Distant Stage Research Articles

Clinicopathologic and survival patterns among prostate carcinosarcoma patients in the U.S. An analysis of SEER database.

Prostatic carcinosarcoma comprises <1% of all prostate neoplasms. The literature on this disease is limited to a few case studies, primarily due to the rarity of this malignancy. We aimed to investigate the demographic, clinical, and histologic factors, prognosis, and survival of prostatic carcinosarcoma. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with prostatic carcinosarcoma from 2000-2018. Demographic and clinical data, including age, race, sex, tumor grade, stage, tumor size, lymph node status, metastasis, and treatment modalities, were recorded. Patients with prostatic carcinosarcoma had a median age of 72 years at diagnosis, most cases among White individuals (93%). When reported, the histologic grade comprised moderately differentiated (3.3%), poorly differentiated (56.7%), and undifferentiated/anaplastic (40%) subtypes. In patients with reported data, tumor size varied between 2-5 cm (15.8%) and >5 cm (84.2%). Distant metastasis most commonly occurred in the liver (12.5%) and lung (12.5%), followed by the bone (8.3%). The most common treatment performed was surgery with radiation (32.4%). The five-year overall survival was 11.9%. Prostatic carcinosarcoma affects men in the seventh decade of life. Regional and distant tumor stage is considered an indicator of survival. Prostate carcinosarcoma is rare; due to its aggressive nature, a deeper understanding, and an improved personalized therapeutic approach are necessary for improving patient outcomes in this challenging arena of oncology.

Medicaid expansion in California and breast cancer incidence across neighborhoods with varying social vulnerabilities.

To investigate changes in breast cancer incidence rates associated with Medicaid expansion in California. We extracted yearly census tract-level population counts and cases of breast cancer diagnosed among women aged between 20 and 64years in California during years 2010-2017. Census tracts were classified into low, medium and high groups according to their social vulnerability index (SVI). Using a difference-in-difference (DID) approach with Poisson regression models, we estimated the incidence rate, incidence rate ratio (IRR) during the pre- (2010-2013) and post-expansion periods (2014-2017), and the relative IRR (DID estimates) across three groups of neighborhoods. Prior to the Medicaid expansion, the overall incidence rate was 93.61, 122.03, and 151.12 cases per 100,000 persons among tracts with high, medium, and low-SVI, respectively; and was 96.49, 122.07, and 151.66 cases per 100,000 persons during the post-expansion period, respectively. The IRR between high and low vulnerability neighborhoods was 0.62 and 0.64 in the pre- and post-expansion period, respectively, and the relative IRR was 1.03 (95% CI 1.00 to 1.06, p = 0.026). In addition, significant DID estimate was only found for localized breast cancer (relative IRR = 1.05; 95% CI, 1.01 to 1.09, p = 0.049) between high and low-SVI neighborhoods, not for regional and distant cancer stage. The Medicaid expansion had differential impact on breast cancer incidence across neighborhoods in California, with the most pronounced increase found for localized cancer stage in high-SVI neighborhoods. Significant pre-post change was only found for localized breast cancer between high and low-SVI neighborhoods.

Disaggregating U.S. Asian and Pacific Islanders: Colorectal cancer

BackgroundColorectal cancer remains a public health concern as the 4th most common cancer in the US. Incidence and mortality have been observed to differ between races; however, Asian and Pacific Islander ethnicities are often documented in aggregate. Recognizing that these groups are heterogeneous, this study seeks to disaggregate Native Hawaiian from the broader “Asian/Pacific Islander” group and examine disparate outcomes in colorectal cancer. MethodsDe-identified data from the Hawaii Tumor Registry was queried to evaluate colorectal cancer in the state of Hawaii. Primary outcomes were cancer stage at diagnosis, first course of therapies received, and duration of survival from diagnosis. Chi-square analyses were performed for differences in categorical variables. Results7943 Hawaii residents were diagnosed with colorectal cancer in 2008–2018 with 1151 (14.5 %) patients identifying as Native Hawaiian. Native Hawaiians were less likely to present with localized cancer (36.7 % vs. 41.7 %; p = 0.002) and more likely to be diagnosed with distant stage cancer compared to non-Native Hawaiians (25.2 % vs. 17.67 %; p < 0.0001) and, among those with distant metastases, more likely to receive chemotherapy (68.3 % vs. 61.1 %; p = 0.029). No significant differences were observed between races on analysis of CRC-specific mortality. ConclusionSignificant differences exist between disaggregated Asian and Pacific Islander ethnic groups. Native Hawaiians are observed to present with more advanced cancer at the time of diagnosis in comparison to ethnicities. Disaggregating these groups reveals racial and ethnic disparities that may inform public health measures. SynopsisDisaggregating Asian and Native Hawaiian and Pacific Islander groups reveals disparities in colorectal cancer. Native Hawaiians presented with more advanced disease across all studied ethnic groups. No significant differences were observed in colorectal cancer specific mortality across groups.

Eric Fillion, Distant Stage: Quebec, Brazil, and the Making of Canada’s Cultural Diplomacy (Montreal: McGill-Queen’s University Press, 2022)

Eric Fillion, Distant Stage: Quebec, Brazil, and the Making of Canada’s Cultural Diplomacy (Montreal: McGill-Queen’s University Press, 2022)

Ethnicity and health insurance disparities in rectal carcinoma.

e13732 Background: Ethnicity and insurance coverage affect healthcare delivery in rectal carcinoma (RC). RC pts (pts) with Medicaid or no insurance are more likely to present with distant stage RC compared to Medicare/private insurance pts, and have a worse prognosis even when stage is accounted for. To combat such issues, federal law requires that non-profit hospitals, which make up 58% of all community hospitals, to provide charity care, or financial assistance, to those eligible. As insurance status, ethnicity and race have been found to independently affect colon cancer care, we expect similar results for RC in our limited but diverse cohort. Methods: Trinitas Medical Center RWJBH is an urban, community hospital that predominantly treats a minority population and provides financial assistance to eligible underinsured pts. Due to this assistance, or Charity Care, we can provide access to cancer care for many who would not ordinarily have such means. With institutional IRB approval, we completed a retrospective chart review of 59 pts diagnosed with Stage I-IV RC from 2017-2023. We assessed ethnicity, insurance carriers and treatment choices. Results: We reviewed 59 pts with the following ethnic distribution: 22 Hispanic (H), 21 White (W), 11 Black (B) and 5 Asian (A) pts. The median age at diagnosis with RC was 57 in H, 64 in B, 71 in W and 71 in A pts. B pts were found to be diagnosed with more advanced disease: 36% at Stage III and 45% at Stage IV, with none diagnosed at Stage I or II. H pts had comparatively fewer distant stage diagnoses (23% at Stage III, 18% at Stage IV). Neoadjuvant chemotherapy and radiation therapy to 20 of 59 pts treated at our center, 15 of whom subsequently received surgery. Four of five of these declined surgical intervention post neoadjuvant therapy. H pts had the following primary insurance carriers: 36% Medicaid, 36% Medicare, 27% Charity care. 62% of W pts had Medicare and 14% Medicaid. 27% had B pts had Medicare, 27% Medicaid and 9% had Charity care. 50% of the 59 pts had Charity care, with most pts in this group being H. Conclusions: Research suggests that immigrants utilize healthcare facilities less than U.S. citizens and programs like Charity care may be underutilized. In our RC cohort, 38 of 59 (64%) pts were racial minorities, of these 50% received Charity care. Most did not receive screening prior to a diagnosis of rectal cancer and many applied for Charity Care only after their diagnosis. Despite offering significant financial assistance to our pts, we suggest education to immigrants regarding insurance coverage, broader screening efforts and the ability to offer improved subspecialty care to RC pts. In particular, we look to target B and H who present at younger ages and are not Medicare eligible. We believe this will lead to earlier staging of RC, which should lead to improved survival for minority pts.

Epidemiology, survival and new treatment modalities for intrahepatic cholangiocarcinoma (IHCC).

e16217 Background: Intrahepatic cholangiocarcinoma (IHCC), a rare biliary tract cancer, has been rising in incidence and is associated with poor survival. With the advent of new treatment modalities and various ongoing research, population-based perspective can be helpful to reflect the progress in managing this deadly disease and provide updated outcome information as a reference for comparison during upcoming clinical studies. We would like to provide a 20-year update on incidence and survival with reference to landmark trials, with a focus on survival outcomes of the recent 5 years for future insights. Recent and ongoing clinical trials will be discussed. Methods: This study extracted population data from the Surveillance, Epidemiology, and End Results (SEER) database. Age-adjusted incidence rate (AAIRs) and survival rate (SR) trends were calculated from January 2000 to December 2020 using 22 registries for the US population. Incidence and survival rates were collected from the SEER database, reported per 100,000 population and age adjusted to the 2020 US standard population. The annual percent change (APC) was used to report long term trends. Results: In this analysis of 19,948 IHCC patients, the AAIR increased from 0.49 per 100,000 in 2000 to 1.38 in 2020 (APC 6.94, 95% CI 6.32 to 7.56), with a notable decline from 2019 to 2020. Incidence rates overall displayed an uptrend course across subgroups divided by sex, race, age, and disease stage. The age-adjusted mOS climbed from 5.28 months in 2000 to 9.3 months in 2013, maintaining between 8.0-9.0 months after 2013. Using 2010 as a cutoff, when the ABC-02 trial was published, the decade-based mOS increased from 6.55 in 2000-2010 to 9.06 in 2010-2020, which remained statistically significant at 1-year, 3-year, and 5-year OS. During 2015-2020, the overall mOS was 8.8 months, with mOS of 24.3 months, 12.1 months, and 5.4 months for local, regional, and distant stages, respectively. Conclusions: These results indicate a steady rise in IHCC incidence since 2000, consistent across all subgroups. Survival rates have improved since 2000 but stabilized after 2013, following the publication of the ABC-02 trial published in 2010, which used systemic gemcitabine and cisplatin for unresectable iHCC. Updated survival data from 2015 onwards will serve as a reference of comparison for forthcoming clinical trials.

Interaction between histology and staging on survival outcomes of patients diagnosed with esophageal cancer over the past decade.

e16054 Background: Esophageal cancer (EC) ranks sixth globally in cancer-related deaths , continuing to be a significant public health concern . The purpose of this study is to assess the impact of staging and histopathology of EC on associated mortality. The study also aims to further investigate clinical characteristics, prognostic factors, and survival outcomes in patients diagnosed with EC between 2010 and 2017. Methods: A total of 22,979 patients diagnosed with EC between 2010 and 2017 in the United States were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic parameters, tumor stage and histologic subtypes were analyzed and associated mortality was measured across all subgroups. Covariates reaching the level of statistical significance, demonstrable by a p-value equal to or &lt; 0.01 were incorporated into a multivariate Cox proportional hazards model. The primary outcome of this study was discernment of clinicopathologic variables associated with mortality, with a primary focus on delineation of the association between the latter, and tumor stage and histologic subtype respectively. A hazard ratio &gt; 1 was indicative of increased risk for mortality in presence of the variable under discussion. Results: 22,979 patients: Male (79.78%), age 60-79 (59.78%), non-Hispanic whites (77.44%). Distant metastases in 41.27%, adenocarcinoma prevalent (66.72%). Crude analysis revealed higher EC-related mortality in males (HR: 1.06, 95% CI: 1.02-1.11), non-Hispanic blacks (HR: 1.32, 95% CI: 1.25-1.39), and Hispanics (HR: 1.12, 95% CI: 1.05-1.18). Multivariate analyses showed higher overall mortality in males (HR = 1.13, 95% CI 1.08-1.18, p &lt; 0.01), distant tumor stage (HR = 2.93, 95% CI 1.56-5.52, p &lt; 0.01), and advanced age. Stand-alone surgical therapy (HR = 0.29, 95% CI 0.28-0.31, p &lt; 0.01) and adenocarcinoma histology (HR = 0.49, 95% CI 0.27-0.89, p &lt; 0.01) correlated with lower mortality. Notable interaction: Gastrointestinal Stromal Tumor (GIST) histology, especially with local structure invasion, increased overall mortality (HR = 7.25, 95% CI 1.17-45.11, p &lt; 0.05) and GIST-related mortality (HR = 46.09, 95% CI 3.42-620.37, p &lt; 0.01). Conclusions: Adenocarcinoma histology and distant metastases at diagnosis elevate all-cause and EC-associated mortality in EC patients. Demographics matter; males, non-Hispanic blacks, and advanced age associate with increased mortality. GIST histology, particularly with local invasion, significantly raises mortality. Further research can unravel histopathology and staging's impact on overall and cancer-specific mortality, aiding targeted therapy. This study aims to assist physicians in identifying at-risk populations and encourages more research to address racial disparities, ultimately enhancing aggressive therapies and improving mortality outcome.

Rectal cancer: Demographics and healthcare outcomes in a minority-rich community hospital.

e13735 Background: Rectal cancer (RC) has seen a decreasing incidence and mortality due to national screening guidelines, innovative therapies and new technology. In recent years, however, we have noted shifts in its demographics pertaining to variation in stage at diagnosis and mortality rates amongst various ethnic groups. Minority populations, namely Hispanic (H) and Black (B) patients (pts), continue to see higher incidence, diagnosis at more advanced stages and poorer survival than White (W) pts. In B pts, mortality rates are higher with an increased likelihood of distant-stage RC creating a significant survival disparity. Current studies involving H and Asians(A) show similar disparities. Compared to other malignancies, RC has improved survival for pts when diagnosed in a timely fashion and therefore, we seek to identify potential patterns within the diverse population we care for. Methods: Trinitas Medical Center RWJBH is an urban, community hospital that predominantly treats a minority population. With institutional IRB approval, we completed a retrospective chart review of 59 pts diagnosed with Stage I-IV RC from 2017- 2023. Pts were treated at our cancer center. We assessed age and stage at diagnosis and demographics such as age, sex and ethnicity. Results: We reviewed 59 pts with the following ethnic distribution: 22 H, 21 W, 11 B and 5 A pts. The median age at diagnosis with RC was 57 in H, 64 in B, 71 in W 71. More males were diagnosed in all groups except A pts. B pts were found to be diagnosed with more advanced disease: 36% at Stage III, 45% at Stage IV. W pts also saw a similar trend with 33% at Stage III and 24% at Stage IV. Our H pts had comparatively fewer distant stage diagnoses: 23% at Stage III, 18% at Stage IV. Common sites of metastasis in B: liver 27%, lung 27%, locoregional lymph nodes 9%. In W pts: liver 24%, locoregional lymph nodes 24%, lung 10% and brain 5%. In H pts, 10 of 22(45%) were diagnosed without metastatic disease, though of the 10 who did, 2 had brain involvement. Mortality was highest in B pts at 55%, 33% for W, 20% for A and 18% for H pts. Conclusions: In our study, we note H pts being diagnosed at an earlier median age, at earlier stages of disease, with higher survival rates. Our B pts were diagnosed younger than W pts, at later stages of disease, with higher mortality rates. Brain involvement, which usually is rare, was seen in both H and W upon recurrence. Despite having a multi specialized cancer center, we note limitations in our access to screening resources and the availability of colorectal surgical expertise to enhance care for our underserved population. The challenge of disentangling disparities within RC will benefit from improved healthcare access and availability of multimodality resources in this disease state where cure is the ultimate goal.

Ovarian carcinosarcoma is highly aggressive compared to other ovarian cancer histotypes

BackgroundOvarian carcinosarcoma (OCS) is an unusual ovarian cancer type characterized by distinct carcinomatous and sarcomatous components. OCS has been excluded from many of the pan-histotype studies of ovarian carcinoma, limiting our understanding of its behavior.MethodsWe performed a multi-cohort cross-sectional study of characteristics and outcomes in ovarian cancer patients from Scotland (n=2082) and the Surveillance, Epidemiology and End Results Program (SEER, n=44946) diagnosed with OCS or one of the other major histotypes: high grade serous (HGSOC), endometrioid (EnOC), clear cell (CCOC), mucinous (MOC) or low grade serous ovarian carcinoma (LGSOC). Differences in overall survival were quantified using Cox regression models to calculate hazard ratios (HR).ResultsAcross both cohorts, OCS patients were significantly older at diagnosis compared to all other histotypes (median age at diagnosis 69 and 67 in Scottish and SEER cohorts) and demonstrated the shortest survival time upon univariable analysis. Within the Scottish cohort, 59.3% and 16.9% of OCS patients presented with FIGO stage III and IV disease, respectively; this was significantly higher than in EnOC, CCOC or MOC (P&amp;lt;0.0001 for all), but lower than in HGSOC (P=0.004). Multivariable analysis accounting for other prognostic factors identified OCS as independently associated with significantly shorter survival time compared to HGSOC, EnOC, LGSOC and MOC in both the Scottish (multivariable HR vs OCS: HGSOC 0.45, EnOC 0.39, LGSOC 0.26, MOC 0.43) and SEER cohorts (multivariable HR vs OCS: HGSOC 0.59, EnOC 0.34, LGSOC 0.30, MOC 0.81). Within the SEER cohort, OCS also demonstrated shorter survival compared to CCOC (multivariable HR 0.63, 95% CI 0.58-0.68), but this was not replicated within the Scottish cohort (multivariable HR for CCOC: 1.05, 95% CI 0.74-1.51). Within early-stage disease specifically (FIGO I-II or SEER localized stage), OCS was associated with the poorest survival of all histotypes across both cohorts. In the context of late-stage disease (FIGO III-IV or SEER distant stage), OCS, MOC and CCOC represented the histotypes with poorest survival.ConclusionOCS is a unique ovarian cancer type that affects older women and is associated with exceptionally poor outcome, even when diagnosed at earlier stage. New therapeutic options are urgently required to improve outcomes.

Incidence of cardiovascular mortality among head and neck cancer patients.

While treatment advancements have prolonged the lives of patients with head and neck cancer, the subgroups of these patients at higher risk for cardiovascular disease (CVD) mortality remain unclear. We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with head and neck cancer from 2000 to 2019. We compared their CVD mortality against the general US population using standardized mortality ratios (SMRs). Our analysis included 474,366 patients, identifying that 14% of deaths were due to CVD, with an SMR of 1.19. Notably, patients under the age of 39 had a CVD SMR increase of over 100-fold. Those with distant tumor stages showed the highest CVD SMR of 1.52 (95% CI 1.50-1.54). An upward trend in SMR to 2.53 (95% CI 2.51-2.56) was observed from 2011 to 2019. Within the initial 5-year post-diagnosis, the SMR for CVD was 3.17 (95% CI 3.14-3.20), which exceeded the general population's rates but declined in the 5-20-year range after diagnosis. Patients who did not any therapy had the greatest CVD SMR of 2.26 (95% CI 2.24-2.28). Hypopharyngeal cancer patients exhibited the highest CVD SMR of 1.54 (95% CI 1.52-1.56). The study highlights that head and neck cancer patients, especially younger individuals and those with advanced disease stages, face substantial CVD mortality risks. The CVD SMR peaks within 5years following diagnosis. Patients abstaining from treatment bear the highest risk of CVD mortality. Cardioprotective measures should be considered critical for this patient population.

Colorectal Adenosquamous Carcinoma: Demographics, Tumor Characteristics, and Survival Benefits of Surgery with Chemoradiation.

Colorectal adenosquamous carcinoma (ASC) is a rare subtype of colorectal carcinoma. This study presents findings from a large database query to highlight the demographic, clinical, and pathological factors, prognosis, and survival of colorectal ASC. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with colorectal ASC diagnosed between 2000 and 2020 and assess factors associated with overall survival (OS) and cause-specific survival (CSS). Among 284 identified cases, the median age of diagnosis was 64 years. The majority of patients were White (69.0%), with income ≤ $70,000 ( 62.3%), and lived in metropolitan areas (85.6%). Regarding tumor characteristics, the majority of tumors were poorly differentiated (49.6%), regional stage (39.8%), size of > 4.0 cm ( 41.5%), and had a negative lymph node status (47.2%). Primary sites were the rectum (35.2%) and colon ( 64.8%). In patients with primary site to the rectum, the majority of treatment modality was multimodal therapy (40.0%). The main treatment modality for the primary site to the colon was surgery only (46.2%), followed by surgery + chemotherapy (34.2%). The overall 5-year survival was 31.3 (95% C.I. 28.4-34.2) and the 5-year cause-specific survival (CSS) was 40.1% (95% C.I. 36.9-43.3). Multivariate analysis showed age ≥ 60 years, regional stage, and distant stage were negative prognostic factors. An income of > $70,000, multimodal therapy, and surgery with chemotherapy were positive prognostic factors. Colorectal adenosquamous carcinomas are more common in the non-Hispanic White populations and appear more frequently later in life (based on the median age of diagnosis at 64). Factors that contributed to a worse prognosis were an age of diagnosis ≥ 60 years, regional stage, and distant stage.

Impact of lymph node dissection on cancer-specific survival in non-small cell lung cancer patients: a SEER database analysis.

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide, and lymph node dissection (LND) is a significant surgical procedure employed in its management. Although some studies suggest benefits of LND, the extent of its impact on survival, the optimal range of lymph nodes to be examined, and the specific patient groups that benefit most remain areas of active debate and investigation. A population-based analysis was conducted using the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed with NSCLC between 2004 and 2017, undergoing primary tumor resection, were included. Descriptive, univariate, and multivariate analyses assessed the effect of LND on survival, and a restricted cubic spline method determined the optimal range for lymph node examination. This study of 37,323 NSCLC patients delved into the impact of LND on lung cancer-specific survival. Key findings revealed a median survival of 19.58 months, with 85% mortality. Baseline characteristics included a majority of White patients (81%), distant stage diagnoses (63%), and 64% with Grade IV tumors. LND emerged as a crucial predictor, influencing survival across age, gender, race, and tumor characteristics. Univariate analysis highlighted its significance, with higher T, N, and M categories, advanced stage, and poorer grade associating with elevated hazard ratios. Multivariate Cox proportional hazards (PH) analysis reinforced LND's impact, showcasing lower hazard ratios post-removal. Hazard ratios for biopsy/aspiration and removal of regional lymph nodes were 0.85 [95% confidence interval (CI): 0.81-0.89; P<0.001] and 0.43 (95% CI: 0.39-0.46; P<0.001), underscoring the protective effect. Visualizations and a U-shaped curve analysis identified an optimal range (24-32 nodes) for examination, emphasizing the nuanced benefits across NSCLC stages. The study findings suggest that LND plays a critical role in improving cancer-specific survival in NSCLC patients, particularly when tailored to the early stages of the disease. The optimal range of lymph nodes examined, between 24 and 32, offers crucial insights for personalized NSCLC treatment strategies and may enhance overall survival. These results underscore the need for refined surgical guidelines that incorporate the extent of LND, supporting the utility of a more personalized approach in NSCLC management.

Colorectal cancer survival disparities in the five regions of Georgia.

The objective of this study was to examine 5-year colorectal cancer survival rates. We also determined whether demographics, tumor characteristics, and treatment modality were associated with 5-year CRC survival in the Clayton, West Central, East Central, Southeast, and Northeast Georgia regions because the significant higher CRC mortality rates in these regions in comparison to the overall rates in the State of Georgia. We conducted a retrospective cohort analysis using data from the 1975-2016 Surveillance, Epidemiology, and End Results program aggregated CRC patients to these five regions. Five-year CRC survival was calculated and stratified by the five regions of Georgia, using the Kaplan-Meier method with log-rank test. Cox proportional hazard regression was used to examine the mentioned association in these five regions. Among 11,023 CRC patients, 5-year CRC survival was lowest in Clayton (65.9%) compared to the West Central (69.0%), East Central (68.2%), Southeast (70.5%), and Northeast regions (69.5%) (p-value = 0.02). In multivariable analysis, greater risk of CRC death was found in the Clayton region compared to the West Central (HR, 1.12; 95%, 1.00-1.25) region when adjusting for demographics, tumor characteristics, and treatment modality. Among Clayton Georgians, age of 75+ years (HR, 2.13; 95%, 1.56-2.89), grade 3 & 4 tumors (HR, 2.22; 95%, 1.64-3.00), and distant stage (HR, 20.95; 95%, 15.99-27.45) were negatively associated with CRC survival. We observed place-based differences in CRC survival with significantly lower survival rates in the Clayton region. Factors associated with higher risk of CRC death include older age at diagnosis, high-grade tumors, and distant stage CRC among Clayton Georgians. Our study provides important evidence to all relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection and improved outcomes.

Distinct Prostate Cancer Survival Outcomes in Firefighters: A Population-Based Study.

Introduction: Survival outcomes for prostate cancer among specific occupational groups prone to regular medical check-ups vis-à-vis the general population have been understudied. For firefighters, a demographic subject to rigorous medical evaluations, possessing above-average medical expertise, and exposed to specific carcinogens of interest, prostate cancer survival in the US has never been studied. Methods: We conducted a retrospective study, utilizing data from the Florida Cancer Data System spanning 2004 to 2014, coupled with firefighter certification records from the Florida State Fire Marshal's Office. Our study cohort consisted of 1058 prostate cancer cases among firefighters as well as prostate cases for the Florida general population (n = 150,623). We compared cause-specific survival between the two using Cox regression models adjusted for demographics and clinical characteristics, including PSA levels, Gleason scores, and treatment modalities. Results: Firefighters demonstrated a higher five-year cause-specific survival rate (96.1%, 95% CI: 94.7-97.1%) than the general population (94.2%, 95%CI: 94.1-94.3%). Overall, firefighters' diagnoses were established at younger ages (median age 63 vs. 67 in the general population), exhibited a higher proportion of localized stage cancers (84.7% vs. 81.1%), and had a greater utilization of surgery (46.4% vs. 37.6%), a treatment modality with a high success rate but potential side effects. In multivariable analysis, firefighters displayed a survival advantage for localized stage (adjusted hazard ratio [aHR] = 0.53; 95%CI: 0.34-0.82). However, for regional or distant stages, firefighters aged 65 and above exhibited a higher risk of death (aHR = 1.84; 95% CI: 1.18-2.86) than the general population. Conclusion: Firefighters experience enhanced prostate cancer survival, primarily in cases diagnosed at localized stages, likely due to increased PSA testing. Nonetheless, for regional or distant stage, survival among older firefighters' lags behind that of the general population. Further investigations are warranted to unravel factors influencing the development of aggressive disease beyond PSA and Gleason scores in this population, as well as to assess the impact of a higher rate of surgical treatment on firefighters' quality of life.

Immature central tumor tertiary lymphoid structures are associated with better prognosis in non-small cell lung cancer

Background & aimsTertiary lymphoid structures (TLSs) are predictive biomarkers of favorable clinical outcomes and immunotherapy response in several solid malignancies, including non-small cell lung cancer (NSCLC). However, the relationship between TLSs and NSCLC prognosis has not been eludicated from the aspects of location, density, and maturity. This study aimed to investigate the clinicopathological and prognostic significance of TLSs in NSCLC.MethodsA collection of 151 resected pulmonary nodules in patients with NSCLC was retrospectively analyzed. Two experienced pathologists reviewed hematoxylin-eosin (H&E) slides and assessed TLS scores at different anatomic subregions. Then, we analyzed their correlation with clinicopathologic parameters and CD8 staining intensity and assessed multiple clinicopathological factors affecting patient prognosis.ResultsCD8 expression was correlated with total (TLS-CT) (P = 0.000), aggregates (Agg) (TLS-CT) (P = 0.001), follicles (FOL)-I (TLS-CT) (P = 0.025), and TLS(overall) (P = 0.013). TLS scores in the central tumor (CT) and invasion margin (IM) areas were negatively correlated with distant metastasis and Union for International Cancer Control (UICC) stage in NSCLC patients, while TLS score in the CT area was positively correlated with CD8 expression. TLS (overall), Agg (TLS-CT), and FOL-I (TLS-CT) were positively correlated with distant metastasis, UICC stage, and CD8 expression in NSCLC patients. Agg (TLS-IM) was positively correlated with distant metastasis and UICC stage. FOL-I (TLS-IM) was positively correlated with UICC stage. FOL-II (TLS-IM) was positively correlated with distant metastasis (P < 0.05). Multivariate Cox regression analysis showed that unfavorable independent prognostic factors were associated with metastasis status and UICC stage. Independent prognostic factors with protective effects included Agg (TLS-CT), FOL-I (TLS-CT), total (TLS-CT), and overall TLS (P < 0.05).ConclusionHistological score assessment of H&E sections of Agg (TLS-CT), FOL-I (TLS-CT), total (TLS-CT), and overall TLS levels in NSCLC has prognostic value.

Abstract 2143: Association between health insurance coverage and stage of diagnosis for cervical cancer among women in Indiana from 2011-2019

Abstract Introduction: Cervical cancer is one of the most common types of cancer among women and it is caused by infection from the human papillomavirus (HPV). The incidence rates of cervical cancer have increased in Indiana from 7.8 in 2008-2012 to 8.4 in 2013-2017. In 2020, the screening rate for cervical cancer among women in Indiana was 76% when compared to a national average of 78%. Women diagnosed at earlier stages for cervical cancer had higher relative survival of 0.98 than those diagnosed at later stages with a relative survival of 0.43. Health insurance status is an important determinant for health outcomes for patients with cancer. This study aims to assess the extent to which health insurance coverage is a contributing factor to the stage of cervical cancer diagnosis. Methods: We examined reported cases of cervical cancer among women (N=2518) using cervical cancer registry data from the Indiana State Department of Health from 2011-2019. Using multinomial logistic regression model, we examined the associations of both race/ethnicity and insurance status with stage of diagnosis after adjusting for age at diagnosis. Results: In this sample, the average age at diagnosis was 48.98 years (SD = 14.98). The largest proportion of the sample was between 45 to 64 years of age (41.7%), Non-Hispanic White (85.5%), had private insurance coverage (41.8%), had cervix uteri, NOS as the primary site of diagnosis (76.5%), lived in a metropolitan area (74.5%) and had squamous cell carcinoma (73.4%). The largest percentage of Non-Hispanic White patients had private insurance (50.9%), whereas the largest percentage of Black patients had Medicaid (39.3%). 20.2% of Hispanic patients were uninsured when compared to 7.7% Non-Hispanic White and 3.6% Black patients. The multivariate analysis shows that women who are uninsured (OR = 2.475) and those who have Medicaid (OR = 2.321) were significantly more likely to be diagnosed at the regional stage than the in-situ stage compared to women with private insurance. Additionally, women who are uninsured (OR = 4.432) and those who have Medicaid (OR = 3.007) were significantly more likely to be diagnosed at the distant stage than in-situ, compared to women with private insurance. Conclusion: The findings show that insurance status is associated with the stage of diagnosis for cervical cancer and detection at regional or distant stages often leads to higher morbidity. Impact - Increased coverage for routine cervical cancer screening and preventive care services is recommended, especially for uninsured women and women with public insurance such as Medicaid or Medicare. Citation Format: Mrithula Suresh Babu, Monica L. Kasting, Natalia M. Rodriguez. Association between health insurance coverage and stage of diagnosis for cervical cancer among women in Indiana from 2011-2019 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2143.

Abstract 6217: Differential genome-wide gene regulatory networks for lung cancer

Abstract Background: Lung cancer remains the leading cause of cancer death worldwide due to the fact that most cases are diagnosed at distant stages, and treatment is less effective. During the past two decades, much effort has been devoted to understanding tumor biology and developing targeted therapeutics, which have significantly improved patient survival. With the increasingly available multi-omics data from healthy controls and lung cancer patients, we constructed gene regulatory networks for the two main subtypes of non-small-cell lung cancer (NSCLC), the most common type of lung cancer. In addition, differential networks were constructed by integrative analysis of data from lung cancer tissue and tissues from healthy lungs. Methods: Transcriptomics and genomic data were obtained from the patients with lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC) tissue available in The Cancer Genome Atlas (TCGA) project, and both types of omics data of normal lung tissue were downloaded from The Genotype-Tissue Expression (GTEx) consortium. The networks for each subtype and the differential networks were constructed by utilizing our newly developed machine learning tools, two-stage penalized least square (2SPLS) approach, and analysis of variance of directed networks (NetANOVA), respectively. Results: For the top three identified subnetworks of LUAD, we identified some well-known genes associated with lung cancer, such as EGFR, IRF1, KRAS, ERBB2, PIK3CA, MYC, at bootstrap frequency &amp;gt;90%. Based on the top three subnetworks with a bootstrap frequency of 100%, results from the Ingenuity Pathway Analysis (IPA) indicated several significant pathways, primary immunodeficiency signaling and communication between innate and adaptive immune cells. GO enrichment analysis showed statistically significant biological processes, including immune response, extracellular matrix organization, and significant KEGG pathways such as Hematopoietic cell lineage. The differential networks between LUAD, LUSC, and healthy lungs showed the same regulations across all three groups, such as the regulation between EEF2 and RACK1, the perturbations between LUAD and healthy (two-way regulations between HIGD2A and ARL10), and LUSC and healthy (GRB14 regulates EIF3E) respectively. In addition, we identified the differences between LUAD and LUSC, such as bi-directional regulations between CLTB and ARL10. Conclusion: Although all groups share most regulations, we identified differential gene regulations between healthy lung tissue and lung cancer tissue and between LUAD and LUSC of NSCLC. Using multi-omics data generated from lung tissues, coupled with advanced machine learning methods, the causal relationships between genome-wide genes from the analysis will help us understand the molecular mechanism of lung cancer and facilitate the development of personalized treatment strategies. Citation Format: Min Zhang, Zhongli Jiang, Dabao Zhang. Differential genome-wide gene regulatory networks for lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6217.

Abstract 1108: The impact of adjuvant radiotherapy (ART) and survival prediction by machine learning in intracranial hemangiopericytoma (HPC)

Abstract Background: Intracranial HPC is a rare brain tumor that accounts for less than 1% of all primary central nervous system malignancies. Surgery is the primary treatment, and while radiation may reduce the risk of local recurrence, its overall effectiveness remains uncertain. Therefore, it is crucial to develop reliable predictions for personalized care and improved management. In this study, we used machine learning (ML) techniques to predict the survival of patients with intracranial HPC. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019). Patients with other malignancies or lack of pathological diagnosis were excluded. T-tests and chi-square tests compared variables, while Kaplan-Meier, log-rank tests, and Cox regression identified prognostic factors for overall survival (OS) and cancer-specific survival (CSS). Patient records were randomly divided into training (80 %) and validation (20 %) sets. Univariate Cox regression and least absolute shrinkage and selection operator were used to identify the significant factors linked to survival, which were used to establish a nomogram for predicting the 3- and 5-year OS and CSS. Results: Of the 367 included patients, 121 underwent surgery and 246 underwent surgery + ART. The median survival time was 54 months. Patients who underwent surgery had 5-year OS rates of 61% and 86% for CSS, while those treated with surgery + ART had 81% and 96% survival rates, respectively. The two treatment groups showed significant differences in the OS and CSS (p&amp;lt;0.022 and p&amp;lt;0.017, respectively). Age ≥ 50 years was a poor prognostic factor for OS, whereas ART, localized stage and regional stage were good prognostic factors. No significant factors were associated with CSS. To construct the OS Nomogram, three predictors, age, stage, and treatment method, were chosen. In the training and validation sets, the C-indices are 0.799 and 0.736, respectively. The receiver operating characteristic curves (AUCs) for the 3- and 5-year OS in the training set were 0.594 and 0.617, respectively, whereas those in the validation set were 0.56 and 0.59. For the CSS nomogram, two factors, age and stage, were utilized. The C-indices for the training and validation sets are 0.814 and 0.774, respectively. In the training set, the AUCs for 3- and 5-year CSS were 0.585 and 0.605, respectively, and 0.563 in the validation set. The most important risk factor was the distant stage, while the most important protective factor was age less than 50 years. Conclusion: This study shows that ART has a significant impact on the treatment of Intracranial HPC and provides better survival outcomes. ML has been used to create prediction models to support personalized patient care. These findings provide valuable insights into the management of this rare brain tumor and the potential of data-driven approaches to improve treatment and outcomes. Citation Format: Sakhr Alshwayyat, Anas Alaa Al-Khalili, Ayah Erjan, Haya Kamal, Tala Abdulsalam, Mustafa Alshwayyat. The impact of adjuvant radiotherapy (ART) and survival prediction by machine learning in intracranial hemangiopericytoma (HPC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1108.

Abstract 4862: Rural-urban disparities in early-onset breast cancer amongst US women aged 20-49, trends from 2000-2020

Abstract Purpose: To characterize rural-urban disparities of breast cancer (BC) incidence among younger women by stage and race/ethnicity. Background: Cancer incidence in younger adults is increasing, but trends and disparity patterns in early-onset BC are not well-described for women aged &amp;lt;50 years. Current screening guidelines recommend against routine screening until age 40 for various perceived harms that outweigh benefits which can lead to delayed diagnosis and more aggressive stage when BC is identified among younger women. It is unclear how BC incidence patterns such as stage at diagnosis and race/ethnicity differ by rurality, as rural residents may experience geographic isolation, lower socioeconomic status (SES), higher rates of cancer risk behaviors, and limited access to healthcare, compared to urban residents. Methods: We used incidence data from the North American Association of Central Cancer Registries to identify trends in early-onset BC among women aged 20-49 from 2000-2020, stratified by rurality (2013 USDA Rural-Urban Continuum Codes) and to explore patterns by stage and race/ethnicity. We extracted age-adjusted incidence rates (IR) [adjusted to 2000 US Standard Population] for each year and detected significant increasing or decreasing trends over time using the Joinpoint Regression Program. The annual percentage change (APC) for IR trends were calculated. Results: Of the 854,590 patients, 88% lived in urban areas (12% rural). Cumulatively over 2000-2020, we observed similar average APCs for early-onset BC both in urban (IR = 68.8 per 100,000; avg. APC +0.37, 95% CI 0.23, 0.50) and rural areas (IR = 65.1 per 100,000; avg. APC +0.35, 95% CI 0.14, 0.57). Rural areas did not significantly trend upwards until 2010-2020 (APC +0.71, 95% CI 0.38, 1.05). Rates for localized stage increased from 2000-2020 (APC +0.69%, 95% CI 0.48, 0.89) for urban areas, but declined in rural areas between 2000-2008 (APC -0.77, 95% CI -1.33, -0.20), only to increase again from 2008-2020 (APC +1.01, 95% CI 0.68, 1.34). In rural areas, there is a corresponding dramatic increase in distant stage BC diagnosed between 2000-2007 (APC +5.99%, 95% CI 2.29, 9.93) but slowed in the period after (2007-2020 APC +1.35, 95% CI 0.22, 2.51). While the rate remained stable for Hispanics living in both urban and rural areas, Non-Hispanic Whites (2000-2020 APC +0.59, 95% CI 0.46, 0.72), Non-Hispanic Blacks (2000-2009 APC +0.85, 95% CI 0.33, 1.37), and Other Non-Hispanic racial groups (2000-2020 APC +1.27, 95% CI 1.16, 1.58) saw significant increased rates in urban areas over time. Conclusions: Overall, early-onset BC has risen over the past 20 years in both urban and rural areas, but clear differences exist by stage at diagnosis and race/ethnicity. More research is needed to understand how SES, healthcare access, screening recommendations, and additional cancer risk factors can modulate BC incidence and disparities among younger women. Citation Format: Katherine L. Ho, Avonne Connor. Rural-urban disparities in early-onset breast cancer amongst US women aged 20-49, trends from 2000-2020 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4862.

Trends in survival of ovarian clear cell carcinoma patients from 2000 to 2015.

To analyze changes in survival outcomes in patients with ovarian clear cell carcinoma (OCCC) treated consecutively over a 16-year period using a population-based cohort. We conducted a retrospective analysis of OCCC from 2000 to 2015 using data from the Surveillance, Epidemiology, and End Results (SEER) program. The ovarian cancer-specific survival (OCSS) and overall survival (OS) were analyzed according to the year of diagnosis. Joinpoint Regression Program, Kaplan-Meier analysis, and multivariate Cox regression analyses were used for statistical analysis. We included 4257 patients in the analysis. The analysis of annual percentage change in OCSS (P=0.014) and OS (P=0.006) showed that patients diagnosed in later years had significantly better outcomes compared to those diagnosed in early years. The results of the multivariate Cox regression analyses showed that the year of diagnosis was the independent prognostic factor associated with OCSS (P=0.004) and had a borderline effect on OS (P=0.060). Regarding the SEER staging, the OCSS (P=0.017) and OS (P=0.004) of patients with distant stage showed a significant trend toward increased, while no significant trends were found in the survival of patients with localized or regional stage diseases. Similar trends were found in those aged <65 years or those treated with surgery and chemotherapy. However, no statistically significant changes in the survival rate were found in those aged ≥65 years or those receiving surgery alone regardless of SEER stage during the study period. Our study observed a significant increase in the survival outcomes in OCCC from 2000 to 2015, and patients aged <65 years and those with distant stage experienced a greater improvement in survival.