Impact Of Primary Site Research Articles

Abstract 3820: Impact of primary site in early-stage follicular lymphoma on patient outcomes: Analysis of a large national database

Abstract Introduction: Follicular lymphoma (FL) is the most common indolent Non-Hodgkin lymphoma and is associated with better outcomes compared to other types of lymphoma. Despite this, cure is usually elusive and most patients experience multiple relapses within their lifetime. Previous studies have identified risk factors associated with worse outcomes, but little is known about the role of primary disease site in FL. We sought to investigate the outcomes of patients with extranodal early-stage FL compared to nodal disease using a large national cancer database. Methods: The Surveillance, Epidemiology, and End Results (SEER) public database was used to identify and extract data for patients with FL. Early-stage disease was defined as stage I or II by the Ann Arbor staging system. Most patients in the database were diagnosed after 2000 so this was used as the diagnosis year cutoff and also to reflect the impact of recent management strategies on outcomes. Patients were divided into two groups based on their primary disease site. These two groups were nodal (includes spleen) and extranodal. Treatment effect (surgery, radiation, or chemotherapy) was analyzed when available. Survival was estimated using the Kaplan-Meier method and compared using log-rank tests. Cox proportional hazards models were used for adjusted survival analyses. Results: A total of 13,400 patients with FL of all histologic grades diagnosed between 2000 and 2015 were identified in the SEER database. The median age at diagnosis was 65 years (2-100). A majority of patients were Caucasian (81%), had stage I disease (62%), and belonged to the nodal FL group (79%). Median overall survival (OS) for patients with nodal FL was 181 months [95% CI (175-187)]. Median OS for extranodal FL was 189 months [95% CI (179-195)]. Extranodal FL was associated with better OS compared to the nodal group [HR=0.89, 95% CI (0.84-0.96); p-value =0.00012] even after adjusting for age and race [HR=0.84, 95% CI (0.79-0.90); p-value <0.0001]. Conclusions: In this analysis of a large national cancer database, early-stage FL presenting as extranodal disease can be seen in about 20% of patients and is associated with slightly better outcomes. Citation Format: Olivia Davis, Rana Kasht, Andrew Cohoon, Silas Day, Sami Ibrahimi, Adam Asch, Taha Al-Juhaishi. Impact of primary site in early-stage follicular lymphoma on patient outcomes: Analysis of a large national database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3820.

Overall survival (OS) in gastrointestinal (GI) neuroendocrine tumors (NETs) based on primary site, stage, and surgery.

643 Background: There are limited data on the impact of primary site and surgical intervention on long-term outcomes in GI-NETs. We hypothesized that primary site would be associated with differences in stage-specific OS. Methods: In the National Cancer DataBase, using histology codes, we identified 124,081 GI-NETs diagnosed between 2004-2019 in individuals 18 years or older. OS was estimated by the Kaplan-Meier method. Differences in survival based on primary site, stage, and surgical intervention were assessed using a Cox proportional hazards model, accounting for multiple comorbidities, e.g. Charlson-Deyo Comorbidity Index. Results: The most common primary site for GI-NETs was small intestine (33.6%), followed by colon, rectum, pancreas, and stomach comprising 19.8%, 17.5%, 15.5%, and 9.2%, respectively. Patients with stage I-III NETs undergoing surgery had significantly better median OS compared to those without surgery (mOS 197 vs 115 mo., p<0.0001 by log rank test). Patients with stage IV NETs undergoing primary resection also had improved mOS vs those with no surgery (125 vs 54 mo., p<0.0001). For stage I-III patients without surgery, 2-yr and 5-yr survival rates were highest in the rectum and lowest in small intestine ( p<0.0001). Among those with stage I-III with surgery, 2-yr and 5-yr survival rates were also highest in the rectum, and lowest in the biliary system at 89% and 82% ( p<0.0001). In contrast, for stage IV patients without primary resection, 2-yr and 5-yr survival rates were highest among small intestine and lowest in the rectum ( p<0.0001). Among those who had primary tumor resection, 2-yr and 5-yr survival rates were highest in pancreas and lowest in colon at 2 yrs and rectum at 5 yrs ( p<0.0001). Conclusions: Surgical intervention for GI-NETs is associated with improved OS in both localized and stage IV disease, with consistent trends across different primary sites. Primary tumor resection was associated with the largest increase in 5-yr survival for stage IV NETs arising from pancreas and stomach. Patient selection for surgery undoubtedly contributed to the improved OS, but resection of primary tumors in stage IV GI-NETs may have a disease modifying effect. Further study is warranted with more granular data to identify patients with stage IV GI-NETs who may benefit from primary tumor resection.[Table: see text]

Impact of primary site on survival in patients with nasopharyngeal carcinoma from 2004 to 2015

Nasopharynx carcinoma (NPC) is the most common malignant tumor of the nasopharynx. Many studies have shown some factors related with the prognosis of NPC patients. Our study aims to evaluate the differences of prognosis between initial and second primary NPC. The Surveillance, Epidemiology, and End Results (SEER) program was used to perform the population-based analysis in NPC patients who were newly diagnosed between 2004 and 2015. Kaplan-Meier and Cox regressions were used to evaluate the effects of primary site on the overall survival (OS), as well as the cancer-specific survival (CSS). Our study included 5,012 NPC patients: 4,474 initial primary NPC patients and 5,38 s primary NPC patients. Significant differences were observed in sex, age at diagnosis, race, median household income, histological type, American Joint Committee on Cancer (AJCC) stage, N-stage, radiation treatment and chemotherapy between patients with initial and second NPC (P < 0.05). Moreover, the patients with second NPC had longer survival months. In addition, radiation and chemotherapy were recommended both in first and second primary NPC patients. Worse prognosis was observed in patients with second primary NPC compared with those with primary NPC in all subgroups of AJCC stage and age at diagnosis.

Impact of Primary Site and Era of Diagnosis on Mortality in Patients with Extranodal Marginal Zone Lymphoma in the United States: A Population-Based Study

Introduction: Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (EMZL) is the most common subtype of MZL. EMZL can affect multiple organs throughout the body, and the management depends on the primary site of involvement and extent of disease. The most common primary site is the stomach, but other sites can be involved including the breasts, eyes, lungs, salivary glands, and skin. The last population-based survival analysis of EZML included follow-up through 2009 (Olszewski and Castillo, 2013). Given the paucity of population-based analyses of EMZL in the contemporary time-period, we sought to provide an updated analysis of disease-specific mortality and site-associated mortality using the Surveillance, Epidemiology, and End Results (SEER)-18 database. Method: We included adult patients with EMZL diagnosed between 2000-2017 who were 18-84 years old at the time of diagnosis. We excluded patients with a history of malignancy prior to EMZL, those with missing survival times and those with central nervous system involvement. Patients were divided into two cohorts based on period of diagnosis (era-1: 2000-2008, and era-2: 2009-2017). Five-year relative survival (RS) was estimated using the Pohar-Perme method. The risk of EMZL-specific death was estimated by calculating the cumulative incidence function (CIF). The difference between CIF distributions was tested with the Pepe-Mori test. The competing risks of EMZL-specific death and death from other causes were modeled using Fine and Gray regression. All tests of differences were performed at a two-sided alpha of 0.05. Results: We included a total of 11,597 patients with EMZL. Table 1 shows the baseline characteristics. Among the entire cohort, the median age at diagnosis was 63 years (IQR = 53-72). There was a slight female predominance (55%), and most patients were Non-Hispanic White (65%). Five-year RS was 95% (95% CI = 94-96%) during era-1 and 96% (95-97%) during era-2. There was a significant reduction in the cumulative incidence of EMZL-specific death between era-1 and era-2 (p &amp;lt; 0.001, Figure 1A) but not death from other causes (p = 0.35, Figure 1B). The cumulative incidence of EMZL-specific death varied according to EMZL subtype (Figure 2). In our multivariable competing risks model after adjusting for confounders (Table 2), EZMLs arising from the genitourinary (GU) tract had the worst prognosis [subhazard ratio (SHR) = 2.06, 95% CI=1.30-3.27, p=0.002], whereas EZMLs arising from the skin and connective tissue had the best prognosis [SHR = 0.66, 95% CI = 0.48 - 0.91, p = 0.01]. Conclusion: In this updated population-based analysis of EZML that includes patients treated in the contemporaneous time-period, we found that patients diagnosed with EZML in the most recent era had a significantly better prognosis. Additionally, we noted that the outcomes varied depending on primary site of involvement. Patients with EZMLs involving the GU tract had the worst prognosis, whereas patients with primary sites in the skin and connective tissue had the best prognosis. It is important to study the biology of EMZL involving the GU tract to design better therapeutic options to improve the outcomes. Disclosures Epperla: Pharmacyclics: Honoraria; Verastem Oncology: Speakers Bureau.

Abstract 4916: Impact of primary organ site on prognosis in extranodal peripheral T cell lymphoma not otherwise specified

Abstract Introduction: Peripheral T cell lymphoma, not otherwise specified (PTCL, NOS) is a rare heterogeneous group of diseases that constitutes 25% of T-cell lymphomas. It predominately affects men with a median age of 60 years at presentation. It is known to be an aggressive disease with high risk of relapse and subsequent poor response to systemic therapies. In this study, we sought to investigate the impact of primary site of disease on prognosis in extranodal PTCL, NOS. Methods: The Surveillance, Epidemiology and End Results (SEER) database was used to identify adult patients (≥20 years) diagnosed with PTCL, NOS between 1973 and 2014. Primary sties excluded were lymph nodes, bone marrow, spleen and skin. All stages of disease were included; treatment effect (surgery, radiation, chemotherapy) was analyzed when available. Sites of disease were grouped into 5 organ systems for convenience. Overall survival (OS) was estimated using the Kaplan-Meier method, and compared using Log-Rank test. Cox proportional hazards models were used for adjusted survival analyses. Results: Total of 392 patients were included. Median age was 62 years, and majority were male (n=242, 61.7%) Caucasian (n=224, 57.1%), and married (n=231, 58.9%). Gastrointestinal/hepatobiliary site was the most common primary extranodal organ system involved (n=156, 39.8%), followed by head and neck (n=147, 37.5%), thoracic excluding breast (n=42, 10.7%), CNS (n=32, 8.2%), and breasts (n=15, 3.8%). Most patients had stage IV disease (n=116, 29.6%). Total of 137 (34.9%) patients had surgery to the primary site, 94 (24%) had radiation, and 241 (61.5%) received chemotherapy. Median overall survival was 13 (0-252) months, and was statistically different by primary organ system involved (p&amp;lt; 0.001). Gastrointestinal/hepatobiliary group had the worst median survival of only 8 months (95% CI 4.3- 11.6), followed by thoracic [median of 9 months; 95% CI (0.0 - 21.7)], and CNS [median of 12 months; 95% CI (3.5 - 20.4)]. Lymphoma was the most common cause of death (n=166, 42.3%). On univariate analysis, patients who received surgery did not have better survival [HR 0.909; 95% CI (0.70-1.16)]; while patients who received radiation [HR 0.53; 95% CI (0.39-0.71)], or chemotherapy [HR 0.76; 95% CI (0.60-0.98)] had better outcomes. In a multivariate analysis model; stage IV disease and Hispanic race were significantly associated with worse survival; while being married, undergoing radiation or chemotherapy was associated with better survival. Conclusion: PTCL, NOS is a rare aggressive disease mostly affecting elderly men. Lymphoma involving gastrointestinal /hepatobiliary system is the most common site of primary extranodal disease and portends the worst survival. Patients who received radiation or chemotherapy had better outcomes. Citation Format: Taha Al-Juhaishi, Arushi Khurana, Danielle Shafer, Victor Yazbeck. Impact of primary organ site on prognosis in extranodal peripheral T cell lymphoma not otherwise specified [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4916.

Prognostic factors in leiomyosarcoma (LMS): Does primary site influence outcome?

10095 Background: LMS is a narrowly defined subset of soft tissue sarcoma with heterogeneous clinical presentation. Recent reports suggest differences in treatment responses between uterine (uLMS) and extrauterine (euLMS) disease. We sought to identify prognostic factors in LMS patients (pts) and study the impact of primary site on clinical outcomes. Methods: Single centre retrospective study. 97 eligible LMS pts seen in our centre from 2002 - 2010 with complete medical records were identified from our sarcoma database of 790 pts. Results: Median follow-up was 20.7 months (mths), 51% of pts had uLMS. Although median age in uLMS and euLMS was similar (49 vs 54 yrs), uLMS was less common beyond 60 yrs (10% vs 38%, p=0.002). Surgical resection rates (92% vs 79%), adjuvant therapy use (56% vs 42%) and metastatic disease at diagnosis (25% vs 27%) were not significantly different between uLMS and euLMS respectively. Amongst pts who underwent resection of disease, more uLMS pts had negative surgical margins (90%...

When to manage level V in head and neck carcinoma?

As superselective neck dissection strategy is gaining popularity to minimize postoperative morbidity and better life quality, we investigated the metastatic nodal status of level V neck lymph node group for head and neck squamous cell carcinoma in various primary sites. We have also aimed to display the impact of involvement of other nodal groups on level V. Retrospective review of histopathologic examination of case series at a comprehensive cancer center. The study group was composed of 107 patients who underwent a type of neck dissection including level V among 243 patients. The impact of primary site and metastatic nodal status of other levels on metastasis to level V involvement were evaluated. The most common primary tumor site was oropharynx (n = 43), followed by oral cavity (n = 32), larynx (n = 16), carcinoma of unknown primary (n = 10), and hypopharynx (n = 6). General pathologic N positivity for all levels was 78.3% (76 of 97) when 10 carcinoma of unknown primary patients were excluded. Level V was involved in 13 of 107 (12.1%) patients. Level V was not involved in any patient when the other levels were not involved (0 of 21). Even when considering only N+ patients, the ratio of N positivity for level V is still <20% (13 of 86, 15.1%). Because level V was not involved in any patient when the other levels were not involved, it might be reasonable to preserve level V especially in clinically and intraoperatively N0 patients.