Differences In Extent Of Disease Research Articles

Abstract PO4-17-11: Normalized Breast Cancer Survival Outcomes in U.S. Tumor Registries

Abstract Background The largest U.S. tumor registries, NCDB (National Cancer Database) and SEER (Surveillance, Epidemiology, and End Results Program), are vital sources of epidemiological data and are frequently utilized in research. Although the NCDB includes the majority of patients diagnosed with breast cancer, it is a hospital-based registry. In contrast, SEER is a population-based registry, but includes less than half of all breast cancer patients diagnosed each year. While the US Cancer Statistics Public Use Database (USCS) captures nearly all breast cancers, treatment and survival data are not included. As such, we sought to normalize the NCDB and SEER populations to mirror the USCS population and examine survival outcomes after normalization. Methods All patients diagnosed with stage I-IV breast cancer (2010-2018) were selected from the NCDB and SEER. Frequencies of patients by select characteristics were exported from the USCS. Rates from the USCS were then used to normalize the NCDB and SEER cohorts, using patient weighted frequencies for age, sex, race/ethnicity, tumor biomarkers [estrogen receptor (ER), HER2], and extent of disease (local, regional, distant; anatomic staging data not available in USCS). Of note, the USCS does not have individual patient-level data (only summary data for select variables), and thus, weighted frequencies were used for normalization. The weighted frequencies were calculated based on the total number of patients in the USCS database divided by the total number of patients in the NCDB or SEER separately for each variable (age, sex, race/ethnicity, etc). Weighted and unweighted data were summarized with N (%). Unweighted patient and disease characteristics (crude data) were compared using Chi-square tests. Overall survival (OS) was estimated using the Kaplan-Meier method before and after normalization. Results The USCS cohort included 2,473,739 patients; the NCDB included 1,441,556 and SEER 504,938. The median followup was 54.9 months for NCDB and 57 months for SEER. There were minimal differences between the cohorts based on age (age < 50y: USCS 18.1%, NCDB 19.3%, SEER 18.9%) or sex (female: USCS 99.1%, NCDB 99.1%, SEER 99.3%). However, there were notable differences in the racial/ethnic composition; non-Hispanic White: USCS 75%, NCDB 78.2%, SEER 68.2%; non-Hispanic Black: USCS 11.4%, NCDB 11.4%, SEER 9.9%; Hispanic: USCS 8.3%, NCDB 5.9%, SEER 11.7%; p< 0.001 for USCS vs NCDB and USCS vs SEER). There were minimal differences in tumor biomarkers (ER+: USCS 82.9%, NCDB 83%, SEER 84.9%; HER2+: USCS 14.5%, NCDB 14.1%, SEER 13.8%), but significant differences in extent of disease (local: USCS 66.1%, NCDB 80.2%, SEER 68.4%; distant: USCS 6%, NCDB 3.9%, SEER 3.9%; p< 0.001 for USCS vs NCDB and USCS vs SEER). For the variables that were similar without weighting (age, sex, tumor biomarkers), OS was also similar after weighting (Table). After normalizing the NCDB based on race, 8-year OS remained comparable (crude 77.2% vs weighted 77.3%); similar findings were noted after normalizing SEER (crude 75.8% vs weighted 75.3%). After normalizing the NCDB based on extent of disease, 8-year OS was notably worse (crude 77.2% vs weighted 74.2%); similar findings were noted for SEER (crude 75.8% vs weighted 74.4%). Conclusions While national tumor registries afford researchers the opportunity to study large breast cancer cohorts, they do not always fully represent the entire breast cancer population. This limitation should be considered when working with these data sets. Table. Citation Format: Tori Chanenchuk, Kerri-Anne Crowell, Samantha Thomas, Rachel Greenup, Jennifer Plichta. Normalized Breast Cancer Survival Outcomes in U.S. Tumor Registries [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-17-11.

Beyond diagnosis: investigating hospital referral impact on biological treatment initiation, hospital admission, and surgery patterns in inflammatory bowel disease – a Danish population based study

Objectives Early biological treatment in patients with inflammatory bowel disease (IBD) is important in disease control. Previous studies have suggested that patients with IBD from Non-Academic Hospitals were less likely to receive biologics. The aims of this study were (1) to use the granular data in the clinical database, GASTROBIO, to study detailed differences in time from IBD diagnosis to first administration of biologics, hospital admission, and surgery in patients referred to Academic Hospitals versus to Non-Academic Hospitals, and (2) to explore differences in disease extent, behavior, and indication for biological treatment. Material and methods This was a retrospective cross-sectional descriptive population-based quality study of patients with IBD initiating biologics in the North Denmark Region between 2016 and 2018. Data from GASTROBIO were extracted, namely demographic data, time of diagnosis, biological treatments with indications, hospital admission, and surgery. Results Of the 146 patients included, 84 were from the Academic and 62 from the Non-Academic Hospitals. No significant differences in median time from diagnosis to (1) treatment, (2) hospital admission or (3) IBD surgery between the groups were observed. A higher percentage of patients with luminal Crohn’s disease were treated with biologics at the Academic Hospital (78% and 66%). Conclusions Based on the findings of this population-based study, we found no evidence that the referral area had a significant impact on the duration from diagnosis to the initiation of biological treatment, hospital admissions, or surgery. However, the data suggested that fewer patients with luminal Crohn’s disease were referred to biologics from Non-Academic Hospitals.

P427 Exploring phenotype and treatment of inflammatory bowel disease in the elderly

Abstract Background On a background of an ageing population, approximately, 10–15% of new cases of IBD are diagnosed in patients over the age of, 60.1,2 Studies show IBD in the elderly is increasing, including both the groups of patients diagnosed at a younger age, and de novo elderly IBD. Older patients are more likely to have other co-morbidities and be concurrently prescribed other medications, which may impact the choice and timing of therapies for their disease. It is not clear if IBD in older age is different phenotypically from that in younger counterparts, and whether current management algorithms can be used safely in this cohort. Aims of the study were to evaluate the IBD phenotype and use of therapies in the elderly (≥75 years) and younger (18–74 years) patients, and to assess for differences in adverse outcomes between both cohorts on immunosuppressants (IMs) and/or biologics. Methods A retrospective study was performed on, 173 IBD patients at Imperial College Healthcare NHS Trust over a two-year period., 91 elderly IBD patients were compared with, 82 younger patients, matched by gender and IBD subtype. Analysis included chi-squared tests with Fisher’s correction. Results There were, 55 elderly patients and, 51 younger matched patients with ulcerative colitis (UC) where no differences in disease extent, remission or surgeries were seen. There were, 36 elderly patients and, 31 younger matched patients with Crohn’s disease (CD). There was less ileocolonic disease in the older CD cohort compared to younger patients (27.8% versus, 51.6%, p=0.046) (figure 1). Medication use in UC was the same regardless of age. There was significantly higher use of IMs and biologics in younger patients with CD (51.6%) versus the older cohort (25%, p=0.047) (figure 2). In elderly patients with CD, a significantly greater mortality was seen in patients on IMs/biologics (27.3%) than those not on these medications (8%, p=0.023) (figure 3). The rate of VTE was higher (18.2% versus, 0%) in those on these treatments with a trend towards significance. Conclusion Overall, this retrospective study demonstrated that elderly IBD patients in this cohort appear to be mostly phenotypically similar to younger patients. However, elderly Crohn’s patients were less likely to be escalated to IMs/biologic treatments than their younger comparators. In view of the higher rate of adverse events recorded in the Crohn’s group managed with these treatments, this may be justified. Further, larger studies in the long-term outcomes of these patients are required. Reference 1. Charpentier C et al. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut., 2014;63(3),423–432

The Value of PET-CT in Ovarian Epithelial Carcinoma: A Population-Based Study in British Columbia, Canada

IntroductionIn epithelial ovarian cancer (EOC), consensus regarding optimal use of PET/CT is lacking. Limited evidence suggests its accuracy in preoperative staging, investigating recurrence and predicting optimal secondary debulking. This study evaluated indications for PET/CT, impact of PET/CT results on EOC management, and its added value over conventional imaging. MethodsPatients with EOC aged 19 years and older who underwent PET/CT at BC Cancer Vancouver between January 2007 and September 2017 were eligible. Medical records were retrospectively reviewed with the following data abstracted: patient demographics, PET/CT indications and results, recent conventional imaging results, and application of PET/CT findings. Basic descriptive analysis was performed to determine most common use of PET/CT and its management impact. Results257 PET/CTs in 216 patients were eligible. Most PET/CTs (135/257, 52.6%) were performed for suspected disease recurrence/progression. Management after PET/CT changed in 1/3 of cases with the greatest impact seen when assessing suitability in recurrent disease for focal radiotherapy or secondary surgical debulking. For 106/257 cases with recent conventional imaging available, although differences in disease extent were found in ~50%, clinical conclusions drawn were the same in ~75%. DiscussionAlthough PET/CT is most commonly used to investigate suspected recurrence/progression, its impact on management here is low. Greater impact is seen when considering localized therapy in EOC recurrence. When compared with recent conventional imaging, although PET/CT may detect differences in disease extent, clinical conclusions are frequently the same. ConclusionImpact of PET/CT on management is greatest in EOC recurrence when considering local therapies, beyond which clinical presentation and conventional imaging may suffice.

Minimally Invasive Adrenalectomy for Adrenocortical Carcinoma: Five-Year Trends and Predictors of Conversion.

Adrenocortical carcinoma (ACC) is rare but often fatal. Surgery offers the only chance of cure. As minimally invasive (MI) procedures for cancer become common, their role for ACC is still debated. We reviewed usage of MI approaches for ACC over time and risk factors for conversion using a large national database. ACC patients with localized disease were identified in the National Cancer Data Base from 2010 to 2014. A retrospective review examined trends in the surgical approach over time. Patient demographics, surgical approach, and tumor characteristics between MI, open, and converted procedures were compared. 588 patients underwent adrenalectomy for ACC, of which 200 were minimally invasive. From 2010 to 2014, MI operations increased from 26 to 44% with robotic procedures increasing from 5 to 16%. The use of MI operations compared to open was not different based on facility type (p=0.40) or location (p=0.63). MI tumors were more likely to be confined to the adrenal (p<0.001) but final margin status was not different (p=0.56). Conversion was performed in 38/200 (19%). Average tumor size was 10.2cm in the converted group compared to 8.6cm in the MI group (p=0.09). There was no difference in extent of disease (p=0.33), margin status (p=0.12), or lymphovascular invasion (p=0.59) between MI and converted procedures. Tumor size >5cm was the only significant predictor of conversion (p=0.04). No patients with pathologic stage I disease required conversion (0/19). The frequency of MI approaches for ACC is increasing. In the final year of the study, 44% of adrenalectomies were MI. Size >5cm was the only significant predictor of conversion.

Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

As the American population is aging, the number of older people with inflammatory bowel disease is increasing. We used clinical data from the Sinai-Helmsley Alliance for Research Excellence (SHARE), a prospective cohort, to examine disease and treatment differences in older adults. We performed a cross-sectional study assessing demographics and disease behavior by age at diagnosis with univariate, bivariate, and multivariate analyses. "Older-onset" patients were diagnosed after age 60, "younger-onset" patients were diagnosed before age 60 but are older than 60 years, and the remainder were "young." There were 91 older-onset, 389 younger-onset, and 3431 young patients with Crohn's disease. Older-onset patients had more ileal (37%) and colonic (27%) disease compared with younger-onset and young patients. There were no differences in disease behavior, location, or surgeries between older-onset and young patients with Crohn's disease within 5 years of diagnosis. Older-onset patients with inflammatory disease had a higher odds of being in remission. Young patients reported more anti-tumor necrosis factor and thiopurine use compared with younger-onset and older-onset patients (P < 0.01). There were 98 older-onset, 218 younger-onset, and 1702 young patients with ulcerative colitis. There were no differences in disease extent, activity index, or surgeries. Young patients with ulcerative colitis reported more anti-tumor necrosis factor use (26%) compared with younger-onset patients (17%, P < 0.01). Disease behavior or location was not different between younger and older adults with inflammatory bowel disease. Older patients were less likely to be treated with immunosuppression. If older patients have similar disease behavior, less frequent treatment with immunosuppressives may risk suboptimally controlled disease.

Is there a sex effect in colon cancer? Disease characteristics, management, and outcomes in routine clinical practice.

The incidence of colon cancer varies by sex. Whether women and men show differences in extent of disease, treatment, and outcomes is not well described. We used a large population-based cohort to evaluate sex differences in colon cancer. Using the Ontario Cancer Registry, all cases of colon cancer treated with surgery in Ontario during 2002-2008 were identified. Electronic records of treatment identified use of surgery and adjuvant chemotherapy. Pathology reports for a random 25% sample of all cases were obtained, and disease characteristics, treatment, and outcomes in women and men were compared. A Cox proportional hazards model was used to identify factors associated with overall (os) and cancer-specific survival (css). The study population included 7249 patients who underwent resection of colon cancer; 49% (n = 3556) were women. Stage of disease and histologic grade did not vary by sex. Compared with men, women were more likely to have right-sided disease (55% vs. 44%, p ≤ 0.001). Surgical procedure and lymph node yield did not differ by sex. Adjuvant chemotherapy was delivered to 18% of patients with stage ii and 64% of patients with stage iii disease; when adjusted for patient- and disease-related factors, use of adjuvant chemotherapy was similar for women and men [relative risk: 0.99; 95% confidence interval (ci): 0.94 to 1.03]. Adjusted analyses demonstrated that os [hazard ratio (hr): 0.80; 95% ci: 0.75 to 0.86] and css (hr: 0.82; 95% ci: 0.76 to 0.90) were superior for women compared with men. Long-term survival after colon cancer is significantly better for women than for men, which is not explained by any substantial differences in extent of disease or treatment delivered.

Is there a gender effect in bladder cancer? A population-based study of practice and outcomes.

The incidence of bladder cancer varies by gender. Whether differences exist between women and men in extent of disease, treatment, and outcome is not well-described. We evaluate gender differences in bladder cancer using a population-based cohort. Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with bladder cancer treated with cystectomy or radical radiotherapy (RT) in Ontario between 1994 and 2008. We compare extent of disease at time of cystectomy, treatment, and outcomes between women and men. In total, 5259 patients with bladder cancer were treated with cystectomy or radical RT; of these, 25% (n = 1296) were women. There was no gender difference in the proportion of patients treated with cystectomy (75% of women [974/1296], 73% of men [2905/3963], p = 0.189). At the time of cystectomy, women were more likely to have muscle-invasive disease (86% [836/974] vs. 80% [2335/2905], p < 0.001), but less likely to have lymph nodes dissected (68% [664/974] vs. 76% [2210/2905], p < 0.001]. Among the 2944 patients with muscle-invasive urothelial carcinoma treated with cystectomy, use of neoadjuvant (5% vs. 4%, p = 0.419) and adjuvant chemotherapy (18% vs. 20%, p = 0.190) did not differ significantly between genders. Five-year cancer-specific survival and overall survival of the full cohort did not differ between women and men (38% vs. 39%, p = 0.522; 33% vs. 33%, p = 0.795). This population-based cohort did not demonstrate any substantial differences in extent of disease, treatment, or outcome between women and men treated with cystectomy or radical RT for bladder cancer.

Endometriosis: Does the menstrual cycle affect magnetic resonance (MR) imaging evaluation?

PurposeTo determine if the menstrual cycle affects MR interpretation in patients with pelvic endometriosis. Materials and methodsThirty-one patients with either laparoscopically proven endometriosis, or a high clinical suspicion of deep infiltrative endometriosis, were prospectively recruited from May 2008 to October 2009 and January to June 2012. Two pelvic MR scans were performed for pre-operative planning; during menses and the other mid-cycle. Two experienced radiologists independently assessed image quality and disease extent. Both were blinded to patient identity, previous imaging and menstrual status. Interobserver agreement was assessed using the Kappa (k) test. Descriptive statistics were prepared using chi-squared (or Fishers’ exact) tests and Mann–Whitney (rank sum) tests to assess for significant differences between menstrual and non-menstrual imaging. ResultsInterobserver agreement for image quality was moderate for T2 weighted imaging (k=0.475, p-value <0.001) and substantial for T1 fat saturated imaging (k=0.733, p-value<0.001), with no significant difference in image quality between menstrual and non-menstrual scans (all p-values>0.255). Readers demonstrated at least moderate interobserver agreement for certainty level of endometriosis at site-specific locations, with median k 0.599 (IQR 0.488–0.807). No significant difference in disease extent was observed between menstruating and non-menstruating scans (all p-values>0.05). ConclusionFindings suggest no significant differences in image quality, disease extent or disease severity between menstruating and non-menstruating MR; thus, timing of pelvic MR for assessment of endometriosis need not be influenced by the menstrual cycle.

BRAF V600E mutational status in pediatric thyroid cancer

Clinical outcome of papillary thyroid carcinoma (PTC) in children differs significantly from that of adults. There is no clear explanation of this difference although previous studies have demonstrated a lower prevalence of the BRAF(V600E) mutation in PTC of children. However, data are limited due to the rarity of this diagnosis. BRAF(V600E) mutation prevalence and its relationship with outcome in pediatric PTC remain unclear. BRAF(V600E) mutational status was determined in 27 PTC patients less than 22 years of age using restriction fragment length polymorphism (RFLP) analysis. The relationship between BRAF(V600E) mutation status, patient and tumor characteristics as well as progression-free survival (PFS) were analyzed. BRAF(V600E) was present in 63% of patients and occurred more often in male patients versus females (P = 0.033). Presence of the mutation did not correlate with any difference in extent of disease at diagnosis, tumor size, capsular invasion, vascular invasion, soft tissue invasion, or margin status. At 10 years, PFS for BRAF(V600E) positive versus negative patients was 55.5% versus 70.0%, respectively (P = 0.48). Overall survival was 100% and median follow-up was 13.9 years. This study of pediatric PTC demonstrates that BRAF(V600E) mutations occur in children at a rate comparable to adults. We found a correlation of BRAF(V600E) with the male gender, but no evidence that the mutation correlates with more extensive or aggressive disease. This analysis suggests that differences in disease course of PTC in children versus adults are not strongly dependent upon the presence of the BRAF(V600E) mutation.

Racial Differences in Disease Extent and Severity in Patients with Ulcerative Colitis: A Retrospective Cohort Study

Ulcerative colitis (UC) is increasing in African-Americans (AA). The objectives of this study were to assess disease extent and severity in UC by race. Disease extent and severity was assessed in UC outpatients evaluated at the University of Maryland and Baltimore VA from 1997 to 2005. About 197 patients were identified; 47 were AA (23%). Of AA, 23% had proctitis, 23% had left-sided colitis, and 53% had extensive colitis compared to 10%, 31%, and 59% of Caucasians, respectively (P = 0.056). African-Americans were less likely to ever receive steroids (45% versus 62%; P = 0.065), be treated with > or = 2 courses of steroids (54% versus 68%; P = 0.242) or be steroid dependant (33% versus 46%; P = 0.304). After adjustment, only female gender (OR 0.32, [0.16-0.66]) and age at diagnosis (OR 2.50, [1.28-4.90]) were associated with extensive colitis. Being seen at UMMS (OR 5.10, [2.60-10.10]) was associated with steroid use. Race was not associated with extent of colitis or disease severity in UC.

Stage and Survival in Breast Cancer Patients in Screened and Non-screened Danish and Swedish Populations

Comparisons between the Danish and Swedish Cancer Registry revealed a 9% difference in 5-year survival for breast cancer patients diagnosed between 1983 and 1989. The purpose of this study was to determine whether previous differences in survival and stage still exist or whether the Danish figures approach those of the Swedish registry. Complete population-based cohorts of patients with breast cancer in the years 1996–1997 from well-defined areas in Denmark and Sweden were compared. The study regions were a Danish (Funen) and a Swedish (Malmö) county with mammography screening and two Danish counties without screening. No difference in extent of disease or survival was observed between screening areas regardless of country. However, there were significant differences in stage distribution and survival between screening populations and Danish non-screening populations, to the benefit of populations provided with a screening programme. Five-year survival was 5–6% higher in screening populations than in Danish non-screening counties. Corresponding disease-specific survival enhanced the difference. In a multivariate analysis increasing age, tumour size and stage decreased survival. Adjusting for these factors eliminated differences in survival according to country/county. Survival difference could be attributed to early diagnosis and favourable stage in populations offered mammography screening and was not related to nation. Denmark may, through early detection, approach the beneficial stage distribution and survival observed in Sweden.

Laparoscopic excision of ovarian endometriomas: does post-operative medical treatment prevent recurrence?

Of 103 women undergoing laparoscopic excision of ovarian endometriomas, 41 patients were prescribed to 3 to 6 months therapy with GnRH analogs or danazol postoperatively and 62 received no additional treatment. No significant difference in extent of disease was present between the two groups at the time of surgery. Follow-up longer than 3 months, including a sonogram, was available for 40 patients of the treatment group and for 42 patients of the group receiving no additional treatment. Four recurrences (10%) at 3, 12, 16 and 21 months occurred in the treatment group, and 3 recurrences (7%) at 5, 6 and 6 months occurred in the no-treatment group (p=NS). Postoperative medical treatment does not prevent recurrence of laparoscopically excised ovarian endometriomas.

Laparoscopic excision of endometriosis with 3-mm scissors: Comparison of operating times between sharp excision and electro-excision

To determine if laparoscopic excision of endometriosis by electrosurgery is more rapid than by sharp dissection, a retrospective comparative study was made of operative times for the two procedures. Median operating times for laparoscopic electro-excision of endometriosis were 26% to 49% faster than excision by sharp dissection. A x 2 analysis of the frequency counts of surgical intervals, and disease stage revealed this difference to be statistically significant and not due to acquired experience or differences in extent of disease in the two groups. The reduction in operating time achieved with monopolar electro-excision seems primarily associated with a more rapid cutting action with simultaneous coagulation of bleeders.

The effects of breast self-examination in a population-based cancer registry. A report of differences in extent of disease.

This study evaluates the effects of breast self-examination (BSE) on extent of disease in newly diagnosed Iowa Surveillance, Epidemiology, and End Results (SEER) breast cancer cases (population-based) between November 1980 and December 1981. Similar to previous findings, BSE patients are more likely to find their tumors than are non-BSE patients when performed two or more times each year. However, no significant improvement in tumor size, number of lymph nodes, or staging is found. In addition, comparison with age-frequency matched controls, although supporting various breast cancer risk factors, also seems to identify a BSE response bias since cases were significantly more likely to report performing BSE than controls (P less than 0.0001), and BSE cases versus non-BSE cases show no differences in risks of disease to suggest an association between potential awareness of disease risks with altered health behavior (performing BSE).

Small Cell Carcinoma of the Lung: Prognosis in Relation to Histologic Subtype

Forty-six of 59 patients with small cell carcinoma of the lung who were treated with multiple drug chemotherapy and radiotherapy were subclassified according to the World Health Organization classification. Subtyping was not possible in the 13 other patients who were diagnosed on sputum cytology findings alone. There was no significant difference in extent of disease, response, duration of response to treatment, or median survival between the different subtypes. Two main difficulties arise in applying the subtyping classification. First, many tumors showed features of several histologic subtypes, implying the existence of a morphologic continuum within the general group of small cell anaplastic carcinomas. Second, tissue crushing artefact was common. Our results do not reveal any advantage in knowing the tumor subtype. It remains essential to differentiate small cell anaplastic carcinoma from other forms of lung carcinoma not responsive to chemotherapy.

Regression Analysis of Grouped Survival Data with Application to Breast Cancer Data

Use of the proportional hazards regression model (Cox 1972) substantially liberalized the analysis of censored survival data with covariates. Available procedures for estimation of the relative risk parameter, however, do not adequately handle grouped survival data, or large data sets with many tied failure times. The grouped data version of the proportional hazards model is proposed here for such estimation. Asymptotic likelihood results are given, both for the estimation of the regression coefficient and the survivor function. Some special results are given for testing the hypothesis of a zero regression coefficient which leads, for example, to a generalization of the log-rank test for the comparison of several survival curves. Application to breast cancer data, from the National Cancer Institute-sponsored End Results Group, indicates that previously noted race differences in breast cancer survival times are explained to a large extent by differences in disease extent and other demographic characteristics at diagnosis.