Differences In Tumor Characteristics Research Articles

Gender differences in tumor characteristics, treatment allocation and survival in stage I–III pancreatic cancer: a nationwide study

IntroductionSex and gender are modulators of health and disease and may have impact on treatment allocation and survival in patients with cancer. In this study, we analyzed the impact of sex and gender on treatment allocation and overall survival in patients with stage I-III pancreatic cancer. MethodsPatients with stage I-III pancreatic cancer diagnosed between 2015 and 2020 were selected from the nationwide Netherlands Cancer Registry. Associations between sex and gender and the probability of receiving surgical and/or systemic treatment were examined with multivariable logistic regression analyses. Overall survival was assessed with log rank test and multivariable Cox proportional hazard analysis. ResultsAmong 6855 patients, 51.2 % were female. Multivariable logistic regression analyses with adjustment for known confounders (age, performance status, comorbidities, tumor location, tumor stage and previous malignancies) showed that females less often received systemic chemotherapy compared to males (OR 0.799, 95 %CI 0.703–0.909, p < .001). No difference was found in the probability for undergoing surgical resection. Furthermore, females had worse overall survival compared to males (median OS 8.5 and 9.2 months respectively, 95 %CI 8.669–9.731). ConclusionThis nationwide study found that female patients with stage I-III pancreatic cancer significantly less often received systemic treatment and had worse overall survival as compared to males. Disparities in pancreatic cancer care can be decreased by recognizing and resolving potential obstacles or biases in treatment decision-making.

Age-specific differences in tumour characteristics between screen-detected and non-screen-detected breast cancers in women aged 40-74 at diagnosis in Sweden from 2008 to 2017.

To analyze differences between screen-detected and non-screen-detected invasive breast cancers by tumour characteristics and age at diagnosis in the nationwide population-based mammography screening program in Sweden. Data were retrieved from the National Quality Register for Breast Cancer for 2008-2017. Logistic regression analysis was used to estimate the likelihood for a tumour to be screen-detected by tumour characteristics and age group at diagnosis. In total there were 51,429 invasive breast cancers in the target age group for mammography screening of 40-74 years. Likelihood of screen detection decreased with larger tumour size, lymph node metastases, higher histological grade and distant metastasis. Odds ratios (ORs) for negative oestrogen (ER) and progesterone (PgR) were 0.41 and 0.57; for positive HER2, 0.62; for Ki-67 high versus low, 0.49. Molecular sub-types had OR of 0.56, 0.40 and 0.28, respectively, for luminal B-like, HER2-positive and triple negative versus luminal A-like. Adjusting for tumour size (T), lymph node status (N), age, year and county at diagnosis slightly elevated the ORs. Statistically significant interactions between tumour characteristics and age were found (p < 0.05) except for ER and PgR. The age group 40-49 deviated most from the other age groups. Our study demonstrates that screen-detected invasive breast cancers had more favourable tumour characteristics than non-screen-detected after adjusting for age, year and county of diagnosis, and even after adjusting for T and N. The trend towards favourable tumour characteristics was less pronounced in the 40-49 age group compared to the other age groups, except for ER and PgR.

Demographic and social vulnerability factors associated with late diagnosis of gastrointestinal cancers.

610 Background: Almost 30% of gastrointestinal cancers (GI) are diagnosed at an advanced stage. These patients have a poor prognosis with no curative options. Certain demographic and social factors adversely impact health outcomes. However, these have not been well studied in the context of late diagnosis of GI cancers. Methods: Texas and California cancer registries, merged with CDC’s Social Vulnerability Index (SVI) database, were used to identify patients diagnosed with gastric, colorectal, pancreatic and liver cancer from 2004 to 2019. To determine the association of demographic and 16 social vulnerability factors, while accounting for differences in tumor characteristics, univariate and multivariate logistic regression analysis (MVA) was performed for each cancer separately. Results: In total, 589,405 patients were included. Of these 166,910 (28.3%) patients had metastasis at diagnosis. This included 55%, 39%, 21%, and 17% of all pancreatic, gastric, colorectal and liver cancers respectively. On MVA, odds of metastatic cancer at presentation decreased with increasing age (except for pancreatic cancer where odds increased). Across all 4 cancer types, females and Asians had decreased odds while Blacks, uninsured and patients on Medicaid had increased odds of metastatic cancer at diagnosis. Poverty below 150% increased odds of metastatic pancreas, liver, and colorectal cancers at diagnosis. Odds were decreased for households with adults aged over 65 years for pancreas, colorectal and gastric cancers. Conclusions: This study has identified multiple demographic and social factors associated with odds of having metastatic GI cancer at diagnosis. Interventions aimed towards these at-risk populations offer an opportunity for early diagnosis and improved survival.[Table: see text]

Molecular Classification of Relapsed DLBCL Reveals Novel Biologic Subgroups

Background Diffuse large B cell lymphoma (DLBCL) is the most common aggressive lymphoid malignancy in adults. Though standard immunochemotherapy regimens can result in clinical remission and cure in a majority of patients, approximately 30% of patients are primary treatment resistant or eventually relapse (rrDLBCL), and their prognosis is very poor. Recent molecular classification by large scale genomic and transcriptomic profiling of newly diagnosed DLBCL tumors has resulted in a deeper understanding of disease drivers, however, the molecular heterogeneity of rrDLBCL is yet to be fully explored. Therefore, in this study, we used an unsupervised approach to better define transcriptional and genetic programs in rrDLBCL samples hypothesizing that molecular stratification within this high-risk group may lead to a better understanding of this disease, which remains an unmet need, and a more personalized therapeutic approach. Methods Data used in this study included RNA (n=143) and whole exome (n=126) sequencing data from available FFPE tumor samples at the time of a relapse (any line of treatment, r1-r10 relapse timepoints included in analysis, one per patient), consented to the Molecular Epidemiology Resource (n=61), banked in the Mayo Lymphoma Biobank (n=50), or consented to the CC-122-ST-001 clinical trial (n=32, NCT01421524). Unsupervised clustering was performed on protein coding gene expression values using the non-negative matrix factorization (NMF) approach. NMF was carried out by performing 200 runs on cluster sizes from 2 to 6. Cell of origin (COO) was determined using the method described by Reddy et al. The tumor microenvironment was analyzed using CIBERSORTx and Lymphoma Microenvironment Classification (LME). Genetic classification was done using LymphGen. Results In order to identify unique transcriptional programs in rrDLBCL, we implemented NMF and consensus clustering to define an ideal quantity of stable patient clusters. We identified 4 rrDLBCL patient clusters (rrC1-rrC4) as the most stable solution, based on consensus clustering selection criteria of iterative NMF runs. While relapse timepoint was not associated with individual clusters, we did observe significant differences in tumor characteristics between the clusters. COO classification found that rrC1 and rrC4 were enriched for GCB-DLBCL while rrC3 was enriched for ABC-DLBCL classification (P &amp;lt; .001). To explore the biologic programs in each cluster, we used pathFindR, which leverages protein-protein interaction networks to identify disease related pathways, rrC1 and rrC4 were defined by pathways involved in cell cycle and mismatch repair; oxidative phosphorylation in rrC2; and MAPK and NF-kB in rrC3. Next, LME classification was done to define patterns in the tumor microenvironment and we found a significant difference between groups (P &amp;lt; .001), with rrC2 and rrC4 tumors enriched for a depleted TME, while rrC1 and rrC3 had a more immune rich or inflammatory TME. This was supported by CIBERSORTx analysis identifying significant differences (P &amp;gt; .001) in abundance of CD8 T cells, memory CD4 T cells, and M1 macrophages between clusters, with rrC4 having the lowest abundance. We then explored genetic patterns in each cluster. Gene level mutation enrichment analysis showed BCL7A mutation exclusively in C4 (6/6, P = .03). The clusters were not associated with LymphGen classification. Lastly, our recently published high risk signature classification that is associated with early clinical failure and is characterized by metabolic dysregulation, a depleted TME, T53 alterations, and poor outcome, was significantly different between the groups (P = .03) with enrichment for high-risk cases in rrC4. In summary, we show for the first time that rrDLBCL patients can be classified into four gene expression clusters that are associated with distinct pathway, TME, and genetic programs. These clusters should now be tested to learn if they can help select patients for newer therapies for rrDLBCL such as CAR-T and bispecific antibodies.

Age-related variations in colon and rectal cancer: An analysis of the national cancer database

BackgroundCharacteristics of colorectal diseases may vary according to the patient’s age. By using a large national database, we assessed age-related differences in characteristics and treatments of colorectal cancer and to evaluate the influence of age on outcomes. MethodRetrospective cohort analysis of all patients who underwent surgical resection for colorectal cancer in the US National Cancer Database between 2005 and 2019. Patients were divided into 3 age groups: young age onset (<50 years), middle age group (50–79 years), and very old (≥80 years). Differences in tumor characteristics among groups were assessed. The main outcomes were clinical and treatment characteristics and short-term mortality. ResultsIn total, 662,102 patients with colon cancer and 114,460 with rectal cancer were included—36.1% of young patients with colon cancer presented with metastatic disease. Older patients underwent open surgery more often and received chemotherapy and radiation therapy less often than did the other 2 groups regarding disease stage. Very old patients, compared to middle-aged and young patients, had longer hospitalization and significantly higher rates of 30-day mortality after colon (7.6% vs 2.4% vs 0.7%; P < .001) and rectal (5.9% vs 1.3% vs 0.3%; P < .001) cancer surgery and higher 90-day mortality after colon (12.9% vs 4.6% vs 1.7% P < .001) and rectal (10.3% vs 2.6% vs 0.7%; P < .001) cancer surgery.Older patients had significantly shorter overall survival than the other 2 groups, regardless of pathologic stage, Charlson –Deyo comorbidity score, or tumor side. ConclusionSignificant age-related disparities in characteristics, treatments, and outcomes of colorectal cancer were found in this study. Recognizing these differences can be the first step toward reducing age-related treatment differences.

Survival Outcome in Early-Onset Metastatic Colorectal Cancer: A Multicenter-Matched Pair Analysis

Introduction: Survival of patients suffering from metastatic colorectal cancer (mCRC) has increased over the last decades. These benefits appear to be restricted to patients aged 50 and above. However, among the population aged <50, colorectal cancer incidence and mortality rates are significantly rising. The clinical benefit of treatment in this population still is a matter of debate. We aim to compare the clinical outcome between patients aged 50 and younger. Methods: In this retrospective, observational study, we analyzed data from 1,077 patients treated for mCRC at three cancer centers in Austria from January 2005 to December 2019. Patients were divided into two groups based on age at diagnosis: <50 years (eo-CRC) and >50 years (regular-onset CRC, ro-CRC). Propensity score matching was used to control for potential biases, and survival outcomes were compared between the two groups. Results: The differences in tumor characteristics between eo-CRC and ro-CRC in the overall population were primarily related to tumor sidedness and disease-free survival following intended curative resection. Our data show that eo-CRC patients underwent metastases resection more often and received significantly more lines of treatment in the palliative setting. Overall survival was superior in eo-CRC compared to ro-CRC, even after adjusting for sidedness, timing of metastases, sex, number of treatment lines, and resection of metastases by propensity scoring. Conclusion: Our study suggests that younger patients benefit at least to the same magnitude or even more from mCRC-treatment than patients aged 50 or above.

Gender differences in tumor characteristics, treatment and survival of colorectal cancer: A population-based study

BackgroundThe importance of sex and gender as modifiers of health and disease is increasingly recognized. The aim of this study was to analyze gender differences in incidence, tumor characteristics, treatment and relative survival (RS) in colorectal cancer (CRC). MethodsObservational population-based study including patients diagnosed with CRC in the Netherlands between 2010 and 2020. Stratified by localization (colon/rectum) and age (18–55/56–70/≥71years), gender differences in incidence, tumor characteristics, treatment and RS were analyzed. Multivariable regression was used to analyze the influence of gender on treatment and RS. ResultsThe age-standardized incidence per 100,000 person-years of colon and rectal cancer is higher among men than women (colon: 41.2 versus 32.4, rectum: 22.8 versus 12.6). Besides differences in patient- and tumor characteristics, differences in treatment allocation and RS were observed. Most strikingly, women aged ≥ 71 years with stage IV colon cancer are less often treated with systemic therapy (31.3 % versus 28.4 %, adjusted odds ratio (OR) 0.63, 95 % CI 0.48–0.83) and more often receive best supportive care only (47.6 % versus 40.0 %, adjusted OR 1.58, 95 % CI 1.19–2.11). ConclusionStatistically significant and clinically relevant gender differences in incidence, patient- and tumor characteristics and treatment allocation are observed in patients with CRC. Reasons for differences in treatment allocation deserve further investigation.

Incidence, Stage, Treatment, and Survival of Noncardia Gastric Cancer

Gastric cancer is the fifth most common cancer worldwide, and investigating its incidence, characteristics, treatment, and outcomes over the past decades can help in selecting clinical strategies and future research directions. To analyze the trends in incidence, staging, and treatment of gastric cancer. This nationwide, population-based cohort study included patients diagnosed with noncardia gastric cancer (NCGC) between 1989 and 2021 in the Netherlands. Differences in tumor characteristics, treatment, and survival were analyzed per fixed time periods (1989-1993, 1994-1998, 1999-2003, 2004-2008, 2009-2013, 2014-2018, and 2019-2021). In total, 47 014 patients (median [IQR] age, 73 [64-80] years; 28 032 [60%] male patients) were identified with mostly adenocarcinomas of the antrum region (when location was known). Age-standardized incidence decreased from 20.3 to 6.1 per 100 000 person-years between 1989 and 2021. During the study period, unknown T and N stages were recorded less frequently, and metastatic disease was diagnosed more frequently (1989-1993: 2633 of 9493 patients [28%]; 2019-2021: 1503 of 3200 patients [47%] in 2019-2021). Over time, fewer patients with metastatic disease underwent surgery with or without other treatment modalities (68% in 1989-1993 vs 64% in 2019-2021), and palliative chemotherapy in metastatic NCGC increased from 9% to 40%. For patients with nonmetastatic disease, 5-year relative survival improved from 28% (95% CI, 26.5%-29.2%) to 36% (95% CI, 33.5%-37.6%) between 1989 and 2021. For patients with nonmetastatic disease undergoing a resection, 5-year survival increased from 40% (95% CI, 38.3%-41.8%) to 51% (95% CI, 47.9%-53.3%). For patients with metastatic disease, 1-year relative survival increased from 10% (95% CI, 8.7%-11.1%) to 19% (95% CI, 17.2%-21.6%), but 3-year relative survival remained poor at 5% (95% CI, 3.6%-7.5%). In this nationwide cohort study involving 47 014 patients diagnosed with NCGC (1989-2021), the results showed a decrease in incidence, more accurate staging, a shift in treatment modalities, and improved patient survival.

Comparison of Survival Outcomes in Young Patients With Breast Cancer Receiving Contralateral Prophylactic Mastectomy Versus Unilateral Mastectomy

BackgroundContralateral prophylactic mastectomy (CPM) has been performed for several decades in patients with unilateral breast cancer (BC). However, the survival benefits of CPM are controversial, particularly in young women. Materials and MethodIn this retrospective study, the clinical total of 69,000 young female patients (age ≤ 40 years) who were diagnosed to have unilateral BC and underwent unilateral mastectomy (UM) or CPM between January 1, 2000 and December 31, 2019 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to minimize selection bias and overcome differences in tumor characteristics between the CPM and UM groups. Overall survival (OS) and BC-specific survival (BCSS) were assessed using Kaplan–Meier curves and compared across groups using log-rank test. Multivariable Cox proportional hazards regression analysis was performed to estimate hazard ratios (HRs). ResultsA total of 36,528 patients (21,600 and 14,928 patients in the UM and CPM groups, respectively) were included in follow study. The CPM group showed a higher 5-year OS rate (82.1% vs. 75.8%) and a higher 5-year BCSS rate (83.5% vs. 77.7%) than the UM group. Multivariate Cox analysis after PSM (n = 13,089) showed that CPM significantly decreased 25% risk of all-cause mortality (OS, HR: 0.75, 95% confidence interval [CI]: 0.70-0.80; P < .001) and 25% risk of BC-specific mortality (BCSS, HR: 0.75, 95% CI: 0.70-0.80; P < .001) in young BC patients as compared to UM. ConclusionThis study suggests that CPM improved OS and BCSS benefits in young BC patients as compared to UM. Randomized clinical trials with a larger sample size are required in the future to confirm these results.

Racial and ethnic differences in tumor characteristics among endometrial cancer patients in an equal-access healthcare population

PurposeThere are racial and ethnic differences in endometrial cancer incidence and mortality rates; compared with Non-Hispanic White women, Black women have a similar incidence rate for endometrial cancer, but their mortality is higher. Pacific Islander women may also have worse outcomes compared to their White counterparts. We assessed tumor characteristics and adjuvant therapy by racial and ethnic group among endometrial cancer patients treated within the Military Health System, an equal access healthcare organization.MethodsWe retrospectively identified women diagnosed with invasive endometrial cancer among US Department of Defense beneficiaries reported in the Automated Central Tumor Registry database (year of diagnosis: 2001–2018). We compared tumor characteristics and receipt of adjuvant therapy across racial and ethnic groups using Chi-square or Fisher tests. Hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of all cause mortality were calculated using Cox proportional hazards regression models adjusting for age at diagnosis, adjuvant therapy, histology and stage.ResultsThe study included 2574 endometrial cancer patients [1729 Non-Hispanic White, 318 Asian, 286 Black, 140 Pacific Islander and 101 Hispanic women]. Among all cases, a higher proportion of Black patients had non-endometrioid histology (46.5% versus ≤ 29.3% in other groups, P < 0.01) and grade 3–4 tumors (40.1% versus ≤ 29.3% in other groups, P < 0.01). In multivariable Cox models, compared with Non-Hispanic White cases, Black endometrial cancer patients had a higher mortality risk (HR 1.43, 95% CI, 1.13–1.83). There was no difference in mortality risk for other racial and ethnic groups.ConclusionBlack patients with endometrial cancer presented with more aggressive tumor features and they had worse overall survival compared with patients in other racial and ethnic groups. Further study is needed to better direct preventive and therapeutic efforts in order to correct endometrial cancer disparities in the future.

1422-P: The Impact of Type 2 Diabetes Mellitus on the Clinical Outcome of Breast Cancer

Objectives: Women with breast cancer and diabetes have worse outcomes than those with breast cancer without diabetes. The objective of this study was to investigate the impact of pre-existing diabetes on breast cancer prognosis. Methods and Materials: This was a retrospective observational study using Cancer database from a single tertiary center. The study population included women aged ≥20 years with breast cancer diagnosed between 1 January 2014 and 31 December 2018. Patients were categorized by diabetes status (T2D: n=111, non-T2D: n= 889). The clinicopathological features and outcomes were collected and compared between women with and without diabetes. Cox proportional hazard regression was used to estimate adjusted hazard ratios for overall mortality. Results: Compared to non-T2D patients, T2D patients were significantly older, had higher BMI, were more post-menopausal state at breast cancer diagnosis, had more comorbid conditions, and were in lower educational states. There were no statistically significant differences in tumor characteristics, including metastasis, lymph nodes, grade, and extent of surgery. Women with T2D had a significantly increased risk of overall mortality after adjusting for demographic and traditional risk factors for breast cancer (HR=2.15; 95%CI=1.10-4.20). Compared to patients with pre-existing T2D (n=111), patients with newly diagnosed T2D after receiving a breast cancer diagnosis (n=34) had a lower risk of breast cancer recurrence (HR=0.30; 95%CI=0.10-0.94). Conclusion: Our study showed that pre-existing T2D and T2D itself increase the risk of recurrence and total mortality among patients with breast cancer. These findings provide important prognostic information for the treatment of women with both T2D and breast cancer. Therefore, diabetes deserves additional attention to assess possible causal relationships that potentially could be modified to improve outcomes. Disclosure Y.Kim: None. I.Goak: None. H.Jin: None. T.Park: None. K.Lee: None.

Long-Term Outcomes of Patients With Carotid and Aortic Body Tumors

Chemodectomas are tumors derived from parasympathetic nonchromaffin cells and are often found in the aortic and carotid bodies. They are generally benign but can cause mass-effect symptoms and have local or distant spread. Surgical excision has been the main curative treatment strategy. The National Cancer Database was reviewed to study all patients with carotid or aortic body tumors from 2004 to 2015. Demographic data, tumor characteristics, treatment strategies, and patient outcomes were examined, split by tumor location. Kaplan-Meier survival estimates were generated for both locations. In total, 248 patients were examined, with 151 having a tumor in the carotid body and 97 having a tumor in the aortic body. Many variables were similar between both tumor locations. However, aortic body tumors were larger than those in the carotid body (477.80±477.58mm vs 320.64±436.53mm, p=0.008). More regional lymph nodes were positive in aortic body tumors (65.52±45.73 vs 35.46±46.44, p<0.001). There were more distant metastases at the time of diagnosis in carotid body tumors (p=0.003). Chemotherapy was used more for aortic body tumors (p=0.001); surgery was used more for carotid body tumors (p<0.001). There are slight differences in tumor characteristics and response to treatment. Surgical resection is the cornerstone of management, and radiation can often be considered. In conclusion, chemodectomas are generally benign but can present with metastasis and compressive symptoms that make understanding their physiology and treatment important.

Abstract PD6-08: PD6-08 Mortality risks over 20 years in men with stage I-III hormone receptor-positive breast cancer

Abstract Background: In women with hormone receptor-positive (HR+) breast cancer, the risk of distant recurrence and death persists for at least 20 years (y) from diagnosis. The risk of late mortality in men with HR+ breast cancer has not been reported. The aims of this study were to evaluate long-term risks of breast cancer-specific mortality (BCSM) and non-BCSM in men with stage I-III HR+ breast cancer. In addition, we aimed to identify factors associated with late deaths from breast cancer in men. Methods: Using data from the Surveillance, Epidemiology, and End Results (SEER) program, we identified men diagnosed with stage I-III HR+ breast cancer between 1990-2008. We used cumulative incidence function to estimate the effect of baseline clinical and pathologic variables including age at diagnosis, stage, tumor size (T), nodal status (N), and tumor grade, on cumulative risks of BCSM and non-BCSM over time. We estimated annual rate of events per 100 person-years. We plotted smoothed hazard estimates over time for BCSM by stage and nodal status. Fine and Gray multivariable regression was used to evaluate the association of pre-selected variables with BCSM, conditional on having survived 5 y. Results: We included 2,836 patients (pts) with a median follow-up of 15.41 y. Median age at diagnosis was 67 y (IQR 57-76 y). Stage distribution was: 34.5% stage I, 46% stage II, and 19.5% stage III. The table shows risks of BCSM and non-BCSM and annual event rates by stage, N status, and grade. The cumulative risk of BCSM in y 0-20 was 12.4% for stage I, 26.2% for stage II and 46.0% for stage III. In contrast, the cumulative risk of non-BCSM over the same period ranged from 42.8% in stage III to 52.4% in stage I. Of all BCSM events, the proportion that occurred 0-&amp;lt; 5y, 5-&amp;lt; 10y and ≥10y was: For stage I 22.55%, 50% and 27.45%; For stage II 37.58%, 38.93% and 23.49%, For stage III 49.15%, 31.62% and 19.23%; respectively (p&amp;lt; 0.001). Among pts with stage II breast cancer, we observed a peak in the risk of BCSM at 6 y with a hazard rate of 3%, followed by a minimal decline in risk thereafter. However, among pts with stage III (n=554), and those with N3 (n=160), we observed a risk of BCSM that peaked first at 4-5 y (hazard rates: 6.3% and 9.9% for stage III and N3, respectively) followed by a small decline and then peaked again at 11-12 y (hazard rates: 7.5% and 12.7% for stage III and N3, respectively). In adjusted Fine and Gray regression conditional on having survived 5 y, risks of BCSM were higher for pts aged &amp;lt; 50 y vs &amp;gt;64 y (Hazard ratio [HzR] 1.59; 95% CI, [1.17 – 2.16]), grade III/IV vs grade I (HzR 1.85; 95% CI, [1.22 – 2.79]), and stage III vs stage I (HzR 3.93; 95% CI, [2.93 – 5.26]). Conclusions: In HR+ male breast cancer, risks of BCSM persist for at least 20 y after diagnosis and depend on traditional clinicopathologic factors such as age, tumor stage and tumor grade. Among the relatively small group of men with higher stages of disease, we observed a prolonged risk of BCSM with an early and late peak, which is different from the risk that is reported in women (Leone JP, BCRT 2021). Whether the observed trends in hazards over time reflect biologic differences in tumor characteristics, tumor dormancy, and/or host factors between male and female breast cancer cannot be elucidated from these data. Better adjuvant therapies are warranted to reduce early and late BCSM risks. Risks of BCSM, non-BCSM and annual event rates in men with stage I-III hormone receptor-positive breast cancer Citation Format: Julieta Leone, Michael J. Hassett, Rachel Freedman, Sara Tolaney, Noah Graham, Nabihah Tayob, Carlos T. Vallejo, Eric Winer, Nancy U. Lin, Jose P. Leone. PD6-08 Mortality risks over 20 years in men with stage I-III hormone receptor-positive breast cancer. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD6-08.

HELENA: HER2-Low as a prEdictive factor of response to Neoadjuvant chemotherapy in eArly breast cancer

BackgroundHER2 expression has a prognostic and predictive impact in early-stage breast cancer (BC). HER2 positive BC (immunohistochemistry (IHC) score 3 + or 2 + with in situ hybridization (ISH) amplification) are treated with HER2 targeted therapies. The concept of HER2-low BC (IHC score 1 + or 2 + without ISH amplification) is drawing attention as anti-HER2 treatment has recently shown efficacy in this subgroup. We aimed to explore the response to neoadjuvant chemotherapy (NAC) in HER2-low early BC according to the HER2 score (1 + or 2 + without amplification).MethodsWe conducted a retrospective study in two French comprehensive cancer centers. All patients with HER2-low BC treated with NAC from January 2014 to December 2020 were included. The primary objective was to analyze the pathological complete response (pCR) rate to NAC using the Sataloff or RCB system, according to the HER2 score. Secondary objectives were to assess disease free survival (DFS), overall survival (OS) and to explore the immune environment through the Neutrophil-to-Lymphocyte Ratio (NLR), according to HER2 expression. Univariate and multivariate analyses were performed.ResultsWe included 237 tumors for 229 patients. Of these, 160 (67.5%) tumors were HER2 1 + , 77 (32.5%) were HER2 2 + , and 152 (64.1%) were hormone receptor (HR) positive. The median age was 53.9 years. No differences in tumor characteristics were observed between HER2 1 + and HER2 2 + subgroups. pCR was achieved in 38 tumors (17%), without any difference between HER2 1 + and HER2 2 + subgroups (p = 0.77). DFS and OS were significantly different between HER2 1 + and HER2 2 + patients (HR = 0.41,CI95%[0.17;0.97] p = 0.037 and HR = 0.31,CI95%[0.09;1.02] p = 0.042, respectively). HER2 status was still associated with DFS and OS after adjustment for age, HR status and NLR, with better outcomes in favor of HER2 score 2 + (HR = 0.35 [0.15–0.84] and HR = 0.24 [0.07–0.81], respectively). NLR was not associated with worse DFS or OS.ConclusionIn HER2-low early BC, no differences in pCR were observed between HER2 1 + and HER2 2 + tumors, however patients with HER2 2 + tumors had a better DFS and OS than those with HER2 1 + . Further investigations are needed to describe the intrinsic differences in the spectrum of HER2-low BC.

The impact of race/ethnicity on pancreaticoduodenectomy outcomes for pancreatic cancer.

To investigate the impact of race/ethnicity on surgical outcomes following pancreaticoduodenectomy for pancreatic cancer. A retrospective review of patients undergoing pancreaticoduodenectomy for adenocarcinoma in the National Surgical Quality Improvement Program (NSQIP) database from 2014 to 2019. Patient and tumor characteristics and 30-day postoperative outcomes were compared. Multivariable logistic and linear regression models were conducted to investigate the relationship between race/ethnicity and surgical outcomes. Six thousand five hundred and sixty-twopatients were included (84.5% White, 7.9% Black, 3% Hispanic, 4.6% Asian). Larger proportions of Blacks had preoperative American Society of Anesthesiologists class 3 or 4. There were no significant differences in tumor characteristics or operative techniques. A smaller proportion of Asians and Hispanics received neoadjuvant chemotherapy and/or radiation than Blacks and Whites. Relative to White, the Black race was independently associated with postoperative sepsis and reoperation. Both Black and Hispanic race/ethnicity were associated with prolonged intubation and delayed gastric emptying, and minorities races/ethnicities were associated with longer length of hospital stay. Relative to White, Hispanic, and Asian race/ethnicity were independently associated with a lower likelihood of neoadjuvant therapy(NAT) receipt. In ACS-NSQIP participating hospitals, non-White race/ethnicity was independently associated with adverse outcomes after pancreatic cancer resection. A possible disparity in NAT receipt may exist in Asian and Hispanic patients undergoing surgical resection.

1302P Gender differences in tumor characteristics, treatment allocation and survival in patients in a real-world non-metastatic pancreatic cancer cohort

Differences in biological sex and gender may have impact on treatment allocation and survival in patients with localized and locally advanced pancreatic cancer. The aim of the present study is to systematically analyse patient- and tumour characteristics, treatment allocation and overall survival in patients with stage I-III pancreatic cancer in the Netherlands.

Racial and ethnic differences in tumor characteristics and overall survival of women with melanoma: A national cancer database retrospective cohort study

To the Editor: Despite a lower risk of acquiring melanoma, racial/ethnic minorities with melanoma experience worse outcomes than White individuals. 1 Cormier J.N. Xing Y. Ding M. et al. Ethnic differences among patients with cutaneous melanoma. Arch Intern Med. 2006; 166: 1907-1914https://doi.org/10.1001/archinte.166.17.1907 Crossref PubMed Scopus (245) Google Scholar , 2 Wu X.C. Eide M.J. King J. et al. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006. J Am Acad Dermatol. 2011; 65: S26-S37https://doi.org/10.1016/j.jaad.2011.05.034 Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar , 3 Lam M. Zhu J.W. Hu A. Beecker J. Racial differences in the prognosis and survival of cutaneous melanoma from 1990 to 2020 in North America: A systematic review and meta-analysis. J Cutan Med Surg. 2022; 26: 181-188https://doi.org/10.1177/12034754211052866 Crossref Scopus (2) Google Scholar Additionally, women experience better overall survival (OS) than men. 4 Behbahani S. Maddukuri S. Cadwell J.B. Lambert W.C. Schwartz R.A. Gender differences in cutaneous melanoma: demographics, prognostic factors, and survival outcomes. Dermatol Ther. 2020; 33: e14131-e14132https://doi.org/10.1111/dth.14131 Crossref Scopus (12) Google Scholar However, much remains unknown about racial/ethnic differences in women with melanoma, which is investigated here.

Impact of alcohol consumption on treatment outcome of hepatocellular carcinoma patients with viral hepatitis who underwent transarterial chemoembolization.

BACKGROUNDAlcohol consumption increases the risk of hepatocellular carcinoma (HCC) in patients with pre-existing liver disease, including viral hepatitis. However, studies on the impact of alcohol consumption on the outcomes of HCC are limited. We hypothesized that alcohol had an additional effect with chronic viral hepatitis infection on treatment outcomes after transarterial chemoembolization (TACE) in patients with intermediate-stage HCC (Barcelona Clinical Liver Cancer [BCLC] -B).AIMTo evaluate the additional effect of alcohol on treatment outcomes of TACE among HCC patients with viral hepatitis.METHODSThis study, conducted at Hatyai Hospital in Thailand, included HCC patients over 18 years of age with chronic viral hepatitis. Records of HCC patients with viral hepatitis classified as BCLC-B who underwent TACE as the first treatment modality between 2014 and 2019 were retrospectively reviewed. Patients with chronic viral hepatitis only were categorized under group A, and those with chronic viral hepatitis and concurrent alcohol consumption were categorized under group B. Both groups were compared, and the Cox proportional-hazards model was used to identify the survival-influencing variables.RESULTSOf the 69 patients, 53 were categorized in group A and 16 in group B. There were no statistically significant differences in tumor characteristics between the two patient groups. However, Group A had a statistically significantly higher proportion of complete response (24.5% vs 0%, P = 0.030) and a higher median survival rate (26.2 mo vs 8.4 mo; log-rank P = 0.012) compared to group B. Factors associated with decreased survival in the proportional-hazards model included alcohol consumption (hazards ratio [HR], 2.377; 95% confidence interval [CI], 1.109-5.095; P = 0.026), presence of portal hypertension (HR, 2.578; 95%CI, 1.320–5.037; P = 0.006), largest tumor size > 5 cm (HR, 3.558; 95%CI, 1.824-6.939; P < 0.001), and serum alpha-fetoprotein level > 100 ng/mL (HR, 2.536; 95%CI, 1.377-4.670; P = 0.003).CONCLUSIONIn HCC BCLC B patients with chronic viral hepatitis, alcohol consumption is an independent risk factor for increased mortality and decreases the rate of complete response and survival after TACE.

Risk factors for the failure of endoscopic resection of gastric submucosal tumors: a long-term retrospective case-control study.

Endoscopic resection (ER) is an effective treatment method for gastric submucosal tumors (G-SMTs), but endoscopic resection failure requires emergency surgery. The purpose of this study was to assess potential risk factors for endoscopic resection failure. A total of 1041 patients with G-SMT undergoing endoscopic resection were enrolled. Twenty-five patients in whom endoscopic resection failed, requiring a transition to surgery midway through the operation, were included in the failed group, and 1016 patients who received successful endoscopic resection were included in the successful endoscopic resection group. Baseline and lesion characteristics were recorded, and the differences in tumor characteristics and risk factors for resection failure of G-SMT were analyzed. Sensitivity analysis was performed to detect the stability of the indicator. Of the 1041cases included, there were 25 cases (2.4%) of failed endoscopic resection. Binary logistic analysis showed that the independent risk factors included tumors originating from deep muscularis propria(OR = 14.42, 95% CI 4.47-46.52), size > 3cm (OR = 7.75, 95% CI 2.64-22.70), exophytic growth pattern (OR = 4.98, 95% CI 1.62-15.29), endoscopist with less experience (OR = 5.99, 95% CI 1.07-12.19), and irregular borders (OR = 4.13, 95% CI 1.40-12.19). The stable risk factors were tumors size, tumor origin and growth pattern according to sensitivity analysis. Tumors originating from the deep muscularis propria, tumor size > 3cm, endoscopists with less experience, an exophytic growth pattern, and irregular boundaries were found to be independent risk factors for endoscopic resection failure. To reduce the risk of endoscopic resection failure, physicians should carefully evaluate G-SMT characteristics preoperative.

Age-related Differences in Tumour Characteristics and Prognostic Factors for Disease Progression in Cutaneous Squamous Cell Carcinoma of the Head and Neck.

Guidelines for cutaneous squamous cell carcinoma of the head and neck do not take the age of the patient into account, but instead assume equal tumour characteristics and prognostic factors for poor outcome in younger and elderly patients. The aim of this study was to compare tumour characteristics of younger (< 75 years) and elderly (≥ 75 years) patients and identify age-specific risk factors for progression of disease, comprising local recurrence, nodal metastasis and distant metastasis. Patient and tumour characteristics were compared using χ2 or Fisher's exact tests. Multivariable competing risk analyses were performed to compare risk factors for progression of disease, incorporating the risk of dying before developing progression of disease. A total of 672 patients with primary cutaneous squamous cell carcinoma of the head and neck were retrospectively included. Larger tumour diameter, worse differentiation grade and deeper invasion were observed in older patients. In elderly patients, but not in younger patients, tumour diameter ≥ 40 mm, moderate differentiation grade and an invasion depth ≥ 2 mm were independent risk factors for progression of disease.