Highest Median Survival Research Articles

Disparities in Pancreatic Cancer Outcomes in the Disaggregated Asian American Population.

The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population is among the fastest-growing population in the USA. However, this is not reflected in scientific research, in which ethnic groups are often combined. We identified trends in treatment and outcomes for pancreatic cancer in a disaggregated AANHPI population. We hypothesize that patients from different AANHPI groups have differences in survival. A retrospective analysis of the National Cancer Database between 2010 and 2019 identified patients treated for pancreatic cancer. We identified demographic factors for patients of Caucasian, African American, and disaggregated Asian subpopulations. Survival curves were generated and multivariate analysis was performed to help determine which factors impacted overall survival. A total of 296,448 patients met the inclusion criteria. Of those, 8568 (3%) patients were Asian. Median survival of AANHPI patients was 11.3 months, as compared with Caucasians (8.9 months) and African Americans (8.1 months) (p<0.0001). Asian Indians had the highest median survival (14.3 months), whereas the Japanese subpopulation had the lowest (7.6 months) (p<0.0001). There were significant differences in median survival between the different AANHPI subpopulations irrespective of stage. Multivariate analysis demonstrated that belonging to an AANHPI racial/ethnic group, excluding Japanese and Filipino, was associated with decreased risk of overall mortality. Significant differences were identified in the overall median survival for patients with pancreatic cancer between AANHPI subpopulations. Disparities in socioeconomic factors may have played a role in overall survival. This study highlights the need to include disaggregated data in future studies to subdue disparities in cancer care for patients.

Abstract A023: Racial differences in lung cancer burden: A retrospective analysis of TriNetX data

Abstract Background. Lung cancer is the number one cause of cancer-related deaths in the U.S. and many other countries. Lung cancer incidence and mortality rates have decreased for all races over the past 20 years, in part because of decreased tobacco use. Yet, there have been few clinical studies of lung cancer morbidity and mortality by race. The purpose of this study is to examine racial differences in lung cancer mortality in the U.S. using the electronic health records (EHR) database, TriNetX. Method. This retrospective cohort study was conducted based on the data from US Collaborative Network in TriNetX, a real-time, EHR database providing 42.7-million patient data from 49 health care organizations (HCOs). The cohort of interest was lung cancer patients in the U.S., which were identified using the ICD-10 code of C34 with an index diagnosis date of January 1, 2010. Kaplan-Meier curves, log-rank chi-square statistics, and hazard ratio (HR) were compared among different racial groups in the EHR data. Results. Of 42.7-million patients in the U.S., the majority (60.3%) were people who are non-Hispanic white (NHW) followed by people who are Black/African American (15.4%), Hispanic (7.2%), Asian (4.6%), and others (Native Hawaiian/Pacific Islander, 0.5%). 394,560 lung cancer patients were identified. Kaplan-Meier survival curves showed that Asians had the highest survival probability with median overall survival (OS) from the initial lung cancer diagnosis of 127.3 months, compared to 92.1 months for Hispanic, 69.1 months for African American/Black, 61.4 months for others, and 53.8 months for NHW. The HR was highest among NHW (HR=1.71, 95% CI=1.62-1.81), others (HR=1.62, 95% CI=1.41-1.85), African American/Black (HR=1.52, 95% CI=1.43-1.61), and Hispanic patients (HR=1.40, 95% CI=1.30-1.52) compared to Asian patients Conclusion. These findings suggest racial disparities in lung cancer survival, with NHW having the lowest and Asians having the highest median survival. These findings are inconsistent with the results from the Multiethnic Cohort study (prospective population based study), which reported blacks having the lowest median survival. It indicates that there are different racial burdens of lung cancer from clinical data and population data. Further analyses are needed to adjust potential confounders such as smoking status and stage of diagnosis. Citation Format: SoHye Park, Zachary Urdang, Julie Barta, Kuang-Yi Wen, Joseph Curry, Hee-Soon Juon. Racial differences in lung cancer burden: A retrospective analysis of TriNetX data [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A023.

Racial Difference in Part D Enrollment and Survival Among Older Patients with Multiple Myeloma

Introduction Multiple myeloma (MM) is the second most common hematologic malignancy in the United States. African Americans (AAs) are disproportionately affected by MM.Previous studies found that among patients with MM, when having equal access to treatment, AAs had better survival than Whites. Oral agents, e.g., immunomodulatory drugs, play an active role in the treatment of both newly diagnosed and relapsed or refractory MM. For Medicare patients, these oral agents are covered by Part D only. However, little is known about the potential role of Part D enrollment in racial difference among older patients with MM. Methods Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we conducted a population-based cohort study to assess the role of part D enrollment and race in MM survival. The study included AA and White patients with first primary MM (International Classification of Diseases for Oncology-3rd edition, 9732) who 1) were diagnosed from 2007-2017, 2) ages ≥ 66 years at diagnosis, and 3) had continuous Parts A & B enrolment and were not a member of HMO from 12 months before diagnosis to end of follow-up (death or 12/31/2019, whichever came first). Patients were categorized as ever or never enrolled in Part D. We applied a published algorithm to define smoldering and symptomatic MM patients. Our outcome of interest is overall survival. Cochran-Armitage trend test was used to test trend of Part D enrollment by year of diagnosis. Kaplan-Meier curves were generated, and log-rank tests were used for comparisons across groups. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated from a multivariable Cox proportional hazards model, adjusting for demographics, comorbidities, and socioeconomic factors. All statistical tests were two-sided with a type I error of 0.05 and were performed with SAS Version 9.4. Results The final cohort included 17,097 patients with a median follow-up of 2.64 (interquartile range [IQR] 0.81-4.78) years for 3,315 AAs and 2.58 (IQR 0.70-4.72) years for 13,782 Whites. The median age of AAs was 75 ([IQR 70-80) and of Whites 76 (IQR 71-82) years. Compared with Whites, AAs were more likely to be female, younger, unmarried, diagnosed in more recent years, had a high Elixhauser score, be frail, have state buy-in, and reside in census tracts with 20-100% population below poverty (all ps<.01). However, AAs were less likely to have a diagnosis of symptomatic MM (69.0% vs 71.0%, p=0.02). During the follow-up, 85.7% AAs and 78.1% Whites were ever enrolled in Part D (p<.01). Among both races, Part D enrollment increased over years (ptrend<.01). AAs had higher Part D enrollment percentage than Whites in both smoldering MM (AAs 88.8%, Whites 84.7%, p<.01) and symptomatic MM groups (AA 84.3%, Whites 75.4%, p<.01). The median survival was 3.05 (95% CI 2.85-3.24) years for AAs and 2.86 (95% CI 2.75-2.97) years for Whites (p<.01). Smoldering MM patients who ever had Part D enrollment had highest median survival; among these patients, AA had higher median survival (5.76, 95% CI 5.39-6.62 years) than their White counterparts (4.94, 95% CI 4.71-5.15 years; Figure 1). In the multivariable models, Part D enrollees (vs non-enrollees) had better overall survival (p<.01), and the interaction term between race and Part D enrollment was statistically significant for all patients (p=0.04) and smoldering patients (p<.01). As shown in Figure 2, among patients who were ever enrolled in Part D, compared to Whites AAs had lower risk of death (HR=0.88, 95% CI 0.83-0.93, p <.01), especially among smoldering MM patients (HR=0.78, 95% CI 0.70-0.87, p<.01). However, among patients never enrolled Part D, no difference on survival (HR=0.99, 95% CI 0.89-1.11, p=0.92) was observed. Conclusions Among patients who ever enrolled in Part D, AAs, especially with smoldering MM, had better survival than Whites, yet there was no racial difference in survival among patients who never had Part D coverage. A higher percentage of Medicare Part D enrollment in AAs than that in Whites may help explain the racial difference in survival observed in MM patients. Future research is needed to evaluate patterns of MM care by both race and Part D enrollment. Acknowledgement This study was supported by grant 1U01CA265735-01. The contents are solely the responsibility of the authors and does not necessarily represent the official views of funding agency. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Primary site and survival in osteosarcoma: A National Cancer Database (NCDB) analysis.

e23512 Background: Osteosarcoma (OSC) is the most common primary bone tumor and typically affects the appendicular skeleton (specifically, the long bones of the upper and lower extremities). However, this cancer can affect other regions of the body as well, such as the skull, mandible, ribs, vertebral column, and other areas involving bone and/or any articular cartilage and, to the author’s knowledge, all possible primary sites have not been investigated. The aim of this study is to see whether or not the primary site of the tumor in OSC patients may have an effect on survival outcomes. Methods: Using the NCDB, patients diagnosed with OSC between 2004-2018 were identified using ICD-O-3 histology codes 9180 through 9193. The cohort was analyzed to investigate survival outcomes in different primary sites. Univariate analysis was then performed assessing patient length of survival for each primary site subtype. Data was analyzed using SPSS and statistical significance was set at α = 0.05. Results: A total of 9826 patients with known primary site that had survival data were included. The site with the best survival was the lower limb which had significantly better survival than all other primary sites. Tumors of the upper limb had highest median survival (153 months) of those with median survival reported (which was all except for lower limb). Patients with primary tumor of ribs, sternum, clavicle had a significantly better survival than both vertebral column and pelvis/sacrum/coccyx (all p &lt; .01). Upper limb patients survived significantly longer than all groups other than the skull, face, and mandible (p &lt; .05). The labeled primary site with the highest mean survival was the lower limb at 123.1 months and the lowest survival was the pelvis, sacrum, and coccyx, with a median survival of 54.6 months. Conclusions: This study found numerous survival differences between patients diagnosed with OSC of different primary sites. Labeled primary sites of the lower limb and upper limb were associated with best survival while the pelvis, sacrum, and coccyx were associated with worst survival. Future studies should be done to investigate variables that may impact the survival of different primary sites, including staging, treatments, time from diagnosis to treatment, socioeconomic factors, and insurance status.[Table: see text]

Primary site and survival in chondrosarcoma: A National Cancer Database analysis.

e23503 Background: Chondrosarcoma is one of the most common primary malignancies of bone, accounting for around a fifth of all primary malignant bone tumors. These tumors typically affect the pelvis, hip, and shoulder but can arise anywhere that there is bone and cartilage (e.g. hands, feet, skull, etc.). To the authors’ knowledge, other primary sites have not been investigated in relation to its effect on survival outcomes. The aim of this study is to investigate this effect and see if there is any difference in survival amongst different primary sites in this patient population. Methods: Using the NCDB, patients diagnosed with chondrosarcoma between 2004-2018 were identified using ICD-O-3 histology codes 9220 and 9221. We analyzed the cohort to investigate survival outcomes in different primary sites. Univariate analysis was performed using SPSS to assess patient length of survival for each primary site. Statistical significance was set at α = 0.05. Results: A total of 7681 patients with known primary site that had survival data were included. The mean survival of the cohort was 140.3 months. The sites with the longest survival were the upper limb and the skull, face, and mandible, each of which had significantly longer survival than all other primary sites (all p &lt; .01). The lower limb and ribs, sternum, and clavicle had the next highest survival which was significantly longer than the vertebral column and pelvis, sacrum, and coccyx (all p &lt; .01). The vertebral column was the primary site with shortest survival with a median of 121 months. Conclusions: This study found significant survival differences between patients diagnosed with chondrosarcoma of different primary sites. Of all sites analyzed, the upper limb had the highest median survival of 187 months and showed statistical significance versus all other primary sites, and the vertebral column had the lowest median survival of 121 months. Future studies could be done regarding primary site to further elicit why there is such a large difference in survival, and can look at different imaging modalities used, time to treatment, and demographic and socioeconomic variables in each cohort.[Table: see text]

Solid Carcinoma of the Canine Mammary Gland: a Histological Type or Tumour Cell Arrangement?

Mammary neoplasms are the most frequently diagnosed tumours in female dogs and are classified into various histological types, including solid carcinomas. We proposed a subclassification of solid carcinomas based on morphological and immunohistochemical characteristics, and correlated the subtypes with prognostic factors. A total of 135 cases of solid mammary carcinoma were selected from 3,400 canine mammary neoplasms in the archives of the Laboratory of Comparative Pathology, Institute of Biological Sciences, Federal University of Minas Gerais, Brazil. Epidemiological and survival data were obtained, and immunolabelling for chromogranin A, pancytokeratin, cytokeratin 14, Ki67 and p63 was performed. Solid carcinomas were classified into six subgroups: malignant adenomyoepithelioma (68/135), carcinoma with solid pattern (22/135), malignant myoepithelioma (16/135), basaloid carcinoma (14/135), neuroendocrine carcinoma (10/135) and solid papillary carcinoma (5/135). Shorter survival time was associated with the presence of lymphatic invasion (P=0.009) in the initial clinical staging (I-III). When considering all clinical stages (I-V), vascular invasion (P<0.001) and the presence of regional metastasis (P=0.004) were important prognostic factors. Basaloid carcinoma and solid papillary carcinoma did not reach the median survival time for early-stage cases, and malignant myoepithelioma had the highest median survival in advanced stages. Carcinoma with a solid pattern was associated with a higher number of regional metastases. Distinguishing the various histological and immunophenotypic subtypes that exhibit a solid arrangement, using histological and immunohistochemical criteria, is essential for understanding the behaviour of these neoplasms and for the selection of more appropriate and specific therapies.

Impact of surgery on survival in breast cancer with bone metastases only: a SEER database retrospective analysis

BackgroundIt was controversial to operate on the primary site of breast cancer (BC) with bone metastasis only. We investigated the impact of surgery on BC patients with bone metastases via a SEER database retrospective analysis.MethodsA total of 2917 BC cases with bone metastasis, first diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and Results Database (SEER) of National Cancer Institute were selected. We assessed the effect of different surgical procedures on survival and prognosis.ResultsCompared with the non-surgical group, the primary tumor surgical group showed longer median survival time (χ2 = 146.023, P < 0.001), and the breast-conserving subgroup showed the highest median survival time of 70 months (χ2 = 157.117, P < 0.001). Compared with the non-surgery group, the median overall survival (OS) of primary surgery group was longer (HR = 0.525, 95%CI = 0.467–0.590, P < 0.001), and the breast-conserving subgroup showed the longest median operative OS (HR = 0.394, 95%CI = 0.325–0.478, P < 0.001).ConclusionThis study showed that primary surgery could improve the median survival time and OS of BC patients with bone metastasis. Moreover, under the condition of low tumor burden, breast conserving surgery was a better choice.

Mitochondria-Targeted Polyamidoamine Dendrimer-Curcumin Construct for Hepatocellular Cancer Treatment.

Mitochondrial malfunction plays a crucial role in cancer development and progression. Cancer cells show a substantially higher mitochondrial activity and greater mitochondrial transmembrane potential than normal cells. This concept can be exploited for targeting cytotoxic drugs to the mitochondria of cancer cells using mitochondrial-targeting compounds. In this study, a polyamidoamine dendrimer-based mitochondrial delivery system was prepared for curcumin using triphenylphosphonium ligands to improve the anticancer efficacy of the drug in vitro and in vivo. For the in vitro evaluations, various methods, such as viability assay, confocal microscopy, flow cytometry, reactive oxygen species (ROS), and real-time polymerase chain reaction analyses, were applied. Our findings showed that the targeted-dendrimeric curcumin (TDC) could successfully deliver and colocalize the drug to the mitochondria of the cancer cells, and selectively induce a potent apoptosis and cell cycle arrest at G2/M. Moreover, at a low curcumin dose of less than 25 μM, TDC significantly reduced adenosine triphosphate and glutathione, and increased the ROS level of the isolated rat hepatocyte mitochondria. The in vivo studies on the Hepa1-6 tumor-bearing mice also indicated a significant tumor suppression effect and the highest median survival days (Kaplan-Meier survival estimation and log-rank test) after treatment with the TDC construct compared to the free curcumin and untargeted construct. Besides its targeted nature and safety, the expected improved solubility and stability represent the prepared targeted-dendrimeric construct as an up-and-coming candidate for cancer treatment. The results of this study emphasize the promising route of mitochondrial targeting as a practical approach for cancer therapy, which can be achieved by optimizing the delivery method.

Insurance status and cholangiocarcinoma: A NCDB analysis.

500 Background: There is an increasing rise of cholangiocarcinoma though the cause is unclear. Cholangiocarcinoma is more often than not incurable at diagnosis and associated with a high mortality rate. Our goal was to compare survival of patients with differing insurance types diagnosed with cholangiocarcinoma identified in the National Cancer Database (NCDB). Methods: We identified 5,638 patients with cholangiocarcinoma in the NCDB diagnosed between 2004-2014. Patients included were categorized as having no insurance, private insurance, Medicaid, or Medicare were included. Between-insurance survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p &lt; .05 indicated statistical significance. Results: Statistically significant survival differences were indicated between all insurance groups (all adjusted p &lt; 0.05), such that privately insured patients had the highest median survival. The discrepancy in survival between uninsured and privately insured patients was the largest (6.5 months vs 13.1 months, respectively). Medicaid patients on average had a survival of 7.5 months, while Medicare patients had a median survival of 7.8 months. 2.8% of uninsured patients presented with stage I cholangiocarcinoma, whereas 34% of privately insured patients presented with stage I cholangiocarcinoma. More Medicare patients were treated at community cancer programs compared to privately insured patients (56.7% vs 30.7%, respectively). Likewise, more Medicare patients were treated at academic/research programs compared to those with private insurance, Medicaid, or those who were uninsured (44.7% vs 38.7% vs 7.2% vs 3.7%, respectively). Conclusions: Our study shows the discrepancies in survival between patients with differing insurance statuses. Of all insurances, those privately insured had the largest median survival. [Table: see text]

EPID-20. TRENDS IN GLIOBLASTOMA OUTCOMES OVER TIME, GEOGRAPHIC LOCATION AND TYPE OF INTERVENTION

Abstract INTRODUCTION The management of glioblastoma (GBM) has changed over time and varies based on geographic location. Despite its universally fatal prognoses, it is unclear if GBM outcomes have changed over time, if they vary by geographic location, and differ based on type of intervention. As a result, we conducted a systematic review of the literature to identify the average survival differences of GBM patients across time, between different continents, and among various treatments. METHODS The systematic review of PubMed included glioblastoma, GBM, and survival. Inclusion criteria consisted of full-text titles with human subjects, GBM/Grade IV astrocytoma, age &gt;18 years old, and with available survival data. RESULTS 9,162 articles were screened for survival data, 1728 were eligible, 405 complied with the inclusion criteria. Of the 405 studies, 179 (44.2%) were conducted in Europe, 151 (37.3%) in the Americas, 61 (15.1%) in Asia, 9 (2.2%) in Oceania, and 1 (0.2%) in Africa. Leading countries are the United States (33.1%), Germany (12.3%), and Italy (11.1%). Asia had the highest median survival (14.9 months), followed by Europe (13.2 months), and the United States (12.9 months) (P=0.003). Regarding treatment, survival was significantly higher after the introduction of the Stupp protocol (P&lt; 0.001). Post-Stupp Studies had longer survival estimates (15.3 months, range: 3.8–29.6) than Pre-Stupp Studies (12.2 months, range: 2.3–28). In the included clinical trials (182), radiation (43.4%), temozolomide (25.3%), or other chemotherapies (24.2%) were the most common interventions. Clinical trial median survival estimates were significantly higher than all other studies (P&lt; 0.017). Bevacizumab (19.3 months) and Temozolomide (15.9 months) had the longest recorded median survival estimates; while radiation (14 months), other chemotherapies, and carmustine (13.2 months) had the shortest (P=0.009). CONCLUSION This epidemiological study describes the current global state of GBM. Important differences regarding survival and treatment of patients with GBM were found.

Survival and Prognosis of Chondrosarcoma Subtypes: SEER Database Analysis.

Chondrosarcomas are rare tumors and, historically, investigation of these tumors has been limited to small series and single-institution studies. There have been no studies that evaluated the identification or comparison of differences in prognostic factors between the five known non-conventional chondrosarcoma subtypes (myxoid, juxtacortical, clear-cell, mesenchymal, and dedifferentiated). The purpose of this paper was to determine the demographic, clinical, incidence, and tumor characteristics of all five known non-conventional chondrosarcoma subtypes, determine the 1-, 5-year, and median survival differences between these subtypes, and to determine the demographic and clinical variables that are significant prognostic indicators for each chondrosarcoma subtypes. We retrospectively reviewed the SEER database for all patients with non-conventional chondrosarcoma. χ2 testing was used for correlations between clinical variables. Kaplan-Meier and Cox proportional hazard analysis were used to compare survival of the subtypes, and to assess the prognostic value of age group, race, sex, grade, anatomic location, and metastatic involvement. Several demographic characteristics including gender, race, age, and grade varied between chondrosarcoma subtypes. The tumor characteristics showed marked differences in presence of metastasis on presentation between the subtypes with increasing order of rate of metastasis with juxtacortical (2.1%), clear cell (5.7%), myxoid (7.6%), mesenchymal (10.6%), and the highest in dedifferentiated (19.8%). One-, 5-year, and median survival differed significantly between chondrosarcomas subtypes. The highest median survival was found in the juxtacortical subtype (97 months), followed by clear cell (79 months), myxoid (60 months), mesenchymal (33.5 months), and lowest in dedifferentiated (11 months). The only prognostic variable that was shown to significantly impact the survival of each non-conventional chondrosarcoma subtype was a metastatic disease at diagnosis (p = 0.03 to p < 0.001). Subtyping classification of chondrosarcoma should be made whenever possible, given differences in survival and prognostic factors between chondrosarcoma subtypes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:311-319, 2020.

Patterns of Care and Survival Outcomes in the Treatment of Anal Melanoma.

Anal mucosal melanoma is an uncommon malignancy of the anal canal, with few large studies available to establish clear trends in the treatment modalities presently available. The primary goal of this study was to identify the patterns of care in the treatment of anal melanoma and secondarily to determine outcomes. This was a retrospective study performed utilizing the National Cancer Database (NCDB). A total of 787 patients diagnosed with anal melanoma between 2004 and 2014 were selected, of which 398 had staging information. The four treatment groups analyzed were surgical excision alone, surgical excision and radiation therapy, surgical excision and immunotherapy/chemotherapy, and radiation therapy plus minus immunotherapy/chemotherapy. Treatment was grouped by extent of disease; the Kaplan-Meier method was used to analyze overall survival and multivariate Cox proportional model was used to identify factors associated with overall survival. The majority of patients presented with either node-positive (39.4%) or metastatic disease (37.4%). Patients with surgical excision and radiation therapy had the highest median survival at 32.3months. This is in contrast with those receiving surgical excision alone (22.9months), surgery and immunotherapy/chemotherapy (18.4months), and radiation without surgery (5.1months) (p < 0.0001). Treatment with surgical excision was the most common initial treatment with no single modality superior over another in this rare entity.

Impact of Tumor Location and Variables Associated With Overall Survival in Patients With Colorectal Cancer: A Mayo Clinic Colon and Rectal Cancer Registry Study.

Background: Our study investigated the demographic characteristics of Mayo Clinic Colon and Rectal Cancer Registry patients and sought to associate tumor location with overall survival.Methods: Using the cohort of patients seen at Mayo Clinic (Minnesota, Arizona, Florida) from 1972 to 2017, we obtained 26,908 colorectal adenocarcinoma patient records. Overall survival of patients with colorectal cancer was analyzed by sidedness (right vs. left) and location (right vs. left vs. rectum). Kaplan–Meier method was used to analyze all demographic and cancer variables available within the dataset to trace survival over a 35-year period. Subgroups within variables were compared to each other using log-rank test and considered significantly different at P < 0.05. Cox proportional hazards regression model was used to assess impact of tumor location while controlling for age, year of diagnosis, sex, tumor stage, and tumor grade. Cox regression models were used to evaluate the independent effect of cancer location on overall survival after adjusting for age, gender, year of diagnosis, and cancer stage. To further explore the potential interaction effect of cancer location with cancer stage and year of diagnosis, similar multivariable Cox model was fit stratified by cancer stage (1–3 vs. 4) and by year of diagnosis (<1980, 1980–2000, >2000).Results: Overall survival differed significantly within all variables studied after Kaplan–Meier method analysis (P < 0.0001). Survival was higher in the left-side group when evaluated by tumor sidedness, and rectal cancer patients had the highest median survival (101.3 months). Right-sided cancer patients had the worst prognosis in both tumor location and sidedness analyses, with a median survival of 76.6 months. However, the stratified analysis showed that, the difference in survival between left- and right-sided cancer only existed in late cancer stage (stage 4) patients but not in early cancer stage; therefore, screening for CRC to pick cancer at an early stage can influence overall survival significantly.Conclusion: These observations confirm some of the previous and recent studies on sidedness of colorectal cancer patients. Our analysis is novel in that it included patients of all stages rather than just stage IV metastatic patients. This initial study provides a platform to investigate more biologic and clinical factors associated with tumor location. Merging this dataset with other available datasets and previously conducted studies within the institution will provide a robust platform for multiple future studies and collaborations. Finally, appropriate screening can result in a decrease in incidence and mortality of CRC.

Insurance status and hepatocellular carcinoma: A NCDB analysis.

240 Background: Typically occurring in patients with chronic liver disease, hepatocellular carcinoma is the most common liver cancer. Our goal was to compare survival of patients with differing insurance types diagnosed with hepatocellular carcinoma identified in the National Cancer Database (NCDB). Methods: We identified 113,159 patients with hepatocellular carcinoma in the NCDB diagnosed between 2004-2014. Patients included were categorized as having no insurance, private insurance, Medicaid, or Medicare were included. Between-insurance survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p &lt; .05 indicated statistical significance. Results: Statistically significant survival differences were indicated between all insurance groups (all adjusted p &lt; 0.05), such that privately insured patients had the highest median survival. The discrepancy in survival between uninsured and privately insured patients was the largest (4.6 months vs. 16.9 months, respectively). Medicaid patients on average had a survival of 9.8 months, while Medicare patients had a median survival of 10.0 months. 19% of uninsured patients presented with stage I hepatocellular carcinoma, whereas 30.3% of privately insured patients presented with stage I hepatocellular carcinoma. More uninsured patients did not have surgery of the primary site compared to privately insured patients (87.7% vs. 70.0%, respectively). Likewise, more privately insured patients had a transplant compared to those with Medicaid, Medicare, or those who were uninsured (13.0% vs. 5.7% vs. 5.0% vs. 1.6%, respectively). Conclusions: Our study shows the discrepancies in survival between patients with differing insurance statuses. Of all insurances, those privately insured had the largest median survival. Median survival and percentage surviving. [Table: see text]

Site-specific proportion cured models applied to cancer registry data

Proportion-cured models were applied to evaluate their applicability on data from a relatively small cancer registry and to assess the up-to-date survival level of major cancer types in Tyrol, Austria. In total, the 25 most common types of cancer were analyzed with mixture cure models using the period approach for estimation of the proportion cured and median survival time of the fatal cases. For several of the cancer types, no estimates could be obtained. The models converged for 14 sites among females and for 15 among males. The highest estimate of the proportion cured was found for cervix cancer (74.0 %; 95 % CI 64.4-83.6) and the lowest for male pancreas cancer (4.6 %; 95 % CI 0.2-9.0). The highest median survival of the uncured was 2.7 years (95 % CI 1.2-6.0) for male larynx cancer and the lowest 0.3 years (95 % CI 0.1-0.6) for male acute myeloblastic leukemia (AML). The estimates seem reliable for stomach, colon, rectum, pancreas, lung, cervix, ovary, central nervous system/brain and AML cancer and among men also for head/neck, esophagus, liver and kidney cancer. Altogether, it is demonstrated that even data from a regional cancer registry covering a rather small region can be utilized to derive up-to-date survival estimates of various cancer types, enabling monitoring of the development and changes in cancer treatment. Moreover, potentially this methodology is advantageously employable in any situation where the number of cancer cases is limited.

Survival trends in palliative care patients with cancer: A Mayo Clinic 5-year review

9592 Background: Palliative care (PC) is an essential part of the continuum of care for cancer (CA) patients (pts). Little is known about the aggregate characteristics and survival of pts receiving inpatient palliative care consultation (PCC). Methods: We reviewed data prospectively collected on patients seen by the Palliative Care Inpatient Consult Service at Mayo Clinic - Rochester from 2003–2008. Demographics, consult characteristics, and survival were analyzed. Kaplan-Meier survival curves and a Cox model of survival were produced. Results: 1794 total patients were seen over the five year period. Cancer is the most common primary diagnosis (47%). Growth in annual PCC has risen dramatically (113 in 2003 vs. 414 in 2007) despite stable total hospital admissions. Patient are predominantly men (52% vs. 48%, p=0.02); median age is 76. General medicine, medical cardiology, and medical intensive care unit services refer most often. Most frequent issues addressed are goals of care, dismissal planning, and pain control (29%, 19%, 17%). PCC in actively dying pts have increased with 27% of all non-operating room, non-trauma in-hospital deaths being seen. Although CA pts have the highest median survival after PCC vs. other diagnoses (17 days, p = 0.018), we observed a five-year trend of decreasing survival from admission to death and PCC to death. Median time from admission to death in CA pts is 36 days in 2003 and 19 days in 2008 (p&lt;0.01). Median time from PCC to death is 33 versus 11.5 days (p&lt;0.01). Despite this, median hospital length of stay and time from PCC to discharge have remained fixed at 8 and 2.5 days, respectively. A Cox model of survival to discharge and &lt;6 months survival (hospice eligibility) shows hospital length of stay, time from consult to discharge, and dismissal location from hospital are all prognostic factors. Conclusions: Survival window for PC intervention for CA pts is lessening. With the trend of shorter survival after PCC, PC professionals have little over two days to implement a comprehensive, ongoing care plan. This highlights the importance of earlier outpatient palliative care involvement with advanced cancer patients and families. No significant financial relationships to disclose.

Postoperative Survival and the Number of Lymph Nodes Sampled During Resection of Node-Negative Non-Small Cell Lung Cancer

To examine the association between postoperative survival and the number of lymph nodes (LNs) examined during surgery among persons who underwent definitive resection of node-negative (stage IA or stage IB) non-small cell lung cancer (NSCLC). Information on postoperative survival and the number of LNs examined during surgery for stage I NSCLC treated with definitive surgical resection was retrieved from the population-based Surveillance, Epidemiology and End Results database for the period from 1990 to 2000. The association between survival and the number of LNs was examined using multivariate Cox proportional hazard models with adjustment for age, race, sex, type of surgery performed, and tumor size, grade, and histology. A total of 16,800 patients were included in the study. The overall survival analysis for patients without radiation therapy (RT) demonstrated that in comparison to the reference group (one to four LNs), patients with five to eight LNs examined during surgery had a modest but statistically significant increase in survival, with a proportionate hazard ratio (HR) of 0.90 and a 95% confidence interval (CI) of 0.84 to 0.97. Similar results for 9 to 12 LNs and 13 to 16 LNs examined produced further increases in survival, with HRs of 0.86 (95% CI, 0.79 to 0.95) and 0.78 (95% CI, 0.68 to 0.90), respectively. There appeared to be no incremental improvement after evaluating > 16 LNs. The corresponding results for lung cancer-specific mortality and for patients receiving RT were not substantially different. The highest median survival (97 months) occurred in patients with 10 to 11 LNs evaluated. Our results indicate that patient survival following resection for NSCLC is associated with the number of LNs evaluated during surgery. This is likely due to reduction of staging error: a decreased likelihood of missing positive LNs with an increasing number of LNs sampled. Although we are reluctant to recommend a definitive "optimal number," our data support the conclusion that an evaluation of nodal status should include somewhere from 11 to 16 LNs.

A comparison between different postoperative treatment modalities of uterine carcinosarcoma

Objective. Uterine carcinosarcomas are highly aggressive neoplasms with no established effective adjuvant therapy. The aim of the present study was to compare between the outcome in three medical institutions in each of which a different postoperative treatment modality was preferred, namely, chemotherapy in one, whole pelvic irradiation (WPI) in another, and sequential treatment (i.e., chemotherapy followed by WPI) in the third. Methods. The hospital records of all 49 uterine carcinosarcoma patients diagnosed and operated from 1995 to 2003 in the three institutions were reviewed. Non-parametric test was used to compare the median age between the treatment groups. Survival was calculated using the Kaplan–Meier method and compared by the log-rank test. Cox proportional hazard regression model was used to assess the effect of treatment type on survival after adjustment for stage. Results. Only about half of the patients (51%) had stage I at diagnosis and the majority of the patients (83.7%) had postoperative adjuvant treatment. The overall 5-year survival of the 41 patients that had postoperative treatment was 49.6%. The highest median survival and 5-year survival rate was observed in the sequential treatment group. Controlling for stage, this treatment modality was associated with a significant decrease in mortality of about 80% when compared to postoperative chemotherapy alone, and a non-significant decrease in mortality of about 50% when compared to WPI alone (HR = 0.20; 95% CI 0.04–0.99, P = 0.049 and HR = 0.50; 95% CI 0.1–2.32, P = 0.4, respectively). Conclusions. The improved outcome in patients who received postoperative sequential treatment seems to indicate that further exploration of this treatment modality is justified.

Colorectal cancer in 2003: state of the art and new developments

Colorectal cancer (CRC) accounts for 10–12% of all cancers and is second in the league of cancer deaths for men and women in western countries. In Western Europe there were more than 200,000 new cases of CRC and over a 100,000 deaths in the year 2000. Despite increased knowledge about the etiology of the disease and improved treatment strategies nearly 50% of patients still die of their disease. Furthermore, the main cause of death is not recurrence at the primary site, but disease spread, predominantly to the liver. The 5-year survival for patients with metastatic CRC is less than 5%, and while patients with resectable metastases have a 5-year survival of 30%, resectable patients currently represent only 15–20% of patients with liver metastases. The standard therapy for patients with advanced CRC remains palliative 5-fluorouracil (5-FU)-based systemic chemotherapy, which is administered with the aim of improving survival and quality of life (QoL). New combination regimens such as irinotecan/5-FU/folinic acid (FA) and oxaliplatin/5-FU/FA have improved survival [1–5] (Table 1). The recently reported EORTC trial of K€ ohne et al. [5] using irinotecan in combination with the German AIO 5-FU/FA regimen, has produced one of the highest median survival times for first-line chemotherapy in this setting with a median survival time of 20.1 months. The recently published study of the sequential administration of two combination regimens showed that the two regimens FOLFIRI (irinotecan/ 5-FU/FA [modified de Gramont]) and FOLFOX (oxaliplatin/5-FU/FA [modified de Gramont]) were essentially similar with both achieving high response rates (RRs) and impressive survival when either regimen was administered first-line followed by the other second-line [6]. Patients receiving FOLFIRI followed by FOLFOX achieved a RR of 56% first-line with a median overall survival (OS) of 21.5 months whilst patients receiving FOLFOX followed by FOLFIRI achieved a RR of 54% and a median OS of 20.6 months Table 2 [6]. These