Clinical Cancer Registry Research Articles

Analysis of the methodology of skin cancer incidence registration in German cancer registries

Skin cancer is one of the most common cancers in the world but non-melanoma skin cancer (NMSC) has been included for the first time in the Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN). Germany is one of the countries with high-quality data collected by 16 population-based cancer registries, yet NMSC always faced completion issues because of out-patient based treatment. The purpose of this study is to analyze the methodology of skin cancer incidence registration, assess the quality of data on skin cancer, and suggest improvements. The information was extracted from annual reports of all German cancer registries, the Robert Koch Institute (RKI), the Manual of cancer registration, through a questionnaire sent to all the registries and relevant articles. Comparison of the methodology with that of Nordic countries was done to suggest improvements. Legislative laws for remuneration, changing ICD codes, no multiple tumors counting, all affect skin cancer registration and its reported incidence rate. Use of mortality/incidence (M/I) ratio as an assessment of completeness, national skin cancer screening (SCS) project, the incomplete Tumor Node Metastasis (TNM) staging, determine the quality of skin cancer data. This data is definitely more complete for malignant melanoma (MM) as compared to NMSC. Nordic countries have achieved higher completion even for skin cancer data. Reporting basal cell cancer (BCC) in a separate file, recording the tumor stage and site specifications will improve the quality of data. Remuneration laws and rules for multiple tumors need to be reformed and standardized across all the federal states. Upcoming clinical cancer registries would complement the epidemiological registries and help improve the situation in the future in Germany.

Complementing clinical cancer registry data with patient reported outcomes: A feasibility study on routine electronic patient-reported outcome assessment for the Austrian Myelome Registry.

ObjectivesRoutinely assessed patient‐reported outcomes (PROs), such as quality of life (QOL), are important to supplement clinical cancer data but requires rigorous implementation. This study aims at depicting the implementation procedure and evaluating the feasibility of routine electronic PRO monitoring (ePRO) for collecting data supplementing the Austrian Myeloma Registry (AMR).MethodsIntegration of ePRO monitoring into clinical routine was planned according to the Replicating Effective Programs framework. QOL data were assessed regularly during treatment and aftercare at the hematooncological outpatient unit at the Medical University of Innsbruck with the EORTC QLQ‐C30/ +MY20 and the EQ‐5D‐5L. Feasibility and usability testing were performed via a multimethod approach.ResultsWithin the first year, 94.4% of the MM patients (N = 142, mean age 65.4, SD 11.8, 60% male) provided 748 PRO assessment time points overall. Patients and clinicians were satisfied with ePRO monitoring and indicated no to little disruption in clinical routine. Patient preference on assessment time points and completion frequency became evident.ConclusionsComplementing the AMR with ePRO data proved to be feasible. Our findings provide useful insights for healthcare providers considering introducing ePRO monitoring to their units for informing clinical registries as well as individualised feedback to patients alike.

Fear of cancer recurrence across the survivorship trajectory: Results from a survey of adult long-term cancer survivors.

Our study analysed fear of cancer recurrence (FoR) in long-term cancer survivors in relation to medical variables, depression, anxiety, and quality of life. We present data obtained from 1,002 cancer survivors (53% male, mean age=68 years, 26% prostate cancer, 22% breast cancer) across all cancer types 5 (N=660) and 10 (N=342) years after diagnosis, who were recruited via a large Clinical Cancer Registry in Germany in a cross-sectional study. FoR, depression, and anxiety were measured using validated self-report questionnaires (12-item short version of the Fear of Progression Questionnaire [FoP-Q-SF], Patient Health Questionnaire-9 [PHQ-9[, and General Anxiety Disorder-7 [GAD-7]). Hierarchical regression models were carried out with FoR as dependent variable and time since diagnosis as control variable. We found high FoR-values in 17% of the cancer survivors (FoP-Q-SF total score>33). FoR was higher in the 5-year cohort (P=.028, d=0.153). Cancer survivors were most worried about the future of the family; they report being nervous prior to doctor's appointment and being afraid of relying on strangers help. Higher FoR was related to female gender (Beta=.149, P<.001), younger age (Beta=-.103, P<.001), low social (Beta=-.129, P<.001) and emotional functioning (Beta=-.269, P<.001), received hormone therapy (P=.025, d=0.056), and high anxiety levels (Beta=.227, P<.001). Even though FoR declines slightly over time, it is still a common mental health problem for long-term survivors even 10 years after cancer diagnosis. Since FoR is associated with reduced emotional and social quality of life, patients who are at greater risk of experiencing FoR must be identified and supported. Particularly at risk are younger women who received hormone therapy.

Risk of emergency hospitalisation and survival outcomes following adjuvant chemotherapy for early breast cancer in New South Wales, Australia.

To examine risk of emergency hospital admission and survival following adjuvant chemotherapy for early breast cancer. Linked data from New South Wales population-based and clinical cancer registries (2008-2012), hospital admissions, official death records and pharmaceutical benefit claims. Women aged ≥18years receiving adjuvant chemotherapy for early-stage operable breast cancer in NSW public hospitals were included. Odds ratios (OR) for emergency hospitalisation within 6months following chemotherapy initiation were estimated using logistic regression and survival using Kaplan-Meier and Cox proportional hazards methods. A total of 3,950 women were included and 30.6% were hospitalised. The most common principal diagnosis at admission was neutropenia (30.8%). Women receiving docetaxel/carboplatin/trastuzumab (TCH) and docetaxel/cyclophosphamide (TC) were the most frequently hospitalised. After adjustment for demographic and clinical factors, the increased risk of hospitalisation for TCH and TC remained compared with doxorubicin/cyclophosphamide 3-weekly (OR 1.71, 95% confidence interval [CI] 1.24-2.37 and OR 1.47, 95% CI 1.17-1.85 respectively). Five-year overall survival was similar for women who were (92.2%, 95% CI 90.7-93.8) and were not hospitalised (93.1%, 95% CI 92.1-94.1). Emergency hospitalisations following chemotherapy for early breast cancer were relatively common, especially following docetaxel-containing protocols. Further examination of reasons for admission is needed to inform actions to improve patient safety.

Laparoscopic and open surgery in rectal cancer patients in Germany: short and long-term results of a large 10-year population-based cohort

BackgroundRectal cancer is frequent in Germany and worldwide. Several studies have assessed laparoscopic surgery as a treatment option and most have shown favorable results. However, long-term oncologic safety remains a controversial issue.MethodsThe current dataset derives from 30 clinical cancer registries in Germany and includes 16,378 patients diagnosed with rectal cancer between 2007 and 2016. Outcomes were 90-day mortality, overall survival (OS), local recurrence-free survival (RFS) and relative survival of patients treated with either open or laparoscopic surgery. Multivariable logistic regression was used to evaluate factors that affected the probability of a patient undergoing laparoscopic surgery as well as to evaluate short-term mortality. OS and RFS were analyzed by Kaplan–Meier plots and multivariable Cox regression conducted separately for UICC stages I–III, tumor location, and sex as well as by propensity score matching followed by univariable and multivariable survival analysis.ResultsOf 16,378 patients, 4540 (27.7%) underwent laparoscopic surgery, a trend which increased during the observation period. Patients undergoing laparoscopy attained better results for 90-day mortality (odds ratio, OR 0.658, 95% confidence interval, CI 0.526–0.822). The 5-year OS rate in the laparoscopic group was 82.6%, vs. 76.6% in the open surgery group, with a hazard ratio (HR) of 0.819 in multivariable Cox regression (95% CI 0.747–0.899, p < 0.001). The laparoscopic group showed a better 5-year RFS, with 81.8 vs. 74.3% and HR 0.770 (95% CI 0.705–0.842, p < 0.001). The 5-year relative survival rates were also in favor of laparoscopy, with 93.1 vs. 88.4% (p = 0.012).ConclusionLaparoscopic surgery for rectal cancer can be performed safely and, according to this study, is associated with an oncological outcome superior to that of the open procedure. Therefore, in the absence of individual contraindications, it should be considered as a standard approach.

Predicting the risk of locoregional recurrence after early breast cancer: an external validation of the Dutch INFLUENCE-nomogram with clinical cancer registry data from Germany

PurposeFollow-up after breast cancer treatment aims for an early detection of locoregional breast cancer recurrences (LRR) to improve the patients’ outcome. By estimating individual’s 5-year recurrence-risks, the Dutch INFLUENCE-nomogram can assist health professionals and patients in developing personalized risk-based follow-up pathways. The objective of this study is to validate the prediction tool on non-Dutch patients.Material and methodsData for this external validation derive from a large clinical cancer registry in southern Germany, covering a population of 1.1 million. Patients with curative resection of early-stage breast cancer, diagnosed between 2000 and 2012, were included in the analysis (n = 6520). For each of them, an individual LRR-risk was estimated by the INFLUENCE-nomogram. Its predictive ability was tested by comparing estimated and observed LRR-probabilities using the Hosmer–Lemeshow goodness-of-fit test and C-statistics.ResultsIn the German validation-cohort, 2.8% of the patients developed an LRR within 5 years after primary surgery (n = 184). While the INFLUENCE-nomogram generally underestimates the actual LRR-risk of the German patients (p < 0.001), its discriminative ability is comparable to the one observed in the original Dutch modeling-cohort (C-statistic German validation-cohort: 0.73, CI 0.69–0.77 vs. C-statistic Dutch modeling-cohort: 0.71, CI 0.69–0.73). Similar results were obtained in most of the subgroup analyses stratified by age, type of surgery and intrinsic biological subtypes.ConclusionThe outcomes of this external validation underline the generalizability of the INFLUENCE-nomogram beyond the Dutch population. The model performance could be enhanced in future by incorporating additional risk factors for LRR.

Mini Review on the Use of Clinical Cancer Registers for Prostate Cancer: The National Prostate Cancer Register (NPCR) of Sweden.

Given the increasing prevalence of cancer, it is vital to systematically collect data in order to monitor disease trends and quality of cancer care. For this purpose, clinical cancer registries have been developed in some countries. These registers are intended to be used as a basis for quality assurance and quality improvement, but they also constitute a rich resource of real world data for research. The aim of this mini-review was to describe the structure and the organization of the National Prostate Cancer Register (NPCR) with some examples on how data in NPCR have affected prostate cancer care in Sweden.

Using clinical cancer registry data for estimation of quality indicators: Results from the Norwegian breast cancer registry

IntroductionIncreased focus on quality indicators and the use of clinical registries for breast cancer for real world studies have shown higher compliance to recommended therapy and better survival. In 2010, the European Society of Breast Cancer Specialist (EUSOMA) proposed quality indicators (QI) covering diagnosis, treatment and follow-up. To become a EUSOMA certified Breast Cancer Unit, 14 specified quality indicators, in addition to other requirements, need to be met. To evaluate the compliance and results of recommended treatment in breast cancer care in Norway and to improve the quality of epidemiological data, the Cancer Registry of Norway (CRN) in cooperation with the Norwegian Breast Cancer Group (NBCG) developed the Norwegian Breast Cancer Registry (NBCR).The objective of this study is to assess the feasibility of using the NBCR for estimating the EUSOMA QI individually for all hospitals diagnosing and treating breast cancer in Norway. MethodsTo provide researchers with high quality cancer data as well as for the purpose of national cancer statistics, the CRN employs a cancer registry system to 1) longitudinal capture data from all patients from all medical entities that diagnose and/or treat cancer patients (e.g., pathology, radiology and clinical departments) in Norway; 2) curate data, i.e. validate the correctness of collected data, and assemble the validated cancer data as cancer cases; 3) provide data for analytics and presentation. Estimates for 10 EUSOMA QI were calculated at national and hospital level. To compare hospitals, a summary score of QIs was defined for each hospital. ResultsAll hospitals currently treating breast cancer patients have the technical ability to submit data to the NBCR for estimation of QIs defined by EUSOMA. Data from pathology and surgery are of high quality. However, data from oncological and radiological departments are incomplete, but improving. This currently hinders three QIs from being calculated. QI on benign to malign diagnosis needs to be calculated at the individual Breast Centre. Over time the adherence to guidelines have improved and the hospital variation for the respective QI have decreased. Two hospitals met all minimum standard on ten QIs in year 2016 and one hospital did not meet one minimum standard, but met all other targets. ConclusionThe NBCR has since 2012 published annual reports on breast cancer care and for the year 2016 measured 10 of 14 QI defined by EUSOMA. Increased compliance of recommended treatment in Norway has been observed during the years the registry has been active.

Role of robot assisted retroperitoneal lymph node dissection in metastatic malignant mesothelioma of the tunica vaginalis: Case series.

536 Background: The management of malignant mesothelioma of the tunica vaginalis of the testes (MMTVT) is not clearly defined, though retroperitoneal lymph node dissection has been reported as a diagnostic and potentially therapeutic option. Herein we present our experience with robot assisted retroperitoneal lymph node dissection (RARPLND) in a series of patients with MMTVT. Methods: The Mayo Clinic cancer registry was queried from 1972-present for all patients who had a diagnosis of MMTVT. Six patients were identified, five of whom were treated with RPLND, where four underwent RARPLND. Data was collected on pertinent demographic, preoperative, perioperative, postoperative outcomes and follow-up oncological data. Results: In five patients who underwent RPLND, the median age was 50 years (IQR 34-51), median BMI was 26.9 (IQR 26.4-30.6). Four patients originally presented with right sided symptomatic hydroceles, while one presented with right sided chronic epididymitis. Orchiectomy (one simple, two inguinal radical) was performed in three patients and hydrocelectomy in the other two patients prior to presentation. Preoperative cross-sectional imaging, including PET-CT scan in three patients, was negative for lymphadenopathy or metastasis. RARPLND was performed in 4/5 (80%) cases and concomitant hemiscrotectomy in 4/5 (80%) cases. Full bilateral template was performed in three patients and right modified template was performed in the remaining two. Median lymph node yield was 29 (IQR 22-32) and median blood loss was 275 cc (IQR 200-300). Positive retroperitoneal lymph nodes were found in 3/5 (60%) cases. Final margins of hemiscrotectomy were negative in all four cases. All patients who underwent RARPLND were discharged home on postoperative day one. One patient received four cycles of adjuvant Cisplatin and Pemetrexed. Mean follow-up was 27 months (range 2-47). No patients recurred. Conclusions: MMTVT is a very rare malignancy with high potential for retroperitoneal lymph node dissemination. Regardless of the approach, RPLND may provide both a diagnostic and therapeutic benefit, with the robotic approach affording a potentially expedited recovery.

Bias in survival estimates created by a requirement for consent to enter a clinical breast cancer registry

BackgroundA requirement for consent for inclusion may bias the results from a clinical registry. This study gives a direct measure of this bias, based on a population-based clinical breast cancer registry where the requirement for consent was removed after further ethical review and data could be re-analysed. MethodsIn Auckland, New Zealand, the population-based clinical breast cancer registry required written patient consent for inclusion from 2000-2012. A subsequent ethical review removed this requirement and allowed an analysis of consented and non-consented patients. Kaplan-Meier survival to 10 years (mean follow-up 5.1 years, maximum 13.9 years), demographic and clinical characteristics were compared. Of 9244 women with invasive cancer, 926 (10.4%) were not consented, and of 1642 women with ductal carcinoma in situ, 245 (14.9%) were not consented. ResultsSurvival was much higher for consenting patients; invasive cancer, 5 year survival 83.2% (95% confidence limits 82.2–84.1%) for consenting patients, 57.1% (53.0–60.9%) for non-consenting, and 80.8% in all patients. Analyses based only on consenting patients overestimate survival in all patients by around 2% at 2, 5, and 10 years. Non-consented patients were older, more often of Pacific ethnicity, had fewer screen-detected cancers, and more often had metastatic disease; they less frequently had primary surgery or systemic treatments. ConclusionData from a registry requiring active consent gives an upward bias in survival results, as non-consenting patients have more extensive disease, less treatment, and lower survival. To give unbiased results active consent should be not required in a clinical cancer registry.

DNA ploidy status, S-phase fraction, and p53 are not independent prognostic factors for survival in endometrioid endometrial carcinoma FIGO stage I-III.

To assess the effects on relative survival of established and new prognostic factors in stage I-III grade 1-3 endometrioid endometrial carcinoma and in the subgroup of stage I grade 1-2. This was a population-based, retrospective study including all women (n=1113) in the western Swedish healthcare region diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I-III grade 1-3 endometrioid endometrial carcinoma in 2006-2011. Histology, grade, stage, and age were prospectively reported to the regional clinical and national cancer registers. DNA ploidy and S-phase fraction were analyzed by flow cytometer. S-phase fraction cut-off was set at ≥8%. Tumor biopsies were classified as diploid if there was one G0/G1 peak or the DNA index was 1.0±0.04. Overexpression of p53 as determined by immunohistochemistry was positive if strong nuclear staining was found in >30% of the neoplastic cells. Based on univariable statistical analyses we found that 5-year relative survival was significantly associated with S-phase fraction, DNA ploidy, p53, stage, grade, and age. Excess mortality for S-phase fraction ≥8%, aneuploidy, and p53 overexpression was 8, 14, and 8 and times higher, respectively. However, in a multivariable regression model, adjusted for stage, grade, and age, S-phase fraction, DNA ploidy, and p53 were not statistically independent prognostic factors (p=0.413, p=0.107, p=0.208, respectively) for 5-year relative survival in stage I-III grade 1-3 endometrioid endometrial carcinoma. In a subgroup analysis of stage I grade 1-2, aneuploidy identified a subgroup with impaired 5-year relative survival. We can conclude that S-phase fraction, DNA ploidy, and p53 overexpression did not improve identification of high-risk patients by stage, grade, and age in stage I-III endometrioid endometrial carcinoma. In stage I, aneuploidy and grade 2 predicted lower relative survival rates than other variables.

Adherence to guidelines and benefit of adjuvant radiotherapy in patients with invasive breast cancer: results from a large population-based cohort study of a cancer registry.

According to German S3 guidelines, radiotherapy (RT) is indicated in patients with invasive breast cancer after breast-conserving therapy (BCT). The aim of this analysis was to assess adherence to guidelines, long-term survival, recurrence rates, and recurrence-free survival after adjuvant RT in patients with BCT in daily clinical practice. This retrospective cohort study comprised data from the population-based clinical cancer registry of the Tumor Centre Regensburg (Bavaria, Germany). 6370 patients with non-metastatic invasive breast cancer and UICC tumor stages I, II, and III who were treated in certified breast cancer centers by BCT and diagnosed between 2003 and 2013 were included in the study. 6184 (97.1%) breast cancer patients received guideline concordant RT and showed a 3-year overall survival (OAS) of 96.8% in contrast to 90.9% in patients without RT (5-year OAS of 93.1% vs. 79.0%, p < 0.001). In multivariable Cox regression models, better overall survival was confirmed for the RT group (HR 0.64, 95% CI 0.46-0.88, p = 0.007). The 5-year local recurrence-free survival rate (RFS) in the irradiated patients was 92.1% vs. 62.0% in the comparison group (p < 0.001). The 10-year RFS was 80.5% vs. 36.0% (p < 0.001). This difference persisted after adjusting in multivariable analysis (HR 0.20, 95% CI 0.16-0.26, p < 0.001). This population-based analysis showed that the implementation of German guidelines in clinical routine was successful and guideline concordant adjuvant radiotherapy after BCT leads to better overall and recurrence-free survival and lower local recurrence rates.

Validation of a Clinical Cancer Register at the Head and Neck Oncology Center in Örebro.

This was a validation study of a regional register of oral cancer in Örebro, Sweden. The purpose was to assess the rate of errors in baseline, and treatment, and the completeness and accuracy of data on recurrences. A total of 653 cases with squamous cell cancer in the oral cavity were identified from the register. A randomized sample of 73 (11%) was selected, and a set of relevant data was compared to medical records. Data on patient and tumour characteristics showed high accuracy, with 98% correct data and more than 99% of treatment data were correct. Follow-up data had a higher rate of errors, with 23% of recurrences not recorded, 13.6% misclassified, and 9.1% of cases showing errors in timing of the recurrence. data concerning patients, tumour status, and treatment in the Regional Head and Neck Register in Örebro are highly accurate. However, the follow-up data contain a higher rate of errors, that must be taken into consideration when evaluating outcome after treatment.

Factors Associated with Overall Survival in Follicular Lymphoma Patients Who Are Eligible for Maintenance Therapy

Background: Follicular lymphoma (FL) is the most common indolent Non-Hodgkin lymphoma. Diagnosed with advanced disease, most patients have an excellent prognosis, but treatment options are not curative and can have significant morbidity. To date, there is no standard of care for first-line (1L) treatment for FL. In fact, current National Comprehensive Care Network (NCCN) guidelines list 11 (including three category 1) 1L treatment options for FL. Following the successful completion of 1L treatment, patients may also receive consolidation or maintenance rituximab (MR) therapy, with the intent of prolonging remission. Although MR has been shown to improve progression free survival, its impact on overall survival (OS) remains controversial. Leveraging electronic healthcare records, we identify and describe the demographics, treatment practices, and associated outcomes of FL patients diagnosed and treated in the nation's largest integrated healthcare system, the Veterans Health Administration (VHA),Methods: FL patients diagnosed and treated in the VHA between 2006-2014 were identified by linking information from the VA Clinical Cancer Registry (VACCR) and the Corporate Data Warehouse (CDW). Patients were excluded if they had evidence of a prior cancer, documented grade 3b, or stage I disease. Patient demographics, disease characteristics, and treatment history and associated outcomes were extracted. Patients were grouped by 1L treatment(s) which included rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP); rituximab, cyclophosphamide, vincristine, and prednisone (RCVP); bendamustine rituximab (BR), single-agent rituximab; and whether or not they received MR. Descriptive statistics were used to describe patient demographics, disease characteristics, and treatment practice patterns. Proportions were used for discrete variables; means and/or medians (with standard deviation or interquartile range, respectively) were used to describe continuous variables. Overall survival (OS) was compared between patients who received MR and those who did not, using an adjusted Cox proportional hazards model.Results: From 2006-2014, 2290 FL patients were diagnosed at VHA, from all regions of the United States. Median age was 65 years, 95% were male, 81% were non-Hispanic white, 7% were black, 2% were Hispanic, and 8% were other/unknown. At diagnosis, 25% of patients were grade 1, 27% grade 2, and 12% grade 3, and 4% were documented as grade 1-2. More than half (58%) of these patients had disease at stage III or IV at diagnosis, with 13% at stage II, and 21% at stage I. The most common comorbidity was diabetes, present in 27% of patients, followed by pulmonary disease (18%), peripheral vascular disease (8%), and renal disease (8%). Overall, 793 (85%) patients were treated with chemoimmunotherapy, with 341 (15%) patients receiving RCHOP, 253 (11%) receiving RCVP, and 199 (9%) receiving BR; while 132 (6%) patients were treated with single-agent rituximab. Compared to patients treated with chemoimmunotherapy, patients treated with single-agent rituximab were significantly older (77% ≥ 60 vs 67%, p=0.022) and less likely to have elevated LDH (14% vs 24%, p=0.03) or grade 3 disease (9% vs 21%, p= 0.002). Of the 905 patients who were treated with chemoimmunotherapy or single-agent rituximab and showed no evidence of progressive disease (i.e., MR-eligible patients), 319 patients (35%) received MR. On multivariable analysis, the following were independently associated with decreased OS: age at treatment ≥ 60 (HR=2.1, p=0. 0.0003), hemoglobin < 12 g/L (HR=1.5, p=0.041), LDH > ULN (HR=1.6, p=0.013), and Charlson comorbidity index (CCI) ≥ 2 (HR=1.1, p=0.05). Accounting for immortal time bias, MR was associated with a significant improvement in OS (HR = 0.7, p = 0.04).Conclusions: This nationwide real-world study yields detailed information and new insights into current FL patient characteristics, treatment practices, and associated outcomes. Rituximab maintenance was independently associated with an improvement in overall survival in patients with FL. DisclosuresHalwani:Takeda: Research Funding; Seattle Genetics: Research Funding; Pharmacyclics: Research Funding; Miragen: Research Funding; Kyowa Hakko Kirin: Research Funding; Immune Design: Research Funding; Genentech, Inc.: Research Funding; Bristol-Myers Squibb: Research Funding; Amgen: Research Funding; Abbvie: Research Funding. Masaquel:Genentech: Employment, Equity Ownership; Roche: Equity Ownership. Henderson:Genentech/Roche: Employment, Equity Ownership. Delong-Sieg:Roche: Equity Ownership; Genentech, Inc.: Employment. Sauer:Amgen: Research Funding; COHRDATA: Research Funding; Abbvie: Research Funding; Genentech: Research Funding; Pharmacyclics: Research Funding.

Use of metformin and survival of patients with high-grade glioma.

High-grade glioma (HGG) is associated with poor prognosis. Drug repurposing evolves as new modality to improve standard therapy. The antidiabetic drug metformin has been found to inhibit glioma cell growth in vitro and in vivo. The aim of the present retrospective cohort study was to evaluate the survival of patients with HGG with or without treatment with metformin, based on a large cohort of a cancer registry. The analysis included 1,093 patients with HGG diagnosed between 1998 and 2013 from the population-based clinical cancer registry Regensburg (Germany), which covers 2.1 Mio inhabitants and 98% of all cancer diagnoses. We performed multivariable adjusted Cox-regression analyses. Hazard Ratios (HRs) with 95% Confidence Intervals (CIs) for overall survival (OS) and progression-free survival (PFS) of patients with HGG with or without treatment with metformin were obtained. Use of metformin was associated with a significantly better overall and progression-free survival of patients with WHO grade III glioma (HR for OS = 0.30; 95% CI = 0.11-0.81, HR for PFS = 0.29; 95% CI = 0.11-0.78), while there were no significant relations with OS (HR = 0.83; 95% CI = 0.57-1.20) or PFS (HR = 0.85; 95% CI = 0.59-1.22) in patients with WHO grade IV glioma. In conclusion, use of metformin is associated with better overall and progression-free survival of patients with WHO grade III. Possible underlying mechanisms include the higher prevalence of IDH mutations in WHO grade III glioma, which might sensitize to the metabolic drug metformin.

Rising Proportion of Young Individuals With Rectal and Colon Cancer

BackgroundRecent trends have identified increasing number of young individuals with rectal and colon cancers. These individuals, who are younger than 50 years old, in most instances would not meet screening guidelines. We aimed to report the characteristics and trend of the rising proportion of young individuals being diagnosed with rectal and colon cancers at our institutions. Patients and MethodsThis study included 3381 rectal and colon cancer patients from the Mayo Clinic cancer registry from 1972 to 2017 who were diagnosed with rectal or colon cancer and who were < 50 years old. Patient and cancer characteristics are described. The Cochran-Armitage trend test was used to see if the change in percentage diagnosed at age < 50 years had a significant trend over the years. A linear regression model was fit to estimate the percentage change per year when the trend was approximately linear. ResultsThe percentage of patients diagnosed with rectal or colon cancer in different age categories over the years showed a rising trend for individuals aged < 50. Most of these tumors were distal (rectum, left-sided colon, and right-sided colon were 49.8%, 28.8%, and 21.4%, respectively). This was more so for patients < 50 diagnosed with rectal cancer, which showed a linear increase at a rate of 0.26% per year (P < .001). ConclusionOur study affirms the rising proportion of colorectal cancers found in young individuals, with a linear ongoing rise of rectal cancers in particular. This may have implications for the current screening recommendations for colorectal cancers, which are already being revised.

Entwicklung der Krebsfrüherkennung in Deutschland

Cancer is one of the most relevant chronic diseases in the German population, but not all neoplastic entities are eligible for early cancer detection (ECD) programs. In 1971, ECDs were introduced as population-wide screenings for the first time in the catalogue of benefits of the West German statutory health insurance funds. However, the implementation at that time was rarely systematic. Concurrently, adiscussion on the perspectives of ECD arose in the former German Democratic Republic, where astructured program was not prepared in the country until the late 1980s.Anational cancer plan (NCP) was initiated in 2008 and its area of action#1 was titled "Further development of ECD". In April 2013, the law for the development of early cancer detection and quality assurance by clinical cancer registries was passed, which adopted major suggestions of the NCP. Consequently, the pertinent recommendations of the EU guidelines for the screening of the breast, cervix, and colon-rectum are currently being implemented.Public opinion in Germany with regard to ECDs has changed in recent years from unanimous consent to arather critical distance. While ineffective and inefficient preventive action is being replaced by quality-assured screening procedures, public discussion about the fundamental reasonability of ECDs is controversial as never before.

Comparison of cancer diagnosis recording between the Clinical Practice Research Datalink, Cancer Registry and Hospital Episodes Statistics

IntroductionThe Clinical Practice Research Datalink (CPRD) is a large electronic dataset of primary care medical records. For the purpose of epidemiological studies, it is necessary to ensure accuracy and completeness of cancer diagnoses in CPRD. MethodCases included had a colorectal, oesophagogastric (OG), breast, prostate or lung cancer diagnosis recorded in a least one of CPRD, Cancer Registry (CR) or Hospital Episodes Statistics(HES) between 2000 and 2013. Agreement in diagnosis between the datasets, difference in dates, survival at one and five-years, and whether patient characteristics differed according to the dataset or the timing of diagnosis were investigated. Results116,769 patients were included. For each cancer, approximately 10% of cases identified from CPRD or HES were not confirmed in the CR. 25.5% colorectal, 26.0% OG, 8.9% breast, 32.0% lung and 18.6% prostate cases identified from the CR were missing in CPRD. The diagnosis date was recorded later in CPRD compared with CR for each cancer, ranging from 81.1% for prostate to 59.6% for colorectal, especially if the diagnosis was an emergency. Compared with the CR and HES, the adjusted risk of a missing diagnosis in CPRD was significantly higher if the patient was older, had more co-morbidities or was diagnosed as an emergency. Survival at one and five-years was highest for CPRD. ConclusionPatient demographics and the route of diagnosis impact the accuracy of cancer diagnosis in CPRD. Although CPRD provides invaluable primary care data, patients should ideally be identified from the CR to reduce bias.

P1.15-25 Has Lung Cancer Radiotherapy Utilisation Changed over Time in New South Wales, Australia?

Evidence based indications suggest that 73% of all Australian lung cancer patients would benefit from radiotherapy at diagnosis. In 2001-2002, the radiotherapy utilisation (RTU) rate in NSW for lung cancer was 39%. Since then a number of new radiation oncology centres have opened and the number of linear accelerators increasing from 29 to 46. There has also been an increase in the number of lung cancer multidisciplinary teams. We aimed to evaluate whether there had been any change in RTU for lung cancer in NSW from 2001-2002 to 2009-2011. All patients diagnosed with lung cancer in NSW between 1/1/2009 and 31/12/2011 were identified from the NSW Central Cancer Registry (NSWCCR). Data linkage with the Admitted Patients Data Collection, Retrospective Radiotherapy Data and Clinical Cancer Registry was performed to ascertain radiotherapy treatment within 1 year of diagnosis. Patients with non-lung cancer pathologies and those who lived closer to interstate radiotherapy centres were excluded. Patients with a clinical diagnosis of lung cancer (no pathological confirmation (NPC)) were included. A total of 10,712 patients were identified through NSWCCR of which 947 patients were excluded leaving 9,765 patients for analysis. The median age was 71 years and 60% were males. Histopathology was NSCLC, SCLC and NPC in 76%, 12% and 13% respectively. Stage was IandII in 12%, III in 12%, IV in 28% and unknown in 47%. The overall RTU for lung cancer was 40%. RTU was 43% for NSCLC, 56% for SCLC and 8% for NPC. RTU by stage compared to previous figures is shown in Table 1.Table 1Radiotherapy utilisation rate by stage of lung cancer, NSW 2001-2002 and 2009-2011HistologyStageRTU N (%) (2001-2002)RTU (%) (2009-2011)NSCLCI76(26)201(27)II35(39)164(41)III170(55)753(72)IV258(49)1,497(66)Unknown17(22)544(18)Total556(43)3,159(43)SCLCI-III39(47)157(80)IV61(32)280(61)Unknown1(17)202(41)Total101(36)639(56)NPCI12(22)12(43)II4(33)3(50)III11(35)17(71)IV20(27)37(60)Unknown5(8)25(2)Total52(23)94(8)OVERALLTotal709(39)3,892(40) Open table in a new tab Increased RTU was seen in some groups of patients including Stage III-IV NSCLC, Stage I-IV SCLC and Stage I-IV NPC. Despite an increase in resources, overall RTU for lung cancer has remained unchanged over the last decade.

PS02.240: COMBINED GERMAN CLINICAL CANCER REGISTRIES: FIRST EXPERIENCE WITH ANALYSES ON DEMOGRAPHY AND TREATMENT OF CANCERS OF THE ESOPHAGUS AND STOMACH

Abstract Background One critical aspect for improvement of health care delivery to the population is a continuous monitoring of results. In this context, an increasing number of clinical cancer registries has been implemented in Germany since 2013. Main aspects of these registries include quality control, assessment of clinical outcome, support of epidemiological registries and potential implementation into clinical follow up. The ADT (Cooperation of German Cancer Centres e.V.) aims to merge data from local cancer registries into one nation-wide registry. In this context, we were able to analyse for the first time data of &gt; 100.000 patients with malignant diseases of the stomach and esophagus. Methods Data from all local cancer registries in Germany were requested in the context of the National German Cancer Conference 2018 hosted by the German Cancer Society (DKG). After preparation of data, analysis included demographic and treatment aspects, and esophageal/gastric/GOJ cancers were analysed separately. Results From 2000–2016, 101.559 patients with cancers of the esophagus and stomach have been reported, representing approximately one quarter of the expected cancer cases in this time frame in Germany. Data quality and completeness improved over time. Incidences of esophageal and GOJ cancers increased, whereas incidence of gastric cancer decreased. Median age differed between entities with highest respectively lowest age in gastric/esophageal cancer. Further, median age increased in all three tumor types in the study period. Treatment pattern changed over time with a distinct increase of the use of neoadjuvant therapy in all cancer types. Percentage of curative intended surgery increased over time, reaching roughly 60% in gastric cancer, about 50% in GOJ and esophageal adenocarcinoma, and slightly less then 25% in esophageal squamous cell carcinoma. Finally, analysis of tumor stage dependent treatment confirmed higher rates of curative intended surgical treatment in early tumor stages, and an increased use of neoadjuvant treatment or chemo/radiotherapy approaches in higher tumor stages. Conclusion Combined Clinical Cancer Registries provide the unique opportunity to assess clinical relevant data of a large population based cohort of patients for purposes such as quality control and outcome measurement. Further, subgroup analyses can provide valid information on clinically relevant questions such as outcome/quality of different treatments. Disclosure All authors have declared no conflicts of interest.