End Results Database Analysis Research Articles

Increased incidence of thyroid, renal, lung, melanoma, bladder, and prostate cancers after diagnosis of primary cutaneous B-cell lymphoma: A Surveillance, Epidemiology, and End Results database analysis

Increased incidence of thyroid, renal, lung, melanoma, bladder, and prostate cancers after diagnosis of primary cutaneous B-cell lymphoma: A Surveillance, Epidemiology, and End Results database analysis

Prognostic Factors of Survival for Grade 3 Solitary Fibrous Tumor/Hemangiopericytoma: A Population-Based Retrospective Surveillance, Epidemiology, and End Results Database Analysis

Introduction: Grade 3 solitary fibrous tumor, previously known as anaplastic hemangiopericytoma, is a rare and highly malignant intracranial tumor with a limited understanding of its natural history and treatment outcomes. Methods: We conducted a retrospective analysis using the Surveillance, Epidemiology, and End Results (SEER) database spanning 2000–2019 to evaluate the clinical characteristics and treatment modalities that influence overall survival in this tumor entity. A cohort of 249 patients with intracranial grade 3 solitary fibrous tumors was identified. Univariate and multivariable Cox proportional hazard models were employed to determine significant prognostic factors for overall survival. Kaplan-Meier models were used to visualize survival curves, and a nomogram was constructed to predict survival probabilities at 6- and 12-month following diagnosis. Results: Our findings indicated that patient age (Conclusions: These data emphasize the importance of surgical resection and radiation therapy in the management of grade 3 solitary fibrous tumors, supporting the use of combination therapies to improve overall survival in this rare and aggressive intracranial neoplasm.

Impact of Commission on Cancer Accreditation on Cancer Survival: A Surveillance, Epidemiology, and End Results (SEER) Database Analysis.

To analyze the cancer burden in the United States, researchers are relying on the Surveillance, Epidemiology, and End Results (SEER) Program. Our objective was to analyze differences in cancer outcome between Commission on Cancer (CoC)-accredited and non-accredited facilities. The SEER database was queried for diagnosis years 2018 and 2019. Only analytic cases were included. Observed survival was calculated using the Kaplan-Meier method for all cancer sites, stratified by accreditation status. Univariate analyses were performed to quantify differences in survival between cancer cases in CoC-accredited and non-CoC-accredited facilities. Cancers of interest were chosen based on statistical significance (p<0.01) and clinical significance (>25% difference in end survival). Multivariate analyses were conducted on cancers of interest. Overall, there were 602,185 cases from CoC-accredited facilities and 198,492 from non-CoC-accredited facilities. 5 of 59 solid organ cancers showed statistically and clinically significant reductions in survival in non-accredited facilities (lung and bronchus: 27.9%; liver: 41.1%; esophagus: 30.4%; pancreas: 32.7%; intrahepatic bile duct: 39.4%). Multivariate analysis on these 5 cancers was performed. CoC accreditation was a statistically significant variable decreasing the hazard in all 5 cancers (hazard ratio 0.86-0.91; all p-values <0.005). All these cancers demand resource-intensive treatment. Accreditation has a significant impact on survival in 5/59 solid organ cancers. Although accredited facilities may be better apt to handle these cancer cases, the survival in most cancers is not significantly affected by accreditation. However, examining longer-term endpoints elucidate further nuances. Herein, CoC accreditation was found to be an independent variable impacting 2-year survival for a minority of cancers.

Prognostic Indicators for Intracranial Metastases from Pancreatic Cancer: A Population-Based Retrospective Surveillance, Epidemiology, and End Results Database Analysis

ObjectiveThe natural history, treatment options, and clinical outcomes of pancreatic metastases to the brain remain largely unknown. Here, we seek to investigate characteristics that influence OS in pancreatic metastases to the brain. MethodsThis is a population-based retrospective study of OS in 508 patients with pancreatic metastases to the brain using the SEER database. Univariate and multivariate Cox regression analyses were utilized, and a predictive nomogram was developed. ResultsThere were 508 patients identified for this study, with a median OS of two months. In the univariate analysis, patients older than 65 years had significantly reduced OS (p<0.001). Patients with liver metastases (p<0.001) and liver and lung metastases (p<0.001) exhibited significantly reduced OS. Treatment of the primary tumor with chemotherapy only (p<0.001), radiation only (p=0.01), radiation and chemotherapy (p<0.001), and surgery only (p=0.01) were associated with increased OS. Resection of a distant metastasis site (p=0.009) and of a brain metastasis (p=0.03) were associated with increased OS. In the multivariable analysis, factors that remained significant included patient age (p=0.01), liver metastases (p<0.001), liver and lung metastases (p<0.001), treatment with chemotherapy (p<0.001), treatment with radiation and chemotherapy (p<0.001), and treatment with surgery and chemotherapy (p<0.001). The nomogram had a C-index of 0.766, suggesting congruence between the findings on the nomogram and the results in the internal verification. ConclusionsMedian OS is influenced by age, multiorgan metastases, and treatment of the primary tumor. These data highlight the marginal benefit of treatment, yet improved quality of life remains to be elucidated.

Classical Hodgkin lymphoma: A Surveillance, Epidemiology, and End Results (SEER) Database analysis comparing racial and ethnic disparities with emphasis on Hispanics.

e19514 Background: Classical Hodgkin Lymphoma (cHL) and it’s 4 subtypes, account for 95% of cases of Hodgkin Lymphoma in Western countries (J Natl Compr Canc Netw PMID 35390768). Race is a known survival predictor for this disease and studies have shown that outcomes vary between Non-Hispanic (NH) and Hispanic (HI) patients (Adv Hematol PMID 21197477 Ann Oncol PMID 22241896). This analysis attempts to clarify how sociodemographic characteristics influence survival of HI diagnosed with cHL in the United States (US). Methods: Retrospective data analysis on cHL patients in the US reported to the Surveillance, Epidemiology, and End Results (SEER) 18 database from 2000-2018. Demographics, disease characteristics, and survival patterns were analyzed for each ethnic group. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS). Multivariate analysis and propensity score matching was performed, adjusting for age, stage, and B-symptoms. Results: 40776 cHL patients were included, 6621 HI. Males predominated in both HI and NH. HI compared to NH, were diagnosed at a younger median age, 34 years(y) vs 39y, respectively [p &lt; 0.001]. Majority of patients belonged to the age bracket of less than 40y; favoring a younger age distribution in both ethnicities. Most patients were white, and NH had greater heterogeneity [p &lt; 0.001]. Stage II at diagnosis prevailed in HI (29.8%) and NH (33.7%), followed by unknown for both [p &lt; 0.001]. Preponderance of cases were nodal disease, ≈98% for HI and NH [p = 0.014]. Presence of B-symptoms was 23% for HI vs 19% for NH [p &lt; 0.001]; however, B-symptoms were mostly unknown for both. Only 27% of HI and 31% of NH received radiation. Survival probability at 2, 5 and 10y for HI (0.856, 0.804, and 0.737) was similar compared to NH (0.864, 0.804 and 0.733), respectively. Median survival time wasn’t reached for HI and NH, with no statistically significant difference in OS among ethnicities [p = 0.64]. On multivariate analysis, patients older than 80y and between 60-80y, had worse OS than those less than 60y, with hazard ratio (HR) 17 [95% CI: 15.6–18.7] and 6.31 [95% CI: 5.9–6.7], respectively. Stage III/IV had inferior OS vs early stages, with HR 1.5 [95% CI: 1.38–1.66] and 2.3 [95% CI: 2.1–2.5], respectively. Conclusions: No statistically significant difference in OS was noted between HI and NH diagnosed with cHL, despite HI presenting with more B-symptoms, younger age, and less likely diagnosed at early stages. On multivariate analysis, HI older than 60y and with advance stage do have inferior OS. This suggests that unique disease characteristics, environmental and biological factors may have some influence that drive survival outcomes, especially in the elderly. Although racial disparities and different disease characteristic exist, cHL remains a malignancy with favorable outcomes for both HI and NH.

Clinical Features and Survival Outcomes in Children and Adolescents With Malignant Mediastinal Germ Cell Tumors Based on Surveillance, Epidemiology, and End Results Database Analysis

IntroductionThe purpose of this study was to perform a population-based investigation to assess the disease characteristics and prognosis of children and adolescents with malignant mediastinal germ cell tumors (MMGCT). MethodsData on the demographics, treatment, and survival outcomes of children and adolescents with MMGCT from January 1, 2000 to December 31, 2018 were obtained. To compare survival curves, the log-rank test was employed. The generation of survival curves based on different parameters was done using Kaplan–Meier estimations. Cox proportional hazards regression was performed to determine the variables linked to disease-specific survival. ResultsThe selection criteria were met by 152 MMGCT patients, 130 of whom were male. Fifty three cases of mixed germ cell tumors (GCTs), 41 cases of malignant teratomas, 26 cases of yolk sac tumors, 14 cases of seminoma, 13 cases of choriocarcinomas, and five cases of embryonal carcinoma were reported. Overall survival at 3 and 5 y for all patients was 63.1% and 61.2%, respectively. Malignant teratoma, yolk sac tumors, and mixed GCTs in children and adolescents had comparable survival rates, while those with choriocarcinoma and embryonal carcinoma showed the worst prognosis. Embryonal carcinoma, malignant teratoma, mixed GCTs, and choriocarcinoma were found as risk factors by multivariate Cox proportional hazards analysis. In contrast, surgery and younger age were protective factors. However, chemotherapy alone showed no survival benefits. ConclusionsOur population-based evidence showed that MMGCT had worse prognosis in older children and adolescents. Choriocarcinomas and embryonal carcinomas had the worst prognosis. Surgery can prolong survival time. Chemotherapy and radiotherapy were not associated with improved prognosis.

Tumor size as a significant prognostic factor in T1 gastric cancer: a Surveillance, Epidemiology, and End Results (SEER) database analysis

BackgroundIt has previously been observed that the prognostic value of tumor size varied according to different stages patients enrolled in gastric cancer. We aimed to investigate the influence of T stage on the prognostic and predicting value of tumor size.Material and methodsA total of 13,585 patients with stage I–III gastric cancer were selected from the Surveillance, Epidemiology, and End Results Program (SEER) database. Univariate and multivariate cox regression analysis stratified by T stage were performed. C-index and time-dependent receiver operating characteristic curve (ROC) curve were applied to assess discrimination ability of tumor size and other factors. Nomograms were constructed to further assess the performance of tumor size in a specific model. Calibration ability, discrimination ability, reclassification ability and clinical benefits were executed to judge the performance of models.ResultsStratified analyses according to T stage illustrated that with the increase of T stage, the effect of tumor size on overall survival (OS) and cancer-specific survival (CSS) significantly decreased. Moreover, tumor size showed superior discrimination ability in T1 gastric cancer, outperformed other prognostic factors in predicting both CSS (C-index: 0.666, AUC: 0.687) and OS (C-index: 0.635, AUC: 0.660). The cox regression model included tumor size showed better performance than the model excluded tumor size in every aspect.ConclusionT stage had a negative impact on the predicting value of tumor size. Tumor size showed significant prognostic value in T1 gastric cancer, which may be effective in clinical practice.

Abstract 5521: Racial and ethnic disparities for intravascular large B-cell lymphoma: A Surveillance, Epidemiology, and End Results (SEER) database analysis with emphasis on Hispanics

Abstract Background: Intravascular large b-cell lymphoma (IVLBCL) is a rare but highly aggressive subtype of non-Hodgkin lymphoma (NHL). IVLBCL is a clonal proliferation with selective growth within the blood vessel. It has been primarily described in Asian and European populations, and a median age presentation is in the sixth to seventh decades without a sex predilection. The US incidence is 0.95 in 1 million, but is thought to be higher, as the diagnosis is mainly done postmortem. Meanwhile, the incidence rate of IVBCL in Hispanics (HI) remained unknown. This study looks at demographics, treatment patterns, and outcomes of patients with IVLBCL in the US, examining disparities by HI vs Non-Hispanic (NH). Methods: Data were analyzed on IVLBCL patients reported to the SEER 18 database between 2000 and 2018. SEER 18 contains the most comprehensive population-based cancer information in the US, covering approximately 27% of the US population and 36% of HI alone. The racial groups analyzed were NH whites, HI whites, blacks, and Asians/PIs (Pacific Islanders). Patient characteristics, age-adjusted incidence rate, and survival rate were compared across ethnic groups. Kaplan-Meier and Cox regression analyses compared overall survival (OS) between HI and NH. Multivariate analysis and propensity score matching were performed, with adjustment for age, stage and B-symptoms. Results: We identified 164 patients with IVLBCL, of which 10% were HI. 41% of HI were male vs 44% of NH. HI were diagnosed at an older age, 72. vs 69 y.o., compared to NHI (p=0.907). Most of NH and HI were diagnosed between 60-80 y.o. (p=0.322), 53.1% and 47.1%, respectively. Regarding race, HI and NH were mainly identified as whites (88% vs 78%), followed by Asians (6% vs 17%) (p=0.013). For HI, 53% presented B symptoms compared to 16% of NH (p=&amp;lt;0.001). On survival analysis, the survival probability at 2, 5 and 10 years of HI vs NH was (0.540 vs 0.505), (0.432 vs 0.425), and (0.443 vs 0.237), respectively. The median survival time was 0.8 years for HI and 1.9 years for NH. The 10 year OS probability was not significantly different for HI vs NH (p=0.66).On multivariate analysis, when adjusted for age, those patients who were 60 to 80 y.o. had worse OS compared to those younger than 60 y.o., with HR 1.4 (95% CI: 0.7 - 2.1). Conclusion: In our study, despite a lower percentage of patients identified as Asian in our HI population, there is a significant difference in the presence of B-symptoms between HI and NH, going against the traditional description of an Asian variant with increased systemic symptoms. Despite this finding, it demonstrated similar outcomes in the 10 years survival analysis for HI and NH. Standardized treatment may explain why no variation was reported in OS. Our analysis shows that ethnic variations do not seem to affect oncological outcomes in IVLBCL for HI in the US. Citation Format: Daniela Urueta Portillo, Daniel Rosas, Joel E. Michalek, Qianqian Liu, Adolfo E. Diaz Duque. Racial and ethnic disparities for intravascular large B-cell lymphoma: A Surveillance, Epidemiology, and End Results (SEER) database analysis with emphasis on Hispanics. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5521.

Radiotherapy After Gross Total Resection of Skull Base Chordoma: A Surveillance, Epidemiology, and End Results Database Analysis of Survival Outcomes.

Skull base chordoma is a rare and locally destructive malignancy which presents unique therapeutic challenges. While achieving gross total resection (GTR) confers the greatest survival advantage, the role of adjuvant radiotherapy (RT) for patients who receive GTR remains unclear in the absence of prospective trials. Here, we aim to assess the effect of RT on survival outcomes in skull base chordoma patients who receive GTR by utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Patients with diagnostic, primary site, and resection codes specific for chordoma, skull base, and GTR, respectively, were queried in the SEER database (2000-2018). Kaplan-Meier curves (log-rank test) were constructed and Cox proportional hazards models were used to assess survival outcomes. A total of 115 skull base chordomas undergoing GTR were identified, of which 37 (32%) received no RT and 78 (68%) received RT. Median follow-up was 55.00months (range: 0.00-227.00). Overall survival (OS) of patients with GTR was 85% and 70% at 5 and 10years, respectively. Multivariate Cox proportional hazard analysis among chordoma patients undergoing GTR found age ≥65 (P < 0.01) was associated with poorer OS outcomes. RT appeared to trend toward offering benefit in terms of OS in patients after GTR, however this did not achieve statistical significance in the adjusted model (HR= 0.51, CI= 0.23-1.16, P= 0.09). When comparing, disease-specific survival was also not improved in patients undergoing RT (HR= 0.58, CI= 0.23-1.46, P= 0.25). It remains unclear whether RT after GTR of chordoma improved survival outcomes among SEER database patients.

Prognostic factors and treatment outcomes of spinal osteosarcoma: Surveillance, epidemiology, and end results database analysis.

Spinal osteosarcoma is a rare osseous neoplasm. The aim of this study is to make a comprehensive analysis of the demographic features, clinicopathologic characteristics and factors affecting prognosis of spinal osteosarcoma using the Surveillance, Epidemiology and End Results (SEER) database. SEER data were reviewed to identify patients diagnosed with spinal osteosarcoma between 1975 and 2016 and determine their overall survival (OS) and disease-specifc survival (DSS). Univariate and multivariate analyses were performed using the Cox-regression proportional hazards model and Kaplan-Meier method. A total of 668 patients (53.1% males) with spinal osteosarcoma were identified. The mean age at diagnosis was 45.2 years, including 67.5% patients younger than 60 years. The median OS of these patients was 15 months, and the 5-year OS was 16.8%. Multivariate analysis showed that age ≥60 year (HR=2.271, p = 0.008), high grade (HR=1.323, p = 0.008), regional stage (HR=1.658, p = 0.017), metastasis stage (HR=3.045, p < 0.001) and no-surgery treatment (HR=1.761, p < 0.001) were adversely associated with OS; gender (HR=0.657, p = 0.044), tumor grade (HR=1.616, p = 0.006), tumor stage (HR=3.329, p = 0.011; HR=7.983, p < 0.001) and radiotherapy (HR=0.606, p = 0.031) were independent prognostic factors affecting DSS. Based on SEER data analysis, male, high tumor grade, regional stage, metastasis stage and radiotherapy are independent predictors of poor survival of patients with spinal osteosarcoma. The clinical treatment of spinal osteosarcoma still faces serious challenges. Future research should focus on the clinical impact and survival outcomes of the emerging targeted and immune therapies for the sake of improving the survival stalemate of spinal osteosarcoma.

Epidemiology and Survival of Eccrine Porocarcinoma by Sex in the United States: A Surveillance, Epidemiology, and End Results Database Analysis.

Epidemiology and Survival of Eccrine Porocarcinoma by Sex in the United States: A Surveillance, Epidemiology, and End Results Database Analysis.

Trends in All-Cause and Cardiovascular Mortality Among Patients with Myeloproliferative Neoplasms: A Surveillance, Epidemiology, and End Results Database Analysis

Background: Patients with myeloproliferative neoplasms (MPN), including essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF), are at risk of death due disease progression. However, thrombohemorrhagic complications are frequent cause of morbidity and mortality in MPN. Despite this, the burden of cardiovascular disease and mortality has not been thoroughly investigated. However, differences in all-cause death (ACD) and CV death among MPN types have not been well characterized in large cohort studies. Therefore, we performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database to assess 2-year ACD and CV death in patients with MPN. Methods: Patients who had a diagnosis of MPNs were identified using SEER 18 November 2020 registry. Patients who were included had International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) codes of 1.5 (PV), 1.6 (ET), and 1.7 (PMF), were age 18 years or older, had known survival time, and histologic or laboratory confirmation between the years of 2005 and 2018. Patients were divided by MPN type. ACD was estimated using Kaplan-Meier method and Cox proportional hazards regression was used to estimate predictors of ACD. CV death incidence was estimated using competing-risk regression (Fine-Gray's method) with non-CV death as competing risk. Results: A total of 28618 patients (11466 with PV, 12941 with ET, 4211 with PMF) were included. The median age at diagnosis was 67 years (66 for PV, 67 for ET, 70 for PMF). In this cohort, 51.3% were female (45.1% for PV, 60.5% for ET, 40.1% for PMF), 73.8% were non-Hispanic White (77.7% for PV, 70.1% for ET, 74.2% for PMF). A total of 9380 (32.8% total) patients died of which 2377 deaths (25.3%) were CV deaths. 988 patients with PV (30.0% of deaths), 1085 with ET (29.5% of deaths), 304 with PMF (12.6% of deaths) died of CV causes. Incidence of 2-year ACD were similar for patients when diagnosed in 2014-2016 compared with 2005-2017 (11.43% vs 11.36%). Incidence of 2-year CV death was similar for all patients diagnosed in 2014- 2016 compared with 2005- 2007 (4.81% vs 4.90%), Figure. After Cox proportional hazards regression and competing-risk regression, risk of ACD decreased in patients diagnosed in 2017-2018 compared with 2005-2007 (HR 0.83, 95% CI 0.71 - 0.96) and risk of CV death similarly decreased (SHR 0.45, 95% CI 0.33 - 0.63). This decreased risk of ACD was seen in ET (HR 0.60, 95% 0.45 - 0.79) and PMF (HR 0.77, 95% CI 0.61 - 0.98) but not PV (HR 1.08, 95% CI 0.83 - 1.40). The decrease in CV death was seen across PV (SHR 0.52, 95% CI 0.30 - 0.89), ET (SHR 0.36, 95% CI 0.20 - 0.63), and PMF (SHR 0.54, 95% CI 0.29 - 0.98). After multi-variable Cox proportional hazards regression, PMF, non-Hispanic Black race, rural residence, county median income < $70,000, age at diagnosis, and additional non-MPN malignancies were associated with increased risk of ACD. After competing-risk regression, non-Hispanic Black race and age were associated with increased risk of CV death, Table. Conclusions: Patients with MPN are at high risk of CV death, with 1 in 4 deaths attributable to CV cause. While ACD and CV death risk has decreased over time, 2-year ACD and CV rates have remained static suggesting opportunities for improvement in short-term CV risk. Additionally, our study highlights socioeconomic and health disparities with patients living in rural, low-income areas and being of non-Hispanic Black race being at higher risk of ACD and CV death. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Current Status of Racial and Ethnic Disparities for Follicular Lymphoma: A Surveillance, Epidemiology, and End Results (SEER) Database Analysis with Emphasis on Hispanics

Background Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma (NHL) in the Western hemisphere (Blood PMID: 26989204). In prior studies, better progression-free survival has been noted in Hispanics (HI), however, further characterization of this ethnic difference needs to be addressed. This result is consistent with previous research explaining the development of NHL as an heterogeneous process where unique outcomes for races have been noted. There is a need for further understanding of HI diagnosed with FL. METHODS: Data were analyzed on follicular FL patients in the United States (US) reported to the Surveillance, Epidemiology, and End Results (SEER) 18 database between 2000 and 2018. SEER 18 contains the most comprehensive population-based cancer information in the US, covering approximately 27% of the total US population, and up to 36% of HI alone. Racial groups analyzed included NH whites, HI whites, blacks, and Asians/PIs (Pacific Islanders). Patient characteristics, age-adjusted incidence rate, and survival rate were compared across ethnic groups, HI vs NH. Stratification by age, gender, and stage at diagnosis was considered. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) between HI and NH. Multivariate analysis and propensity score matching were performed with adjustment for age, stage and B-symptoms. RESULTS Of 59250 FL patients, 11% were HI, and 89% NH. 48% of HI were male, compared to 50% of NH. The majority of HI (42%) were diagnosed in the age bracket of (40-60) vs majority of NH (50%) who were diagnosed in the age bracket of (60-80) (p<0.001). HI were diagnosed at a median younger age, 59 y.o vs 65 y.o, compared to NH (p<0.001). Regarding race, most of HI and NH were whites (96% vs 88%), followed by blacks (1% vs 5%). When examining stage, most of HI (22%) as well as NH (22%) were stage IV (p<0.001). In terms of radiation, 13% of HI received it, compared to 14% of NH (p<0.001). On survival analysis, the survival probability at 2, 5 and 10 years of HI vs NH were (87%vs 86%),(77% vs 74%), and (64% vs 86%), respectively. The median survival time was 17.1 years for HI, vs 13.2 years for NH; and there was OS difference favoring HI/NH with (p<0.001). On multivariate analysis, when adjusted for age, those patients who were older than 80 y.o and between 60 to 80 y.o, had worse OS compared to those younger than 60 y.o, with hazard ratio (HR) 9.4 (95% CI: 8.7 - 10 ) and HR 3 (95% CI: 2.8-3.2) respectively. Regarding stage, those who were at stage III and IV, had worse OS than those at early stage (I/II) with HR 1.3 (95% CI: 1.26 - 1.45) and HR 1.7 (95% CI: 1.6 - 1.8), respectively. CONCLUSION In this data analysis from the SEER 18 database, HI with FL lymphoma, had a statistically significant prolonged OS compared to NH. There were also, statistically significant differences in median survival at 2, 5, and 10 years among the HI cohorts. Unique characteristics from HI may explain why there is an increase in OS after a FL diagnosis in this data set. Biological differences in the background of HI with FL are needed to better understand improved outcomes on this cohort. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Updated Outcomes in Adult Philadelphia-Positive Acute Lymphoblastic Leukemia Patients Using Tyrosine Kinase Inhibitors Combined with the Modified University of Southern California (USC ALL) Regimen without Peg-Asparaginase in the Era of Novel Agents

Introduction: Prior to the introduction of tyrosine kinase inhibitors (TKIs), the presence of BCR-ABL1 conferred a poor prognosis in patients with acute lymphoblastic leukemia (ALL). We published our analysis in 2017 comparing the survival of Ph-Positive (Ph+) and Ph-negative ALL patients during the period when TKIs were universally available in the United States for Ph+ ALL using a Surveillance, Epidemiology, and End Results (SEER) Database analysis, but despite using TKIs, we have continued to remain reliant on cytotoxic chemotherapy and allogenic hematopoietic stem cell transplant (allo-HSCT) to achieve the best long-term outcomes. However, with the introduction of more potent TKIs and other novel agents, and better methods for monitoring minimal residual disease (MRD), the best approach is yet to be determined. In this study we present updated data from our institution with incorporation of TKIs in our modified USC ALL pediatric-based regimen without PEG. Methods This retrospective, single institution chart review included adults aged 18 with newly diagnosed Ph+ ALL between 2016 and 2020. Primary objectives were Overall survival (OS) and event-free survival (EFS) at 3 years and secondary objectives were rates of complete remission/complete remission with incomplete recovery (CR/CRi), minimal residual disease (MRD) by flow cytometry and presence of BCR-ABL1 fusion transcript by real time polymerase chain reaction. Descriptive statistics of patients were reported and evaluated using Fisher's exact test. OS and EFS were reported through Kaplan Meier curves and Log-rank tests. Two-sided p value ≤0.05 considered significant. RESULTS: 25 Ph+ ALL patients were reviewed. Median age at diagnosis was 43.5 years with 44% males and 56% females in this study. Median BMI was 31.9 kg/ m2. Most patients were Hispanic at 84%, 12% White and 4% Asian.43.5% had hepatic steatosis and 4% had CNS disease pre-induction. After induction 1, 80% of patients achieved CR/CRi, 4% were refractory, and 50% were MRD negative by flow, with 24% of patients with undetectable BCR-ABL1 by PCR. After induction 2, 90.5% had achieved CR/CRi, none were refractory and 56.3% were MRD negative by flow with 32% of patients with undetectable BCR-ABL1 PCR. 48% of patients received blinatumomab for MRD flow positivity with a median of 3 cycles, none received inotuzumab. 44.4% underwent allo-HSCT, none were sent for CAR-T. Of note, 64% of patients received Dasatinib only, 0.04% received imatinib and 32% received at least 2 TKIs. Overall, 12% had known relapse, none were refractory, and 12.5% died. The 3y OS was 89.4%, 3y EFS and DFS was at 77%. When stratified by blinatumomab use, 3y OS was 87.5% vs 91.7% (p=0.49), 3y DFS was 80.2% vs 76.4% and 3y EFS was 80.2% vs 76.4% (p=0.8). When survival was stratified by transplant status, 3y OS with allo-HSCT was 100% vs 76.9% (p=0.048), 3y EFS/DFS with allo-HSCT was 100% vs 50.1% (p=0.033) (Fig 1-2). CONCLUSIONS: The use of the modified USC ALL regimen without PEG for the treatment of newly diagnosed Ph+ ALL combined with TKI continued to lead to a high 3-year OS at 89.4% and 3-year EFS and DFS at 77%. All patients received TKI, half of the patients received blinatumomab and received allo-HSCT which led to high OS, EFS and DFS even without PEG. This was statistically significant in those who were able to undergo allo-HSCT (3y OS/EFS/DFS 100% vs 76.9% OS/50.1% EFS/DFS) (p=0.033-0.048). This study further highlights the importance of allo-HSCT in Ph+ ALL patients who received TKI without PEG. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

PULMONARY SARCOMATOID CARCINOMA WITH EXTENSION INTO THE RIGHT PULMONARY VEIN AND LEFT ATRIUM

PULMONARY SARCOMATOID CARCINOMA WITH EXTENSION INTO THE RIGHT PULMONARY VEIN AND LEFT ATRIUM

The influence of marital status on survival in patients with nasopharyngeal carcinoma: A surveillance, epidemiology, and end results database analysis.

To assess the influence of marital status on the survival of patients with nasopharyngeal carcinoma (NPC), we used the Surveillance, Epidemiology, and End Results (SEER) database to analyze 5477 patients who were diagnosed with NPC from 2004 to 2016. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to analyze the influence of marital status on cause-specific survival (CSS) and overall survival (OS). Subgroup analyses was used to assess the influence of marital status on CSS based on different factors. For the 5477 patients, 61.5%, 22.4%, and 16.1% were married, single/unmarried, and separated/widowed/divorced, respectively. The separated/widowed/divorced group was more likely to be female (P < .001), had the highest proportion of elderly subjects (P < .001), were mostly Caucasian (P < .001), had pathological grade I/II (P < .001), were likely to undergo surgery (P = .032), and were registered in the northeast, north-central, and south (P < .001) regions. The 5-year CSS rates were 92.6%, 92.4%, and 85.1% in the married, single/unmarried, and separated/widowed/divorced groups, respectively (P < .001), and the 5-year OS rates were 60.7%, 54.6%, and 40.1%, respectively (P < .001). Marital status is an independent prognostic factor of NPC. Separated/widowed/divorced patients had a significantly increased risk of NPC-related death (hazard ratio [HR] = 2.180, 95% confidence interval [CI] 1.721-2.757, P < .001) compared to married patients. The single/unmarried (P = .355) group had a CSS similar to that of the unmarried group. Marital status is an independent prognostic factor of survival in NPC patients. Separated/widowed/divorced status increases the risk of NPC mortality.

Epidemiology and Survival of Kaposi's Sarcoma by Race in the United States: A Surveillance, Epidemiology, and End Results Database Analysis.

The introduction of highly active antiretroviral treatment (HAART) for acquired immunodeficiency syndrome (AIDS) has led to a significant decrease in the incidence of Kaposi’s sarcoma (KS) in recent years. However, a concomitant increase in racial disparities in KS has arisen. Here, we analyze data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program for epidemiology and survival of Kaposi’s sarcoma by race. The highest incidence was observed among Black patients (incidence rate (IR), 1.189; 95% confidence interval (CI), 1.092–1.189), followed by White patients (IR, 0.486; 95% CI, 0.473–0.498). Relative survival at 1, 3, and 5 years differed significantly by race, with White patients having the highest survival rates (84.26%, 77.79%, and 74.79% at 1, 3, and 5 years respectively) and Black patients demonstrating the lowest (71.50%, 61.37%, and 57.38%), with intermediate survival rates in Asians/Pacific Islanders (AAPI) (80.62%, 71.19%, and 67.28%) and American Indians/Alaska Natives (AIAN) (80.56%, 61.45%, and 61.45%). We conclude that there are significant racial disparities in the incidence, epidemiology, and survival of KS.

Clinical characteristics and outcomes of extrapulmonary small cell cancer: A retrospective analysis of the SEER database.

e20616 Background: Extrapulmonary small cell cancer (EPSCC) accounts for only 5-10% of small cell carcinoma, with the rest consisting of small cell lung cancer (SCLC). The incidence of this entity has been rising due to better diagnosis, however it is not well described and data is limited. We performed a Surveillance, Epidemiology and End Results (SEER) database analysis to further characterize the biology and clinical aspects of this entity, in comparison to SCLC. Methods: The Surveillance, Epidemiology and End Results (SEER) 18 database was used to obtain data on age, gender, ethnicity, survival, and tumor characteristics of n = 9,712 US patients diagnosed with EPSCC between 2000-2018 and these were compared to n = 118,514 patients with SCLC diagnosed during the same period. Results: Among the EPSCC cohort 58.1 % were males while in the SCLC cohort 50.3% were males. Median age of diagnosis was 65.50 years for EPSCC and 66.81years for SCLC. Among the EPSCC patients, 75.9 % were Caucasians, 9.2 % were African-Americans, and 8.8% were Hispanics. Amongst SCLC patients, Caucasians made up 83.1% of the patients, while African-Americans made up 8.6% and Hispanics made up 4.5 % of the patients. Most common sites for EPSCC were urinary bladder (20.2%), prostate (7%), cervix uteri (6.2%), pancreas (4.5%), rectum (3%), and ovaries (2.6%). Median OS for EPSCC was 8 months (95% CI: 8 - 8), while median overall survival for SCLC was 7 month (95% CI: 7 - 7). Hazard ratio for death for EPSCC: 0.77 (95% CI: 0.75 - 0.79), p &lt; 0.001. The survival at 12 months, 24 months and 60 months was 36%, 22%, and 13 % for EPSCC and 29%, 13%, and 5% for SCLC. There were no significant gender or racial differences in overall survival (OS). Conclusions: EPSCC has better overall and 5-year survival as compared to SCLC. There are no significant differences in survival outcomes in EPSCC patients based on location of primary, gender or race.

Breast Reconstruction Does Not Affect the Survival of Patients with Breast Cancer Located in the Central and Nipple Portion: A Surveillance, Epidemiology, and End Results Database Analysis.

BackgroundTumors in the central and nipple portion (TCNP) are associated with poor prognosis and aggressive clinicopathological characteristics. The availability and safety of postmastectomy reconstruction in breast cancer patients with TCNP have still not been deeply explored. It is necessary to investigate whether reconstruction is appropriate for TCNP compared with non-reconstruction therapy in terms of survival outcomes.MethodsUsing the Surveillance, Epidemiology, and End Results (SEER) database, we enrolled TCNP patients diagnosed between the years 2010 and 2016. The propensity score matching (PSM) technique was applied to construct a matched sample consisting of pairs of non-reconstruction and reconstruction groups. Survival analysis was performed with the Kaplan–Meier method. Univariate and multivariate Cox proportional hazard models were applied to estimate the factors associated with breast cancer-specific survival (BCSS) and overall survival (OS).ResultsIn the overall cohort, a total of 6,002 patients were enrolled. The patients in the reconstruction group showed significantly better BCSS (log-rank, p < 0.01) and OS (log-rank, p < 0.01) than those in the non-reconstruction group (832 patients) after PSM. However, the multivariate Cox regression model revealed that breast reconstruction was not associated with worse BCSS and OS of TCNP patients.ConclusionOur study provided a new perspective showing that breast reconstruction did not affect the survival and disease prognosis in the cohort of TCNP patients from SEER databases, compared with non-reconstruction. This finding provides further survival evidence supporting the practice of postmastectomy reconstruction for suitable TCNP patients, especially those with a strong willingness for breast reconstruction.

Comparison of Typical Prostate Adenocarcinoma and Rare Histological Variant Prostate Cancer Showed Different Characteristics and Prognosis: A Surveillance, Epidemiology, and End Results Database Analysis

There are currently few large-scale studies describing the clinical characteristics of these histological variants of prostate cancer (PCa) and the prognostic results of these patients. Thus, we used the Surveillance, Epidemiology, and End Results (SEER) database to achieve a more comprehensive understanding of the current prevalence and prognosis of these histological variants. A total of 780 (3.3%) patients with histological variants and 235834 patients with typical adenocarcinoma were included in the present study. The variants group presented with a more advanced stage than the typical adenocarcinoma group. The results also showed that patients with neuroendocrine (NE) PCa were more likely to have visceral metastases. In prognostic comparison, we found that variants, except for mucinous, had a worse prognosis than typical adenocarcinoma. Moreover, among these variants, we also discovered that NEPCa patients with low prostate-specific antigen level had the worst survival. In contrast, mucinous PCa had similar overall survival to typical adenocarcinoma. Patient summaryWe reported follow-up results for prostate cancer (PCa) patients from the Surveillance, Epidemiology, and End Results database (2004–2016). We focused on the prognosis of PCa with different histological variants and evaluated the risk factors that were significant in predicting poor prognosis. We suggested that neuroendocrine PCa patients should receive active treatment as soon as possible to improve their prognosis. We still need further studies to identify the role of mucinous PCa in patients’ prognosis compared with typical adenocarcinoma.