End Results Registry Research Articles

Lung Large Cell Neuroendocrine Carcinoma: A Population-Based Retrospective Cohort Study.

Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rarely high-grade neuroendocrine carcinoma of the lung with features of both small cell and non-small cell lung cancer. In this study, we aim to construct a prognostic nomogram that integrates the clinical features and treatment options to predict disease-specific survival (DSS). A total of 713 patients diagnosed with LCNEC were from the US National Cancer Institute's Surveillance Epidemiology and End Results (SEER) registry between 2010-2016. Cox proportional hazards analysis was conducted to choose the significant predictors of DSS. External validation was performed using 77 patients with LCNEC in the West China Hospital Sichuan University between 2010-2018. The predictive accuracy and discriminative capability were estimated by the concordance index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. The clinical applicability of the nomogram was verified through the decision curve analysis (DCA). Additionally, we conducted a subgroup analysis of data available in the external cohort that may impact prognosis but was not recorded in the SEER database. Six independent risk factors for DSS were identified and integrated into the nomogram. The nomogram achieved good C- indexes of 0.803 and 0.767 in the training and validation group, respectively. Moreover, the calibration curves for the probability of survival showed good agreement between prediction by nomogram and actual observation in 1-, 3- and 5-year DSS. The ROC curves demonstrated the prediction accuracy of the established nomogram (all Area Under Curve (AUC) > 0.8). DCA exhibited the favorable clinical applicability of the nomogram in the prediction of LCNEC survival. A risk classification system was built which could perfectly classify LCNEC patients into high-, medium- and low-risk groups (p < 0.001). The survival analysis conducted on the West China Hospital cohort indicated that whole brain radiation therapy (WBRT), prophylactic cranial irradiation (PCI), surgical procedures, tumor grade, Ki-67, and PD-L1 expression were not significantly associated with DSS. This study has effectively developed a prognostic nomogram and a corresponding risk stratification system, which demonstrate promising potential for predicting the DSS of patients with LCNEC.

Differences in racial/ethnic disparities in patient care experiences between prostate cancer survivors and males without cancer: A SEER-CAHPS study

IntroductionOur purpose was to evaluate whether racial/ethnic disparities in patient care experiences (PCEs) differ between males with prostate cancer (“PCa group”) and males without cancer (“non-cancer group”). Materials and MethodsThis retrospective study used 2007-2015 National Cancer Institute's Surveillance, Epidemiology and End Results registry data linked to Consumer Assessment of Healthcare Providers and Systems surveys. PCa and non-cancer groups were propensity score matched 1:5 on demographic and clinical characteristics. Differences in racial/ethnic disparities (DRD) (non-Hispanic Black [NHB], Hispanic, non-Hispanic Asian [NHA], and Other Races compared to non-Hispanic White [NHW]) in PCEs (getting needed care, getting care quickly, doctor communication, customer service, and getting needed prescription drugs) were compared between matched PCa and non-cancer groups. Per prior literature, DRD in PCE scores were categorized as small (<3), medium (≥3 but <5) or large (≥5). ResultsThere were 7312 males in the PCa group and 36,559 matched males in the non-cancer group. Within each group, all racial/ethnic minority categories reported worse scores compared to NHW individuals (p < 0.05) for ≥3 PCE composite measures. Compared to PCa group, a larger NHA-NHW difference was observed in non-cancer group for getting needed care (−4.65 in PCa vs. −7.77 in non-cancer; DRD = 3.11, p = 0.029) and doctor communication (−2.46 in PCa vs. −4.85 in non-cancer; DRD = 2.38, p = 0.023). DiscussionIn both PCa and non-cancer groups, racial/ethnic minorities reported worse experiences compared to NHW individuals for several PCE measures. However, the difference in getting needed care and doctor communication between NHA and NHW individuals were more pronounced in non-cancer group than PCa group.

Germline Genetic Testing After Cancer Diagnosis

Germline genetic testing is recommended by practice guidelines for patients diagnosed with cancer to enable genetically targeted treatment and identify relatives who may benefit from personalized cancer screening and prevention. To describe the prevalence of germline genetic testing among patients diagnosed with cancer in California and Georgia between 2013 and 2019. Observational study including patients aged 20 years or older who had been diagnosed with any type of cancer between January 1, 2013, and March 31, 2019, that was reported to statewide Surveillance, Epidemiology, and End Results registries in California and Georgia. These patients were linked to genetic testing results from 4 laboratories that performed most germline testing for California and Georgia. The primary outcome was germline genetic testing within 2 years of a cancer diagnosis. Testing trends were analyzed with logistic regression modeling. The results of sequencing each gene, including variants associated with increased cancer risk (pathogenic results) and variants whose cancer risk association was unknown (uncertain results), were evaluated. The genes were categorized according to their primary cancer association, including breast or ovarian, gastrointestinal, and other, and whether practice guidelines recommended germline testing. Among 1 369 602 patients diagnosed with cancer between 2013 and 2019 in California and Georgia, 93 052 (6.8%) underwent germline testing through March 31, 2021. The proportion of patients tested varied by cancer type: male breast (50%), ovarian (38.6%), female breast (26%), multiple (7.5%), endometrial (6.4%), pancreatic (5.6%), colorectal (5.6%), prostate (1.1%), and lung (0.3%). In a logistic regression model, compared with the 31% (95% CI, 30%-31%) of non-Hispanic White patients with male breast cancer, female breast cancer, or ovarian cancer who underwent testing, patients of other races and ethnicities underwent testing less often: 22% (95% CI, 21%-22%) of Asian patients, 25% (95% CI, 24%-25%) of Black patients, and 23% (95% CI, 23%-23%) of Hispanic patients (P < .001 using the χ2 test). Of all pathogenic results, 67.5% to 94.9% of variants were identified in genes for which practice guidelines recommend testing and 68.3% to 83.8% of variants were identified in genes associated with the diagnosed cancer type. Among patients diagnosed with cancer in California and Georgia between 2013 and 2019, only 6.8% underwent germline genetic testing. Compared with non-Hispanic White patients, rates of testing were lower among Asian, Black, and Hispanic patients.

Racial and ethnic disparities in survival among persons with subsequent primary cancer.

12093 Background: Racial and ethnic disparities in survival after first primary cancer diagnoses have been well documented. Yet comprehensive data for disparities after subsequent primary cancer (SPC) are lacking despite the growing burden of SPCs. Methods: This study included 230,370 persons diagnosed with one of the 13 common SPCs at ages≥20 years during 2000-2013 in 18 Surveillance, Epidemiology, and End Results registries. Cause-specific proportional hazards models were used to estimate HR (hazard ratio), overall and stratified by SPC types, comparing the risk of cancer or cardiovascular death in Hispanic, non-Hispanic Asian or Pacific Islander (API), or non-Hispanic Black (Black) persons to that in non-Hispanic White (White) persons. HRs were adjusted for sex, first primary cancer type and stage, age and year of SPC diagnosis (base model); and additionally household income, urbanicity, SPC stage, subtype, and treatment receipt (surgery, radiotherapy, chemotherapy) (final model). Results: During 54 months of median follow-up, 109,757 cancer deaths and 18,283 cardiovascular deaths occurred among persons with SPCs. Overall, HRs for cancer death were higher among Black (HR = 1.21, 95% CI = 1.18-1.23) and Hispanic (HR = 1.10, 95% CI = 1.07-1.13) persons compared with White persons, but lower among API persons (HR = 0.93, 95% CI = 0.90-0.96) in the base model. When stratified by SPC types, the increased HRs were evident for 10 of 13 cancers among Black persons with the greatest HR among those with uterine corpus cancer (HR = 1.87, 95%CI = 1.63-2.15) and for 7 of 13 cancers among Hispanic persons with the highest HR among those with melanoma (HR = 1.46, 95%CI = 1.21-1.76). For cardiovascular death, compared with White persons, the overall HR was higher among Black (HR = 1.42, 95% CI = 1.35-1.49) persons but lower among API (HR = 0.75, 95%CI = 0.69-0.81) and Hispanic (HR = 0.90, 95% CI = 0.84-0.96) persons. The risk of cardiovascular death was higher for 11 of 13 cancers among Black persons with the greatest HR among those with pancreatic (HR = 1.80, 95%CI = 1.17-2.75), thyroid (HR = 1.70, 95%CI = 1.12-2.57), and kidney (HR = 1.63, 95%CI = 1.38-1.93) cancers. Additional adjustments in the final model reduced the elevated HRs substantially especially for cancer death among Black or Hispanic persons, although the associations remained statistically significant for most cancers. Conclusions: Among persons with SPCs, Black persons had a higher risk of death from both cancer and cardiovascular disease, whereas Hispanic persons had a higher risk of death from cancer. Adjusting for differences in potentially modifiable factors attenuated the associations substantially, highlighting opportunities for interventions toward health equities among cancer survivors.

Clinical characteristics of interval breast cancer within 12 months and 13-24 months in Utah.

10531 Background: A breast cancer (BC) that emerges following a negative/benign screening mammogram (SMG) but before the next expected SMG is referred to as an interval breast cancer (IBC). Current guidelines vary in the recommended frequency of SMG: some guidelines support SMG every 12 months, others every 24 months, and many adapt the 12- or 24-month recommendation by age. This study compared the clinical characteristics of IBC that developed within a 3-12 month interval (12m IBC) and a 13-24 month interval (24m IBC) in a statewide population. Methods: This is a retrospective cohort study using demographic/medical records in the Utah Population Database linked to the Utah Cancer Registry, a Surveillance, Epidemiology, and End Results (SEER) registry. Index SMG refers to the SMG just prior to a diagnostic mammogram or other clinical encounter, which led to a BC diagnosis before the next, expected SMG. Women ages ≥38y who underwent SMG during 2005-2019 at Intermountain Healthcare and University of Utah Health, had no history of BC prior to first SMG, and had BI-RADS assessment of normal or benign finding at index SMG were included. Clinical characteristics of 12m IBC and 24m IBC were compared using multivariable logistic regression to provide odds ratio estimates with covariate adjustment for age at diagnosis, stage, tumor size, grade, histology, biomarkers, breast density, body mass index, family history of breast cancer, and age at first birth. Women who developed IBC during the 3-12 month interval were not counted in the 24m IBC group. Results: A total of 7776 BC were observed in this study, among which 2122 were IBC; 486 (6.3%) 12m IBC and 1636 (21.0%) 24m IBC. Women with 12m IBC and 24m IBC had similar rates of a first-degree family history of breast cancer (16% and 17%, respectively). Women 70 and older were the least likely to develop IBC in 12 months as compared to 24 months (OR 2.34, 95% CI: 1.61-3.40, p&lt; 0.01). The odds of having axillary lymph node metastases (regional disease) at the time of BC diagnosis was higher among 12m IBC than 24m IBC (OR 1.68, 95% CI: 1.29-2.19, p&lt; 0.01). A total of 41 women with IBC had distant metastatic disease at the time of diagnosis (5% 12m IBC, 1% 24m IBC). Among those, the odds that metastatic IBC would be a 12m IBC were significantly higher than 24m IBC (OR = 4.07, CI 2.03-8.29, p&lt; 0.01). The 12m IBC group was more likely to be HER2 positive (OR 2.10, 95% CI: 1.36-3.22, p&lt; 0.01) or triple negative (OR 2.08, 95% CI: 1.26-3.39, p&lt; 0.01) than the 24m IBC group. Extremely dense breast tissue at SMG increased the odds of developing 12m IBC compared to 24m IBC (OR 2.05, 95% CI: 1.13-3.80, p&lt; 0.01). Conclusions: Compared to 24m IBC, 12m IBC appeared to be more advanced and aggressive. Women with Extremely dense breast tissue were more likely to develop 12m IBC than 24m IBC. These results suggest that women with extremely dense breast tissue or age &lt; 70y may benefit from annual SMG instead of biennial SMG.

Comparison of diversity across real-world evidence, randomized clinical trial, and Surveillance, Epidemiology, and End Results (SEER) data in patients with metastatic breast cancer.

e18670 Background: Compared with patients in typical care settings, participants in randomized clinical trials (RCTs) tend to be younger and less diverse. We compared representation of age, race, and ethnicity at initiation of first-line (1L) therapy for metastatic breast cancer across real-world evidence (RWE), RCT, and Surveillance, Epidemiology, and End Results (SEER) registry data. Methods: RWE and SEER inclusion criteria were based on corresponding RCTs. We compared age, race, and ethnicity at initiation of 1L therapy among female patients with metastatic breast cancer across 2 RWE chart review studies (completed between 2019-2021), 4 RCTs with similar eligibility (reported between 2014–2021), and the latest SEER registry data (2017–2019) using t-tests and 2-sided chi-square tests. Results: We collected demographics of 57,479 patients (RWE: n = 860, 1.5%; RCT: n = 2,707, 4.7%; SEER: n = 53,912, 93.8%). Mean age at 1L therapy initiation was significantly higher in RWE than RCT studies (61.8 vs 56.0 years) and representation of Black patients was significantly higher in RWE than RCT studies (25.3% vs 2.9%), both P&lt; .001. Mean age at metastatic diagnosis in SEER was 59.0 years; age at 1L initiation was not reported. SEER included 13.4% Non-Hispanic Black patients. Hispanic representation was 11.2% in RWE, not reported in RCT, and 15.9% in SEER studies (Table). Conclusions: Decisions about treatment choices among clinicians and payers are primarily driven by RCT results, yet they may not be representative of real-world populations. We found that RCTs had lower representation of older and Black patients than both SEER and RWE studies. Limitations included varying study periods, lack of Hispanic ethnicity reporting in RCTs, differential SEER participation by US region, and potential patient overlap. Well-conducted RWE studies may fill gaps left by RCTs for improving representation and generalizability to patients with metastatic breast cancer. [Table: see text]

Identifying associations between race and gender in the incidence and mortality of patients with multiple myeloma.

e20052 Background: Multiple Myeloma (MM) is a plasma cell malignancy due to proliferation of malignant clonal plasma cells. Prior studies have shown that overall incidence of MM was 8.47 per 100,000 individuals. It has also been seen that the incidence of MM has trended upwards in non-Hispanic white (NHW) males and non-Hispanic blacks (NHB) across all age groups. This retrospective, database-driven population study sought to further assess racial and gender-based differences in the trends of the incidence of MM and mortality from MM. Methods: Data obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registry 17 were available to assess trends of multiple myeloma incidence and mortality from 2000 to 2019. Trends were described as average annual percentage change (APC) rates. Results: A total of 102,467 MM patients were identified in this data set; 56,508 (55.1%) were males and 45,949 (44.8%) were female. The distribution of MM by race was as follows (in order from highest to lowest): Non-Hispanic White [NHW] patients was 63.2% (N = 64,776), Non-Hispanic Black [NHB] patients was 18.6% (n = 19,099), Hispanic patients was 11.6 % (11,841), Non-Hispanic Asian [NHA] patients was 5.6% (5,769), and Non-Hispanic American Indian [NHAI]/Alaska Native patients was 0.5% (523). Incidence of MM (cases per 100,000 persons) was highest in males (7.5; 95% CI: 7.5, 7.6) and blacks (13; 95% CI: 12.8, 13.2). Overall trend in the incidence of MM has increased significantly for all gender and ethnicity groups over the period from 2000-2019, except for NHA patients. The incidence-based mortality of MM was highest in male (5.2; 95% CI: 5.2, 5.3) and black (8.7; 95% CI: 8.5, 8.8) patients. The overall incidence-based mortality increased significantly in males APC 4.1% (95% CI: 2.2,5.9; p &lt; 0.001), females APC 3.6% (95% CI, 1.8,5.5; p &lt; 0.001) and all ethnicities - NHW patients APC 4.1%, (95% CI, 2.2,6.0; p &lt; 0.001), NHB (APC 4.2%, 95% CI, 2.1,6.3; P &lt; 0.001), NHAI (APC 4.7%, 95% CI, -2.2,7.2; p &lt; 0.001), NHA (APC 3.0%, 95% CI: 0.8,5.2; P = 0.009) and Hispanic (APC 2.9, 95% CI:1.1,4.7; P = 0.003). Conclusions: Population-based trends in MM incidence and mortality, as reported in this study, were increased commensurate with prior reports. Of note, mortality was noted to be highest amongst the NHB and male populations, indicating a need for further research focused efforts in this potentially high-risk population.

Sex differences in cancer incidence rates by race and ethnicity: Results from the surveillance, epidemiology, and end results (SEER) Registry (2000-2019).

10547 Background: Sex differences in cancer incidence are pronounced, with men having 2-3 times the rate of most non-reproductive cancers than women. However, whether the male predominance is due to differences in biological factors or behavior remains not well understood. This study investigated sex differences in cancer incidence by race and ethnicity to provide a greater understanding of whether differences are driven by biological factors or environmental exposures. Methods: Cancer incidence data from the Surveillance, Epidemiology and End Result (SEER) program (2000-2019) was used to calculate male-to-female incidence rate ratios (MF IRR) for each cancer site and histological subtype, stratified by race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian/Pacific Islander, American Indian/Alaskan Native, and Hispanic), and age-standardized to the 2000 U.S. population for individuals ages ≥20 years. Results: Most non-reproductive cancers had a male predominance across race and ethnicity, with the largest MF IRR seen for cancers of the tonsil, hypopharynx, larynx, and Kaposi sarcoma (MF IRR &gt; 4). Three cancers, gallbladder; peritoneum, omentum, mesenter; and thyroid, were more common among females than males across all race and ethnicity. Females had a higher incidence of anal cancer than males for all racial and ethnic groups except for non-Hispanic Black individuals where the MF IRR was &gt;1. Cancers of the stomach, skin (excluding basal and squamous cell), melanoma skin, and other non-epithelial, and myeloma had greater MF IRR among non-Hispanic White adults than all other racial and ethnic groups. Non-Hispanic Black individuals had higher MF IRR of cancers of the liver and lung and bronchus, compared to other racial and ethnic group. Non-Hispanic White males had the highest MF IRRs for esophagus adenocarcinoma and gastric cardia adenocarcinoma and the lowest MF IRR for esophagus SCC compared to other races and ethnicity. Conclusions: The MF IRR for most cancers in this study did not differ by race and ethnicity, suggesting the influence of biological factors. Differences in the MF IRR across race and ethnicity may indicate carcinogenic exposure differences leading to the development of non-sex-specific cancers. Further research is needed to identify biological drivers of cancer incidence for most non-reproductive cancers. Funding: Intramural Research Program of the Division of Cancer Epidemiology and Genetics in the National Cancer Institute, National Institutes of Health.

Germline genetic testing use and results after a cancer diagnosis.

10500 Background: Germline genetic testing is increasingly essential for cancer prevention and treatment. There is a growing call for universal germline testing after a cancer diagnosis. In this evolving context, little is known about genetic testing use and results across cancer types at the population level. Methods: All patients aged ≥20 years, diagnosed with any cancer type and reported to statewide Surveillance Epidemiology and End Results (SEER) registries in Georgia and California from 2013-2019, were linked to 2013-2021 results from four laboratories providing nearly all germline testing in these regions. Testing use was evaluated in patients diagnosed with all cancer types reported by SEER. Pathogenic variant (PV) and variant of uncertain significance (VUS-only) results were evaluated across cancer types. Tested genes were grouped by major cancer associations and by clinical guidelines for testing and results management after a cancer diagnosis, as follows: breast/ovarian including BRCA1/2; gastrointestinal including the Lynch syndrome genes ( MLH1, MSH2, MSH6, PMS2, EPCAM); other hereditary cancer syndromes; and preliminary evidence genes with no clinical guidelines. Genetic testing trends were analyzed with logistic regression modeling. Results: Among 1,369,660 patients, 6.8% linked to genetic testing results. Genetic testing use was highest among patients with male breast cancer (50.0%), followed by ovarian cancer (38.6%), female breast cancer (26%), multiple primary cancers (7.5%), endometrial cancer (6.4%), pancreatic cancer (5.6%), colorectal cancer (5.6%), prostate cancer (1.1%) and lung cancer (0.3%). Genetic testing use increased over time, notably ten-fold for pancreatic cancer (2013 diagnoses, 1.2%; 2019 diagnoses, 18.6%). Most (67.5-89.6%) of identified PVs were in genes with clinical guidelines for testing and management, and had an established association with the patient's cancer type (breast/ovarian including BRCA1/2: 79.5% of PVs in patients with female breast cancer, 83.8% in patients with male breast cancer, 82.0% in patients with ovarian cancer; gastrointestinal including Lynch syndrome genes: 68.3% of PVs in patients with colorectal cancer, 71.8% in patients with endometrial cancer). Preliminary evidence genes comprised 5.1%-28.1% of PVs detected across cancer types. Compared to non-Hispanic Whites (NHW), patients from other racial/ethnic groups received less testing (Black, odds ratio (OR) 0.58, 95% confidence interval (CI) 0.55-0.63; Hispanic, OR 0.62, CI 0.58-0.66; Asian OR 0.71, CI 0.58-0.66) without improvement over time, and more VUS-only results (NHW, 24.9%; Black 39.0%; Asian, 40.0%), a difference which increased over time. Conclusions: At the population level, germline testing use is low across cancer types, falling short of guidelines. Racial/ethnic disparities in testing use and clarity of test results persisted over time. These gaps are priorities for intervention.

State mandatory paid medical leave policies and survival among adults with cancer in the US.

1511 Background: Cancer treatment is often costly and time intensive. Paid medical leave can help employed patients with cancer more effectively manage side effects and complete recommended cancer treatments without loss of income. Since 2012, several states have introduced mandatory paid medical leave policies. We examined whether mandatory paid medical leave policies were associated with better survival among working age adults with cancer. Methods: Adults ages 18 to 64 years diagnosed with cancer 2007- 2019 were identified from the Surveillance, Epidemiology, and End Results registry program covering 12 states. The primary outcome was overall survival (OS). The exposure of interest was the presence of state mandatory paid medical leave policies. Difference-in-differences (DID) analyses with additive hazards regression models compared changes in OS from pre- to post- mandatory paid sick leave policy implementation in states with vs. without paid sick leave policies. Models adjusted for year-quarter fixed effects, state fixed effects, state Medicaid expansion status, age, race, sex, marital status, metropolitan residence status, county-level income, cancer site, cancer stage, and insurance status. Clustered standard errors by state were achieved via the cluster bootstrap. The plausibility of the common trends assumption was tested using event study analyses and was satisfied for all analyses. Primary analyses focused on data from 2007-2016, where information on month of diagnosis, county, and insurance coverage status were available (note these variables are not available for 2017-2019), though sensitivity analyses with data through 2019 without these additional variables were conducted. Results: A total of 1,491,208 adults with cancer were identified. In adjusted DID analyses, after policy implementation, 1-year OS improved from 85.0% to 86.4% in states with mandatory medical leave policies compared to 85.1% to 85.6% in states without such policies. This translates to a 0.85% improvement in 1-year OS (hazard DID: -0.0007, 95% CI = -0.0016 to -0.0001, P = .027). The largest improvement was found among the uninsured population (hazard DID: -0.0038, 95% CI = -0.0076 to -0.0011, P = .013). In sensitivity analyses with abbreviated data through 2019, results were similar (DID for 1-year OS: 1.3%; hazard DID: -0.0010, 95% CI = -0.0025, 0.0001, P = .070). Conclusions: State mandatory paid medical leave was associated with improved survival for working-age adults with newly diagnosed cancer, particularly for those who are uninsured. Policy changes that better support patients through cancer treatment may pay off with improved cancer outcomes.

The tumor characteristics, treatment strategy, and prognosis in colorectal cancer patients with synchronous liver metastasis in China and the USA.

This study performed an analysis of clinicopathological characteristics, surgical treatment strategy, and survival for CRC patients with LM between China and the USA. The CRC patients with simultaneous LM were identified from the Surveillance, Epidemiology, and End Results (SEER) registry and the Chinese National Cancer Center (CNCC) database from 2010 to 2017. We assessed 3-year cancer-specific survival (CSS) according to surgical treatment strategy and time period. Differences in patient age, gender, primary tumor location, tumor grade, tumor histology, and tumor stage were observed between the USA and China. Compared to the USA, a larger proportion of patients in China underwent both primary site resection (PSR) and hepatic resection (HR) (35.1% vs 15.6%, P < 0.001), and fewer patients underwent only PSR in China (29.1% vs 45.1%, P < 0.001). From 2010 to 2017, the proportion of patient who underwent both PSR and HR has increased from 13.9% to 17.4% in the USA and from 25.4% to 39.4% in China. The 3-year CSS were increasing over time in both the USA and China. The 3-year CSS of patients receiving HR and PSR were significantly higher than those receiving only PSR and patients treated with no surgery in the USA and China. There were no significant differences of 3-year CSS between the USA and China after adjustment (P = 0.237). Despite the distinctions of tumor characteristics and surgical strategy in patients with LM between the USA and China, increased adoption of HR has contributed to the profound improvements of survival during recent decade.

Use of Metformin and Survival in Patients with Hepatocellular Carcinoma (HCC) Undergoing Liver Directed Therapy: Analysis of a Nationwide Cancer Registry.

Examine theassociation of metformin use and overall survival (OS) in patients with HCC undergoing image-guided liver-directed therapy (LDT): ablation, transarterial chemoembolization (TACE), or Yttrium-90 radioembolization (Y90 RE). Using National Cancer Institute Surveillance, Epidemiology, and End Results registry and Medicare claims databases between 2007 and 2016, we identified patients ≥ 66years who underwent LDT within 30days of HCC diagnosis. Patients with liver transplant, surgical resection, and other malignancies were excluded. Metformin use was identified by atleast two prescription claims within 6 months before LDT. OS was measured by time between first LDT and death or last Medicare observation. Comparisons were performed between both all and diabetic patients on and not on metformin. Of 2746 Medicare beneficiaries with HCC undergoing LDT, 1315 (47.9%) had diabetes or diabetes-related complications. Among all and diabetic patients, 433(15.8%) and 402 (30.6%) were on metformin respectively. Median OS was greater for patients on metformin (19.6months, 95% CI 17.1-23.0) vs those not (16.0months, 15.0-16.9; p = 0.0238). Patients on metformin had lower risk of death undergoing ablation (HR 0.70; 0.51-0.95; p = 0.0239) and TACE (HR 0.76, 0.66-0.87; p = 0.0001), but not Y90 RE (HR1.22, 0.89-1.69; p = 0.2231). Among diabetics, OS was greater for those on metformin vs those not (HR 0.77, 0.68-0.88; p < 0.0001). Diabetic patients on metformin had longer OS undergoing TACE (HR 0.71, 0.61-0.83; p < 0.0001), but not ablation (HR 0.74, 0.52-1.04; p = 0.0886) or Y90 RE (HR 1.26, 0.87-1.85; p = 0.2217). Metformin use is associated with improved survival in HCC patients undergoing TACE and ablation.

Disparities in survival improvement for U.S. childhood and adolescent cancer between 1995 and 2019: An analysis of population-based data

BackgroundAlthough treatment advances have increased childhood and adolescent cancer survival, whether patient subgroups have benefited equally from these improvements is unclear. MethodsData on 42,865 malignant primary cancers diagnosed between 1995 and 2019 in individuals ≤ 19 years were obtained from 12 Surveillance, Epidemiology, and End Results registries. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for cancer-specific mortality by age group (0–14 and 15–19 years), sex, and race/ethnicity were estimated using flexible parametric models with a restricted cubic spline function in each of the periods: 2000–2004, 2005–2009, 2010–2014 and 2015–2019, versus 1995–1999. Interactions between diagnosis period and age group (children 0–14 and adolescents 15–19 years at diagnosis), sex, and race/ethnicity were assessed using likelihood ratio tests. Five-year cancer-specific survival rates for each diagnosis period were further predicted. ResultsCompared with the 1995–1999 cohort, the risk of dying from all cancers combined decreased in subgroups defined by age, sex and race/ethnicity with HRs ranging from 0.50 to 0.68 for the 2015–2019 comparison. HRs were more variable by cancer subtype. There were no statistically significant interactions by age group (Pinteraction=0.05) or sex (Pinteraction=0.71). Despite non-significant differences in cancer-specific survival improvement across different races and ethnicities (Pinteraction=0.33) over the study period, minorities consistently experienced inferior survival compared with non-Hispanic Whites. ConclusionsThe substantial improvements in cancer-specific survival for childhood and adolescent cancer did not differ significantly by different age, sex, and race/ethnicity groups. However, persistent gaps in survival between minorities and non-Hispanic Whites are noteworthy.

Abstract LB129: Survival of most commonly diagnosed second primary cancers among adult cancer survivors

Abstract Background Second primary cancer (SPC) burden is increasing in the US, but few studies comprehensively examined survival in persons diagnosed with SPCs in relation to survivors’ antecedent cancer types. Methods Persons aged ≥20 years and diagnosed with one of the six most common SPCs (female breast, prostate, bladder, lung, colorectum, corpus uteri) from 2000-2013 were identified from 17 Surveillance, Epidemiology, and End Results registries (n=152,204). For comparison, persons diagnosed with same type cancers occurring as first primary cancers (FPCs) were also identified (n=2,131,953). For each cancer type, differences in the risk of cancer-specific or all-cause death between SPC and FPC were estimated using multivariable Cox proportional hazards models adjusted for potential confounders. Subgroup analyses were conducted to estimate the risk difference between SPC and FPC by antecedent cancer types of those with SPCs. Results During a median follow-up of 6.5 years (interquartile range, 1.8-10.6), cancer-type specific death occurred among 34% of persons with SPCs and among 32% of persons with FPCs. The corresponding proportions for all-cause death were 67% and 53%, respectively. In multivariable models, the risk of cancer-specific death was statistically significantly higher in persons with SPC than in persons with FPC for breast (hazard ratio [HR]=1.43; 95% confidence interval [CI]=1.40-1.48), bladder (HR=1.19; 1.09-1.29), corpus uteri (HR=1.10; 1.05-1.15), and colorectal (HR=1.05, 1.03-1.07) cancer, whereas it was lower for lung cancer (HR=0.78; 0.77-0.79). The risk did not vary between groups for prostate cancer (HR=0.92; 0.79-1.06). Subgroup analyses showed large variations in HRs across survivors by antecedent cancer types. In particular, the highest HR associated with SPC (vs FPC) was among ovarian cancer survivors for colorectal cancer (HR=1.31; 1.10-1.56), gallbladder cancer survivors for breast cancer (HR=1.78; 1.09-2.91), head and neck cancer survivors for uterine cancer (HR=1.69, 1.05-2.72), gallbladder cancer survivors for bladder cancer (HR=1.87; 1.06-3.22), while the lowest HR for lung cancer was among testicular cancer survivors (HR=0.54; 0.38-0.76). Associations were generally consistent across strata of diagnosis years, race/ethnicity, household income, and urbanicity. The risks of all-cause death were also higher among persons with SPC vs FPC, including prostate cancer. Persons with second primary prostate cancer were almost twice as likely to die from all causes as persons with first prostate cancer (HR=1.83; 1.80-1.87). Conclusion Persons with SPC generally have a higher risk of cancer-specific and all-cause death than those with FPC, suggesting that intensive SPC surveillance may benefit those at increased risk of developing SPC. Importantly, the risk difference substantially varied by survivors’ antecedent cancer type, highlighting a need for targeted strategies for treatment and survivorship care for persons with SPCs. Citation Format: Hyuna Sung, Lauren Nisotel, Ephrem Sedeta, Farhad Islami, Ahmedin Jemal. Survival of most commonly diagnosed second primary cancers among adult cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB129.

Abstract LB128: Cardiovascular disease mortality among cancer survivors by race and ethnicity in the United States

Abstract Background Cancer survivors have higher cardiovascular disease (CVD) mortality than the general population but comprehensive data by race and ethnicity are limited. Methods Data from 17 Surveillance, Epidemiology, and End Results (SEER) registries were used to identify adults diagnosed with invasive cancer at ages ≥20 years from 2000 to 2018. CVD mortality was calculated for five mutually exclusive race/ethnicity categories (non-Hispanic American Indian/Alaska Native [AIAN], non-Hispanic Asian or Pacific Islander [API], Hispanic, non-Hispanic Black [Black], and non-Hispanic White [White]). Standardized mortality ratios (SMR) were estimated to compare mortality rates in cancer survivors to their counterparts in the general population. Analyses were stratified by demographic factors, CVD subtype, and cancer site. Results During a mean follow up of 5.3 person-years among 5,786,876 survivors (20-64 years, 49.3%; men, 51.2%; White, 71.7%; Black, 10.1%; Hispanic, 10.9%; API, 7%, AIAN, 0.3%), 358,970 CVD deaths (cardiac death, 76.9%; cerebrovascular death, 15.9%) occurred. CVD mortality per 10,000 person-years was highest among survivors who were Black (122.9), followed by White (114.7), AIAN (86.7), API (78.6) and Hispanic (75.3). In contrast, SMRs were greatest among AIAN survivors (SMR=1.42, 95% CI=1.32-1.51), followed by API (SMR=1.39, 1.37-1.41), Hispanic (SMR=1.29, 1.27-1.30), Black (SMR=1.19, 1.17-1.20) and White (SMR=1.08, 1.07-1.08) survivors. Among survivors ages 20-64 years, Black survivors were approximately three times as likely to die from cardiac death as Hispanic or API survivors (46.7 vs. 14.5-17.6 per 10,000). SMR, however, was 1.47 among Hispanic survivors (95% CI=1.42-1.51) and 1.80 among API survivors (95% CI=1.42-1.51), greater than 1.25 among Black survivors (95% CI=1.22-1.27). Across cancer types, the highest SMR was among API survivors of pancreatic cancer (SMR=5.27, 3.83-7.08) and brain cancer (SMR=4.56, 3.10-6.48) in ages 20-64 years and among Hispanic (SMR=3.77, 3.09-4.56) and API survivors of brain cancer (SMR=3.24, 2.40-4.28) in ages ≥65 years. Conclusion Black survivors had the greatest CVD mortality of all groups, demonstrating that CVD health disparities in the general population extend to cancer survivors. Despite the lower absolute mortalities, relative risks compared to their counterparts in the general population were greatest among API and Hispanic survivors, implying a greater impact of cancer diagnosis on the risk of CVD death among survivors of these populations. Targeted primary care and cardio-oncologic intervention strategies are needed to improve CVD outcomes and achieve cardiovascular health equity among cancer survivors. Citation Format: Lauren Nisotel, Rebecca L. Siegel, Eric H. Yang, Ahmedin Jemal, Hyuna Sung. Cardiovascular disease mortality among cancer survivors by race and ethnicity in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB128.

Abstract 4213: Comparison of benign breast disease subtypes and breast cancer risk among Hispanic and non-Hispanic white women in New Mexico

Abstract Introduction: Benign breast disease (BBD) is an important breast cancer (BC) risk factor, which may be classified as non-proliferative disease (NPD), proliferative disease without atypia (PDWA), or atypical hyperplasia (AH) for risk stratification. Data related to the frequency of specific types of BBD and their relationship to BC risk in the Hispanic American population are limited. To address this knowledge gap, we compared BBD and associated BC risk among Hispanic white (HW) and non-Hispanic white (NHW) in New Mexico (NM). Methodology: A retrospective IRB-approved study was performed of women 19 years or older residing in six counties in NM (Bernalillo, Sandoval, Sante Fe, Socorro, Torrance, Cibola/Valencia) between 1996 and mid-2007 to compare the frequency of BBD subtypes and BC risk among HW and NHW. We excluded women who had a history of BC prior to BBD diagnosis or who were diagnosed with BC within 6 months after BBD biopsy. Race and ethnicity were self-reported by women at the time of biopsy. BBD was categorized as NPD, PDWA, or AH based on medical records. Incident BC (in-situ or invasive) was ascertained via linkage to the NM Surveillance Epidemiology End Results (SEER) Registry and BC risk was assessed using standardized incidence ratios (SIRs), comparing the observed number of BC events to that expected based on the NM SEER six-county race- and ethnicity-specific incidence rates, accounting for age and calendar period. Results: Our analysis included 3,870 HW and 6,996 NHW women with BBD. The HW were younger (47.1 vs. 51 years) compared to NHW. HW women had slightly more NPD (69.4% vs. 66.6%) but less PDWA (26.2% vs. 29.4%) and similar frequency of AH (4.3% vs. 3.9%) as compared to NHW. Over a median post-BBD follow-up period of 13 years (range 6 months-17 years), 644 BCs were observed (4.81% in HW and 6.55% in NHW). The observed BC risk among women with BBD was higher than population-based expected rates (SIR 1.98, 95% CI 1.82-2.13, p&amp;lt;0.001) and showed expected increases in risk with increasing degrees of BBD abnormality: SIR=1.90 for NPD, 2.00 for PDWA, and 3.01 for AH. Comparing BC risk by ethnic subgroups, HW women had an overall risk of BC after BBD that was statistically indistinguishable from NHW women (SIR=2.17, 95% CI 1.86-2.48 in HW women, and SIR=1.91, 95% CI 1.73-2.08 in NHW women). Within the major subgroups of the BBD findings, there were no significant differences in risk of BC after BBD for HW versus NHW women. Conclusions: In this population-based study, benign breast disease subtypes and their associated breast cancer risk were similar among the Hispanic and non-Hispanic white women. Citation Format: Kush Raj Lohani, Andrea M. Nibbe, Robert A. Vierkant, Laura M. Pacheco-Spann, Lisa R. Seymour, Celine M. Vachon, Mark E. Sherman, Amy C. Degnim, Deirdre Hill. Comparison of benign breast disease subtypes and breast cancer risk among Hispanic and non-Hispanic white women in New Mexico. [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 4213.

PD20-08 TRENDS IN PROSTATE CANCER SPECIFIC MORTALITY BY RACE OVER TIME: A SEER ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD20-08 TRENDS IN PROSTATE CANCER SPECIFIC MORTALITY BY RACE OVER TIME: A SEER ANALYSIS Davuluri Meenakshi, Gina Demeo, Himanshu Nagar, Leonardo Borregales, and Jim Hu Davuluri MeenakshiDavuluri Meenakshi More articles by this author , Gina DemeoGina Demeo More articles by this author , Himanshu NagarHimanshu Nagar More articles by this author , Leonardo BorregalesLeonardo Borregales More articles by this author , and Jim HuJim Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been demonstrated there was an increase in metastatic prostate cancer diagnosis from 2004 to 2013 in a previous SEER analysis. Our goal was to evaluate trends in prostate cancer specific mortality (PCSM) during this time period to determine if increased metastatic disease correlated with increased mortality rates. METHODS: Using Surveillance, Epidemiology, and End Results (SEER) registry database, we identified men diagnosed with prostate cancer from 2004-2013. Men were stratified by age at diagnosis, race (White, Black, Hispanic, Asian, Native American, and Other), and stage at diagnosis. Number of deaths were identified and PCSM mortality was calculated. Descriptive statistics were used. RESULTS: We identified 497,166 men in SEER who met our inclusion criteria from 2004-2013. In this time period, the overall cohort PCSM decreased from 9.65% in 2004 to 5.95% in 2013 (Figure 1). We then stratified PCSM by race (Figure 2). We found that across all races PCSM decreased from 2004 to 2013 with the largest decrease in Native American men (18.0% to 10.4%) followed by Black men (11.6% to 7.0%). We further sub-stratified PCSM for men with distant metastasis at time of diagnosis (Figure 3). In this cohort of men, again a decrease in PCSM across all races was seen. The differences in PCSM from 2004 to 2013 are 3.9%, 8.9%, 5.9%, 13.2% and 22.8% for White, Black, Hispanic, Asian, and Native American men respectively. The largest decrease of PCSM was seen in Native American men with a 22% reduction of death rates in men diagnosed with metastatic disease from 2004 to 2013. CONCLUSIONS: PCSM has decreased overtime despite previous findings of increasing metastatic disease at time of diagnosis. This may be due to improved treatment options for metastatic disease. PCSM has decreased across all races, however Native American and Black men continue to have higher rates PCSM compared to other races. As more interventions are implemented to address disparities, longitudinal studies will be required to determine the impacts on survival outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e586 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Davuluri Meenakshi More articles by this author Gina Demeo More articles by this author Himanshu Nagar More articles by this author Leonardo Borregales More articles by this author Jim Hu More articles by this author Expand All Advertisement PDF downloadLoading ...

Radical versus partial nephrectomy for T1 non-clear cell renal cell carcinoma

IntroductionNephron-sparing surgery is the recommended surgical management of T1 renal cell carcinoma (RCC). However, non-clear cell RCC (nccRCC) is heterogeneous and included many histological types. Therefore, the present study was performed to compare radical nephrectomy (RN) versus partial nephrectomy (PN) in nccRCC. Materials and methodsWithin the Surveillance, Epidemiology, and End Results registry (2000–2019), the patients with nccRCC were identified. Kaplan-Meier survival curve and the log-rank test were conducted. Univariate analysis and multivariate Cox regression analysis were performed to explore the prognostic factors. ResultsA total of 7575 patients with nccRCC were included, of which papillary RCC (n = 5219) is the major histology. Kaplan-Meier plots and log-rank tests showed that nccRCC patients who underwent RN had significantly worse overall survival (OS) and cancer-specific survival (CSS) than those who received PN (all P < 0.05). Multivariate analysis also revealed that RN was significantly associated with poor OS and CSS in nccRCC patients. Stratified by histological types, the multivariate analysis also revealed that RN was significantly associated with poor OS in papillary and chromophobe (all P < 0.05). Besides, the multivariable analysis indicated that RN was associated with poor CSS in papillary RCC (P < 0.05). For other histology, the patients who received RN had a comparable survival to those who received PN. ConclusionFor patients with T1 nccRCC, our findings revealed that PN was not inferior to RN in OS and CSS. PN may be also the preferred option for T1 nccRCC, but more prospective studies are required to validate this finding.

Abstract P6-07-01: Costs of breast cancer recurrence after initial treatment for high risk early breast cancer using SEER-Medicare linked data

Abstract Background: Despite the good prognosis with treatment for most patients with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) early breast cancer (EBC), ~ 20–30% of patients experience locoregional or distant disease recurrence. To assist in value assessments of novel therapies in the adjuvant setting, this study aimed to determine the costs of treated breast cancer recurrence following treated EBC. Methods: This retrospective study analyzed linked patient data from the US Surveillance Epidemiology and End Results (SEER) registry (2010-2014) and Medicare claims (2009 to 2019, which included data from Part A, B, and Prescription Drug Events [Part D]). Data were analyzed for patients aged ≥65 years with HR+, HER2-, node-positive EBC at high risk of recurrence (consistent with monarchE trial high risk criteria). Treated recurrences were defined based on treatment events/procedure codes, including surgery, radiation and systemic therapy, after a 90-day gap following the last treatment for initial EBC. Recurrences were classified based on Medicare claim diagnosis codes or SEER registry data. Extra cost was defined as cost attributable to treated recurrence. Cumulative extra costs were estimated by calculating cost differences between patients with treated vs non/untreated recurrence. Cumulative extra costs were analyzed over the first 6 years following first treated recurrence, a duration which ensured adequate sample size. Costs were inflated to 2021-US$. Results: We identified 3081 eligible patients (mean age at diagnosis 74.5±7.1 years, 97.4% female, 87.8% White). We identified 964 patients with treated recurrence (distant=432, locoregional=128, contralateral=9, unclassified=347) and 2117 patients with non/untreated recurrence. Six-year cumulative extra costs were higher for patients with distant recurrences ($168,656) than for patients with locoregional recurrences ($96,465) (Table 1). Conclusions: Cost of recurrence in patients with high risk EBC is considerable, particularly in patients with distant recurrences. Most patients who recurred in this population experienced distant recurrence. Delaying or preventing recurrence may reduce long term costs in these high risk EBC patients. Table 1. Mean cumulative extra costs attributable to treated recurrence. Citation Format: Alexandra S. Vitko, Pamela A. Martin, Sheng Zhang, Adam F. Johnston, Robert L. Ohsfeldt, Shen Zheng, Astra M. Liepa. Costs of breast cancer recurrence after initial treatment for high risk early breast cancer using SEER-Medicare linked data [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-07-01.

A Clinical Decision Tool to Calculate Pretest Probability of Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma.

Although sentinel lymph node biopsy (SLNB) status is a strong prognostic indicator for cutaneous melanoma, unnecessary SLNBs have substantial cost and morbidity burden. This study was designed to develop, validate, and present a personalized, clinical, decision-making tool using nationally representative data with clinically actionable probability thresholds (Expected Lymphatic Metastasis Outcome [ELMO]). Data from the Surveillance, Epidemiology, and End Results (SEER) Registry from 2000 to 2017 and the National Cancer Database (NCDB) from 2004 to 2015 were used to develop and internally validate a logistic ridge regression predictive model for SLNB positivity. External validation was done with 1568 patients at a large tertiary referral center. The development cohort included 134,809 patients, and the internal validation cohort included 38,518 patients. ELMO (AUC 0.85) resulted in a 29.54% SLNB reduction rate and greater sensitivity in predicting SLNB status for T1b, T2a, and T2b tumors than previous models. In external validation, ELMO had an accuracy of 0.7586 and AUC of 0.7218. Limitations of this study are potential miscoding, unaccounted confounders, and effect modification. ELMO ( https://melanoma-sentinel.herokuapp.com/ ) has been developed and validated (internally and externally) by using the largest publicly available dataset of melanoma patients and was found to have high accuracy compared with other published models and gene expression tests. Individualized risk estimates for SLNB positivity are critical in facilitating thorough decision-making for healthcare providers and patients with melanoma.