Distribution Of Clinical Stage Research Articles

390. CONTINUED IMPLICATIONS OF THE COVID-19 PANDEMIC ENVIRONMENT ON ESOPHAGEAL CANCER CHARACTERISTICS AND TREATMENT IN THE UNITED STATES

Abstract Background The COVID-19 pandemic significantly impacted the stage of presentation and subsequent therapies for patients who were diagnosed with esophageal cancer during the first pandemic year. We aimed to assess for continued implications of the altered healthcare landscape on esophageal cancer presentation and treatment in the second year of the pandemic. Methods This was a retrospective review of the United States National Cancer Database (2019-2021). Demographic, cancer-related and treatment variables were compared between patients diagnosed in the pre-pandemic year (2019), pandemic year one (2020) and pandemic year two (2021). Multivariate logistic regression was performed to control for the impact of demographics on oncologic variables, and then for the impact of oncologic variables on treatment modalities and outcomes. Results Of 42,807 esophageal cancer cases, 15,127 (35.3%) were pre-pandemic, 13,975 (32.7%) were pandemic year 1, and 13,705 (32.0%) were pandemic year two. There were significant differences in the distribution of clinical stage at presentation by year (p=0.0001), see figure, suggesting more advanced stage presentation throughout the pandemic. Compared to the pre-pandemic year, patients diagnosed in pandemic year two had risk-adjusted increases in time to first course treatment (incidence rate ratio 1.057 [95% confidence interval [1.036–1.078]), to radiation (1.029 [1.008–1.050]), and to systemic therapy (1.035 [1.018–1.051]). Additionally, when compared to pandemic year one, patients in pandemic year two continued to experience risk-adjusted increases in time to first course therapy (1.084 [1.063–1.106]), to surgery (1.049 [1.000–1.097]), to radiation (1.046 [1.024–1.068]) and to systemic therapy (1.060 [1.043–1.077]). Conclusions Compared to the pre-pandemic year, patients diagnosed with esophageal cancer in in the U.S. during pandemic year two continued to experience delays to treatment including delays to first course therapy, including delays to surgery, radiation and systemic therapy. The treatment characteristics of esophageal cancer have not returned to pre-pandemic baseline in the United States possibly due to compounding delays to diagnosis and treatment and a growing back log of cases.

Trends in Disparities and Transitions of Treatment in Patients With Early Breast Cancer in China and the US, 2011 to 2021

Breast cancer treatment has profoundly improved in China recently. However, trends in disparities and transitions of treatment in early-stage cancer between China and the US are not well known. To identify changes for patients with early breast cancer by using large databases from China and the US. This multicenter cross-sectional study used the Chinese Society of Clinical Oncology Breast Cancer (CSCO BC) database from hospitals in 13 provinces in China and the Flatiron Health (hereinafter referred to as Flatiron) database from more than 280 community oncology clinics in the US. Patients with stage I to III breast cancer diagnosed from January 1, 2011, to December 31, 2021, were included. Data were analyzed from June 10 to December 1, 2022. The distribution of age, clinical stage, and cancer subtypes at diagnosis were examined overall and by year. The mean annual percent change (MAPC) from 2011 to 2021 in systemic therapy and surgery was also analyzed. A total of 57 720 patients with early breast cancer were screened from the CSCO BC (n = 45 970) and Flatiron (n = 11 750) databases. The median age at diagnosis in China among the 41 449 patients included in the age analysis was 47 (IQR, 40-56) years; in the US, the median age was 64 (IQR, 54-73) years. Among patients with clinical stage data in the CSCO BC (n = 22 794) and Flatiron (n = 4413) databases, the proportion of stage I cancer was 7250 (31.8%) vs 2409 (54.6%); stage II cancer, 10 043 (44.1%) vs 1481 (33.6%); and stage III cancer, 5501 (24.1%) vs 523 (11.9%). The proportion of hormone receptor-positive cancer in China was 69.8%, lower than that in the US (87.5%). For patients with ERBB2 (formerly HER2 or HER2/neu)-positive cancer, the proportion in China (30.2%) was higher than that in the US (15.6%). For neoadjuvant therapy, the annual rate increased from 247 of 1553 (15.9%) to 200 of 790 (25.3%) in China, with an MAPC of -4.4% (95% CI, -50.6% to 85.0%; P = .89). For patients with ERBB2-positive cancer, the proportion treated with trastuzumab in early-stage cancer in China increased significantly, with an MAPC of 22.1% (95% CI, 17.4%-26.9%; P < .001), and overtook that in the Flatiron database since 2017 (1684 [68.5%] vs 550 [62.5%]; P < .001). The findings of this cross-sectional study suggest that disparities in treatment of early breast cancer narrowed between China and the US during the study period. The rapid growth of trastuzumab treatment in China was suggestive of differential access to targeted ERBB2 therapy.

Breast cancer survival in Mexico between 2007 and 2016 in women without social security: a retrospective cohort study

Essential indicators of health system performance for breast cancer are lacking in Mexico. We estimated survival and clinical stage distribution for women without social insurance who were treated under a health financing scheme that covered 60% of the Mexican population. We conducted a retrospective cohort study cross-linking reimbursement claims for 56,847 women treated for breast cancer between 2007 and 2016 to a mortality registry. We estimated overall- and clinical stage-specific survival and breast cancer survival according to patient age, state of residence, marginalization, type of treatment facility, and patient volume of the treatment facility. We also explored the distribution of clinical stage according to age, year of treatment initiation, and state where the woman was treated. We used log-rank tests and estimated 95% CIs to compare differences between patient groups. Median age was 52 years (interquartile range [IQR] 45, 61) (Sixty five percent patients (36,731/56,847) had advanced disease at treatment initiation. Five-year overall survival was 72.2% (95% CI 71.7, 72.6). For early disease (excluding stage 0), 5-year overall survival was 89.0% (95% CI 88.4, 89.5), for locally advanced disease 69.9% (95% CI 69.0, 70.2) and for metastatic 36.9% (95% CI 35.4, 38.4). Clinical stage at treatment initiation and breast cancer survival remained unchanged in the period analyzed. Clinical stage and survival differed across age groups, state of residence, and type of facility where women received treatment. In the absence of population-based cancer registries, medical claims data may be efficiently leveraged to estimate essential cancer-related performance indicators. The authors received no financial support for this research.

Clinical profile of geriatric cervical cancer patients in a tertiary hospital in Surabaya, Indonesia

HIGHLIGHTS Squamous cell carcinoma majorly covered in histopathologic of the records, while adenosquamous followed second. Most of the subjects were referral patients to Dr. Soetomo General Academic Hospital. They were mostly originated from Java outside Surabaya. ABSTRACT Objective: To identify the distribution of age, histopathology type, clinical stage, treatment type, parity, first complaint, and referral origin of geriatric cervical cancer patients at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Materials and Methods: This study was a retrospective study observing data from medical records and presented the data descriptively. The medical records were taken from Oncology Outpatient Clinic in Dr. Soetomo Hospital, from 2020-2021, covering geriatric patients aged more than 55 years old. The data were screened and processed. Results: At Dr. Soetomo Hospital, in 2020-2021 there were 228 cervical cancer patients. From 176 patient data that met the inclusion criteria, the average age was 65.38 ± 4.86 years, with 4 types of histopathology dominated by squamous cell carcinoma (82.39%), adenocarcinoma (11.93%), adenoquamous (3.41%) and others (4%), divided into 8 clinical stages and dominated by stages IIIB (77.27%), IIB (15.9%), IVB (2.84%), IIIA and IB had same number (1.14%), 1A (0.57%) and no cases of IIA were found. The treatments were dominated by chemotherapy (86.36%), radiation therapy (7.38%), no treatment (3.41%), hysterectomy (1.7%), while for conization and palliative therapy each in 1 case (0.57%). Most experienced 3 parity (29.5%), followed by 4 parity (17.61%), &gt;5 (13.07%), 5 (10.23%), 1 (6.82%) and no parity (2.27%). The three first complaints were. vaginal bleeding (82.38%), vaginal discharge (46.02%), and pain (82.38%), and the patients were dominated by referrals from Java Island other than Surabaya City (78.40%), outside Surabaya in Java Island as many as 36 referrals (20.45%) and outside Java Island 2 referrals (1.14%). Conclusion: There were 176 geriatric patients with cervical cancer at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, in the 2020-2021 period, dominated by age 56-65 years, the histopathology type of squamous cell carcinoma, stage IIIB patients, most received therapy was chemotherapy, most were multiparous with 3 parities, the majority experienced complaints of vaginal bleeding when diagnosed with cervical cancer, and were dominated by referrals from Java Island outside Surabaya.

Effects of COVID-19 pandemic on hospital visit of head and neck cancer patients

ObjectiveHead and neck cancer (HNC) often causes respiratory symptoms, so diagnostic delays due to COVID-19 are anticipated. Especially, our institute is a designated medical institute for Class 1 specified infectious diseases, and most of the severe COVID-19 patients in this region were preferentially admitted or transferred. Hereby, we evaluated the trends of the numbers, primary sites and clinical stages of HNC patients before and after COVID-19 pandemic. MethodsA retrospective analysis of all patients diagnosed and treated for HNC from 2015 to 2021 was performed. Especially, 309 cases between 2018 and 2021 were extracted in order to examine a direct impact of COVID-19 pandemic, which were dichotomized into “Pre” group in 2018–2019 and “COVID” group in 2020–2021. They were compared about the distribution of clinical stage, the period between onset of symptom and hospital visit. ResultsHNC patients decreased by 38% in 2020 and by 18% in 2021 compared to average number of patients from 2015 to 2019. Patients of stage 0 and 1 in “COVID” group significantly decreased compared to that in “Pre” group. Cases performed emergent tracheostomy in hypopharyngeal cancer and laryngeal cancer increased in “COVID” group (10.5% vs 1.3%). ConclusionPatients with slight symptoms would hesitated to visit hospital after COVID-19, and only a few delays of HNC diagnosis could have increased tumor burden and caused narrowed airway, especially in advanced HPC and LC.

Improved survival after laparoscopic compared to open gastrectomy for advanced gastric cancer: a Swedish population-based cohort study

BackgroundLaparoscopic gastrectomy is increasingly used for the treatment of locally advanced gastric cancer but concerns remain whether similar results can be obtained compared to open gastrectomy, especially in Western populations. This study compared the short-term postoperative, oncological and survival outcomes following laparoscopic versus open gastrectomy based on data from the Swedish National Register for Esophageal and Gastric Cancer.MethodsPatients who underwent surgery with curative intent for adenocarcinoma of the stomach or gastroesophageal junction Siewert type III from 2015 to 2020 were identified, and 622 patients with cT2-4aN0-3M0 tumors were included. The impact of surgical approach on short-term outcomes was assessed using multivariable logistic regression. Long-term survival was compared using multivariable Cox regression.ResultsIn total, 350 patients underwent open and 272 laparoscopic gastrectomy, of which 12.9% were converted to open surgery. The groups were similar regarding distribution of clinical disease stage (27.6% stage I, 46.0% stage II, and 26.4% stage III). Neoadjuvant chemotherapy was administered to 52.7% of the patients. There was no difference in the rate of postoperative complications, but laparoscopic approach was associated with lower 90 day mortality (1.8 vs 4.9%, p = 0.043). The median number of resected lymph nodes was higher after laparoscopic surgery (32 vs 26, p < 0.001), while no difference was found in the rate of tumor-free resection margins. Better overall survival was observed after laparoscopic gastrectomy (HR 0.63, p < 0.001).ConclusionsLaparoscopic gastrectomy can be safely preformed for advanced gastric cancer and is associated with improved overall survival compared to open surgery.

Clinical Outcomes After Trimodality Therapy With Dose-Escalated Neoadjuvant Intensity-Modulated Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer

Trimodality therapy (TMT) with preoperative chemoradiation followed by surgical resection is used in the management of locally-advanced non-small cell lung cancer (LA-NSCLC). Traditionally, preoperative radiation doses ≤54 Gy are used due to concerns regarding excess morbidity, but little is known about outcomes and toxicities after TMT with intensity-modulated radiotherapy (IMRT) to higher doses. We investigated whether clinical outcomes were different after TMT with IMRT using less than definitive doses of < 60 Gy and definitive doses ≥60 Gy for LA-NSCLC.We conducted an Institutional Review Board-approved retrospective cohort analysis of patients who received planned TMT using IMRT for LA-NSCLC between 2008 and 2017 at one institution. We recorded clinical and treatment characteristics, pathologic response, and surgical toxicity within 30 days. Toxicity was graded using Common Terminology Criteria for Adverse Events version 5.0. Chi-square or Fisher exact tests were used for categorical variables. Survival outcomes were analyzed by Kaplan-Meier method and log-rank test. Univariate and multivariate analyses were performed using Cox proportional-hazards regression.We identified 46 patients receiving doses < 60 Gy and 30 patients receiving doses ≥60 Gy. Distribution of clinical nodal stage was different between the two groups with more cases of N0 and N3 disease in the higher dose group (P = 0.015), but other factors, including age, comorbidities, clinical stage, and surgical approach, were not different. Rates of R0 resection, pathologic complete response, and postoperative toxicity, including cardiovascular toxicity, post-operative infection, intensive care unit (ICU) admission, and length of hospital stay (LOS), were not significantly different between the two groups. Three patients died within 30 days of surgery with two receiving doses ≥60 Gy. Mean esophageal (24.2 vs. 20.2 Gy, P = 0.029) and lung (16.7 vs. 13.6 Gy, P = 0.005) doses were significantly higher for patients receiving doses ≥60 Gy. With median follow-up of 3.6 years (range: 0.4-11.4), 3-year locoregional recurrence-free survival (78.0% vs. 68.3%) and overall survival (OS) (61.0% vs. 69.4%) was not different between patients receiving < 60 Gy and ≥60 Gy. On multivariate analysis, older age, clinical stage, and LOS > 7 days were significantly associated with decreased OS when controlling for sex, surgical approach, post-operative grade ≥3 toxicity, and mean lung dose.We found no increased rate of post-TMT complications in patients receiving higher doses using IMRT. Survival outcomes or LOS did not differ based on radiation dose, but increased LOS was associated with worse OS. Larger prospective studies are needed to further examine outcomes after IMRT in patients with LA-NSCLC receiving TMT.

Abstract 47: Survival of Breast Cancer in Women Treated Under Mexico's Seguro Popular

Abstract Purpose: To determine 5-year survival for breast cancer among uninsured women treated under Mexico's Seguro Popular landmark health reform according to clinical stage and identify factors associated to survival. Methods: We conducted a retrospective cohort study with data obtained from national reimbursement claims of patients treated under Seguro Popular from January 2007 to December 2016. Reimbursement data was cross-linked with a national mortality registry. We used the Kaplan-Meier method to estimate overall survival according to different variables and stratified them by clinical stage as early (I-IIA), locally advanced (IIB-IIIC), and metastatic (IV). We explored the relation between age, hospital patient volume, hospital infrastructure, and mortality. Hazard ratios and 95% confidence intervals (95%CI) were estimated, using the Cox proportional hazards model to adjust for clinical stage. Results: A total of 57,175 patients with breast cancer were analyzed. The mean age was 43.4 (SD 12.4). Most patients had locally advanced disease at diagnosis (55.1%, n=31,559) and 9.5% (n=5,435) had metastatic disease. The distribution of clinical stage did not appear to change over time (11% in 2007 vs. 13% in 2015 for metastatic disease). Five-year survival was 88.9% (CI95% 88.3-89.5) for early-stage disease, 69.6% (CI95% 69-70.2) for locally advanced cancer, and 36.9% (CI95% 35.4-38.5) for metastatic disease. These survival estimates did not change over time. After adjustment for clinical stage, age &amp;lt;40 years old (HR 1.17 [CI95% 1.12-1.23]), low hospital patient volume (≤248 patients/year, HR 1.21 [CI95% 1.17-1.25]), and treatment at a locally funded hospital (HR 1.15 [CI95% 1.11-1.2]) were associated with higher mortality. Conclusions: While Seguro Popular provided access to treatment for breast cancer, a high proportion of women were treated at advanced stages and clinical stage at diagnosis and survival did not appear to change over a decade. Future programs should prioritize early detection and strengthen quality of care. Citation Format: Antonio Bandala-Jacques, Rodrigo Huerta-Gutierrez, Salvador Zamora-Muñoz, Paula Cabrera, Alejandro Mohar, Martin Lajous. Survival of Breast Cancer in Women Treated Under Mexico's Seguro Popular [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 47.

Oral cavity cancer incidence rates in Osaka, Japan between 2000 and 2014.

We investigated trends in oral cavity cancer incidence from 2000 to 2014 in Osaka, Japan. Using Osaka Cancer Registry (OCR) data, oral cavity cancer incidence number and age-standardized incidence rates were calculated according to three 5-year-time-periods: 2000-2004, 2005-2009 and 2010-2014. We calculated the distribution of clinical stage for each 5-year period and the proportion of oral cavity cancer among all cancers. A total of 6,086 oral cavity cancers were registered in OCR in 2000-2014. Across the period, between 55.6% and 65.0% were 65years+and approximately 60% were men. Tongue cancer accounted for 30.4% to 43.8% of the registrations, while gum accounted for 30.7% to 34.7%. 36.3% to 37.3% were regional, while 1.8% to 2.8% were distant. The age-standardized incidence rate of oral cavity cancer increased from 2.1/100,000 in 2000 to 3.8/100,000 in 2014, although the proportion of oral cavity cancer among all cancers only increased slightly from 0.71% in 2000 to 0.92% in 2014. Proportion of localized stage cancer was 60.8%-67.5% for tongue and 31.0%-49.5% for gum or floor of mouth. Proportion of distant stage cancer was 0.3%-1.0% for tongue and 2.5%-4.2% for gum or floor of mouth. Age-standardized incidence rate of oral cavity cancer increased, but was not higher than other countries. The proportion of localized stage tongue cancer was higher, while that of distant stage cancer was lower than other sites. Tongue cancer might be easier to detect in its earlier stages than other sites.

Clinical staging in pancreatic adenocarcinoma underestimates extent of disease

Background/objectivesWe sought to identify the reliability of AJCC clinical staging was in comparison to pathologic staging in surgically resected patients with pancreatic cancer. MethodsWe used the National Cancer Database Pancreas from 2004 to 2016 and evaluated patients who underwent resection for PDAC with all documented components of clinical and pathologic stage. We first evaluated the distribution of overall clinical stage and pathologic stage and then evaluated for stage migration by assessing the number of patients who shifted from a clinical stage group to a respective pathologic stage group. To further characterize the migratory pattern, we assessed the distribution of clinical and pathologic T-stage and N-stage. ResultsIn our cohort of 28,338 patients who underwent resection for PDAC, AJCC clinical staging did not reliably predict pathologic stage. Stage migration after resection was responsible for discrepancies between the distribution of overall clinical stage and pathologic stage. The predominant migration was from patients with clinical stage I disease to pathologic stage II disease. Most patients with clinical T1 and T2 disease were upstaged to pathologic T3 disease and over half of patients with clinical N0 disease were upstaged to pathologic N1 disease after resection. DiscussionClinical staging appears to overrepresent early T1, T2, and N0 disease, and underrepresent T3 and N1 disease.

Clinicopathological characteristics of surgically treated localized renal masses in patients previously exposed to chemotherapy.

ABSTRACTPurpose:To explore the potential association between renal mass characteristics and a history of chemotherapy.Materials and methods:A retrospective review of records of patients surgically treated for a localized renal mass between 2000 and 2012 was undertaken following an institutional review board approval. Patients age and sex, renal mass clinical characteristics (radiological size and mode of presentation) and pathological characteristics (diagnosis, renal cell carcinoma subtype, Fuhrman grade and stage) were compared between patients with and without a history of chemotherapy, using Fisher's exact test, Student's t-test and Wilcoxon rank sum test. A multivariate logistic analysis was performed to evaluate the independent association of chemotherapy and tumor pathology.Results:Of the 1,038 eligible patients, 33 (3%) had a history of chemotherapy. The distribution of clinical stage, renal mass diagnosis, renal cell carcinoma subtype, Fuhrman grade, pathological stage, sex and median age were similar between the general population and the chemotherapy group. However, the latter had a higher rate of incidental presentation (P = 0.003) and a significantly smaller median radiological tumor size (P = 0.01). In a subset analysis of T1a renal cell carcinoma, the chemotherapy group presented an increased rate of high Fuhrman grade (P = 0.03). On multivariate analysis adjusted for radiological tumor size, sex and age the chemotherapy cohort had a 3.92 higher odds for high Fuhrman grade.Conclusion:Patients with a history of chemotherapy typically present with smaller renal masses that, if malignant, have higher odds of harboring a high Fuhrman grade and thus may not be suitable for active surveillance.

Abstract P1-15-16: Pathological complete response rates with the addition of carboplatin to standard neoadjuvant chemotherapy in a cohort of real–world patients with triple negative breast cancer

Abstract Objectives: Addition of carboplatin to standard neoadjuvant chemotherapy (NACT) for triple negative breast cancer (TNBC) remains controversial. There are several randomized trials showing that carboplatin increases the likelihood of achieving pathological complete response (pCR) in TNBC. Patients with TNBC who achieve pCR has been shown to have better disease-free and overall survival. The aim of this study was to asses the impact of adding carboplatin to standard NACT in TNBC in terms of pCR rates and toxicity. Methods:In this cross-sectional study, 252 consecutive patients with primary TNBC who were submitted to neoadjuvant chemotherapy between 2013 and 2018, in a single center, were selected. Patients with biopsy-confirmed TNBC, previously untreated, with clinical stages I-III were included (n=179). Clinical pathological features, pathological response, treatment protocol, and toxicities were analyzed and considered for statistical analysis. Eighty patients treated from 2013 to 2015 received doxorubicin plus cyclophosphamide once every 3 weeks (AC) for four cycles, followed by 12 weeks (wP) or every 3 weeks (P) paclitaxel(AC-T group). Ninety-nine patients, treated from 2015 to 2018 had four cycles of AC followed by wP plus weekly carboplatin (Cb) area under curve (AUC) 1.5-2.0 (AC-TCb group). Pathologic response was determined locally, and pCR was defined as the absence of residual invasive disease with or without ductal carcinoma in situ in the breast and axilla. Results: Data from 179 patients were included in the analysis (AC-T: n=80; AC-TCb: n=99). Patients in AC-TCb group had a median age of 51.7 years vs. 47.4 years in AC-T group, p=0.01. In AC-TCb group 61.6% of patients were postmenopausal vs 43.7% in AC-T group, p=0.03. The distribution of clinical stage in groups AC-TCb and AC-T were as follows: stage I 6.0% vs 0%; stage II 42.4% vs 43.7%; stage III 51.6% vs 56.3%, respectively (p=0.02). In AC-TCbgroup, 34 patients (35.0%) had pCR in comparison to 20 patients (25.0%) on AC-T group (p=0.22). Pathological stage distribution in groups AC-TCb and AC-T were: stage I 24.7% vs 33.7%; stage II 23.7% vs 26.3%; stage III 16.4% vs 15%, respectively (p=0.42). More than 85.0% of patients in AC-TCb group received at least 9 weeks of carboplatin and less than 20.0% required dose reduction due to toxicity.Conclusions: An improved pathological complete response for TNBC patients submitted to standard NACT plus carboplatin was observed. The results are in accordance with previous studies demonstrating that the addition of carboplatin to NACT improves pCR rate in TNBC with a favorable risk to benefit profile. Therefore carboplatin might be a potential component of NACT and should be considered in this context. Distribution of patients with TNBC submitted to NACT with AC-T and AC-TCb according clinical–pathological characteristicsClinical pathological characteristicsAC-T n= 80AC-TCb n=99pMenopausal 0.03yes3561 no4538 Clinical stage 0.02I06 II3542 III4551 Histologic type 0.25IDC8096 others03 Histologic grade 0.86101 22932 35164 Pathological stage 0.42O2034 I2724 II2123 III1216 pCR 0.22yes2034 no6063 Citation Format: Ramalho S, Natal RdA, Cardoso Filho C, Xavier MB, da Silva AER, Silva LR, Vasconcelos V, Reinert T, Coelho GP, Silva GRdP, dos Santos CC. Pathological complete response rates with the addition of carboplatin to standard neoadjuvant chemotherapy in a cohort of real–world patients with triple negative breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-16.

Characteristics of melanoma in Japan: a nationwide registry analysis 2011-2013.

The distribution and incidence of melanoma vary among different races and ethnic groups. This study aimed to investigate the characteristics of cutaneous melanoma, mucosal melanoma, uveal melanoma, and melanoma of unknown primary (MUP) origin in a Japanese population. We studied these four types of melanoma in patients registered in Hospital Based Cancer Registries in Japan from 2011 to 2013. A total of 5566 patients with melanoma were identified. The distribution of sex, age, primary site, and clinical stage was analyzed. The number of patients, proportion in comparison with all melanoma cases, and crude incidence rate per 100 000 person-year of each melanoma type were 4481, 80.5%, and 1.24 in invasive cutaneous; 821, 14.8%, and 0.32 in mucosal; 163, 2.9%, and 0.064 in uveal; and 101, 1.8%, and 0.039 in MUP origin, respectively. Including the patients with in-situ cutaneous melanoma and stage unknown cutaneous melanoma, the crude incidence rate of cutaneous melanoma increased at 1.75. Almost half of the cutaneous melanomas were located in the lower limb. Cutaneous melanoma was the most common, but less frequent than that in western countries. Mucosal melanoma was quite rare, but its proportion and crude incidence rate were higher than those in western countries. Uveal melanoma was particularly rare, and its crude incidence rate was lower than that in western countries. MUP origin was also particularly rare, but it had almost the same incidence rate as that in other countries. Melanoma in Japan was heterogeneous among the four melanoma types and shares some attributes with that in western countries.

A comparative study of distribution of residual cancer cells in the bowel wall after preoperative three-dimensional conformal radiotherapy versus volumetric modulated arc therapy with concurrent chemotherapy in treatment of locally advanced rectum cancer

Objective To compare the distribution of residual cancer cells (RCC) in each layer of bowl wall after preoperative three-dimensional conformal radiotherapy (3DCRT) versus volumetric modulated arc therapy (VMAT) combined with concurrent chemotherapy, and to investigate the effect of different radiotherapy techniques on the distribution of RCC. Methods A total of 334 patients with locally advanced rectum cancer (LARC) who were admitted to our hospital from May 2007 to April 2013 were enrolled as subjects. In those patients, 172 received preoperative 3DCRT (46 Gy/23 F) with concurrent chemotherapy and 162 received VMAT (50 Gy/25 F) with concurrent chemotherapy. There was no significant difference in the distribution of clinical stage Ⅱ or Ⅲ between the 3DCRT group and VMAT group. All the RCCs in different layers of surgical specimens were evaluated pathologically. Between-group comparison of data was made by Pearson Chi-Square and Fisher's exact test. Results There were no significant differences in ypT, ypN, or ypTNM staging between the two groups (P values>0.05). In the 226 patients with ypT2-4 disease, the proportion of RCC in the mucosa, submucosa, muscularis propria, and subserosa/perirectal fat was 34.1%, 43.8%, 73.5%, and 69.0%, respectively. In patients with ypT2-4, pN+ , cN+ , or cT4 disease, compared with the VMAT group, the 3DCRT group had significantly higher proportion of RCCs in the mucosa (47.9% vs. 18.1%, 54.5% vs. 17.2%, 39.8% vs. 15.3%, 41.3% vs. 14.3%; P=0.000, 0.001, 0.000, 0.000) and submucosa (50.4% vs. 36.2%, 56.8% vs. 27.6%, 43.0% vs.26.6%, 45.3% vs. 27.5%; P=0.032, 0.014, 0.006, 0.017). In patients with pN0 or cT3 disease, the 3DCRT group had a significantly higher proportion of RCCs in the mucosa than the VMAT group (28.1% vs. 12.9%, P=0.002; 29.5% vs. 13.2%, P=0.015). In patients with ypT2-4, pN0/pN+ , cT3/cT4, or cN0/cN+ disease, there were no significant differences in the proportion of RCCs in the muscularis propria or subserosa/perirectal fat between the two groups (P values>0.05). Conclusions After neoadjuvant chemoradiotherapy, most RCCs reside in the muscularis propria and subserosa/perirectal fat of the bowl wall. There are no significant differences in the distribution of most RCCs in the bowel wall or postoperative pathological staging between patients undergoing different radiotherapy techniques. Key words: Rectum neoplasms/three-dimensional conformal radiotherapy; Rectum neoplasms/volumetric modulated arc therapy; Rectum neoplasms/neoadjuvant chemoradiotherapy; Residual cancer cell; Pathological staging

Outcome of 136 Children with Advanced Lymphoblastic Lymphoma Receiving an BFM-Type Therapy with Intensified Maintenance: A Report from the Japanese Pediatric Leukemia/Lymphoma Study Group ALB-NHL03 Study

BACKGROUND: Lymphoblastic lymphoma (LBL) accounts for 30% of childhood non Hodgkin’s lymphoma in Japan. From European and North American groups, favorable results have been reported, using treatment strategies for acute lymphoblastic leukemia, over 80% of event free survival rate even in advanced LBL. However there were few data on Japanese or Asian patients with LBL. Here we report final outcome of first nation-wide prospective study over one hundred cases with advanced childhood LBL from Japan.PATIENTS & METHOD: Patients with stage 3 or 4 LBL received for 9 weeks induction phase, which consisted of 7 drugs and triple IT , followed by three courses of high dose MTX(5g/m2). After high dose MTX, re-induction, early maintenance, and late maintenance phase were administered. With an attempt to intensify maintenance therapy,early maintenance was consisted by two cycles of four courses of six drugs(MTX, PSL,VCR, L-ASP, 6MP, THP#) and late maintenance was five cycles of five drugs(MTX, PSL,VCR, 6MP,AraC). We omitted local radiotherapy including prophylactic cranial radiotherapy except patient with initial central nervous system (CNS) disease. The total duration of the treatment was 24 month“.RESULTS: From November 2004 to October 2010, 154 children with newly diagnosed advanced stage LBL were entered in this study. A total of 136 cases were eligible. Ages ranged from four month to 15 years, with a median of 9.07 years. Of the 136 patients, 36 were girls and 100 were boys. The distribution of clinical stage 3 and stage 4 was 82 and 54 patients respectively. 94 patients had primary mediastinal disease. 41 patients had BM disease, 31 patients had CNS disease and 8 patients had BM and CNS disease. 104 patients (76.5%) had precursor T LBL (T-LBL), 31 patients (22.8%) had precursor B LBL (B-LBL), onepatient (0.7%) had bi phenotype LBL. The follow-up time ranged from 2.8 to 94 months, with a median 58 months. For the 136 patients analyzed in this study, 5-year OS was 82.9% and 5-year EFS was 77.9%. There was no significant difference in outcome by gender (5-year EFS, male 78.2% vs. female 73.0%), or by immunophenotype (5-year EFS, B-LBL 80.7% vs. T-LBL 76.9%). Of note, the 5-year EFS for stage 3 T-LBL patients were worse than that of stage 4 T-LBL patients (70.6% vs. 88.9%, P=0.031). There were also significant difference in 5-year EFS for T-LBL patients who achieved CR and CRu at end of induction, 86.9%, and 69.7% (P=0.034), respectively.Most events were observed as mediastinum enlargement before initiation of intensified maintenance therapy.CONCLUSIONS: Our firstnationwide study provided about 80% cure rate with only one case of toxic death in childhood advanced LBL. However, our intensified maintenance therapy could not improve survival outcome. Our result also emphasize the significant difference between T-LBL stage 3 and stage 4 and might suggest the difference in ethnicity for the composition of biological subgroup in T-LBL. THPPirarubicin DisclosuresNo relevant conflicts of interest to declare.

Serum p53 antibody in breast cancer.

The significance of the measurement of anti-p53 antibodies in serum remains undisclosed. The aim of this study was to assess anti-p53 antibodies in the serum of patients with breast cancer, and correlate these results with various clinicopathologic parameters. We analyzed serum anti-p53 antibody levels in 124 patients with breast cancers and 7 patients with benign disease between April 2012 and March 2013, as well as levels of serum carcinoembryonic antigen (CEA) and cancer antigen (CA) 15-3. Twenty-two of 124 patients with breast cancer had an increased concentration of anti-p53 antibodies. By distribution of clinical stage, in stage 0-II the positive ratio of anti-p53 antibodies was significantly higher than that of CEA (p=0.03) and CA15-3 (p=0.01). There was a significant correlation between anti-p53 antibodies and family history (p=0.03). Triple-negative cancer also showed a significant correlation with anti-p53 antibodies (p=0.007). In patients with multiple and/or bilateral breast cancer, the level of anti-p53 was significantly higher than in unilateral breast cancer (62.5% vs 14.7%, p=0.004). Measurement of anti-p53 antibodies is useful for the prevention of oversight in the evaluation of multiple and/or bilateral breast cancer.

Breast Cancer in Turkey: Clinical and Histopathological Characteristics (Analysis of 13.240 Patients).

Breast cancer is the most common type of cancer and the leading cause of cancer related deaths in women in Turkey, as elsewhere around the world. However, detailed and systematic demographics, data on clinical and pathological characteristics, and treatment were largely unavailable in Turkey until now. This paper is intended to provide an analysis of clinical and pathological data on women registered in the National Breast Cancer Database (Ulusal Meme Kanseri Veri Tabanı [UMKVT]), established within Turkish Federation of Breast Diseases Societies (TMHDF) and available for use in Turkey since 2005. Clinical and pathological data on breast cancer patients registered online in the database from May 01, 2005 to May 01, 2011 were investigated. Parameters examined in patients included age, menopausal status, distribution of clinical and pathological stage, histological type, tumor diameter, histological grades, regional lymphatic stage, estrogen (ER), progesterone (PR), HER-2 receptors and molecular subtypes. Analysis results of these parameters were compared with literature data and discussed. A total of 13,240 patients with breast cancer since April 07, 1992 were included in the study, and 99% of them were female. Female breast cancer patients whose requisite parameters had been completely entered in the database were included in the analysis. The mean age was 51.6 years (±12.6; range 12-97), 17% of them were younger than 40 years of age, and 45% were premenopausal. According to an analysis of age groups at diagnosis, the frequency of cancer peaked at the 45 - 49 age group with 16.7%, declining to 7.6% in the 65-69 age group, and then rose again. Most of the patients (78.7%) had invasive ductal, 7.8% were invasive lobular cancers, 9.8% were invasive mixed cancers (invasive ductal + invasive lobular), and 4% were other histological types (e.g. inflammatory, intracystic papillary, mucinous, etc.), respectively. Half of them (50%) had grade III histology. According to an analysis of pathological stages of all breast cancers (stage 0 - IV), 5% were stage 0, 27% were stage I, 44% were stage II, 21% were stage III, and 3% were stage IV breast cancer, respectively. The mean tumor diameter was 2.5 cm (±1.6; range 0.1-20 cm). The rates of lymphatic stages were pN0 50%, pN1 28%, pN2 15%, and pN3 7%, respectively. ER, PR, and HER-2 receptors were positive in 70%, 59%, and 23% of patients. A subtype analysis of tumors showed that 62% were type luminal A. This was followed by subtypes luminal B (15%), triple negative (15%), and HER-2 positive (8.5%). As a conclusion patients with breast cancer in our breast cancer registry program were younger, and had more advanced disease, and worse prognostic factors than patients in developed countries.

Improvement of long-term outcomes in pancreatic cancer and its associated factors within the gemcitabine era: a collaborative retrospective multicenter clinical review of 1,082 patients

BackgroundAlthough the outcomes of pancreatic cancer have been improved by gemcitabine, the changes in its characteristics and long-term outcomes within the gemcitabine era remain unclear. This study was conducted to identify clinical characteristics of pancreatic cancer patients within the gemcitabine era.MethodsA retrospective chart review was performed at 10 centers for 1,248 consecutive patients who were ever considered to have a diagnosis of pancreatic cancer between 2001 and 2010. Data collected included demographics, diagnosis date, clinical stage, treatment, and outcome; 1,082 patients met the inclusion criteria and were analyzed further. The chi-square test, Student’s t-test, and Mann–Whitney U-test were used for statistical analysis. Outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Differences in survival analyses were determined using the log-rank test.ResultsThe distribution of clinical stages was: I, 2.2%; II, 3.4%; III, 13%; IVa, 27%; and IVb, 55%. Chemotherapy alone was administered to 42% of patients and 17% underwent resection. The 1-, 3-, and 5-year survival rates were 39%, 13%, and 6.9%, respectively. The median survival time was 257 days, but differed considerably among treatments and clinical stages. Demographics, distribution of clinical stage, and cause of death did not differ between groups A (2001–2005, n = 406) and B (2006–2010, n = 676). However, group B included more patients who underwent chemotherapy (P < 0.0001) and fewer treated with best supportive care (P = 0.0004), mirroring improvements in this group’s long-term outcomes (P = 0.0063). Finally, factors associated with long-term outcomes derived from multivariate analysis were clinical stage (P < 0.0001), location of the tumor (P = 0.0294) and treatments (surgery, chemotherapy) (P < 0.0001).ConclusionsLong-term outcomes in pancreatic cancer has improved even within the gemcitabine era, suggesting the importance of offering chemotherapy to patients previously only considered for best supportive care. Most patients are still diagnosed at an advanced stage, making clinical strategy development for diagnosing pancreatic cancer at earlier stages essential.

Gleason Grade Progression Is Uncommon

Gleason grade is universally used for pathologic scoring of the differentiation of prostate cancer. However, it is unknown whether prostate tumors arise well differentiated and then progress to less differentiated forms or if Gleason grade is an early and largely unchanging feature. Prostate-specific antigen (PSA) screening has reduced the proportion of tumors diagnosed at advanced stage, which allows assessment of this question on a population level. If Gleason grade progresses as stage does, one would expect a similar reduction in high-grade tumors. We studied 1,207 Physicians' Health Study and Health Professionals Follow-up Study participants diagnosed with prostate cancer from 1982 to 2004 and treated with prostatectomy. We compared the distribution of grade and clinical stage across the pre-PSA and PSA screening eras. We re-reviewed grade using the ISUP 2005 revised criteria. The proportion of advanced stage tumors dropped more than six-fold, from the earliest period (12/1982-1/1993), 19.9% stage ≥ T3, to the latest (5/2000-12/2004), 3% stage T3, none T4. The proportion of Gleason score ≥ 8 decreased substantially less, from 25.3% to 17.6%. A significant interaction between stage and diagnosis date predicting grade (P = 0.04) suggests that the relationship between grade and stage varies by time period. As the dramatic shift in stage since the introduction of PSA screening was accompanied by a more modest shift in Gleason grade, these findings suggest that grade may be established early in tumor pathogenesis. This has implications for the understanding of tumor progression and prognosis, and may help patients diagnosed with lower grade disease feel more comfortable choosing active surveillance.

Gender, anthropometric factors and risk of colorectal cancer with particular reference to tumour location and TNM stage: a cohort study

BackgroundIt remains unclear whether the increased risk of colorectal cancer (CRC) associated with obesity differs by gender, distribution of fat, tumour location and clinical (TNM) stage. The primary aim of this study was to examine these associations in 584 incident colorectal cancer cases from a Swedish prospective population-based cohort including 28098 men and women.MethodsSeven anthropometric factors; height, weight, bodyfat percentage, hip circumference, waist circumference, BMI and waist-hip ratio (WHR) were categorized into quartiles of baseline anthropometric measurements. Relative risks of CRC, total risk as well as risk of different TNM stages, and risk of tumours located to the colon or rectum, were calculated for all cases, women and men, respectively, using multivariate Cox regression models.ResultsObesity, as defined by all anthropometric variables, was significantly associated with an overall increased risk of CRC in both women and men. While none of the anthropometric measures was significantly associated with risk of tumour (T)-stage 1 and 2 tumours, all anthropometric variables were significantly associated with an increased risk of T-stage 3 and 4, in particular in men. In men, increasing quartiles of weight, hip, waist, BMI and WHR were significantly associated with an increased risk of lymph node positive (N1 and N2) disease, and risk of both non-metastatic (M0) and metastatic (M1) disease. In women, there were no or weak associations between obesity and risk of node-positive disease, but statistically significant associations between increased weight, bodyfat percentage, hip, BMI and M0 disease. Interestingly, there was an increased risk of colon but not rectal cancer in men, and rectal but not colon cancer in women, by increased measures of weight, hip-, waist circumference and bodyfat percentage.ConclusionsThis study is the first to show a relationship between obesity, measured as several different anthropometric factors, and an increased risk of colorectal cancer of more advanced clinical stage, in particular in men. These findings suggest that risk of CRC differs according to the method of characterising obesity, and also according to gender, location, and tumour stage.