections is not well understood. To compare the clinical outcomes between patients who were hospitalized with Enterobacterales bloodstream infections receiving early vs delayed PDAT. This retrospective cohort study used a large, geographically diverse, hospital-based US database (PINC AI Healthcare Database). Participants were adult (aged ≥18 years) patients with an inpatient admission between January 1, 2017, and June 30, 2022, with at least 1 blood culture isolate positive for Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, or Proteus mirabilis and receiving PDAT on blood culture collection days 0 to 4. Early vs delayed PDAT, with early PDAT defined as receipt of PDAT on blood culture collection days 0 to 2. The main outcome was desirability of outcome ranking, in which patients were assigned a mutually exclusive rank 1 through 5. Rank 1 indicated the most desirable outcome (alive with no events), whereas rank 5 indicated the least desirable outcome and included all patients who died within 30 days of blood culture collection. Among 8193 eligible patients (mean [SD] age, 69.0 [16.4] years; 4758 [58.1%] female; 1200 [14.6%] African American or Black, 729 [8.9%] Hispanic, and 5778 [70.5%] White) from 252 hospitals, 5033 (61.4%) received early PDAT. Patients receiving early PDAT were similar in age (mean [SD], 68.2 [16.9] vs 70.3 [15.6] years) but more likely to have a lower median (IQR) Charlson-Deyo comorbidity score (2 [1-5] vs 3 [1-5]) compared with patients receiving delayed PDAT. After adjusting for comorbidities and severity of illness, patients receiving early PDAT were 20% less likely to be readmitted within 30 days compared with those receiving delayed PDAT (odds ratio, 0.80; 95% CI, 0.69-0.92; P < .001). A higher percentage of patients receiving early PDAT had a desirability of outcome ranking of 1 compared with patients receiving delayed PDAT (56.3% vs 52.2%, P < .001). Those receiving early PDAT had a 52.5% probability (95% CI, 51.3%-53.7%) of a more desirable outcome than those receiving delayed PDAT, a finding that persisted in the adjusted analysis (probability, 52.0%; 95% CI, 50.9%-53.2%). Receiving early PDAT was associated with favorable 30-day clinical outcomes among patients hospitalized with Enterobacterales blood stream infections. Early PDAT may be important not only for antimicrobial stewardship but also for improving patient outcomes.

EPID-17. REAL-WORLD OUTCOMES OF BRAIN METASTASES FROM PANCREATIC CANCER: AN ANALYSIS OF 1266 PATIENTS

Abstract BACKGROUND Brain metastases (BMs) from pancreatic cancer (PC) are uncommon. This study examined patterns of care and clinical outcomes for PC BMs. METHODS A retrospective analysis was conducted on PC BMs patients in the US National Cancer Database between 2010-2020, following STROBE guidelines. Treatments were categorized into systemic therapy (Sys) alone, stereotactic radiosurgery (SRS)±Sys, whole brain radiation (WBRT)±Sys, and no brain-specific treatment (NoTx). Primary outcome was median overall survival (mOS), with corresponding hazard ratio for death (HR) and 95% confidence intervals. Prognostic factors were determined using multivariable Cox proportional-hazards analysis including age, sex, race/ethnicity, insurance, Charlson-Deyo score (CDS), concurrent metastases (CMs), and treatment type. RESULTS Of 170,071 metastatic PC patients, 1,266 (0.7%) PC BM patients were included. 45.7% were female and 81.3% were White. Median age was 66.0 years (IQR:58.0-74.0). 34.4% had bone CMs, 45.4% had lung CMs, 60.2% had liver CMs. 48.1% of patients received NoTx, 22.6% Sys, 12.4% WBRT+Sys, 9.8% WBRT, 4.6% SRS+Sys, and 2.5% SRS. mOS (95% CI) was 2.4 months (2.2-2.5) in patients with BMs and 3.9 months (3.8-3.9) in those without BMs (P&amp;lt;0.001). Amongst BM patients, SRS+Sys had a significantly higher mOS of 7.8 months (6.1-14.3) followed by WBRT+Sys: 5.2 months (4.2-6.8), Sys: 4.8 months (4.2-5.8), WBRT: 2.0 months (1.6-2.2), SRS: 1.8 months (1.4-3.7), and NoTx: 1.2 months (1.0-1.3) (P&amp;lt;0.001). Patients treated with SRS alone (HR:2.9, 1.8-4.7, P&amp;lt;0.001), WBRT alone (HR:2.9, 2.0-4.0, P&amp;lt;0.001), and Sys alone (HR:1.5, 1.1-2.1, P=0.009) had significantly lower survival than with SRS+Sys. Patients treated in nonacademic facilities (HR:1.3, 1.1-1.4, P&amp;lt;0.001) and those with CMs (HR:1.4, 1.2-1.6, P&amp;lt;0.001) had poorer survival. CONCLUSIONS BMs in PC are rare and associated with lower survival. SRS+Sys was associated with the best prognosis, but &amp;lt;5% received it. 48% of patients receiving NoTx had mOS of 1.2 months. Future studies exploring care variations are warranted.

EPID-14. PATTERNS OF CARE AND PROGNOSTIC FACTORS FOR PATIENTS WITH BRAIN METASTASES FROM COLON CANCER: A REAL-WORLD STUDY

Abstract BACKGROUND Brain metastases (BMs) from colon cancer (CC) have limited published literature. This work sought to examine patterns of care and prognostic factors for patients with CC BMs. METHODS A retrospective study was conducted on patients with CC BMs in the National Cancer Database between 2010-2020 and reported using STROBE guidelines. Treatment was stratified into receipt of stereotactic radiosurgery only (SRS), whole brain radiation only (WBRT), systemic therapy only (Sys), combination therapy, and no brain-directed treatment (NoTx). Median overall survival (mOS) and prognostic factors were determined using multivariate cox proportional hazards adjusting for age, sex, race/ethnicity, insurance, Charlson-Deyo score (CDS), concurrent metastases (CMs), and treatment. Outcomes were reported as hazard ratio (HR) and 95% confidence intervals. RESULTS Among 1,383 BMs patients, median age was 64.0 years (IQR 56.0-73.0). 46.4% were female and 81.2% were White. Overall mOS (95% CI) was 5.6 months (4.5-6.2). 26.1% had bone, 71.5% had lung and 72.4% had liver CMs. 24.4% underwent WBRT+Sys, 22.6% NoTx, 18.5% Sys, 14.8% SRS+Sys, 14.7% WBRT, and 5.0% SRS. Patients who underwent SRS+Sys had the highest mOS of 14.4 months (12.8-16.3) followed by Sys: 11.6 months (8.6-13.4), WBRT+Sys: 9.5 months (8.5-10.9), SRS: 3.2 months (2.5-4.4), WBRT: 2.5 months (2.2-2.8), and NoTx: 2.5 months (2.2-2.8) (P&amp;lt;0.001). Patients treated with WBRT+Sys (HR:1.2, 1.0-1.5, P=0.028), SRS alone (HR:1.8, 1.4-2.5, P&amp;lt;0.001), WBRT alone (HR:3.6, 2.9-4.4, P&amp;lt;0.001), NoTx (HR:2.5, 2.0-3.0, P&amp;lt;0.001) was associated with significantly lower survival than SRS+Sys. Patients treated at non-academic facilities (HR:1.1, 1.0-1.3, P=0.038), with Medicare-insurance (HR:1.2, 1.1-1.5, P=0.013) and with left-sided mCC (HR:0.8, 0.7-0.9, P&amp;lt;0.001) had lower survival. CONCLUSIONS SRS+Sys was associated with the highest survival in patients with CC BMs, however only 14.8% received it. Notably, 22.6% of patients received NoTx. Further prospective studies exploring factors behind heterogeneity in clinical care are warranted.

“Thanks, but no thanks”: Factors associated with patients who decline surgical intervention for thyroid cancer

BackgroundSurgery is the mainstay of therapy for thyroid cancer. A rising number of patients decline recommended surgical intervention. This study aimed to identify factors associated with the decision to decline surgery for well-differentiated thyroid cancer. MethodsPatients with papillary or follicular thyroid cancer diagnosed between 2004 and 2017 were identified from the National Cancer Database. Patients were grouped based on patient-documented refusal of recommended surgery and patients who successfully completed surgery. Baseline characteristic comparison, univariable and multivariable logistic regression, and survival analyses were performed. ResultsA total of 221,664 patients met inclusion criteria: 565 (0.3%) patients declined and 221,099 (99.7%) underwent recommended surgery. Patients who declined surgery were older, male, Black or Asian, and not privately insured. They more frequently had Charlson-Deyo scores ≥3, were diagnosed at academic centers, and presented with larger tumors and advanced clinical stage. Multivariable modeling demonstrated that older age, Black or Asian race, diagnosis at an academic center, no insurance or lack of private insurance, clinical N stage ≥1a, and clinical M stage >0 were associated with higher odds of declining surgery (P < .001). A mean survival of 10 years was found among patients who declined surgery versus 16 years among patients who underwent surgery (P < .0001). ConclusionMost patients diagnosed with well-differentiated thyroid cancer undergo physician-recommended surgical intervention. Declining surgery is associated with worse overall survival and is more likely in older, male, Black, or Asian patients with socioeconomic disadvantage. This study underscores the importance of understanding barriers to thyroid cancer surgery and opportunities to optimize outcomes and reduce disparities for these populations.

Medicaid Status is Independently Predictive of Increased Complications, Readmission, and Mortality Following Primary Total Shoulder Arthroplasty

In recent years, several studies have evaluated the effect of Medicaid insurance status on total shoulder arthroplasty (TSA) outcomes and have presented discordant findings. The purpose of this study is to determine if Medicaid status is an independent predictor of all-cause complications, readmission, revision, and mortality following elective primary TSA using a large, national administrative claims database. The Nationwide Readmissions Database was queried to identify patients who underwent elective primary TSA from 2016 to 2020. Patients were propensity score matched in a 1:1 proportion based on age, sex, and discharge weight, yielding 15,374 Medicaid cases and 15,448 control cases. Patient demographic and discharge information, preoperative comorbidities, and postoperative outcomes were compared with bivariate analysis. Binary logistic regression was performed to account for the influence of variables other than Medicaid status on postoperative outcomes. Medicaid patients had higher rates of preoperative comorbidities, higher Charlson-Deyo Comorbidity Index scores, and lower household incomes than matched controls. Compared to controls, Medicaid patients undergoing TSA had higher odds of adverse clinical outcomes, including all-cause complications, readmission, and mortality within 180days, along with other specific medical and implant-related complications including broken hardware, dislocation, prosthetic loosening, and surgical site infection. Medicaid status was independently predictive of increased rates of all-cause complications within 180days, readmission within 180days, dislocation, pneumonia, sepsis, and decreased rates of prosthetic loosening. Medicaid patients had an increased mean cost of $1396 and increased mean length of stay of 0.4days. Medicaid status was independently predictive of readmission, complications, and mortality within 180days of primary TSA, as well as other specific medical and surgical complications. Medicaid patients experience higher admission costs and longer hospital stays compared to those with other insurance types. Medicaid status is a risk factor for adverse clinical outcomes, and orthopedic surgeons need to consider the multitude of disparities that Medicaid patients experience when determining surgical options, treatment plans, and hospital disposition.

The Role of Metastasectomy in Patients with Liver-Only Metastases from Gastric Adenocarcinoma.

The role of metastasectomy in patients with liver-only metastases from gastric adenocarcinoma remains under investigation. Therefore, we performed a national registry analysis comparing surgical treatment options for patients with gastric adenocarcinoma and liver-only metastases. In this retrospective National Cancer Database (2010-2019) study, adults (≥ 18 years) with gastric adenocarcinoma and liver-only metastases (no brain, bone, or lung metastases) were included. Patients were stratified into four groups: no surgical treatment, primary tumor resection (PTR), liver metastasectomy, and PTR with liver metastasectomy. Survival was evaluated using the Kaplan-Meier method, log-rank test, and Cox regression. Of 10,977 included patients, 93.6% underwent no surgical treatment, 4.6% PTR alone, 0.8% liver metastasectomy alone, and 1.0% both PTR and liver metastasectomy. The median OS after no surgical treatment was 6.5 months, after PTR alone 10.9 months, after liver metastasectomy alone 9.9 months, and after PTR and liver metastasectomy 18.6 months. In multivariable analysis, when adjusting for age, sex, race/ethnicity, insurance status, Charlson-Deyo score, chemotherapy, and radiation, PTR and liver metastasectomy was associated with superior OS compared with no surgical treatment (HR 2.17, 95% CI 1.76-2.69, p < 0.001), PTR alone (HR 1.42, 95% CI 1.12-1.79, p = 0.003), and liver metastasectomy alone (HR 1.96, 95% CI 1.45-2.64, p < 0.001). These data suggest that, in highly selected patients with gastric adenocarcinoma and synchronous liver-only metastases and favorable biology, surgical resection might grant a survival advantage.

Survival After Simple Compared With Radical Hysterectomy for Patients With Early-Stage Cervical Cancer.

To assess the effect on overall survival of simple hysterectomy with lymph node staging compared with radical hysterectomy with lymph node staging for patients with early-stage cervical cancer. We conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with early cervical carcinoma of 2 cm or smaller (stage IA1 with lymphovascular space invasion through IIA1, International Federation of Gynecology and Obstetrics staging) from 2010 to 2019. After 1:1 propensity score matching, we compared patients who underwent simple hysterectomy with lymph node staging and those with radical hysterectomy with lymph node staging. The variables used for matching were age, tumor size, race and ethnicity, lymphovascular space invasion, year of diagnosis, Charlson-Deyo comorbidity score, histology, and surgical approach. The primary outcome was overall survival at the end of follow-up. Secondary outcomes included 30-day readmission rate and 30- and 90-day mortality rates. In total, 4,167 patients met the inclusion criteria, of whom 2,637 patients (63.3%) underwent radical hysterectomy and lymph node staging and 1,530 patients (36.7%) underwent simple hysterectomy and lymph node staging. After propensity score matching, 1,529 patients in each group were included. There was no statistically significant difference in overall survival between patients who underwent simple hysterectomy and those who underwent radical hysterectomy (hazard ratio 1.25, 95% CI, 0.91-1.73, P =.17). Subgroup analysis by histology, lymphovascular space invasion, tumor size, and surgical approach did not reveal statistically significant differences in overall survival according to hysterectomy type. The hysterectomy groups also did not significantly differ in 30-day readmission rate (4.6% vs 4.2%, P =.73), 30-day mortality rate (0.1% vs 0%, P =.14), or 90-day mortality rate (0.1% vs 0.1%, P =.93). Patients with low-risk cervical cancer could undergo less radical surgery without a negative effect on their oncologic outcomes.

Real-world evaluation of multimodal treatment practice in older oesophageal cancer patients.

Elderly-specific data for multimodal treatment of oesophageal cancer (EC) is lacking. This study aimed to evaluate the safety and efficacy of multimodal treatment in older EC patients and to compare the impact of neoadjuvant chemotherapy (NCT) and neoadjuvant chemoradiotherapy (NCRT). Patients diagnosed with oesophageal squamous cell carcinoma or adenocarcinoma who received NCT/NCRT were identified in the National Cancer Database (NCDB, 2004-2015). First, we compared baseline and post-treatment characteristics between younger (<70 years) and older patients (≥70 years). Logistic regression was used to investigate risk factors of postoperative mortality. Second, we evaluated the effect of neoadjuvant chemotherapy on postoperative mortality and overall survival in the older cohort. Inverse probability of treatment weights and multivariable analyses were used to compensate for differences in baseline covariates. We 1st compared outcomes of neoadjuvant therapy plus oesophagectomy in 14778 eligible EC patients. The older group experienced higher rates of postoperative mortality at 30 days (5.8%) and 90 days (13.5%) compared to younger patients. Postoperative mortality was significantly related to the Charlson-Deyo score and treatment-related factors including neoadjuvant therapy type and minimally invasive technique. Second, among the 3141 older patients (with a median follow-up of 57.8 months and 2029 deaths), those receiving NCT obtained significantly lower postoperative mortality and improved overall survival compared with NCRT (inverse probability of treatment weights-adjusted P = 0.05; hazard ratio 0.85; 95% Cl 0.72-0.99). Neoadjuvant therapy plus oesophagectomy carries increased short-term mortality risk in older EC patients. NCT in older EC patients showed lower postoperative mortality but no statistically significant differences in overall survival, with a point estimate favouring NCT compared to the NCRT group, making NCT a potential option for consideration in specific cases.

Primary site surgical resection in cM1 oral cavity squamous cell carcinoma.

To investigate primary site surgical resection and overall survival (OS) in clinically distantly metastatic (cM1) oral cavity squamous cell carcinoma (OCSCC). The 2006-2018 National Cancer Database was queried for patients presenting with cM1 OCSCC who underwent chemotherapy. Binary logistic, Kaplan-Meier, and multivariable Cox proportional hazards regression models were implemented. Of 278 patients satisfying inclusion criteria, 139 (50.0%) underwent chemotherapy alone, 80 (28.8%) underwent chemoradiotherapy, 25 (9.0%) underwent surgical resection + adjuvant chemotherapy, and 34 (12.2%) underwent surgical resection + adjuvant chemoradiotherapy; 5-year OS was 9.4%, 15.2%, 8.3%, and 23.8%, respectively (p < .001). Compared with those not undergoing surgical resection, patients undergoing surgical resection underwent radiotherapy more frequently (57.6% vs. 36.5%) but multiple-agent chemotherapy less frequently (40.7% vs. 74.4%) (p < .005). Twenty-one (36.2%) patients undergoing surgical resection had positive surgical margins. Academic facility (adjusted odds ratio [aOR] 3.19, 95% CI 1.54-6.62) and Charlson-Deyo comorbidity score ≥1 (aOR 2.82, 95% CI 1.25-6.32, p < .025) were associated with increased odds of undergoing surgical resection. Compared with chemotherapy alone, chemoradiotherapy (adjusted hazard ratio [aHR] 0.56, 95% CI 0.38-0.83) and surgical resection + adjuvant chemoradiotherapy (aHR 0.37, 95% CI 0.21-0.66) were associated with higher OS (p < .005). Immunotherapy (aHR 0.48, 95% CI 0.28-0.81, p = .006) was also independently associated with higher OS. A minority of patients with cM1 OCSCC underwent primary site surgical resection. Despite the high rate of positive surgical margins, surgical resection + adjuvant chemoradiotherapy was associated with higher OS than chemotherapy alone, chemoradiotherapy, or surgical resection + adjuvant chemotherapy. Definitive local therapy may benefit select patients with cM1 OCSCC.Level of evidence: 4.

The survival outcomes of localized low-risk prostate cancer, a population-based study using NCDB.

The optimal treatment approach for low-risk prostate cancer (LRPC) remains controversial. While active surveillance is an increasingly popular option, definitive local treatments, including radical prostatectomy (RP), external beam radiotherapy (EBRT), and prostate seed implantation (PSI), are also commonly used. This study aimed to evaluate the survival outcomes of patients with LRPC using a large patient population from the National Cancer Database (NCDB). We analyzed data from 195,452 patients diagnosed with LRPC between 2004 and 2015 using the NCDB. Patients were classified based on their treatment modalities, including RP, EBRT, PSI, or no local treatment (NLT). Only patients with Charlson-Deyo comorbidity scores of 0 or 1 were included to ensure comparability. Propensity score analysis was used to balance the treatment groups, and the accelerated failure time model was used to analyze the survival rates of the treatment groups. After a median follow-up of 70.8 months, 24,545 deaths occurred, resulting in an all-cause mortality rate of 13%. RP demonstrated a survival benefit compared with NLT, particularly in patients younger than 74 years of age. In contrast, radiation treatments (EBRT and PSI) did not improve survival in the younger age groups, except for patients older than 70 years for EBRT and older than 65 years for PSI. Notably, EBRT in patients younger than 65 years was associated with inferior outcomes. This study highlights the differences in survival outcomes among LRPC treatment modalities. RP was associated with improved survival compared to NLT, especially in younger patients. In contrast, EBRT and PSI showed survival benefits primarily in the older age groups. NLT is a reasonable choice, particularly in younger patients when RP is not chosen. These findings emphasize the importance of individualized treatment decisions for LRPC management.

Demographic and Prognostic Factors of the Columnar Cell Variant of Papillary Thyroid Carcinoma: A National Cancer Database Study.

Objective The columnar cell variant of papillary thyroid carcinoma (PTC-CC) is a rare, malignant tumor of the thyroid gland. This study uses the National Cancer Database (NCDB) to analyze demographic and prognostic factors affecting the overall survival rates of PTC-CC. Methods From 2004 to 2020, 7,079 patients diagnosed with columnar cell papillary thyroid carcinoma were identified in the NCDB. Patient demographics were reviewed based on categories listed in the NCDB participant user file data dictionary. Kaplan-Meier curves, log-rank tests, and multivariable Cox hazard regression models were used to analyze the significance of demographic and prognostic factors on overall survival rates of PTC-CC. Results Multivariate analysis demonstrated each five-year increment in age was associated with a 30% increase in mortality (hazard ratio (HR) = 1.30, 95% confidence interval (CI): 1.25-1.36, P < 0.001). Charlson-Deyo scores displayed similar incremental increases, such that patients with a score ≥ 3 had a 154% increase in mortality risk relative to a score of 0 (HR = 2.54; 95% CI: 1.75-3.68, P < 0.001). Black individuals had a 70% increase in mortality compared to White individuals (HR = 1.70, 95% CI: 1.25-2.30, P < 0.001), while all Other races had the highest 10-year survival rate of 92.7%. Females had a significant 37% decrease in mortality compared to males (HR = 0.63, 95% CI: 0.54-0.73, P < 0.001). Patients in the lowest income quartiles were found to have a significant increase in mortality compared to the highest income group (HR = 0.54; 95% CI: 0.41-0.71, P < 0.001). Survival rates were negatively correlated with NCDB Analytic Staging increases. Conclusion In general, age, sex, race, education, income, comorbidities, and cancer staging were found to be predictive factors of overall survival rates of PTC-CC. However, insurance status and education levels did not result in significant differences.

National Cancer Database analysis of radiation therapy consolidation modality and dose for inoperable endometrial cancer

We utilized the National Cancer Database (NCDB) to evaluate trends and assess outcomes in radiation therapy (RT) boost modality and total dose among medically inoperable endometrial cancer (EC) patients with locoregional disease. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage I - IIIC2 inoperable EC treated with RT ± chemotherapy were analyzed. Practice patterns compared external beam RT (EBRT) versus high-dose-rate brachytherapy (BT) boost and total RT dose (palliative: ≤3000 cGy, definitive low dose [DLD]: 4500 - 6249 cGy, definitive high dose [DHD]: ≥6250 cGy) over time. Kaplan-Meier method evaluated overall survival (OS) and Cox proportional hazard modeling assessed variables associated with OS. NCDB included 1755 total cases, of which 1209 received a radiotherapy boost. From 2004 to 2019, boost modality rates differed with increasing utilization of BT consolidation and a decreasing rate of palliation. Predictors of a palliative dose were stage III disease, Black race, N2 disease, and poorly or undifferentiated grade. Multivariable analysis found BT boost was associated with lower mortality compared to EBRT (HR: 0.81, CI: 0.68-0.97; p = 0.019). Mortality rates were higher for palliation versus DHD. Additional factors associated with inferior survival were increasing age, worse Charlson-Deyo score, higher T stage, higher N stage, and moderately, poorly, or undifferentiated grade. Utilization of BT boost for locoregionally confined, medically inoperable EC has increased since 2004. Brachytherapy consolidation remains an effective RT modality for medically inoperable EC, associated with lower mortality compared to EBRT consolidation.

Atypical and anaplastic meningiomas in the later decades of life: A national cancer database analysis.

We conducted a National Cancer Database (NCDB) study to investigate the epidemiological characteristics and identify predictors of outcomes associated with geriatric meningiomas. The NCDB was queried for adults aged 60-89years diagnosed between 2010 and 2017 with grade 2 and 3 meningiomas. The patients were classified into three age groups based on their age: 60-69 (hexagenarians), 70-79 (septuagenarians), and 80-89 (octogenarians). The log-rank test was utilized to compare the differences in overall survival (OS). Univariate and multivariate Cox proportional hazards regressions were used to evaluate the mortality risk associated with various patient and disease parameters. A total of 6585 patients were identified. Hexagenerians were the most common age group (49.8%), with the majority of meningiomas being classified as grade 2 (89.5%). The incidence of high-grade meningiomas increased in all age groups during the study period. Advanced age, male sex, black race, lower socioeconomic status, Charlson-Deyo score ≥ 2, and higher tumor grade were independent factors of poor survival. Among the modes of treatment, the extent of surgical resection, adjuvant radiotherapy, and treatment at a noncommunity cancer program were linked with better outcomes. In geriatric patients with high-grade meningiomas, the greater extent of surgical resection and radiotherapy are associated with improved survival. However, the management and outcome of geriatric patients with higher-grade meningiomas are also associated with several socioeconomic factors.

Identifying and Treating Those at Risk: Disparities in Rapid Relapse Among TNBC Patients in the National Cancer Database

PurposeThis study was designed to characterize features of rapid relapse TNBC (rrTNBC), an aggressive, poor prognosis breast cancer subset using the National Cancer Database (NCDB).MethodsPatients diagnosed with TNBC between 2010 and 2019 within NCDB were included in analyses. rrTNBC was defined as all-cause mortality ≤24 months from diagnosis. Patient demographic, tumor, and treatment association with rrTNBC were evaluated in univariate, bivariate analyses, and multiple logistic regression models. Two-part models are used to compare receipt of treatment (i.e., receipt of both chemotherapy and breast surgery) versus not in its relationship with rrTNBC.ResultsOverall, 14.5% of patients were categorized as rrTNBC. Age older than 75 years (−41.3%), Black race (−1.4%), Medicare (−2.6%), and Charlson-Deyo score ≥2 (−4.9%) were associated with a lower probability of receiving both chemotherapy and breast surgery. Not receiving both treatments (vs. receiving both chemotherapy and breast surgery) was associated with a two-to-three-fold higher probability of rrTNBC among patients aged older than 75 years (16.6% vs. 6%), having Medicare (3.6% vs. 1.6%), and Charlson-Deyo score ≥2 (16.6% vs. 5.9%).ConclusionsAge, insurance, and comorbidity were related to a lower likelihood of treatment; yet receiving treatment reduced the risk of rrTNBC threefold for each. These findings might be valuable to inform clinical care delivery, as well as future research that examines treatment protocols among diverse patients.

Malignant chondroblastoma: NCDB analysis of demographic and socioeconomic factors.

e23500 Background: Malignant chondroblastomas are atypical forms of the rare benign chondroid-producing neoplasm known as a chondroblastoma. Chondroblastomas account for less than 1% of all bone tumors and arise in the epiphyses of long bones in young adults. Unlike conventional chondroblastoma, the majority of patients diagnosed with malignant chondroblastomas tend to be older and tumors present at atypical body sites. Therefore investigating trends in diagnosis may yield important insight into its epidemiology. The National Cancer Database (NCDB) was explored to analyze the demographic factors in patients diagnosed with malignant chondroblastoma. Methods: A retrospective cohort analysis utilizing the 2004–2020 National Cancer Database (NCDB) included 67 patients with a histologically-confirmed diagnosis of malignant chondroblastoma (ICD-O-3 Code 9230). Demographic factors (age, sex, race, Hispanic status, insurance status, facility type, distance from facility, and Charlson-Deyo score) were analyzed by descriptive statistics, and incidence trends were interpreted using regression analysis. Results: Between 2004 – 2020, the NCDB identified 67 patients with a confirmed malignant chondroblastoma diagnosis. There was a slightly increasing incidence of patients diagnosed per year (R² = 0.471). The most common primary site was the frontal lobe (60%). Males and females were affected equally (49% and 51%, respectively) with a mean age at diagnosis of 46.5 years (SD = 15.3, Range = 21 – 74 years). The majority of patients were White (90%), non-Hispanic (87%), lived in metropolitan areas (82%), and were privately insured (63%). Treatment facilities primarily consisted of academic programs (48%). Patients lived an average of 27 miles away from the facility (SD = 49, Range = 356.3 miles). Most individuals (76%) had Charlson-Deyo comorbidity scores of 0. Primary treatment methods involved administering radiation therapy (52%). 60 patients (90%) underwent surgical intervention. For valid data, post-surgery survival rates were 100% after 30 days and 93% after 90 days. About half of the patients (57%) survived 5 years after their initial diagnosis. Conclusions: Malignant chondroblastoma is locally aggressive and has metastatic potential. Surgical intervention was the most common treatment (90%), which is consistent with the previous literature. In this study, AJCC staging was not applicable to almost all of the patients (99%). To the best of our knowledge, this is the first NCDB analysis of malignant chondroblastoma patient demographic and socioeconomic factors which addresses a significant gap in knowledge. Most patients were White, non-Hispanic, lived in metropolitan areas and were privately insured. Additional investigation is required to enhance our understanding of how demographic and socioeconomic factors influence the diagnosis, staging, and treatment of individuals with malignant chondroblastoma.

Malignant mesenchymoma: A demographic analysis of the National Cancer Database.

e23556 Background: Malignant mesenchymoma is a rare, aggressive soft tissue tumor characterized by the presence of two or more histologic subtypes of sarcoma. As a result of these characteristics, this cancer has a poor prognosis and a lack of proven treatment options. It may be epidemiologically beneficial to analyze the diagnostic trends to further understand the factors contributing to the disease. This study examines the demographic factors of malignant mesenchymoma, ICD-O-3 Code 8990, through the National Cancer Database (NCDB). Methods: The 2004-2020 NCDB was used for retrospective analysis. 72 patients were identified and their demographic factors such as age, sex, race, Hispanic status, educational attainment, insurance status, facility type and location, distance from facility, and Charlson-Deyo score were analyzed using descriptive statistics. Regression analysis was used to interpret incidence trends. Results: The NCDB contains 72 recorded cases of malignant mesenchymoma from 2004-2020 with an average age at diagnosis of 49.9 ± 21.3 years, with the incidence rate exhibiting variability (R2= 0.1028). Women had a considerably higher diagnosis rate (67%) compared to men (33%). The majority of patients were White (75%), and 11% of patients were Black. Most patients were of non-Hispanic origin (81%). A higher percentage of patients fell into the fourth quartile of income earners (32%) compared to the top three quartiles. A significant portion of patients (26%) did not have a high school degree. The sites with the highest cancer prevalence were the retroperitoneum (10%) and endometrium (10%). A majority of individuals (78%) had Charlson-Deyo comorbidity scores of 0. The size of the tumors ranged from 10.0 to 250.0 mm with an average size of 61.6 ± 67.4 mm. A majority of the patients (72%) underwent surgery at the primary site. Most (96%) patients survived at least thirty days following their primary surgery, with 94% surviving for ninety or more days. The mean survival time was 91.0 months. The cancer’s 2-year, 5-year, and 10-year survival rates were 61.5%, 45.5%, and 43.1% respectively. Conclusions: Based on our searches, this is the first NCDB study on malignant mesenchymoma to address epidemiological gaps in the literature. Most malignant mesenchymoma patients identified as non-Hispanic and White with a primary site of either the retroperitoneum or endometrium. The majority of patients fell into the fourth income quartile, and a significant amount did not have a high school degree. Due to this cancer’s rarity, recent literature exploring the factors contributing to the disease course is scarce. Additional research is necessary to understand how demographics influence the diagnosis, treatment, and long-term outcomes of individuals diagnosed with malignant mesenchymoma.

Analysis of demographic and socioeconomic factors in adamantinoma using data from the National Cancer Database (NCDB).

e23501 Background: Adamantinoma is a rare low-grade primary malignant bone tumor accounting for less than 1% of all malignant bone tumors. It largely presents in the tibia of young adults, is locally aggressive, and can metastasize. Definitive diagnosis is primarily established by histopathological examination. This rare tumor with uncertain histogenesis remains under-studied. Therefore, exploring trends in diagnoses may provide insight into its epidemiology. The National Cancer Database (NCDB) was examined to reveal the demographic factors in patients diagnosed with Adamantinoma. Methods: A retrospective cohort analysis utilizing the 2004–2020 NCDB included 206 patients with a histologically-confirmed diagnosis of adamantinoma (ICD-O-3 Code 9261). Demographic factors such as age, sex, race, Hispanic status, insurance status, facility type, distance from facility, and Charlson-Deyo score were analyzed via descriptive statistics. Trends in incidence were interpreted using regression analysis. Results: A total of 206 patients were identified in the NCDB with a confirmed diagnosis of adamantinoma of long bones between 2004-2020. Incidence remained relatively stable over this time period (R² = 0.009). The most common primary site of diagnosis were the long bones of lower limb and associative joints (97%). Most individuals (88%) had a Charlson-Deyo comorbidity score of 0. The majority of patients (66%) were classified as Stage 1 AJCC staging. Men were more likely to be diagnosed (56%) compared to women (44%). Most patients were White (78%) and non-Hispanic (85%). A higher percentage of patients were privately insured (67%) and lived in metropolitan areas (87%). Treatment facilities primarily were academic programs (74%). Almost all of the patients were treated surgically (92%) with the most common approach being lymph node dissection (61%) more so than local tumor excision or removal of adjacent organs. Following surgery, the patients observed had a very good prognosis, with a 99% ninety-day survival, a 93% five-year survival, and an 89% ten-year survival. Conclusions: Adamantinoma has a risk for recurrent and metastatic disease. This first NCDB analysis on adamantinoma’s demographics addresses a significant knowledge gap on this topic. The primary site of diagnosis were lower extremity long bones, most commonly treated with surgical intervention, and had a high survival rate which is consistent with earlier studies. The majority of patients included in this study tend to be White, non-Hispanic, and privately insured. This may suggest a demographic and socioeconomic factor that plays a part in diagnosis, prognosis, and treatment of individuals with adamantinoma. Future research should focus on the understanding of factors that impact the course of one’s health and the etiology of this rare pathology.

Survival outcomes associated with treatment modalities in stage 4 gallbladder neuroendocrine tumors: A nationwide analysis.

e16295 Background: Gallbladder neuroendocrine tumors (GNETs) are rare, heterogeneous, and aggressive tumors of the gallbladder. GNETs usually present in the elderly ( &gt; 60 years) and there are no clear clinical guidelines to treat stage 4 GNETs due to rarity. We evaluated therapeutic options for stage 4 GNETs. Methods: We included stage 4 GNETs diagnosed between 2004-2020 in the National Cancer Database. Treatment was stratified into combination therapy (Comb) - surgery (Sx) and chemotherapy (CT), Sx alone and CT alone. Survival outcomes were expressed as Kaplan-Meier curves and Cox proportional hazard model adjusting for age, Charlson-Deyo score (CDS) and sociodemographic variables like sex, race, ethnicity, insurance status, and facility location. We expressed survival outcomes as median overall survival (mOS, 95% CI) and time-dependent survival as hazard ratio (HR, 95% CI). Results: Of 242 patients with stage 4 GNETs, the median age was 64 years (range 29-90+ years), 62.4% were female, 66.9% had CDS of 0, 22.4% had CDS of 1, 10.8% had CDS ≥2, 98.7% had poorly differentiated tumor (grade 3 or 4), 70.3% were White, 85.9% were non-Hispanic, median size of the primary tumor was 10.7 cm (range 0.8-14.1 cm) and 47.8% were treated at academic or research program. 46 (19.0%) patients received Comb, 171 (70.7%) received CT and 25 (10.3%) patients received Sx alone. The mOS was 11.5 months (9.3-18.4), 9.4 months (7.9-11.2), 4.2 months (2.3-6.3) for Comb, CT and Sx, respectively (P &lt; 0.001). Pairwise log-rank revealed no significant differences between Comb and CT groups (P = 0.07). In univariate Cox analysis, CDS ≥2 showed HR of 1.6 (1.0-2.4; p = 0.04), Sx showed HR of 1.7 (1.1-2.7; P = 0.02), and Medicare had HR of 1.35 (1.02-1.78; p = 0.037). However, on multivariate analysis, uninsured patients (HR = 5.16; 95% CI 1.50-17.7; P = 0.009) and those receiving Sx alone (HR = 2.09; 95% CI 1.27-3.46; P = 0.004) had unfavorable outcomes. Conclusions: The combination of primary site surgery with CT improves survival in stage 4 GNETs as compared to resection alone. However, there is no significant difference in survival in combination therapy and CT. We emphasize the need for robust prospective studies comparing the efficacy of chemotherapy, neoadjuvant and adjuvant chemotherapy for stage 4 GNETs.[Table: see text]