End Results Program Research Articles

Primary diffuse large B-cell lymphoma of bone in adults: A SEER population-based study.

Primary diffuse large B-cell lymphoma of the bone (PB-DLBCL) is an extremely rare type of extra-nodal lymphoma. The clinical characteristics, management, and survival outcomes of adult PB-DLBCL patients remain poorly defined. To explore the clinical manifestations, staging, therapeutic options, prognostic factors and outcomes of adult patients with PB-DLBCL and to create a model to predict survival outcomes. Data of adult PB-DLBCL patients were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program 18 registries database from 2000 to 2018. The Kaplan-Meier survival analysis was conducted to calculate survival rates. Univariate Cox regression, best subset selection (BESS), and least absolute shrinkage and selection operator (LASSO), followed by backward stepwise multivariable Cox regression, were used to construct the nomogram. The nomograms were evaluated using the concordance index (C-index), calibration curves and decision curve analysis (DCA). Diffuse large B-cell lymphoma (DLBCL) (67.51%) was the most frequent type of primary bone lymphoma. The most involved sites were the spine and lower-limb long bones. For the whole cohort, the 3-, 5-, 10- and 15-year overall survival (OS) rates were 74.9%, 70.5%, 60.0%, and 49.9%, and corresponding disease-specific survival (DSS) rates were 79.7%, 77.8%, 75.1%, and 71.4%, respectively. For OS, age, Ann Arbor stage, primary site and therapy were confirmed as final factors to develop the nomogram in adult PB-DLBCL patients, whereas for DSS, Age, marital status, Ann Arbor stage, number of bone lesions, therapy and year of diagnosis were confirmed as final factors in developing the nomogram. The nomograms demonstrated good accuracy and clinical utility. Established nomograms can accurately predict the survival of patients with PB-DLBCL and help clinicians optimize treatment.

Pediatric non-nasopharyngeal head and neck squamous cell carcinoma: Analysis of the Surveillance, Epidemiology, and End Results (SEER) program with review of the literature

BackgroundDespite its prevalence in adults, head and neck squamous cell carcinoma (HNSCC) is considered a rare entity in pediatrics where lymphomas, neural tumors, and soft tissue sarcomas predominate in the head and neck. Given the association of squamous cell carcinoma with the human papillomavirus, a risk factor that may be present from birth, and the difficulties in staging this disease for prognostication in children, it is important to revisit nationally collected data for prevalence and outcomes assessments. ObjectiveTo examine a publicly available national database to describe the incidence, pathology, treatment, and survival of pediatric HNSCC. To review the available literature regarding management, outcomes, and risk factors for this disease process. MethodsThe National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor database was queried to identify pediatric subjects ages 0 to 19 diagnosed HNSCC between 1973 and 2019. ResultsTwo-hundred ninety-two cases were identified. Subjects were 62.7 % male (n = 183) and the average age was 15.4 years (range 2–19, median 16). Subjects were 65.8 % white (n = 192), 22.9 % black (n = 67), 8.9 % Asian/Pacific Islander (n = 26), 1 % American Indian (n = 3), and 1.4 % unknown (n = 4). The most common primary sites were nasopharynx (45.9 %), oral cavity (30.5 %), larynx (8.6 %), salivary gland (4.1 %), nasal cavity & paranasal sinus (3.4 %), and lip (2.7 %). There was no statistically significant difference between primary subsite and age, race, histologic grade, or extent of disease. The 5-year overall survival was 83.6 %. DiscussionHead and neck squamous cell carcinoma is more likely to present in older children and is more prevalent in White populations. The nasopharynx is the most common subsite involved, which differs from adult populations in which non-nasopharyngeal subsites including the larynx, oral cavity, and oropharynx are most frequently affected. ConclusionHead and neck squamous cell carcinoma is rare in pediatric patients but should not be overlooked by physicians in the differential diagnosis, particularly in teenagers. Further study is needed to determine whether this represents a unique entity or can be staged and treated according to adult guidelines.

Recovery From COVID-19–Related Disruptions in Cancer Detection

The COVID-19 pandemic impacted the timely diagnosis of cancer, which persisted as the second leading cause of death in the US throughout the pandemic. To evaluate the disruption and potential recovery in cancer detection during the first (2020) and second (2021) years of the COVID-19 pandemic. This cross-sectional study involved an epidemiologic analysis of nationally representative, population-based cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program. Included patients were diagnosed with incident cancer from January 1, 2000, through December 31, 2021. The analysis was conducted in May 2024 using the April 2024 SEER data release, which includes incidence data through December 31, 2021. Diagnosis of cancer during the first 2 years of the COVID-19 pandemic (2020, 2021). Difference between the expected and observed cancer incidence in 2020 compared with 2021, with additional analyses by demographic subgroups (sex, race and ethnicity, and age group) and community (county-level) characteristics. The analysis included 15 831 912 patients diagnosed with invasive cancer between 2000 and 2021, including 759 810 patients in 2020 and 825 645 in 2021. The median age was 65 years (IQR, 56-75 years), and 51.0% were male. The percentage difference between the expected and observed cancer incidence was -8.6% (95% CI, -9.1% to -8.1%) in 2020, with no significant difference in 2021 (-0.2%; 95% CI, -0.7% to 0.4%). These translated to a cumulative (2020-2021) deficit in observed vs expected cases of -127 931 (95% CI, -139 206 to -116 655). Subgroup analyses revealed that incidence rates remained substantially depressed from expected rates into 2021 for patients living in the most rural counties (-4.9%; 95% CI, -6.7% to -3.1%). The cancer sites with the largest cumulative deficit in observed vs expected cases included lung and bronchus (-24 940 cases; 95% CI, -28 936 to -20 944 cases), prostate (-14 104 cases; 95% CI, -27 472 to -736 cases), and melanoma (-10 274 cases; 95% CI, -12 825 to -7724 cases). This cross-sectional study of nationally representative registry data found that cancer incidence recovered meaningfully in 2021 following substantial disruptions in 2020. However, incidence rates need to recover further to address the substantial number of patients with undiagnosed cancer during the pandemic.

Prevalence of cancer survivors diagnosed during adolescence and young adulthood in the United States.

Adolescent and young adult (AYA) cancer incidence rates are rising, and survivors are at risk for numerous cancer- and treatment-related consequences. Despite growing attention to this population, prevalence estimates are lacking. To estimate the number of individuals living in the United States with a history of cancer diagnosed during the AYA period. Prevalence of cancer survivors diagnosed between the ages of 15 and 39 years was estimated using data from the Surveillance, Epidemiology, and End Results (SEER) program as of January 1, 2020. Limited duration prevalence data were also used to generate complete prevalence by sex, years since diagnosis (0-<1, 1-<5, 5-<10, 10-<15, 15-<20, 20+), and attained age (15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70+) for the 15 most common AYA cancer sites. There were an estimated 2,111,838 survivors of AYA cancers in the United States as of January 1, 2020. More survivors were female (66%) and long-term (>5 years from diagnosis, 83%) or very long-term survivors (>10 years from diagnosis, 68.8%). A large percentage (44%) were more than 20 years from diagnosis. The most common cancer sites among females were breast (24%) and thyroid cancers (23%) and, among males, testicular cancer (31%). Across the population, the highest percentage of survivors of AYA cancers were 40- to 49-years of age (25.3%). There are over 2.1 million cancer survivors diagnosed in the AYA period who are living in the United States; most are more than 10 years from diagnosis.

8061 Factors Affecting Survival of Metastatic Medullary Thyroid Cancer: A Population-Based Study From Surveillance, Epidemiology, and End Results (SEER) Program

Abstract Disclosure: A. Abdelhameed: None. H. Ibrahim: None. M. Mortagy: None. Introduction: Medullary thyroid cancer (MTC) arises from parafollicular cells of the thyroid. 43% of patients with MTC have metastasis. It was shown that the overall 5-year survival of patients with MTC is 40.4%. The clinical course of MTC is highly variable. The Aim is to identify factors affecting survival of the metastatic MTC sub-population. Understanding these factors is important in treating these patients. Methods 340 patients: with metastatic MTC who were diagnosed from 1975 to 2020 were extracted from SEER after removing duplicates and those not diagnosed by positive histology or cytology. Survival analysis was conducted, and Kaplan-Meier graph was generated. Univariate Cox regression was performed for all variables and respective hazard ratios (HR) were produced. Multivariable cox regression was performed for statistically significant variables. Results: The cohort were 59% males with a median age of 60 years. Median survival for the cohort was 20 months with survival of 63%, 41% and 31% at 1, 3, and 5 years respectively. Univariate Cox regression was statistically significant for age (HR 1.02), brain metastasis (HR 2.70), liver metastasis (1.65), lung metastasis (1.42), not performing total thyroidectomy (HR 2.77), lymph node ratio (HR 2.45), and systemic therapy after surgery (HR 0.34). Univariate Cox regression was not statistically significant for sex, grade, radiotherapy, chemotherapy, treatment delay, bone metastasis, distant lymph node metastasis, multifocal cancer, total number of benign and malignant tumors, race/ethnicity, income, tumor size and living in rural areas. Multivariable cox regression was done after inclusion of all significant variables from univariate Cox regression. It was only significant for age (HR 1.04), presence of lung metastasis (HR 1.91), and systemic therapy before surgery (HR 14.41). Conclusion: Increasing age, presence of lung metastasis and systemic therapy before surgery lead to worse prognosis in metastatic MTC. Gender, grade, radiotherapy, chemotherapy, treatment delay, bone or brain or liver metastasis, presence of multifocal cancer, race, tumor size and surgery don't affect survival according to multivariable cox regression. Future research is needed to study this group of patients. Presentation: 6/2/2024

Number of Resected Lymph Nodes and Survival Status in Node-Negative Esophageal Squamous Cell Carcinoma: A Cohort Study.

To explore the association between survival status and the number of resected lymph nodes in node-negative esophageal squamous cell carcinoma(ESCC) after surgical treatment. This was a retrospective observational cohort study and data were obtained from the Surveillance, Epidemiology, and End Results program (SEER) and TaiZhou hospital in China. The data for subjects with negative lymph nodes and no distant metastasis (pN0M0) after post-operative pathology were screened. The nonlinear relationship between resected lymph node number and survival status in node-negative ESCC was conducted using restricted cubic spline regression analysis. The association between the number of resected lymph nodes and survival status in node-negative ESCC was evaluated by Cox proportional hazards regression models. Subgroup analysis based on different subgroups was also performed. A total of 999 subjects were included in the study. Restricted cubic spline regression was used to show a U shaped association between the number of resected lymph nodes and survival status in node-negative ESCC, with low count associated with a decreased survival. To elucidate the association, we adjusted for age, sex, race, T stage, TNM (tumor node metastasis classification), location, grade, chemotherapy, and radiotherapy. As the resected lymph node number increased by one node, the survival status was improved by 2% (Hazard ratio(HR) = 0.98, 95% confidence interval (CI) 0.98-0.99). Sensitivity analysis indicate that the effect size and direction in different subgroups are consistent, the results is stability in SEER. A low count of resected lymph nodes correlated with reduced survival in patients with ESCC, where resecting 25 to 28 or more nodes is considered optimal. Larger prospective studies are warranted to confirm these findings.

Assessing racial and ethnic disparities in time to surgery for patients with oral cavity cancers.

109 Background: Despite advances, challenges remain in the early detection and management of oral cancers. Studies have indicated that worse outcomes can be linked to disparities in sex, race, and ethnicity. Research indicates that despite a greater incidence of oral cancer among White patients, the five-year survival rate for Black patients is 52%, compared to 70% for their counterparts (1). While existing research focuses on racial and ethnic disparities in the time to diagnosis and prognosis, there is limited literature that discusses disparities in time to treat. As such, our study aims to evaluate potential racial, ethnic, and/or gender disparities in the time between diagnosis and surgery. Methods: We conducted a retrospective cohort study evaluating 185 patients with oral cancer at the University of Miami. Patient information was obtained from electronic medical records. We performed analysis of variance (ANOVA) with post hoc tests. Levene's test was used to assess the homogeneity of variances assumption. All statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA), and p-values less than 0.05 were considered statistically significant. Results: The mean age at diagnosis was 68.50 years (SD =13.079 years), with the majority of patients (42%) diagnosed as Stage 1. Our cohort was 46% female and 54% male. 62% identified as White and Non-Hispanic/Latinx, 29% as White and Hispanic/Latinx, 6% as Black, and 3% as other race/ethnicities. We also assessed time to treat as a function of gender, race and ethnicity. We found there was no significant difference between men and women (x̄= 148 vs 136 days) in time to surgery. We also found no difference between Hispanic/Latinx patients and non Hispanic/Latinx patients (x̄= 163 vs 137 days). Although not statistically significant, there was a notable trend in the data that showed a longer time to surgery. Black patients had a much greater time to surgical intervention compared to White patients (x̄= 308 days vs 134 days) (Table). At the time of data cutoff, nearly 81% of patients were alive. Conclusions: In conclusion, despite lack of statistical significant, our study found higher trends to time to surgery between Hispanic/Latinx and non-Hispanic/Latinx, and even more so a much greater difference in time to surgery between Black and White patients. Further research is needed to elucidate these potential systematic, socio-economic or cultural barriers to ensure equitable access. 1. Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute. Days between diagnosis and surgery. Ethnicity Mean Standard Deviation N Black or African American 308.44 737.375 9 Other 20.33 .577 3 White 134.37 467.579 147 Total 142.08 481.112 159

Impact of household income on survival in solid malignancies with synchronous brain metastases: A population-based study.

142 Background: Solid malignancies presenting with brain metastasis at the initial diagnosis usually carry a poor prognosis. Increased incidence of brain metastasis can be attributed to the advancements in neuroimaging techniques and improvements in the treatment of solid malignancies. The role of socioeconomic factors in cancer survival is being increasingly recognized. In this study, we analyzed the effect of median household income on survival outcomes in patients diagnosed with brain metastasis at the time of diagnosis of primary malignancies from 2010 to 2020. Methods: We analyzed the Surveillance, Epidemiology, and End Results (SEER) Program 17 registry (November 2022 submission) database for four primary sites of cancers based on their high propensity to develop brain metastases- Lung and/or Bronchus, Breast, Kidney and/or Renal Pelvis, and Melanoma. Patients with a median household income (MHHI) greater than 75,000 per year were classified as a high-income group, whereas those less than 75,000 per year were low-income. Patients diagnosed with malignancy during autopsy or via death certificate and with incomplete data were excluded. Kaplan-Meier method was used for 2-year survival rates and overall survival analyses. Cox regression analysis was used to calculate hazard ratios (HR). Results: A total of 66493 patients were identified across the four primary sites of tumors. Lung and/or bronchus tumors comprised most of the cases (n = 58,324). 25337 patients were in the high-income group, and 41156 patients comprised the low-income group. Median survival in the low-income group was 4 months, and in the high-income group was 5 months, with a 2-year survival rate of 11% and 18% respectively. Patients in the high-income group had better survival outcomes than the low-income [HR:0.88, 95% CI:0.86-0.90, p&lt;0.001]. Additionally, the high-income group had 19% higher odds of receiving chemotherapy [OR:1.19, 95% CI:1.16-1.23, p&lt;0.0001]. Amongst the cancer subgroups, household income did not have a significant effect on survival in patients with kidney and/or renal pelvis tumors [HR:0.97, 95% CI:0.88-1.06, p=0.5]. The 2-year survival rates are outlined (Table). Conclusions: Our analysis highlights a modest improvement in survival in the patient population with higher median household income. This difference could be attributed to the greater accessibility to treatment modalities and other resources for patients with higher household incomes. Further studies are needed to address socioeconomic disparities in survival for patients with solid malignancies having synchronous brain metastases. 2-year survival rates (95% CI). Cancer Groups Low-income High-income Combined Cancers 11% (11-12%) 18% (18-19%) Lung and/or Bronchus 10% (10-11%) 17% (17-18%) Breast 27% (25-29%) 34% (31-37%) Melanoma 19% (17-21%) 23% (20-25%) Kidney and/or Renal Pelvis 15% (13-17%) 18% (15-21%)

Sex differences in survival outcomes of early-onset colorectal cancer

Colorectal cancer (CRC) is one of the most fatal cancers in the United States. Although the overall incidence and mortality rates are declining, an alarming rise in early-onset colorectal cancer (EOCRC), defined as CRC diagnosis in patients aged < 50 years, was previously reported. Our study focuses on analyzing sex-specific differences in survival among EOCRC patients and comparing sex-specific predictors of survival in both males and females in the United States. We retrieved and utilized data from the Surveillance, Epidemiology, and End Results (SEER) program. EOCRC patients, between the ages of 20 and 49, were exclusively included. We conducted thorough survival analyses using Kaplan–Meier curves, log-rank tests, Cox regression models, and propensity score matching to control for potential biases. Our study included 58,667 EOCRC patients (27,662 females, 31,005 males) diagnosed between 2000 and 2017. The baseline characteristics at the time of diagnosis were significantly heterogeneous between males and females. Males exhibited significantly worse overall survival (OS), cancer-specific survival (CSS), and noncancer-specific survival (NCSS) in comparison to females in both the general cohort, and the matched cohort. Predictors of survival outcomes generally followed a similar pattern in both sexes except for minor differences. In conclusion, we identified sex as an independent prognostic factor of EOCRC, suggesting disparities in survival between sexes. Further understanding of the epidemiological and genetic bases of these differences could facilitate targeted, personalized therapeutic approaches for EOCRC.

Comparative overall survival analysis of chordomas of the base of the skull from the Surveillance, Epidemiology, and End Results (SEER) program between 2000 and 2020

Chordomas of the skull base are rare, slow growing, locally invasive cancers with limited long-term survival analysis reported in the literature. We seek to provide comparative survival analysis of patients on a long-term (20-year) basis using population-level data. The Surveillance, Epidemiology, and End Results (SEER) program was queried for cases of chordoma relegated to the base of the skull, diagnosed between 2000 and 2020. Demographic, disease, and treatment information were analyzed using Cox proportional hazards and log-rank comparisons. 630 patients with chordoma of the skull base were identified. Age ≤ 49 years at diagnosis was associated with increased five-, 10-, and 20-year overall survival (hazard ratio (HR) = 0.39, 0.33, and 0.30, respectively; p < 0.001 for all). Treatment with surgery and adjuvant radiotherapy was associated with increased five-, 10-, and 20-year survival (HR = 0.71, 0.79, and 0.79, respectively; p < 0.001 for all). On univariate analysis, widowed patients had decreased survival (20-year overall survival = 34.8% [15.3%-34.8%] compared to married patients (74.4% [68.1%-80.8%]. Surgery remains the primary treatment associated with increased survival among patients with chordoma of the skull base, with adjuvant radiotherapy serving a complimentary role. Demographic factors such as marital status are also associated with changes in survival.

Comparing the prognosis of esophageal adenocarcinoma with bone and liver metastases: A competing risk analysis.

About half of the patients with esophageal cancer are presenting with metastasis at initial diagnosis. However, few studies have concerned on the prognostic factors of metastatic esophageal adenocarcinoma (mEAC). This research aimed to investigate the effects of single bone metastasis (BM) and single liver metastasis (LM) on prognosis of mEAC patients. Data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program database. We compared the effects of LM and BM on overall survival (OS), EAC-specific survival (CSS), and EAC-specific death (EASD) by multivariate Cox regression, Kaplan-Meier analysis, and competing risk regression models. A total of 1,278 EAC patients were recruited in this study. Of which 78.95% (1009/1278) were EASD, and 12.68% (162/1278) were non-EAC-specific death (non-EASD). In multivariate Cox regression analysis, surgery, chemotherapy, and AJCC.T2 (vs. T1) were identified as protective factors for OS&CSS, while divorced/separated, single/unmarried (vs. married), grade III-IV (vs. grade I-II) and BM (vs. LM) were identified as risk factors. Competing risk regression analysis further confirmed that surgery and chemotherapy were beneficial to the patients with mEAC, and BM (vs. LM) was a risk factor for mEAC patients when considering the existence of the competitive risk events. Our study indicated that mEAC patients with BM face a worse prognosis compared to those with LM. Additionally, surgery and chemotherapy emerge as protective factors for mEAC patients. These findings offer evidence-based insights for clinical management and contribute to the field.

Impact of COVID-19 on 2021 cancer incidence rates and potential rebound from 2020 decline.

The COVID-19 pandemic led to substantial declines in cancer incidence rates in 2020, likely because of disruptions in screening and diagnostic services. This study aimed to assess the impact of the pandemic on cancer incidence rates in the United States using 2021 incidence data from the Surveillance, Epidemiology, and End Results program. The analysis compared observed 2021 cancer incidence rates with expected prepandemic trends, evaluating changes by individual cancer site and stage. Although incidence overall and in many cancer sites the rates were close to prepandemic levels, they did not exhibit a recovery that incorporated the delayed diagnoses from 2020. There were exceptions, however, such as metastatic breast cancer, which showed significantly higher observed rates than expected (rate ratio = 1.09, 95% confidence interval = 1.04 to 1.13). Ongoing monitoring and targeted interventions are needed to address the long-term consequences of the COVID-19 pandemic on cancer care and outcomes.

Abstract B166: Impact of rurality on early-onset colorectal cancer outcomes: Age, geographic disparities, and the need for improved access and awareness in the United States

Abstract BACKGROUND: While overall colorectal cancer (CRC) rates have stabilized or declined in the United States (U.S.), early-onset CRC (EO-CRC), diagnoses before age 50, has increased. Rural U.S. residents face a higher CRC incidence (43.9 vs. 40.1 per 100,000) than urban residents. CRC mortality, once highest in the Northeast, is now most prevalent in the South and Midwest, particularly among Non-Hispanic Black populations. This geographic shift is also evident in EO-CRC. Existing literature lacks comprehensive analysis on the influence of rurality and age at CRC diagnosis. In this study, we sought to elucidate the relationships between age at diagnosis with CRC outcomes, while examining the moderating role of rurality. Methods: We used data from the 2006-2020 Surveillance, Epidemiology, and End Results (SEER) Program. Rurality was defined using census tract level U.S. Department of Agriculture (USDA)’s 2010 Rural Urban Commuting Area (RUCA) codes: rural (codes 8, 9, 10) and urban (all other listed codes). We conducted multilevel regression modeling (logistic and Cox proportional hazards) to examine the associations between age at diagnosis, rurality, and CRC outcomes (late-stage diagnosis and survival), adjusting for race, marital status, sex, and year of diagnosis. Results: We identified 835,907 patients aged 20-79 from the 2006-2020 SEER program. Most patients lived in urban areas (86%), were non-Hispanic white (66%), and married (41%). After adjusting for marital status, race, sex, and diagnosis year, we found that patients aged 30-39 (aOR: 1.49, 95% CI: 1.44–1.55) and 40-49 (aOR: 1.43, 95% CI: 1.39–1.46) had over a 40% increased likelihood of late-stage CRC compared to patients aged 50-59. Urban patients aged 30-39 had a 52% higher likelihood of late-stage CRC (aOR: 1.52, 95% CI: 1.46–1.58). Patients aged 20-29 (aOR: 0.81, 95% CI: 0.77–0.86) had a reduced risk of CRC death compared to those aged 50-59. Conversely, patients aged 40-49 (aOR: 1.09, 95% CI: 1.07–1.11), 60-69 (aOR: 1.16, 95% CI: 1.14–1.17), and 70-79 (aOR: 1.39, 95% CI: 1.28–1.36) had increased risks of CRC death compared to patients aged 50-59. Rural patients aged 20-29 (aOR: 0.79, 95% CI: 0.68–0.94) and 30-39 (aOR: 0.95, 95% CI: 0.87–1.03) had a reduced risk of CRC death compared to rural patients aged 50-59. Conclusion: We observed that patients aged 30-49 were more likely to be diagnosed with late- stage CRC compared to those aged 50-59, particularly in urban areas. To reduce the burden of EO-CRC and prevent advanced-stage diagnoses in young adults, it is essential to enhance access to care and raise awareness of CRC symptoms among younger Americans. Future research should explore urban -rural barriers to healthcare access, including the role of healthcare infrastructure, transportation, and provider availability, to develop strategies for improving EO-CRC early detection and treatment outcomes. Citation Format: Meng-Han Tsai, Justin X. Moore, Caitlyn Grunert. Impact of rurality on early-onset colorectal cancer outcomes: Age, geographic disparities, and the need for improved access and awareness in the United States [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B166.

Survival prediction in sigmoid colon cancer patients with liver metastasis: a prospective cohort study.

Sigmoid colon cancer is a common type of colorectal cancer, frequently leading to liver metastasis. Predicting cause-specific survival and overall survival in patients with sigmoid colon cancer metastasis to liver is challenging because of the lack of suitable models. Patients with sigmoid colon cancer metastasis to liver (2010-2017) in the Surveillance, Epidemiology, and End Results (SEER) Program were recruited. Patients were split into training and validation groups (7:3). Prognostic factors were identified using competing risk and Cox proportional hazards models, and nomograms for cause-specific survival and overall survival were developed. Model performance was evaluated with the concordance index and calibration curves, with a 2-sided P value less than .05 considered statistically significant. A total of 4981 sigmoid colon cancer with liver metastasis patients were included, with a median follow-up of 20 months (interquartile range [IQR] = 9-33 months). During follow-up, 72.25% of patients died (68.44% from sigmoid colon cancer, 3.81% from other causes). Age, race, grade, T stage, N stage, surgery, chemotherapy, carcinoembryonic antigen, tumor deposits, lung metastasis, and tumor size were prognostic factors for cause-specific survival and overall survival. The models demonstrated good discrimination and calibration performance, with C index values of 0.79 (95% confidence interval [CI] = 0.78 to 0.80) for cause-specific survival and 0.74 (95% CI = 0.73 to 0.75) for overall survival. A web-based application for real-time cause-specific survival predictions was created, accessible at https://shuaishao.shinyapps.io/SCCLM/. Prognostic factors for sigmoid colon cancer with liver metastasis patients were identified based on the SEER database, and nomograms for cause-specific survival and overall survival showed good performance. A web-based application was developed to predict sigmoid colon cancer with liver metastasis-specific survival, aiding in survival risk stratification.

Racial/ethnic disparities in all-cause and cause-specific death among children with malignant central nervous system tumours: a registry-based cohort retrospective analysis

It is generally recognized that there is unequal mortality in childhood central nervous system (CNS) malignancy in the United States (US), but little is known about the trends and contributors of racial/ethnic disparities in death. We assessed the trends of racial/ethnic disparities in all-cause and cause-specific death, and the contributions of tumour, treatment and socioeconomic factors to this disparity. This registry-based cohort study included children (aged ≤19 years) diagnosed with malignant CNS tumours, using data from the US population-based cancer registry in the Surveillance, Epidemiology, and End Results (SEER) Program. The clinical outcomes were all-cause and cause-specific death for each racial/ethnic group (White, Black, Hispanic, non-Hispanic Asian/Pacific Islander [API], and non-Hispanic American Indian/Alaska Native [AI/AN] children). We quantified absolute disparities using absolute rate difference in 5-year cumulative incidence of death. Cox proportion risk models were used to estimate the relative racial/ethnic disparities, and the contribution of factors to disparities in death. In this study, data from 14,510 children with malignant CNS tumours (mean [SD] age, 8.5 [5.7]; 7988 [55.1%] male) were analysed. Overall, the cumulative incidence of death from CNS tumours across four racial/ethnic groups decreased from 2001 to 2020. Black patients had the highest risk of death from all causes and CNS tumours between 2001 and 2020, with adjusted hazard ratios (HR) of 1.52 (1.38-1.68) and 1.47 (1.31-1.64), respectively. The absolute disparity in all-cause death between Hispanic and White patients increased slightly (from 8.2 percentage points [ppt] to 9.4ppt), and the relative disparity in death from CNS tumours increased from 1.33 (1.15-1.55) in 2001-2005 to 1.78 (1.44-2.20) in 2016-2020. The absolute disparities in death from CNS tumours between Black and White patients (from 11.8ppt to 4.3ppt) and between API and White patients (from 10.1ppt to 5.1ppt) decreased from 2001-2005 to 2011-2015. Race/ethnicity disparities in death from CNS tumours among childhood malignant CNS tumours had reduced from 2001 to 2020, and quantifying the contribution of factors to this disparity in death could provide a basis for decreasing mortality among racial/ethnic minority patients. Shenyang Young and Middle-aged Science and Technology Innovation Talent Support Program.

The benefit of adjuvant chemotherapy in pathological T1-3N0M0 rectal mucinous adenocarcinoma: no improvement survival outcomes based on long-term survival analysis of large population data.

Currently, the benefits of the administration of adjuvant chemotherapy (AT) in pathological low-risk rectal mucinous adenocarcinoma (RM) with T1-3N0M0 are unclear. The objective of this study is to retrospectively investigate the clinical significance of AT in terms of survival outcomes for patients with pathological T1-3N0M0 RM using data from a large population. The patient data were collected from the Surveillance, Epidemiology, and End Results (SEER) Program. The Chi-squared test was used to analyze categorical variables. The survival curves were compared using the log-rank test and the Kaplan-Meier method. A multivariate proportional hazards regression (Cox) model was applied to identify the independent prognostic factors of survival outcomes. Propensity score matching (PSM) was utilized to eliminate the differences between groups and estimate AT's effect. The median follow-up duration for the rectal cancer (RC) cohort was 116 months. Multivariate analyses revealed that RM was a significant adverse prognostic factor, correlating with poorer overall survival (OS) and cancer-specific survival (CSS) for RC [hazard ratio (HR): 1.226, 95% confidence interval (CI): 1.094-1.375, P<0.001; HR: 1.446, 95% CI: 1.242-1.683, P<0.001]. Among patients with RM, the rates of 5-year OS and CSS were 68.6% and 79.3% in the AT (-) group, respectively. Additionally, the AT (+) group exhibited similar rates of 65.6% for 5-year OS and 74% for CSS (P=0.80, P=0.26). Subtype analysis according to preoperative therapy status showed that AT also did not significantly affect survival outcomes (P=0.65, P=0.34; P=0.90, P=0.76). Our study found that RM is a poor prognostic factor in pathological T1-3N0M0 RC. However, AT does not appear necessary to improve survival outcomes of pathological T1-3N0M0 RM.

The Role of Socioeconomic Status in Patients With Cutaneous Melanoma of the Head and Neck.

To determine the effects of socioeconomic status (SES) on cutaneous melanoma of the head and neck. Surveillance Epidemiology and End Results (SEER) Program. We conducted a retrospective analysis of patients diagnosed with cutaneous melanoma of the head and neck from 2006 to 2018, utilizing population-based data including socioeconomic status (SES) assessed by the US-based Yost quintile index. SES quintiles ranged from Group 1 (lowest) to Group 5 (highest). We examined disease severity at diagnosis (stage, Breslow thickness, and spread) and survival outcomes (overall survival, cause-specific survival) to assess the impact of SES. A total of 53,967 melanomas of the head and neck were identified (14,146 females; 39,821 males; 51,890 white; 125 black; 317 other). Group 1 patients had a significantly higher percentage of end-stage disease (stage IV) at diagnosis (n = 101; 3.2% vs. n = 280; 1.9%, respectively) (p < .001), increased Breslow thickness (.80 mm vs .60 mm, respectively) (p < .001), and higher percentage of distant disease (n = 152; 3.6% vs. n = 431; 2.1%, respectively) (p < .001). Group 1 patients experienced a higher death rate from melanoma than group 5 patients (n = 585; 14% vs n = 1,753; 8.6%). Survival increased with SES. When evaluating cutaneous melanoma of the head and neck, low SES is related to more severe disease at diagnosis and worse survival outcomes. Addressing the underlying causes of this relationship could lead to more equitable management and survival outcomes. III Laryngoscope, 2024.

Cardiovascular death risk in patients with solid tumors: a population-based study in the United States.

Previous studies have focused on the risk of cardiovascular disease (CVD)-specific death in hematological cancers and in some single anatomical tumor sites, there remains a paucity of data on systematic analyses in solid tumors. The objective of this study is to evaluate the distribution, risk, and trends of CVD-specific death in patients with solid tumors. A total of 2 679 293 patients with solid tumors diagnosed between 1975 and 2019 were screened from the Surveillance, Epidemiology and End Results (SEER) program across 15 anatomical sites. Standardized mortality ratios (SMRs) and absolute excess risks (AERs) were used to describe the intensity of CVD-specific death, competing risk regression models were used to assess the risk of CVD-specific death, and restricted cubic spline analyses were employed to investigate the potential linear or nonlinear relationship between age and CVD death. CVD-specific death in patients with solid tumors accounted for 48.95% of non-cancer deaths. Compared with the general population, patients with solid tumors had higher SMR and AER of CVD death (SMR: 1.15; AER: 21.12), heart disease-related death (SMR: 1.13; AER: 13.96), and cerebrovascular disease-related death (SMR: 1.20; AER: 4.85). Additionally, the SMR exhibited a decreasing trend with increasing time to diagnosis. Furthermore, a nonlinear relationship was observed between age and CVD-specific death in patients with solid tumors of different systems. CVD-specific death accounted for a large proportion of the cause of non-cancer deaths. Patients with solid tumors exhibit an elevated risk of CVD-specific death. Screening for CVD death and optimizing risk management in patients with solid tumors throughout anticancer treatment may be beneficial in preventing CVD death.

Disparities in pediatric parotid cancer treatment and presentation: A National study

ObjectivesAlthough parotid gland malignancies are uncommon, they nevertheless represent a cause of morbidity and mortality in the pediatric population. Few studies have sought to identify disparities related to their presentation, treatment, and survival. There is a need to understand these variations to improve care for historically underrepresented groups. Study designRetrospective Cohort Study. SettingSurveillance, Epidemiology, and End Results (SEER) Program Database. MethodsAnalysis of pediatric patients with parotid gland malignancies between 2000 and 2019. Race and ethnicity were classified as Non-Hispanic White, Non-Hispanic Black, Asian, and Hispanic for multivariable analysis. Outcomes included tumor size and stage at diagnosis, survival, and need for facial nerve sacrifice. Kaplan-Meier analysis was used to analyze survival. Multivariable logistic regression was conducted to identify predictors of outcomes. Results149 patients met the criteria for inclusion. Stratified by race/ethnicity, Non-Hispanic Black (Median 23 mm, IQR 15–33), Asian (30 mm, 14–32), and Hispanic (23 mm, 20–28) patients had larger tumors at presentation than Non-Hispanic White patients (18 mm, 12–25, p = 0.017). Disease-specific survival differed by time-to-treatment (log-rank, p = 0.01) and overall survival differed by income (p < 0.001). On multivariable analysis, Hispanic patients were more likely to experience facial nerve sacrifice (OR 3.71, 95%CI 1.25–11.6, p = 0.020), and Non-Hispanic Black (OR 3.37, 0.95–11.6, = 0.053) and Asian (OR 5.67, 1.46–22.2, p = 0.011) patients presented with larger tumors compared to Non-Hispanic White patients. ConclusionsVariations in presentation and treatment exist across race and ethnicity in pediatric parotid cancer. Identifying these disparities may help improve access and outcomes for underserved patient populations. Level of evidenceIII.

Stage IC grade 1 endometrioid adenocarcinoma of the ovary: assessment of post-operative chemotherapy de-escalation

ObjectiveGiven limited real-world practice data evaluating the National Comprehensive Cancer Network clinical practice guidelines for possible post-operative chemotherapy omission as a treatment option for patients with stage IC grade 1...