Five-year Cancer-specific Survival Research Articles

Centralisation of rectal cancer care has improved patient survival in the republic of Ireland

BackgroundCentralisation of rectal cancer surgery to designated centres was a key objective of the Irish national cancer control program. A national audit of rectal cancer surgery indicated centralisation was associated with improved early surgical outcomes. This study aimed to determine the impact of implementation of the national cancer strategy on survival from rectal cancer. Materials and methodsData were collected from the National Cancer Registry of Ireland to include all patients with Stage I-III rectal cancer undergoing rectal cancer surgery with curative intent between 2003 and 2012. Five-year overall survival and cancer-specific survival was compared between patients in the pre-centralisation (2003–2007) and post-centralisation period (2008–2012) and between patients receiving surgery in designated cancer centres and non-cancer centres. ResultsThe proportion of rectal cancer surgery performed in a designated cancer centre increased from 42% during 2003–2007 to 58% during 2008–2012. Five-year overall survival increased from 66.1% in 2003–2007 to 73.5% in 2008–2012 (p < 0.001). Five-year cancer-specific survival increased from 75.3% in 2003–2007 to 81.9% in 2008–2012 (p < 0.001). Surgery in a cancer centre and surgery post-centralisation were significantly associated with overall and cancer specific survival using Cox proportional hazards regression. ConclusionSurvival following resection of rectal cancer was significantly improved following implementation of a national cancer strategy incorporating centralisation of rectal cancer surgery.

S220 Cancer-Specific 5-Year Survival Following Endoscopic Polypectomy versus Surgery for Malignant Colorectal Polyps

Introduction: Current guidelines recommend polyp resection strategies, endoscopic resection (ER) or surgical resection (SR) based on high-risk histological features and depth of invasion to ensure complete removal of the malignant lesion, minimizing the risk of progression through micrometastasis. Data comparing cancer-specific survival following ER or SR for localized malignant polyps based on the AJCC staging (Stage 0, I & II & grade) are scarce. Methods: We used the Surveillance Epidemiology and End Results (SEER) database (2004-2015) on patients diagnosed with at least a single malignant colorectal polyp (Table) on the colonoscopies performed for any indication or screening. Data extraction was through a case listing session using SEER*Stat v8.3.9 on combined SEER 18 incidence registries using specific codes for CRC polyps with cancer. Statistical analysis was performed using SPSS v27 for Mac. Results: A total of 63,147 patients with a diagnosis of a colorectal polyp with a malignant component were identified. The mean age was 47.48 years (± 12.15 SD), 45.6% were females. T stages ranged T1-T3. Patients with stage 0 (carcinoma in situ) polyps showed equivalent 5-year cancer-specific survival regardless of ER or SR (mean 170 vs 169 months, 94.2% vs 93.7%, P=0.429, Figure 1A). Stage I and II patients showed superior 5-year survival with SR than ER (mean 165 vs 159 months, 91.1% vs 88%, p< 0.001, Figure 1B). Patients with well-differentiated histological grade demonstrated no survival differences regardless of ER or SR (mean 165 vs 166 months, 92.7% vs 93%, P=0.175, Figure 1C). In contrast, those with polyps of poor differentiation or anaplastic features showed superior 5-year cancer-specific survival with SR than ER (mean 161 vs 145months, 90% vs 88%, P=< 0.001, Figure 1E). Patients with polyps of moderate differentiation showed superior 5-year cancer-specific survival with SR compared with ER (mean 164 vs 159months, 92% vs 90% p< 0.001, Figure 1D) Conclusion: Our results show that cancer-specific survival improved in patients with malignant polyps with AJCC Stage I or II who underwent SR compared with ER, but not Stage 0 (carcinoma in situ). Another novel finding was superior 5-year cancer-specific survival in patients with polyps of moderately-differentiated histological grade, in addition to poorly differentiated and anaplastic grades, which has not been reported before. These novel findings warrant further corroboration from well-constructed clinical trials.Figure 1.: Five-year cancer specific survival comparing endoscopic resection versus surgical resection for colorectal polyps by cancer stage and histological grade.Table 1.: Number of patients diagnosed with polyps with a malignant component by stage and year of diagnosis.

The Value of Sentinel Lymph Node Mapping for the Staging of Node-Negative Colon Cancer: Propensity Score and Mediation Analyses.

Mediation analysis to assess the protective impact of sentinel lymph node (SLN) mapping on prognosis and survival of patients with colon cancer through a more precise evaluation of the lymph node (LN) status. Up to 20% of patients with node-negative colon cancer develop disease recurrence. Conventional histopathological LN examination may be limited in describing the real metastatic burden of LN. Data of 312 patients with stage I & II colon cancer was collected prospectively. Patients were either staged using intraoperative SLN mapping with multilevel sectioning and immunohistochemical staining of the SLN or conventional techniques. The value of the SLN mapping for the detection of truly node-negative patients was assessed using Cox regression and mediation analysis. SLN mapping was performed in 143 patients. Disease recurrence was observed in 13 (9.1%) patients staged with SLN mapping and in 27 (16%) staged conventionally. Five-year overall survival (OS) rate was 82.7% (95% confidence interval [CI], 76.5-89.4%) with SLN mapping compared with 65.8% (95% CI, 58.8-73.7%). Five-year cancer-specific survival (CSS) was 95.1% (95% CI, 91.3-99.0%) with SLN mapping compared with 92.5% (95% CI, 88.0-97.2%). Node-negative staging with SLN mapping was associated with significantly better OS (hazard ratio [HR], 0.64; 95% CI, 0.56-0.72; P < 0.001) and CSS (HR, 0.49; 95% CI, 0.39-0.61; P < 0.001) in multivariate analysis. Mediation analysis confirmed a direct protective effect of SLN mapping on OS (HR, 0.78; 95% CI, 0.52-0.96; P < 0.01) and disease-free survival (DFS) (HR, 0.75; 95% CI, 0.48-0.89; P < 0.01). Staging performed by SLN mapping with multilevel sectioning provides more accurate results than conventional staging. The observed clinically relevant and statistically significant benefit in OS and DFS is explained by a more accurate detection of positive LN by SLN mapping.

Black race is predictive of decreased survival in low-risk endometrial cancer

<h3>Objectives:</h3> To determine whether Black race is associated with treatment and outcomes among a favorable cohort with low-risk endometrial cancer. <h3>Methods:</h3> All Black and White women with Stage IA grade 1-2 endometrioid endometrial carcinoma diagnosed from 2010 to 2016 in the SEER 18 dataset were identified (n=23431), and clinical and socioeconomic attributes obtained. Five-year cancer-specific survival (CSS) and relative survival (RS) were calculated using SEER*Stat 8.3.8. Statistical analyses were performed with independent t-test, Chi-Square test, and Cox proportional hazard regression. <h3>Results:</h3> Although the majority of patients underwent surgery, there was a significantly higher proportion of Black women who did not have surgery compared to White women (1% vs 3%, respectively; p<0.0001). Reasons for having not undergone surgery were similar between the two groups: not recommended, Blacks 74% vs Whites 75%; medically contraindicated, Blacks 16% vs Whites 9%; patient refusal, Blacks 16% vs Whites 10%; p=0.293. Black women were overrepresented in groups where more women did not undergo hysterectomy: women residing in the South (2.1% vs 1.3%, p=0.002) and those with Medicaid (3.4%) or no insurance (2.1%) compared to those with private insurance or Medicare (1.3%, p<0.0001). However, Black women remained less likely to undergo hysterectomy after adjusting for age, ethnicity, geography, grade, insurance status, and socioeconomic status (OR 0.379, p<0.0001). Five-year CSS was favorable in both groups, though significantly lower among Black women (CSS 95.0%, 95% CI 93.2-96.4%) compared to White women (CSS 97.8%, 95% CI 97.5-98.1%). A similar trend was noted for 5-year RS, with 95.4% for Black women (95% CI 92.2%-97.3%) versus 100% for White women. Black race was an independent predictor of increased cancer-specific death (HR 1.76, 95% CI 1.46-2.12) as well as all-cause mortality (HR 2.14, 95% CI 1.54-2.98) on adjusted analysis. <h3>Conclusions:</h3> We found that, even in a good prognostic group, Black women are less likely to undergo hysterectomy and have an increased risk of death among women with low-risk endometrial cancer. This bolsters prior work demonstrating that the association of race and poor outcomes is not only due to higher grade, more aggressive histologic type, and more advanced stage at diagnosis.

Do factors affecting time from symptom onset to diagnosis or treatment of ovarian cancer also affect survival?

<h3>Objectives:</h3> Little is known about whether factors affecting time from symptom onset to diagnosis or treatment of ovarian cancer also affect overall survival (OS) or cancer-specific survival (CSS). In this study, we aim to identify variables associated with improved time to diagnosis, treatment, and survival of ovarian cancer. <h3>Methods:</h3> A population-based study of the Surveillance, Epidemiology, and End Results (SEER)-Medicare database was conducted on patients ≥66 years old from 1992-2015 with a diagnosis of stage II-IV primary epithelial ovarian cancer. Regression models evaluated time from first coded symptom in a claim to diagnosis and treatment, OS, and CSS by age, race, comorbidity score, marital status, region, poverty level, year of diagnosis, urban/rural location, number of physician visit types in the 30 days prior to diagnosis, and emergency room presentation. <h3>Results:</h3> We identified 18693 women for analysis. Faster time to diagnosis was associated with BlackBlack race (p=.001) and both faster time to diagnosis and treatment were associated with unmarried status (diagnosis p<.001, treatment p<.001) and mostly rural (p=.011, p=.003) or all rural (p<.001, p=.003) location. Conversely, both slower time to diagnosis and treatment were associated with older age (p<.001, p<.001), higher comorbidity score (p<.001, p<.001), non-Northeast region (p<.001, p=.001), >4 physician visit types (p<.001, p<.001), emergency department presentation (p<.001, p<.001), and diagnosis after 1992-1999 (p<.001, p<.001). Five-year OS and CSS were 22.4% and 39.5%, respectively. Despite being associated with faster time to diagnosis and/or treatment, there were lower 5-year OS and CSS associated with unmarried status (OS p<.001, CSS p<.001), all rural location (p<.001, p<.001), and BlackBlack race (p<.001, p=.025). Lower 5-year OS and CSS were also associated with older age (p<.001, p<.001), higher comorbidity score (p<.001, p<.001), emergency presentation (p<.001, p<.001), and higher poverty level (p=.018, p=.048). Despite being associated with slower time to diagnosis and treatment, higher 5-year CSS was associated with >4 physician visit types (p=.002) and both higher 5-year OS and CSS were associated with diagnosis after 1992-1999 (p<.001, p<.001). Compared to 1992-1999, the hazard ratios of 5-year cancer-specific death after 5 years decreased for each subsequent time period (2000-2005 HR=.90; 2006-2010 HR=.82; 2011-2015 HR=.72). <h3>Conclusions:</h3> In our SEER-based database study, variables associated with faster time to diagnosis and treatment of ovarian cancer often correlated with worse OS and CSS. We hypothesize that the discordance between time from diagnosis to treatment and survival seen based on clinical and demographic variables may be due to unmeasured social determinants of health or deviations from guideline-concordant care. Future research to understand this discordance is warranted.

A risk-group classification model in patients withbladder cancerunder neoadjuvant cisplatin-based combination chemotherapy.

The objective of the current research was toexplore the potential prognostic value of readily available clinical and pathologic variables in bladder cancer. The novel association foundbetween cholesterol levels and prognosis may provide the rationale for exploring novel treatments. Patients included had histologically confirmed urothelial bladder cancer and were treated with at least 3 cycles of cisplatin-based neoadjuvant chemotherapy before radical cystectomy with lymphadenectomy. A total of245 patients at low, intermediate and high risk, presentingwith0-1, 2 or 3-4 risk factors, including positive lymph nodes, Hb<12.8, NLR ≥2.7 and cholesterol levels ≥199, were included. Five-yearcancer-specific survival rate was 0.67, 0.78 and 0.94 athigh, intermediate and low risk, respectively. Total cholesterol levels at the time of cystectomy may represent a commonly assessable prognostic factor and maybeincorporated in a clinically meaningful risk-group classification model.

Small cell carcinoma of the bladder: A population-based analysis of long-term outcomes after radical cystectomy and bladder conservation with chemoradiotherapy.

We aimed to describe the oncological outcomes after radical cystectomy and chemo-radiation for localized small cell bladder cancer (SCBC). This population-based analysis of localized SCBC from 1985-2018 in British Columbia included an analysis (analysis 1) of cancer-specific survival (CSS) and overall survival (OS) of patients treated with curative-intent radical cystectomy (RC) and radiation (RT), and an analysis (analysis 2) of CSS and OS in patients treated with RC and chemoRT consistent with the SCBC Canadian consensus guideline. Seventy-seven patients who were treated with curative intent were identified: 33 patients had RC and 44 had RT. For analysis 1, five-year OS was 29% and 39% for RC and RT, respectively (p=0.51), and five-year CSS was 35% and 52% for RC and RT, respectively (p=0.29). On multivariable analysis, higher Charlson comorbidity index (CCI) and the lack of neoadjuvant chemotherapy (NAC) were associated with worse OS, while higher CCI and Eastern Cooperative Oncology Group (ECOG) were associated with worse CSS. For analysis 2, five-year OS was 56% and 58% for the RC and chemoRT groups, respectively (p=0.90), and five-year CSS was 56% for RC and 71% for chemoRT (p=0.71). Four of 42 (9.5%) chemoRT patients had RC at relapse. SCBC is a rare entity with a poor prognosis. RC and chemoRT offer similar CSS and OS for localized SCBC, even when focusing the analysis on patients treated according to the modern consensus guidelines. NAC should be considered for eligible patients. Both chemoRT and RC treatment options should be discussed with patients with SCBC.

Defining prognostic factors in older patients with endometrial cancer.

Endometrial cancer (EC) is most frequently seen in older and postmenopausal women. The aim of this study was to evaluate the rate of recurrence and survival and clinical, pathological, surgical, and treatment factors affecting recurrence and survival in older patients with EC. Three hundred and six (21.7%) patients aged ≥ 65 out of a total of 1413 patients diagnosed with and treated for epithelial EC at the Division of Gynecologic Oncology between January 1993 and May 2013 were evaluated retrospectively. All patients were staged according to FIGO 2009 staging system. Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were determined. Independent prognostic factors affecting recurrence and survival were evaluated by multivariate logistic regression analysis. The median age of the patients was 68 (65-92) years. Eighty-nine patients (29.1%) were diagnosed with stage III-IV disease. Tumor type was endometrioid in 226 (73.9%) patients, and 101 (33%) patients were diagnosed with FIGO grade 1 endometrioid endometrial cancer. One hundred fifty-three patients received adjuvant therapy after surgery. Five-year PFS, 5-year CSS, and 5-year OS were 73%, 85%, and 83%, respectively. Only the 2009 FIGO stage was independently associated with PFS (OR = 3.495, 95% CI 1.592-7.675; p = 0.002) and CSS (OR = 6.135, 95%CI 1.269-31.417; p = 0.024). In conclusion, 2009 FIGO stage was found to be the only independent prognostic factor associated with recurrence and death in older patients with endometrial cancer.

Assessment of predictors of renal cell carcinoma progression after nephrectomy at short- and medium-term follow-up and implication on surveillance protocols

Prediction of risk of RCC progression after surgery is important for follow-up planning. We identified predictors of progression-free survival (PFS) and cancer-specific survival (CSS) in a large single institutional cohort and investigated patterns and sites of progression according to stage and grade. Node-negative non-metastatic clear-cell RCC (ccRCC) patients treated with radical or partial nephrectomy from 2000 to 2020 were included. Sites of progression were defined as thoracic, abdominal and others (bone/brain). Kaplan-Meier curves and multivariable Cox regression (MCR) models tested for PFS and CSS. Of 384 clear cell RCC N0M0 patients, 301 (78.4%) vs. 83 (21.6%) were pT1-2 vs. pT3-4, respectively; 253 (65.9%) vs. 130 (33.9%) were G1-G2 vs. G3-G4. Thoracic progressions occurred in 2.7% pT1-T2 vs. 21.7% pT3-T4 and 2.8% G1-G2 vs. 14.6% G3-G4 tumors. Abdominal progressions occurred in 4.0% pT1-T2 vs. 13.3% pT3-T4 and 4.3% G1-G2 vs. 9.2% G3-G4. Other progressions occurred in 0.3% pT1-T2 vs. 9.6% pT3-T4 and 0.8% G1-G2 vs. 5.4% G3-G4 (5.4%). Five-year PFS and CSS were 81.7 and 90.6%, respectively. At MCR models, pT3-4 (HR 9.1, P<0.001), G3-G4 (HR 2.7, P=0.003) and PSMs (HR 6.1, P<0.001) independently predicted PFS. Similarly, pT3-4 (HR 10.1, P<0.001), G3-G4 (HR 4.1, P=0.02), and PSMs (HR 5.2, P=0.04) independently predicted CSS. In ccRCC N0M0 patients, G3-G4, pT3-4, PSMs were independent predictors of progression after surgery. Lower stage and grade ccRCCs progress predominantly in the abdominal sites and may be followed with less frequent extra-abdominal imaging compared to more advanced/aggressive tumors.

PCN111 Incidence and Long-Term Survival of Cervical Cancer Patients in the United States, an Analysis of SEER Database

Cervical cancer in the United States has decreased substantially since the implementation of widespread screening and prevention measures. This study examined the patterns in incidence and survival rates for cervical cancer in recent years. Using Surveillance, Epidemiology, and End Results (SEER) population-based data, we identified patients with cervical carcinoma (ICD-03: C53.x) diagnosis between January 01, 2005, and December 31, 2017. We calculated annual, age-adjusted incidence rates of cervical carcinoma per 100,000 individuals by age, race/ethnicity, stage at diagnosis, and histologic type. Kaplan Meier method was used to obtain five-year cancer-specific survival rates. According to SEER, there were 41,378 cervical carcinoma patients between 2005-17. About 81.4% of cervical cancer cases were aged below 65 years. The incidence rates were substantially higher among blacks (8.1; standard error [SE]=0.1) and Hispanics (9.2; SE=0.1) as compared to whites (7.2; SE=0.0). Compared to other stages and histologic types, higher incidence rates were observed for localized stage (3.4; SE=0.0) and squamous cell carcinoma (5.0; SE=0.0). The overall 5-year cancer-specific survival rate was (71.7%; SE=0.3), while it was highest for adenocarcinoma (77.2%; SE=0.5) histology type. Incidence rates and survival rates declined from 7.6 (SE=0.1) in 2005 to 7.0 (SE=0.1) in 2012 and 72.2% (SE=0.8) in 2005 to 70.6% (SE=0.9) in 2012, respectively. However, there was a gradual increase in the incidence rates from 2.8 (SE=0.1) to 13.5 (SE=0.1) amongst women below 50 years. Even though the overall incidence rate is on the decline, there was a noticeable increase in incidence amongst patients under 50 years. A significant decrease in the 5-year survival rate was also observed. These patterns warrant concerted efforts to increase the early prevention and screening of cervical cancer.

Predictors of lymph node metastasis in T1 colorectal cancer in young patients: Results from a national cancer registry.

e15590 Background: The incidence of colorectal cancer in young adults ( &lt; 44 years) is on the rise. Identifying young patients at risk of regional lymph node metastasis (LNM) is crucial for long-term survival. Prior studies have examined rates of LMN in average risk patients. The objective of this study is to fill the knowledge gap by examining predictors of LMN in young patients using a national cancer registry. Methods: Patients diagnosed with T1 colorectal cancer were identified in the Surveillance, Epidemiology, and End Results register 2000-2017. Potential predictors of LNM and its impact on cancer-specific survival were assessed in logistic and Cox regression with and without multivariable adjustment. Results: In total, 692 patients with T1 colorectal cancer were identified. Most tumors occurred in White race (77.7%), between 40-44 years of age (49.4%), grade III tumor differentiation (59.8%), 1 to 1.9 cm in size (32.2%), and were left sided tumors (61.1%). The overall LNM rate was 22.5 % (n = 149). Using multivariate analysis, LMN was associated with tumor grade IV (undifferentiated) (odds ratio (OR) 2.94, CL: 1.06-8.12; p = 0.038), and increasing tumor size (1 cm – 1.9 cm: OR 2.92, CL: 1.71-4.97, p &lt; 0.001; 2.0 cm – 2.9 cm: OR 2.00, CI: 1.05-3.77, p = 0.034; and ≥ 3.0 cm: OR 2.68, CI: 1.43-5.01, p = 0.002). Five-year cancer-specific survival for patients with LNM was 91% and for patients without LNM 98%. Adjusted cox proportion models showed that LMN was associated with four times higher rate of mortality (hazard ratio (HR) 4.43, CI: 1.27-15.52, p = 0.020). Conclusions: In conclusion, the overall LNM rate is approximately 22% for T1 CRC in young patients (less than 45 years). Tumor size and tumor grade are significant predictors for LNM in patients with T1 CRC cancer. Moreover, positive lymph node involvement is a significant prognostic factor for cancer specific survival. Thus, careful preoperative assessment of lymph node status is essential in clinical decision making, to achieve better long-term outcomes

Guideline adherence for radical cystectomy significantly affects survival outcomes in non-muscle-invasive bladder cancer patients

The relationship between guideline adherence for radical cystectomy of non-muscle-invasive bladder cancer and patient prognoses currently remains unclear. We investigated whether guideline adherence at the time of non-muscle-invasive bladder cancer affects the oncological outcomes of bladder cancer patients who underwent radical cystectomy. Among 267 cTa-4N0-2M0 bladder cancer patients, 70 who underwent radical cystectomy under the non-muscle-invasive bladder cancer or muscle-invasive bladder cancer status that progressed from non-muscle-invasive bladder cancer were identified. Patients who followed the guidelines from initial transurethral resection of bladder tumors to radical cystectomy were defined as the guideline adherent group (n=52), while those who did not were the guideline non-adherent group (n=18). In the guideline non-adherent group, 8 (44.4%) out of 18 were diagnosed with highest risk non-muscle-invasive bladder cancer for Bacillus Calmette Guérin-naïve patients and 7 (38.9%) had a Bacillus Calmette Guérin unresponsive tumor status. Five-year recurrence-free survival and cancer-specific survival rates for the guideline non-adherent group vs guideline adherent group were 38.9% vs 69.8% (P=0.018) and 52.7% vs 80.1% (P=0.006), respectively. A multivariate analysis identified guideline non-adherence as one of independent indicators for disease recurrence (hazard ratio=2.81, P=0.008) and cancer-specific death (hazard ratio=4.04, P=0.003). In a subgroup analysis of 49 patients with cT1 or less non-muscle-invasive bladder cancer at the time of radical cystectomy, guideline non-adherence remained an independent prognostic factor for cancer-specific survival (hazard ratio=3.46, P=0.027). Guideline adherence during the time course of the non-muscle-invasive bladder cancer stage may result in a favorable prognosis of patients who receive radical cystectomy. Even under non-muscle-invasive bladder cancer status, radical cystectomy needs to be performed with adequate timing under guideline recommendations.

Mucoepidermoid carcinoma of the parotid gland: Twenty-year experience in treatment and outcomes.

Parotid gland mucoepidermoid carcinoma (MEC) has published five-year cancer-specific survival (CSS) rates of 77%-97%, with variance related to grade. Patients receiving primary surgery for parotid gland MEC from 1995 to 2014 at a tertiary medical center underwent clinical review, histopathologic review, and cytogenetic analysis. Survival outcomes were evaluated. Among 58 patients, T/N/M classification was as follows: T1 in 35 patients, T2 in 14, T4a in 9, N0 in 53, N1 in 2, N2b in 3. Histologic grade was low in 27, intermediate in 17, and high in 12 patients with 98% MAML2 positivity. All patients underwent parotidectomy, and seven patients received adjuvant radiation therapy. CSS was 100% at 5 years and 94.1% at 10 and 15 years. Two patients experienced locoregional recurrence. Treatment with adequate surgical resection and adjuvant radiation therapy for high-grade or advanced-stage tumors yields excellent survival, independent of clinical stage or pathologic grade.

Irreversible Electroporation for the Treatment of Small Renal Masses: 5-Year Outcomes.

Introduction: Irreversible electroporation (IRE) is a nonthermal ablative technology that applies high-voltage short-pulse electrical current to create cellular membrane nanopores and ultimately results in apoptosis. This is thought to overcome thermal limitations of other ablative technologies. We report 5-year oncologic outcomes of percutaneous IRE for small renal masses. Patients and Methods: A single-institution retrospective review of cT1a renal masses treated with IRE from April 2013 to December 2019 was performed. Those with <1 month follow-up were excluded. IRE was performed with the NanoKnife© System (Angiodynamics, Latham, NY). Renal mass biopsy was obtained before or during ablation in most circumstances; biopsy was excluded in some patients because of concern for IRE probe displacement. Postablation guideline-based surveillance imaging was performed. Initial treatment failure was defined as persistent tumor enhancement on first post-treatment imaging. Survival analysis was performed through the Kaplan-Meier method for effectively treated tumors (SPSS; IBM, Armonk, NY). Results: IRE was used to treat 48 tumors in 47 patients. Twenty-two per 48 tumors (45.8%) were biopsy-confirmed renal cell carcinoma (RCC). No complications ≥ Clavien Grade III occurred and 36 patients (76.6%) were discharged the same day. Initial treatment success rate was 91.7% (n = 44/48); three treatment failures were managed with salvage radiofrequency ablation and one with robotic partial nephrectomy. Median follow-up was 50.4 months (interquartile range 29.0-65.5). The 5-year local recurrence-free survival was 81.4% in biopsy-confirmed RCC patients and 81.0% in all patients. Five-year metastasis-free survival was 93.3% and 97.1%, respectively, and 5-year overall survival was 92.3% and 90.6%, respectively. Five-year cancer-specific survival was 100% for both biopsy-confirmed RCC and all patient groups. Conclusions: IRE has low morbidity, but suboptimal intermediate-term oncologic outcomes compared with conventional thermal ablation techniques for small low-complexity tumors. Use of IRE should be restricted to select cases.

Operative management in patients with upper tract urothelial carcinoma in Iceland: a population-based study

Objective Radical nephroureterectomy is the standard treatment of organ-confined upper tract urothelial carcinoma (UTUC). The objective of this study was to investigate survival and bladder recurrence rate in Icelandic patients with UTUC who underwent radical nephroureterctomy (RNU) or other procedures with curative intent. Material and methods All patients who were diagnosed with UTUC in Iceland from 2003 to 2016 and treated with curative intent were included in the study. Information on patients was obtained retrospectively from patients’ medical records and from the Icelandic Cause of Death Registry. Results Overall 63 patients underwent a procedure for UTUC with curative intent in Iceland during the study period. The median age was 71 years and the majority were male (65%). In 50 patients (79%), the tumor was a primary UTUC. The most common procedure was RNU (78%) and eight patients (13%) underwent a kidney-sparing procedure. No patient died within 90 d of surgery. Twenty-eight patients (44%) had pathological stage T2 or higher, whereas 35 patients (56%) had pathological stage T1 or lower. The median follow-up time was 98.8 months . During the follow-up time 25 patients (40%) were diagnosed with recurrence in the bladder. Five-year cancer-specific survival (CSS) was 67%. Conclusions This population-based study shows that the oncologic outcome in Icelandic patients with UTUC is similar to what has been reported in other countries. Bladder recurrence rate is high and can hopefully be reduced by improvements in surgical and intravesical instillation treatment. Possibly more kidney-sparing surgeries could have been done during the study period; however, careful selection for those procedures is mandatory.

Leiomyosarcoma of the urinary bladder: A SEER database study and comparison to leiomyosarcomas of the uterus and extremities/trunk

No well-established staging system exists for bladder leiomyosarcoma (LMS), and the current staging system does not include tumor size, a thoroughly validated prognostic parameter for sarcomas. Uterine and extremity/trunk LMS are more common than those in the bladder and have well-established staging systems incorporating tumor size. We aim to improve the understanding of LMS of the urinary bladder by assessing cancer-specific survival (CSS) and comparing LMS at this unusual anatomic site to those arising at other sites using the Surveillance, Epidemiology, and End Results (SEER) database. The SEER database (1973–2013) was queried for bladder, uterus, and trunk/extremity LMS. Multivariable Cox proportional hazard regression was performed to identify predictors of CSS for each anatomic location and used to compare outcomes at different sites. We identified 165 bladder, 4987 uterus, and 2536 extremity/trunk LMS cases. Five-year CSS was 52% for uterus, 73% for bladder, and 82% for extremity/trunk LMS. For LMS at all sites, uterine location (HR = 2.14, P < 0.001) and increasing tumor size (HR = 1.05, P < 0.001) were significant predictors of worse CSS on multivariate analysis. For bladder LMS, increasing tumor size (HR = 1.18, P = 0.003) was an independent prognostic factor and the conventional staging cut-off threshold of 5 cm for sarcomas outside the head/neck showed statistical significance in stratifying patient risk of cancer-related death. Bladder LMS appears to have clinical behavior intermediate between those of the extremities/trunk and uterus. We suggest that the conventional sarcoma staging protocols based on tumor size be applied to LMS of the urinary bladder.

Impact of Age and Comorbidity on Multimodal Management and Survival from Colorectal Cancer: A Population-Based Study.

This retrospective population-based study examined the impact of age and comorbidity burden on multimodal management and survival from colorectal cancer (CRC). From 2000 to 2015, 1479 consecutive patients, who underwent surgical resection for CRC, were reviewed for age-adjusted Charlson comorbidity index (ACCI) including 19 well-defined weighted comorbidities. The impact of ACCI on multimodal management and survival was compared between low (score 0–2), intermediate (score 3) and high ACCI (score ≥ 4) groups. Changes in treatment from 2000 to 2015 were seen next to a major increase of laparoscopic surgery, increased use of adjuvant chemotherapy and an intensified treatment of metastatic disease. Patients with a high ACCI score were, by definition, older and had higher comorbidity. Major elective and emergency resections for colon carcinoma were evenly performed between the ACCI groups, as were laparoscopic and open resections. (Chemo)radiotherapy for rectal carcinoma was less frequently used, and a higher rate of local excisions, and consequently lower rate of major elective resections, was performed in the high ACCI group. Adjuvant chemotherapy and metastasectomy were less frequently used in the ACCI high group. Overall and cancer-specific survival from stage I-III CRC remained stable over time, but survival from stage IV improved. However, the 5-year overall survival from stage I–IV colon and rectal carcinoma was worse in the high ACCI group compared to the low ACCI group. Five-year cancer-specific and disease-free survival rates did not differ significantly by the ACCI. Cox proportional hazard analysis showed that high ACCI was an independent predictor of poor overall survival (p < 0.001). Our results show that despite improvements in multimodal management over time, old age and high comorbidity burden affect the use of adjuvant chemotherapy, preoperative (chemo)radiotherapy and management of metastatic disease, and worsen overall survival from CRC.

Distinct effect of body mass index by sex as a prognostic factor in localized renal cell carcinoma treated with nephrectomy ~ data from a multi-institutional study in Japan ~

BackgroundWe assessed the prognostic value of body mass index (BMI) in Asian patients with localized RCC who underwent nephrectomy.MethodsA total of 665 patients who underwent nephrectomy for localized RCC were enrolled in the present study and divided into the two BMI groups: i.e., BMI < 25 in 463 (69.6%) and BMI > 25 in 202 (30.4%) patients.ResultsIn total, there were 482 (72.5%) males and 183 (27.5%) females. Five-year cancer-specific survival (CSS) rates were significantly higher in increased BMI than the lower BMI group (97.1 and 92.5%: P = 0.007). When stratified by sex, significantly longer CSS in higher BMI was confirmed in males (5-year CSS of 92.7% in BMI < 25 and 98.1% in BMI > 25, p = 0.005), while there was no difference in CSS between BMI groups for female patients. Multivariable analysis exhibited that higher BMI was an independent predictor for favorable CSS in male (cox model: p = 0.041, Fine & Gray regression model: p = 0.014), but not in the female. Subgroup analysis for CSS revealed that favorable CSS with higher BMI was observed in patient subgroups of age < 65 (p = 0.019), clear cell histology (p = 0.018), and tumor size > 4 cm, p = 0.020) as well as male (p = 0.020).ConclusionOur findings collected from the multi-institutional Japanese dataset demonstrated longer survival in patients with higher BMI than lower BMI for non-metastatic RCC treated with nephrectomy. Intriguingly, this finding was restricted to males, but not to females.

Abstract PS7-63: Cause of death discordance between death certificates and medical files: Impact on cancer survival assessment in a Belgian case study

Abstract Introduction Accurate information on cause of death is essential for correct breast cancer-specific mortality assessment. However, registration and coding of cause of death is prone to error since determining the exact underlying condition related to the death is challenging. In this study, an expert review of medical files was done to determine the principal cause of death for breast cancer patients of a Belgian tertiary hospital. The retrieved cause of death was compared to death certificate information to assess concordance between both sources. Secondly, the impact of discordant reporting on cause-specific survival (CSS) and other net survival approaches were examined. Methods Breast cancer patients diagnosed and treated at University Hospitals Leuven (UHL) between 2009 and 2014 with follow-up until December 31st, 2016, were included in the study. Information on cause of death was obtained from death certificates (following ICD-10 rules) and medical files. The latter were reviewed by a board of experts at UHL. Agreement was calculated using Cohen’s kappa coefficient, and reasons for discordant reporting were assessed. CSS was calculated based on cause of death information from both sources using the Kaplan-Meier method. These survival estimates were compared to the relative survival probability (RS) using the Ederer II and Pohar Perme method. Results A total of 2,862 patients were included, of whom 354 died after a median follow-up of 54.6 months. We found overall substantial agreement (kappa-value of 0.69 (95% C.I.: 0.62-0.77)) between cause of death reported by death certificates and medical files (Table 1). In 84.8% of cases, there was concordance between both methods. When comparing to medical files, misattribution of breast cancer-specific death in death certificates (4.5% of cases) was linked to the presence of comorbidities (43.7%), metastases (37.5%), or unspecified causes (18.8%). Five-year CSS based on medical files (93.1% (95% C.I.: 91.9-94.1)) was only slightly higher compared to CSS based on death certificates (92.3% (95% C.I.: 91.2-93.4)). RS measures using Ederer II and Pohar Perme were comparable to CSS measures. Conclusions Overall, substantial agreement of cause of death was seen between death certificates and medical files. Attribution of cause death to comorbidities was the most common reason for discordant reporting of breast cancer-specific death. Five-year breast cancer-specific survival was slightly higher based on cause of death information from medical files, compared to death certificates. Periodic reviews and implementation of ICD-10 guidelines for classification of cause of death could improve accuracy in cause of death annotation. Table 1: Discordance for the principal cause of death between medical files and death certificatesmedical filesother causesbreast cancerdeath certificatesother causes136 (38.4%)16 (4.5%)152 (42.9%)breast cancer38 (10.7%)164 (46.3%)202 (57.1%)174 (49.2%)180 (50.9%)354 (100%) Citation Format: Hava Izci, Tim Tambuyzer, Jessica Vandeven, Jérôme Xicluna, Hans Wildiers, Kevin Punie, Nynke Willers, Eva Oldenburger, Els Van Nieuwenhuysen, Patrick Berteloot, Ann Smeets, Ines Nevelsteen, Liesbet Van Eycken, Harlinde De Schutter, Patrick Neven, Geert Silversmit, Freija Verdoodt. Cause of death discordance between death certificates and medical files: Impact on cancer survival assessment in a Belgian case study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-63.

A Prospective Study on Metronomic Scheduling of Non-chemotherapeutic Drugs in Advanced Epithelial Ovarian Cancers.

The online version contains supplementary material available at 10.1007/s13193-020-01261-w.