Kaplan-Meier Curves For Overall Survival Research Articles

Epigenetic and Tumor Microenvironment for Prognosis of Patients with Gastric Cancer.

Epigenetics studies heritable or inheritable mechanisms that regulate gene expression rather than altering the DNA sequence. However, no research has investigated the link between TME-related genes (TRGs) and epigenetic-related genes (ERGs) in GC. A complete review of genomic data was performed to investigate the relationship between the epigenesis tumor microenvironment (TME) and machine learning algorithms in GC. Firstly, TME-related differential expression of genes (DEGs) performed non-negative matrix factorization (NMF) clustering analysis and determined two clusters (C1 and C2). Then, Kaplan-Meier curves for overall survival (OS) and progression-free survival (PFS) rates suggested that cluster C1 predicted a poorer prognosis. The Cox-LASSO regression analysis identified eight hub genes (SRMS, MET, OLFML2B, KIF24, CLDN9, RNF43, NETO2, and PRSS21) to build the TRG prognostic model and nine hub genes (TMPO, SLC25A15, SCRG1, ISL1, SOD3, GAD1, LOXL4, AKR1C2, and MAGEA3) to build the ERG prognostic model. Additionally, the signature's area under curve (AUC) values, survival rates, C-index scores, and mean squared error (RMS) curves were evaluated against those of previously published signatures, which revealed that the signature identified in this study performed comparably. Meanwhile, based on the IMvigor210 cohort, a statistically significant difference in OS between immunotherapy and risk scores was observed. It was followed by LASSO regression analysis which identified 17 key DEGs and a support vector machine (SVM) model identified 40 significant DEGs, and based on the Venn diagram, eight co-expression genes (ENPP6, VMP1, LY6E, SHISA6, TMEM158, SYT4, IL11, and KLK8) were discovered. The study identified some hub genes that could be useful in predicting prognosis and management in GC.

Abstract C066: Effects of race, ethnicity, and country of origin on incidence and survival in breast cancer

Abstract Purpose: Breast cancer (BC) is the leading cause of cancer related deaths in Hispanic women. Hispanics make up an estimated 82% of the U.S./Mexico border, a region of socioeconomic inequity and barriers to healthcare access. Identifying disparities affecting BC incidence and overall survival (OS) is a priority for optimizing care in this medically underserved population. We hypothesized that differences in ethnicity, border proximity, birthplace, BC subtype, and treatments are associated with poor outcomes. Methods: Data from the Texas Cancer Registry was used to construct Kaplan-Meier curves of OS by ethnicity, birthplace, subtype (Luminal A, Luminal B, HER2, Triple Negative (TNBC)), age group (18-39, 40-69, >70 years), and treatments. Other covariates included rurality, insurance status, socioeconomic status, and comorbidities. Crude and adjusted variable effects on OS were analyzed with Mantel Haenszel and Cox regression methods. Results: Hispanic BC patients were diagnosed at a younger age than non-Hispanic whites (NHW) (57.2 versus 61.1 years). Hispanic ethnicity reduced the risk for luminal A and TNBC (HR 0.90, and 0.87, p<0.01), whereas non-Hispanic blacks (NHB) had higher risk for luminal A, luminal B, and TNBC (HR 1.39, 1.48, and 1.18, p<0.01). A birthplace outside of Texas resulted in a lower risk of developing any subtype of BC (p<0.001). In general, NHBs had more risk to develop any type of BC than NHWs (p<0.0001). Hispanic ethnicity is associated with a significantly decreased risk of mortality in TNBC than NHWs (HR .87, p=.011). TNBC Hispanics born in Mexico have a lower risk of death in comparison to NHWs (HR .93, p=.036), while Hispanics born in the U.S. have a higher risk (HR 1.13, p=.06). Lower HRs were observed for patients in El Paso versus the rest of Texas (HR 0.73, p<0.0001), and hormone therapy, chemotherapy, and radiation treatment (HR 0.92, 0.96, 0.82, p<0.0001). Surgical procedures were not associated with mortality. Median survival (MS) for Hispanic patients compared to NHW was 16 versus 14 years, p<0.0001. Patients in El Paso compared to the rest of Texas had MS 8 versus 6 years, p<0.0001. Hispanics and NHWs with luminal A and luminal B had similar OS. Non-significant differences in OS were noted for HER2. No difference in OS was found for Hispanics and NHWs with TNBC, while OS was higher in El Paso compared to the rest of Texas (MS 4 versus 2 years, p=0.024). HER2 and TNBC Hispanics 18-39 years had worse OS (p=0.0193 and p<0.0001). Those ages 40-69 years had similar OS for HER2 compared to NHWs, but improved OS in TNBC (p<0.0001). Conclusions: Hispanics had comparable OS to NHW. Those in the border region seem to have improved OS versus the rest of Texas. Race/ethnicity and birthplace are significant predictors of survival in TNBC. Hispanic ethnicity is generally associated with better prognoses in TNBC; however, Hispanics born in the U.S. have lower survival rates in comparison with Hispanic patients born in Mexico. NHB patients are associated with significantly worse OS in all BC subtypes. Citation Format: Alfonso E. Bencomo-Alvarez, Vutha Nhim, Luis Alvarado, Mayra A. Gonzalez, Michelle Kilcoyne, Alok K. Dwivedi, Shrikanth S. Gadad, Anna M. Eiring. Effects of race, ethnicity, and country of origin on incidence and survival in breast cancer [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 C066.

Prognosis Score for Overall Survival with CAR-T Therapy in Aggressive Lymphoma

Background: Since 2017, six chimeric antigen receptor T cell (CAR-T) therapies have been approved by the FDA for hematologic malignancies. Despite the transformative potential of this therapy, more tools to assist with identifying patients with increased likelihood of benefitting from this therapy will be helpful, particularly given the logistical complexity and socio-economic demands for CAR-T relative to other therapies. Health care resource restriction during the COVID-19 pandemic highlights the need for these tools. We present a simple survival score that uses 3 readily available clinical labs: platelet (plt), absolute lymphocyte count (ALC), and Lactate dehydrogenase (LDH) to predict the risk of dying within 6 months of CAR-T therapy in patients with aggressive lymphoma. Methods: We conducted a retrospective chart review of patients with aggressive non-Hodgkin lymphoma (NHL) who received FDA-approved CAR-T between Jan 2018 to Jan 2022 at Mayo Clinic Rochester. Demographics and lab variables were selected based on univariate analysis for clinical and statistical significance and tested in a multivariate logistic regression model. Bootstrapping test was used to test the accuracy of the model to predict for death within 6 months of CAR-T infusion. Patients were scored based on the model, and Kaplan-Meier curve for overall survival (OS) based on the score was plotted. Results: Among a total of 110 pts who received CAR-T, 27 (25%) pts died within the first 6 months post CAR-T infusion (OS ≤ 6 mo). Disease progression was the main cause of death (18/25, 72%), followed by infection (4/25, 16%), CAR-T related (HLH/MAS, 2/25, 8%), second primary malignancy (1/25, 4%) and unknown (2/25, 8%).Baseline demographics were comparable between the OS>6mo and ≤6months groups (Table 1). Patients’ ECOG, Karnofsky performance status and 11 labs at the time of evaluation for CAR-T therapy (initial eligibility assessment, prior to leukapheresis) were compared between those who died from any cause within 6 months of CAR-T infusion and those who did not. Hemoglobin, plt, ALC, absolute monocyte count, C- Reactive Protein, ferritin, and LDH were selected as clinically and/or statistically significant variables for multivariate testing. Multivariate regression with boot-strap testing identified plt, ALC, and LDH as the most predictive variables with 80.9 ± 11.7% accuracy for predicting death within 6 months of CAR-T infusion. Patients were scored 0-3 using these 3 labs, with 1 point assigned for plt ≤ 100 X109/L, ALC ≤ 0.4 X109/L, or LDH > 222 U/L (upper limit of normal). OS by this survival score is shown in Figure 1. Discussion: Due to the curative potential of CAR-T, patients with broader characteristics than those treated on registration studies have been treated in standard of care practice. While an estimated 5%-10% risk of CAR-T associated deaths in the first 3 months is seen across all patients in clinical trials, predictors for early death after CAR-T in real-world patient populations can provide additional context for pts and providers when selecting treatment. This survival score is important proof of concept that a simple model using readily accessible clinical labs at the time of CAR-T evaluation could provide additional context to help with additional clinical decision-making. Multicenter prospective studies will help define and validate the definitive survival scoring system. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The Efficacy and Safety of Modified Melphalan and Busulfan-Based Conditioning Regimen for Allogeneic-HSCT in Refractory/Relapsed or Persistent MRD Positive AML Patients

Background: Allogeneic stem cell transplantation (Allo-HSCT) is the only salvage option offering long-term survival opportunity for high-risk AML patients, as those patients respond insufficiently to chemotherapy. However, the overall survival (OS) rate after allo-HSCT is still frustrating. Great efforts have been made in improving the conditioning regimen, such as introducing two alkylating agent, busulfan (Bu) and Melphalan (Mel) to enhance the anti-leukemia efficacy. But high non-relapse mortality (NRM) is reported. In this study, we made refinements in the conditioning regimen with two alkylating agents, namely MCBC (the combination of melphalan, cladribine, busulfan, and cyclophosphamide). We aim to investigate the efficacy and safety of MCBC conditioning regimen for allo-HSCT in refractory/relapsed (R/R) and minimal residual disease (MRD) persistent positive AML patients. Methods: This prospective multi-center clinical trial enrolled R/R AML or AML with MRDpersistentpositivity, who underwent allo-HSCT from July 2020 to May 2022 (ChiCTR Registration ID: ChiCTR2000029936). The MCBC conditioning regimen consists of melphalan 60mg/m2/d, day -9~-8, cladribine 5mg/m2/d, day -7~-5, busulfan 3.2mg/kg/d, day -5~-3, cyclophosphamide 30mg/kg/d, day -2~-1. A post-transplantation maintenance therapy was provided whenever possible, including azacytidine, venetoclax, or FLT3 inhibitors. Results and Discussion: This study included a total 75 AML patients (65 R/R AML and 10 MRD+AML), with median age 37 years (ranged 13-56 years). More than half of patients (40/75) were evaluated as non-remission (NR), including 13 patients with leukemia blast over 20% or active extramedullary disease pre-HSCT. Haplo-identical-donor HSCT (HID-HSCT) was the predominance HSCT type (n=51, 68%). Mucositis was the main reported regimen-related toxicity, mostly were mild and well tolerated. No graft failure was documented. It is inspiring that all patients achieved hematology complete remission (CR) (100%) and 89.3% achieved MRD clearance on reconstitution day, indicating profound anti-leukemia capacity of MCBC regimen. The incidence of severe acute GVHD was 9.3%. With a median follow-up of 232（30-695）days, the estimated one-year overall survival (OS), relapse-free survival (RFS) and NRM of all patients were 72.1±6.3%, 71.4±6.0% and 7.1±3.5% respectively. Notably, patients with persistent MRD positivity obtained 100% OS and RFS. There were 13 patients in R/R AML group relapsed after HSCT, with a median time from HSCT to relapse was 120(75-218) days. The one-year cumulative incidence of relapse was 22.6±5.6%. Univariate analysis using by Kaplan-Meier method was performed. It indicated high blast burden (blast≥20%) pre-HSCT and absence of opportune maintenance therapy post HSCT were two independent risk factors with clinical significance. Competitive risk modal analysis for multivariate analysis also confirms the results. Conclusion: The preliminary data demonstrated profound anti-leukemic capacity and well acceptable toxicity of MCBC regimen for R/R or MRD persistent positive AML. Furthermore, for patients with high leukemia blast burden, opportune maintenance treatment led to significant improved OS and RFS. Figure Legend: Survival outcomes of patients enrolled. Kaplan-Meier curves for Overall survival (A), Disease-free survival (B), Cumulative relapse rate(C) and Non-relapse mortality(D) of patients receiving MCBC conditioning regimen after allo-HSCT. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Oral Chemotherapy Application in Elderly Patients With Diffuse Large B-Cell Lymphoma: An Alternative Regimen in Retrospective Analysis.

A combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered the standard treatment for diffuse large B-cell lymphoma (DLBCL). However, no standard treatment has been established for older patients (age ≥ 75 years). This study retrospectively analyzed different treatment strategies in older patients with DLBCL with different chemotherapy regimens and compared the survival rate of patients using oral or intravenous form cyclophosphamide and etoposide in a single center. We reviewed the records of older patients with DLBCL, aged ≥ 75 years, from January 2010 to August 2019. The different treatment combinations, clinical characteristics, response rates, and toxicity profiles were analyzed. The median overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier (KM) method. Cox regression model was used to identify the risk factors. Eighty-four patients were included. One-quarter of the patients received cytoreduction treatment because of their poor medical condition at the time of diagnosis. Twenty-six percent of the patients were aged ≥ 85 at the time of diagnosis and 46.7% completed the treatment course. Patients receiving non-anthracycline-containing (non-ACR) treatment had worse Charlson comorbidity index, worse PFS, lower body mass index, or were older. The mean anthracycline accumulative dose in the anthracycline-containing (ACR) group was 134 mg/m2. The median OS was 17.2 months and median PFS was 7.7 months. The PFS of R-CHOP is better than R-mini-CHOP and R-CVOP without statistical significance, but OS of R-CHOP is not better than the other regimens. The toxicity, efficacy, and KM curve for OS and PFS in the non-ACR group were lower compared to ACR group, without statistical significance. R-CVOP had similar OS with R-mini-CHOP in our study. The result does not mean etoposide could totally substitute for anthracycline, but etoposide did have lower early progression rate (12.5%), and it may be an option for frail patients with comorbidity. Oral form cyclophosphamide and etoposide could be considered as a substitute for intravenous administration because of the similar effect and toxic profile.

Circulating monocytes associated with anti-PD-1 resistance in human biliary cancer induce Tcell paralysis.

Suppressive myeloid cells can contribute to immunotherapy resistance, but their role in response to checkpoint inhibition (CPI) in anti-PD-1 refractory cancers, such as biliary tract cancer (BTC), remains elusive. We use multiplexed single-cell transcriptomic and epitope sequencing to profile greater than 200,000 peripheral blood mononuclear cells from advanced BTC patients (n= 9) and matched healthy donors (n= 8). Following anti-PD-1 treatment, CD14+ monocytes expressing high levels of immunosuppressive cytokines and chemotactic molecules (CD14CTX) increase in the circulation of patients with BTC tumors that are CPI resistant. CD14CTX can directly suppress CD4+ Tcells and induce SOCS3 expression in CD4+ Tcells, rendering them functionally unresponsive. The CD14CTX gene signature associates with worse survival in patients with BTC as well as in other anti-PD-1 refractory cancers. These results demonstrate that monocytes arising after anti-PD-1 treatment can induce Tcell paralysis as a distinct mode of tumor-mediated immunosuppression leading to CPI resistance.

First-Line Systemic Therapies for Advanced Hepatocellular Carcinoma: A Systematic Review and Patient-Level Network Meta-Analysis

Introduction: Sorafenib was historically the standard of care for advanced hepatocellular carcinoma (aHCC) until it was superseded by the combination of atezolizumab and bevacizumab. Thereafter, several novel first-line combination therapies have demonstrated favorable outcomes. The efficacies of these treatments in relation to current and previous standards of care are unknown, necessitating an overarching evaluation. Methods: A systematic literature search was conducted on PubMed, EMBASE, Scopus, and the Cochrane Controlled Register of Trials for phase III randomized controlled trials investigating first-line systemic therapies for aHCC. Kaplan-Meier curves for overall survival (OS) and progression-free survival (PFS) were graphically reconstructed to retrieve individual patient-level data. Derived hazard ratios (HRs) for each study were pooled in a random-effects network meta-analysis (NMA). NMAs were also conducted using study-level HRs for various subgroups, according to viral etiology, Barcelona Clinic Liver Cancer (BCLC) staging, alpha-fetoprotein (AFP) levels, macrovascular invasion, and extrahepatic spread. Treatment strategies were ranked using p scores. Results: Among 4,321 articles identified, 12 trials and 9,589 patients were included for analysis. Only two therapies showed OS benefit over sorafenib: combined anti-programmed-death and anti-VEGF pathway inhibitor monoclonal antibodies (Anti-PD-(L)1/VEGF Ab), including atezolizumab-bevacizumab and sintilimab-bevacizumab biosimilar (HR = 0.63, 95% CI = 0.53–0.76) and tremelimumab-durvalumab (HR = 0.78, 95% CI = 0.66–0.92). Anti-PD-(L)1/VEGF Ab showed OS benefit over all other therapies except tremelimumab-durvalumab. Low heterogeneity (I² = 0%) and inconsistency (Cochran’s Q = 0.52, p = 0.773) was observed. p scores for OS ranked Anti-PD-(L)1/VEGF Ab as the best treatment in all subgroups, except hepatitis B where atezolizumab-cabozantinib ranked highest for both OS and PFS, as well as nonviral HCC and AFP ≥400 μg/L where tremelimumab-durvalumab ranked highest for OS. Conclusion: This NMA supports Anti-PD-(L)1/VEGF Ab as the first-line therapy for aHCC and demonstrates a comparable benefit for tremelimumab-durvalumab which also extends to certain subgroups. Results of the subgroup analysis may guide treatment according to baseline characteristics, while pending further studies.

LncRNA NUTM2A-AS1 Targets the SRSF1/Trim37 Signaling Pathway to Promote the Proliferation and Invasion of Breast Cancer.

Method Using the tumor database (TCGA) and analysis platform (GEPIA), NUTM2A-AS1 expression in breast cancer cases was compared with the normal cases. In addition, Kaplan-Meier curve of overall survival according to the various levels of NUTM2A-AS1 was assessed. Then, we constructed a knockdown plasmid of NUTM2A-AS1 and successfully reduced the expression function of NUTM2A-AS1 in BC cells. Results We found NUTM2A-AS1 could promote the malignant phenotype of proliferation and invasion of BC. In terms of mechanism research, NUTM2A-AS1 was mainly located in the cytoplasm of BC cells, which indicated that NUTM2A-AS1 may achieve its function through transcriptional or posttranscriptional regulation pathways. While knocking down NUTM2A-AS1, we detected several major molecules of the trim family. The results showed that only trim37 mRNA was significantly affected, and protein detection also showed that knockdown NUTM2A-AS1 expression could reduce the expression of trim37. The results of RIP experiments suggested that NUTM2A-AS1 played a key role by combining with SRSF1 and affecting the interaction between SRSF1 and trim37 mRNA. The stability test of mRNA also confirmed that during the knockdown of NUTM2A-AS1, the mRNA stability of trim37 decreased significantly, but this downward trend could be reversed by overexpressed SRSF1. The above results suggested that NUTM2A-AS1 could maintain the stability and expression of trim37 through SRSF1 pathway. The results of rescue experiment showed the overexpression of trim37, while knocking down NUTM2A-AS1 could reverse the decrease of proliferation and invasiveness of BC cells induced by NUTM2A-AS1 knockdown. Conclusion Therefore, trim37 is seen as a necessary target for NUTM2A-AS1 to exert the biological function of BC. Additionally, NUTM2A-AS1 is to regulate the malignant phenotype of BC through NUTM2A-AS1/trim37 pathway.

Uptake and survival outcomes of sentinel lymph node mapping in vulvar melanoma (552)

Objectives: With the integration of sentinel lymph node (SLN) mapping into cutaneous melanoma and squamous cell carcinomas, the technique is increasingly being applied to vulvar melanomas. However, little is known about the uptake and outcomes of SLN mapping for vulvar melanoma. We examined the trends in use and survival outcomes for SLN mapping compared to lymph node dissection (LND) for vulvar melanoma. Methods: Patients with vulvar melanoma who underwent surgical resection between 2004 and 2018 in the Surveillance, Epidemiology, and End Results Program (SEER) database were included. TNM staging was used to exclude patients with clinically positive nodes and distant metastasis from the cohort. Performance of lymph node evaluation was classified as SLN mapping, LND, or no nodal evaluation. Kaplan-Meier curves of overall survival and multinominal logistic regression models for predictors of type of lymph node evaluation were created. Inverse probability treatment weighting (IPTW) was used to compare overall survival between the groups. Results: Among 398 patients, SLN mapping was performed in 124 (31.2%), LND in 141 (35.4%), and no lymph node dissection in 133 (33.4%) patients. SLN mapping increased from 8% in 2004 to 45% in 2018 (a 5.6-fold increase), while the rate of LND decreased from 40% to 20% (a 2-fold decrease) over the same period. No nodal dissection decreased from 52% in 2004 to 35% in 2018 (a 1.6-fold decrease) (p<0.03). In a multinomial logistic regression model, stage I disease and older age (>70 years old) were associated with a lower likelihood of SLN mapping (p<0.05). In our propensity score weighted cohort, the median overall survival for SLN mapping was 96 months (95% CI: 54-not reached), 70 months (95% CI: 44 months-151 months) for LND, and 55 months (27 months-140 months) for no nodal evaluation. While there was improved overall survival for SLN mapping (HR: 0.86, 95% CI: 0.46-0.97) as compared to no nodal evaluation, there was no significant difference in overall survival between the cohorts (SLN vs LND: HR: 0.77, 95% CI: 0.53-1.14) (No lymph node evaluation vs LND: HR: 1.16, 95% CI: 0.81-1.67) (p=0.35) (Figure 1). Conclusions: Performance of SLN mapping is increasing rapidly for women with vulvar melanoma. Compared to LND, SLN mapping is not associated with worse overall survival. Objectives: With the integration of sentinel lymph node (SLN) mapping into cutaneous melanoma and squamous cell carcinomas, the technique is increasingly being applied to vulvar melanomas. However, little is known about the uptake and outcomes of SLN mapping for vulvar melanoma. We examined the trends in use and survival outcomes for SLN mapping compared to lymph node dissection (LND) for vulvar melanoma. Methods: Patients with vulvar melanoma who underwent surgical resection between 2004 and 2018 in the Surveillance, Epidemiology, and End Results Program (SEER) database were included. TNM staging was used to exclude patients with clinically positive nodes and distant metastasis from the cohort. Performance of lymph node evaluation was classified as SLN mapping, LND, or no nodal evaluation. Kaplan-Meier curves of overall survival and multinominal logistic regression models for predictors of type of lymph node evaluation were created. Inverse probability treatment weighting (IPTW) was used to compare overall survival between the groups. Results: Among 398 patients, SLN mapping was performed in 124 (31.2%), LND in 141 (35.4%), and no lymph node dissection in 133 (33.4%) patients. SLN mapping increased from 8% in 2004 to 45% in 2018 (a 5.6-fold increase), while the rate of LND decreased from 40% to 20% (a 2-fold decrease) over the same period. No nodal dissection decreased from 52% in 2004 to 35% in 2018 (a 1.6-fold decrease) (p<0.03). In a multinomial logistic regression model, stage I disease and older age (>70 years old) were associated with a lower likelihood of SLN mapping (p<0.05). In our propensity score weighted cohort, the median overall survival for SLN mapping was 96 months (95% CI: 54-not reached), 70 months (95% CI: 44 months-151 months) for LND, and 55 months (27 months-140 months) for no nodal evaluation. While there was improved overall survival for SLN mapping (HR: 0.86, 95% CI: 0.46-0.97) as compared to no nodal evaluation, there was no significant difference in overall survival between the cohorts (SLN vs LND: HR: 0.77, 95% CI: 0.53-1.14) (No lymph node evaluation vs LND: HR: 1.16, 95% CI: 0.81-1.67) (p=0.35) (Figure 1). Conclusions: Performance of SLN mapping is increasing rapidly for women with vulvar melanoma. Compared to LND, SLN mapping is not associated with worse overall survival.

Uptake and survival outcomes of sentinel lymph node mapping in squamous cell carcinoma of the vulva (189)

<b>Objectives:</b> Sentinel lymph node (SLN) mapping is feasible for squamous cell carcinoma (SCC) of the vulva, but there is little data on the uptake and survival outcomes for these patients. We aimed to examine the trends in use and survival outcomes of SLN mapping compared to lymph node dissection (LND) for SCC of the vulva. <b>Methods:</b> Patients with SCC of the vulva who underwent surgical resection from 2004 to 2018 in the Surveillance, Epidemiology and End Results Program (SEER) database were included. Patients with metastatic disease or a history of neoadjuvant radiation were excluded from the cohort. Performance of lymph node evaluation was classified as SLN mapping, LND, or no nodal evaluation. The overall cohort was stratified based on TIA (tumor size < 2 cm) and TIB (tumor size > 2 cm) tumors. Kaplan-Meier curves for overall survival as well as multinominal logistic regression models for predictors of type of lymph node evaluation were created. Inverse probability treatment weighting (IPTW) was used to compare overall survival between the groups. <b>Results:</b> Among 6,798 patients, SLN mapping was performed in 736 (10.8%), LND in 3,541 (52.1%) and no lymphatic dissection in 2,521 (37.1%). SLN mapping increased from 7.7% in 2003 to 21.1% in 2018 (a 2.7-fold increase), while the rate of LND decreased from 58.2% in 2003 to 43.1% in 2018 (a 1.26-fold decrease). No nodal dissection remained steady at 34.1% in 2003 and 35.8% in 2018 (p<0.001). In a multinomial logistic regression model, Black race, lower T stage, and chemotherapy were associated with SLN mapping (p<0.05 for all). For patients who were TIA, there was no association between type of nodal evaluation and survival (p=0.97). However, in those who were TIB, there was improved overall survival in the SLN mapping as compared to LND (HR: 0.66, 95% CI: 0.54-0.80) (p=0.002) (Figure 1). <b>Conclusions:</b> The performance of SLN mapping is increasing rapidly for women with vulvar SCC. While our data suggest there may be an overall survival advantage of SLN mapping in our overall cohort and TIB patients, further studies are needed to verify this outcome and clarify which patients would benefit most from SLN mapping.

Abstract 6144: Novel M2 macrophage gene signature as a biomarker of poor outcomes independent of TNM stage in peritoneal liquid biopsy of gastric cancer patients

Abstract Introduction: The infiltration or density of immunosuppressive or M2-macrophages has been correlated with worse prognosis in gastric cancer (GC). We hypothesized that a highly polarized transcriptional phenotype of M2 macrophages would be prognostic if detected in primary and peritoneal fluid samples of GC. Methods: We derived a novel transcriptomic gene signature (MRC1, MS4A4A, CD36, CCL13, CCL18, CCL23, SLC38A6, FGL2, FN1, MAF) from published highly differentially expressed M2 genes that were identified from peripheral blood. We also evaluated a M1 signature (CCR7, IL2RA, CXCL11, CCL19, CXCL10, PLA1A, PTX3) and T cell cytolytic signature (GZMA, GZMB, GZMH, GZMM, PRF1). In primary GC, we used the UCSC Xena tool to analyze the TCGA Stomach Cancer cohort and compared transcriptional signature expression to histologic subtype and pathologic stage. We used log-rank test to compare Kaplan-Meier curves of overall survival (OS) and disease-free interval (DFI) for high versus low signature expression. In our institutional cohort consisting of GC patients with a range of T and N stages as well as with and without metastatic disease (n=28), we evaluated peritoneal fluid samples using single cell RNA sequencing for high and low signature expression in CD68+CD163+ monocytes and used log-rank test to compare OS. Results: A total of 341 TCGA entries of primary GC were included. High expression of the M2 signature in GC was associated with diffuse- and mucinous-type adenocarcinoma, compared to tubular- and papillary-type adenocarcinoma (p&amp;lt;0.001). High M2 signature expression was associated with later stage (Stage II or above) compared to early-stage GC (stage I) (p=0.02). Low M2 signature was associated with significantly improved 5-year OS (p=0.03) and DFI (p=0.04). M1 signature and T cell cytolytic signature were not associated with stage, OS, or DFI in primary GC. In GC peritoneal fluid samples, we identified patients with high (n=15) and low (n=13) signature expression in M2 cells. Independent of TNM-stage, high M2 signature expression in CD68+CD163+ cells within the peritoneal fluid of GC patients was associated with worse OS (median OS not reached at 30 months for low signature expression and 5.5 months for high expression, hazard ratio 2.82, p=0.048). Conclusions: Our study validates a unique M2-associated transcriptomic gene signature as a biomarker of poor outcomes in both primary gastric tumors and peritoneal fluid of GC patients. Because both endoscopic biopsy and laparoscopy with peritoneal fluid collection are part of the standard workup for locoregional GC, an ubiquitous immune signature detected in primary tumor and peritoneal fluid of patients across TNM stages may serve as a clinically valuable indicator of an immunosuppressive patient state associated with poor survival. Citation Format: Kevin M. Sullivan, Haiqing Li, Kelly Mahuron, Yate-Ching Yuan, Joseph Chao, Benjamin Paz, Haiyong Han, Yuman Fong, Yanghee Woo. Novel M2 macrophage gene signature as a biomarker of poor outcomes independent of TNM stage in peritoneal liquid biopsy of gastric cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6144.

Abstract 5097: Influencing factors of postoperative prognosis and screening of adjuvant chemotherapy in patients with early NSCLC

Abstract Introduction: The standard treatment for patients with stage I non-small cell lung cancer (NSCLC) is resection of the primary tumor. However, more than 28% of patients had recurrence or metastasis after surgery. Different studies have shown that the prognosis of stage I NSCLC is significantly different, due to the paucity of evidence for these adjuvant treatments after surgery, whether or not to apply adjuvant chemotherapy is controversial. In conclusion, postoperative adjuvant chemotherapy may be necessary for high-risk groups. Nevertheless, for patients with stage I NSCLC, the factors influencing the postoperative prognosis remains unclear. Methods: Data from LUAD and LUSC cohorts of The Cancer Genome Atlas (TCGA) was used to analyze the disease-free survival (DFS), overall survival (OS), progression-free survival (PFS) and cancer-specific survival (CSS) of different signaling pathways. DFS and OS Kaplan-Meier curves for subgroups of patients were compared using the log-rank test. Cox proportional hazards regression analysis was utilized to identify the independent predictors of DFS. Results: 270 LUAD and 234 LUSC of stage I patients were used in the analysis, through 16 variables, including age, sex, and 14 different signaling pathways associated with tumor development. For the LUAD patients, HR of DFS of notch signaling group is 1.89 (95%CI: 1.03-3.48, P=0.04) in univariate analysis, 2.73 (95%CI: 1.18-6.32, P=0.02) in multivariate analysis; HR of DFS of angiogenesis group is 2.30 (95%CI: 1.26-4.18, P=0.006) in univariate analysis, 2.65 (95%CI: 1.31-5.34, P=0.007) in multivariate analysis. HR of PFS of p53 group is 1.72 (95%CI: 1.08-2.73, P=0.023) in univariate analysis. Others are negatively correlated or have no significant differences. For the LUSC, all the factors are negatively correlated or have no significant differences. Conclusions: These results suggest that harboring notch signaling pathway and angiogenesis pathway mutation may be the biomarker for adjuvant chemotherapy for the stage I LUAD patients, but further validation is needed in large clinical studies. Citation Format: Xiaoning Li, Haibo Tang, Jianhong Cai, Xiaomin Wu, Xue Hu, Yating Zheng, Mengli Huang. Influencing factors of postoperative prognosis and screening of adjuvant chemotherapy in patients with early NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5097.

Impact of site-specific metastases and clinical complications on outcomes of patients with metastatic renal cell carcinoma (mRCC).

e16527 Background: Prognostic models based on the heterogeneity of mRCC disease characteristics, including anemia, hypercalcemia, and neutrophilia, are routinely used in clinic. In an attempt to improve these models, we conducted a retrospective analysis of patients(pts) with mRCC to assess the association of overall outcomes with specific sites of metastasis (mets) and clinical complications. Methods: We extracted data from the SEER-Medicare database on pts diagnosed with RCC from 2004 to 2015. Study cohorts included patients who were &gt; 65 years old and had at least 1 of following site-specific mets or complications: ascites, bone mets, brain mets, liver mets, lung mets, pancreatic mets, and hypercalcemia. To accurately delineate the relationship between site-specific/clinical complications and clinical outcomes, pts were stratified into 3 groups by the timing of site-specific mets and complications appearance : A1 (pts with a site-specific mets or complication at the initial diagnosis of mRCC); A2 (pts with a site-specific mets or complication any time after diagnosis of mRCC); and B (pts who have no site-specific mets or complication but have other mets or complications). Kaplan-Meier curves for overall survival(OS) were produced and median(m) OS were reported. Multivariable Cox modeling was performed to assess the association of individual mets or complications with OS between pre-specified subgroups(A1+A2 vs B, A1 vs A2+B and A1 vs B). Results: We identified 4640 RCC pts in the SEER-Medicare database who had at least 1 of the specified sites of mets or complications. At a median follow-up of 8 months(mons), ascites, brain mets and hypercalcemia were associated with worse mOS in all predefined subgroup analysis. In pts with liver mets, groups A1+A2 had shorter OS than B . In pts with lung mets, mOS in A1 was longer than in A2+B or B. bone mets did not show a statistically significant correlation with OS in any stratified analysis. Lastly, pancreatic mets was associated with longer mOS, but this did not reach statistical significance regardless of the comparison groups (table 1). Conclusions: Our data show that ascites, brain mets, hypercalcemia, and liver mets was associated with poor prognosis, and de novo lung mets was associated with better clinical outcome in patients with mRCC. Based on these findings, we are working on comparing the clinical outcome of mRCC pts treated with targeted therapy to that of pts treated with immunotherapy and building a new prognostic model.[Table: see text]

Patterns of relapse after immunotherapy in patients with high-risk neuroblastoma.

10043 Background: While the addition of anti-GD2 immunotherapy led to improvement in outcomes in patients on the Children’s Oncology Group (COG) ANBL0032 study, relapse remains a concern. Prior studies demonstrated the prognostic importance of time to first relapse, however, the effect of immunotherapy on timing and patterns of relapse in neuroblastoma (NBL) have yet to be evaluated. The purpose of this exploratory analysis was to describe the impact of immunotherapy on patterns of relapse in patients with high-risk NBL, including a descriptive comparison of sites of relapse based on post-consolidation treatment received [dinutuximab with cytokines and isotretinoin (DIN) vs isotretinoin alone (ISO)]. Methods: A retrospective, descriptive analysis of patients on ANBL0032 was performed, including patients randomized to DIN or ISO and those non-randomly assigned to DIN after ISO arm closure. Pt characteristics including age, stage, MYCN amplification status, tumor grade, mitosis-karyorrhexis index (MKI) and ploidy were summarized descriptively and relapse sites were tabulated. For DIN patients who subsequently relapsed, overall survival (OS) was calculated starting from the time of first relapse after enrollment on ANBL0032 (“post-relapse OS”). Kaplan-Meier OS curves were generated based on site of relapse. Results: The analytic cohort included 1,431 (DIN = 1,327; ISO = 104) patients. Among DIN patients, 492 relapsed, many in &gt; 1 site. In the randomized cohort (n = 248), 122 relapsed (DIN = 68/144; ISO = 54/104). The frequencies (DIN; ISO) by site of relapse in the randomized cohort were: bone (53%; 54%), CNS (16%; 11%), lymph node (13%; 17%), abdominal (10%; 17%), paraspinal (6%; 2%), liver (3%; 4%), other soft tissue (22%; 7%). A higher proportion of ISO patients had marrow relapse (29.4% DIN; 48.2% ISO); however, the proportion of DIN patients with lung relapses appeared higher (9% vs 2%). Among all relapsed patients, the proportion with bone relapse did not appear to differ between treatment groups, regardless of MYCN status. Among patients with MYCN amplified disease, the proportion with marrow relapse did not appear to differ based on treatment [21/149 (14.1%) DIN; 3/20 (15.0%) ISO]; however, among patients with MYCN non-amplified disease, the proportion with marrow relapse appeared higher in the ISO group [16/23; 69.6%] vs the DIN group [52/193 (26.9%)]. Conclusions: In this exploratory analysis of patients on COG ANBL0032, the pattern for site of relapse appears to differ between patients treated with DIN vs ISO. While immunotherapy remains the treatment of choice in this population, the findings from this retrospective exploratory analysis warrant further investigation to decrease the risk for post-immunotherapy relapse. Clinical trial information: NCT00026312.

Do patients with metastatic pancreatic adenocarcinoma to the lung have improved survival?

e16257 Background: Pancreatic ductal adenocarcinoma (PDAC) is a genetically heterogeneous disease often diagnosed with synchronous metastatic disease involving the liver. Tumors with extra-abdominal spread that bypass the liver are thought to represent a unique molecular subgroup of the disease. Specifically, those with isolated pulmonary metastatic disease are thought to have a more favorable clinical phenotype. We sought to retrospectively investigate whether patients with isolated pulmonary metastases had improved survival compared to those with disease involving the liver. Methods: We conducted a retrospective review of patients with pathologically confirmed PDAC treated between the years 2010 and 2020 at a Scripps Health hospital. The final study sample included only patients with pulmonary and/or liver primary metastases (N = 175). Analyses were conducted on subgroups defined by metastatic sites of disease in the liver only, lung only and combined liver+lung. Primary and secondary outcome analyses compared isolated lung versus liver/liver+lung. Primary endpoint was overall survival (OS), defined as from the date of diagnosis to date of death or most recent follow up. Progression free survival (PFS) was also analyzed as a secondary endpoint and defined as from the date of diagnosis to date of radiographic progression. Each survival outcome was analyzed using Cox Proportional Hazards tests. Results: No statistically significant differences were seen in OS (HR 0.67, CI 0.44–1.03; p= 0.069) or PFS (HR 1.05, CI 0.68–1.65; p= 0.816) between patients with primary lung metastases compared to those with either liver or liver+lung metastases (reported as hazard ratios of liver/liver+lung relative to lung only). However, a trend towards improved OS was seen for patients with isolated lung metastasis and the kaplan-meier curve for OS showed improved survival for these patients at 3 years, with crossing of the survival curves around 5 years from time of diagnosis. Conclusions: There appears to be a unique clinical phenotype in patients with PDAC presenting with isolated pulmonary disease. Though there was not a statistically significant difference in OS and PFS seen in our population, there was a trend towards improved overall survival compared to those with hepatic involvement. These findings highlight a potential prognostic indicator of metastatic PDAC and further subgroup analysis will help characterize clinical variations that may lead to these differences in tumor biology.[Table: see text]

Systematic literature review and meta-analysis of clinical outcomes for previously-treated patients with advanced biliary tract cancer.

e16143 Background: There is no standard chemotherapy available for previously treated, advanced (unresectable and/or metastatic) biliary tract cancer (BTC). This systematic literature review and meta-analysis were conducted to assess clinical outcomes of chemotherapies in this patient population. Methods: A systematic literature search was conducted through mid-2021 to identify relevant studies using Embase, MEDLINE, and Cochrane Central Register of Controlled trials (January 1, 2000–July 6, 2021) with additional searches of recent ASCO and ESMO conferences. Eligible study designs included randomized controlled trials, controlled clinical trials, and non-randomized clinical trials in patients (≥18 years age, Eastern Cooperative Oncology Group performance score 0 or 1) previously treated for advanced BTC and who had progressed on prior treatment (i.e., ≥2L). The outcomes of interest were objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). A meta-analysis among chemotherapies was performed to obtain a pooled estimate of the efficacy of standard treatments in BTC. The ORR meta-analysis was performed using the Freeman-Tukey double arcsine transformation. For time-to-event outcomes, published Kaplan-Meier curves for OS and PFS were digitized to create pseudo- individual patient data. A meta-analysis of the resulting pooled survival curves for OS and PFS were conducted following the methodology of Combescure et al. (2014). Results: In total, 39 unique studies were identified. Seventeen studies representing 22 unique therapy arms evaluating chemotherapies among 903 patients were included in the meta-analysis for ORR. The random effects pooled estimate for ORR was 6.6% (95% confidence interval [CI]: 4.1-9.7%). Median PFS (12 studies; 16 survival curves) was 3.1 months (95% CI: 2.5-3.8) with PFS rates at 6 and 12 months of 26.7% (95% CI: 19.8-36%) and 6.9% (95% CI: 4.1-11.7%), respectively. Median OS (15 studies; 19 survival curves) was 6.8 months (95% CI: 5.9-7.5) with OS rates at 6, 12, and 24 months of 55.3% (95% CI: 49.9-61.3%), 24.6% (95% CI: 20.0-30.2%), and 2.0% (95% CI: 1.1-3.8%), respectively. Conclusions: The limited efficacy of clinical outcomes for chemotherapies used in the treatment of advanced BTC suggest an opportunity to explore the potential clinical benefits of newer treatments (e.g., immunotherapies).

Systematic literature review and meta-analysis of clinical outcomes for previously treated patients with advanced gastric or gastroesophageal junction cancer.

e16054 Background: Standard of care treatment in advanced (unresectable and/or metastatic) gastric or gastroesophageal junction (GEJ) cancer includes chemotherapies with or without targeted therapies. While there have been many studies undertaken in this patient population, there exists uncertainty around the efficacy of these treatments. A systematic literature review and meta-analysis were conducted to assess clinical outcomes of chemotherapies with or without targeted therapies. Methods: A systematic literature review was conducted through mid-2021 to identify relevant studies using Embase, MEDLINE, and Cochrane Central Register of Controlled trials (January 1, 2000–July 6, 2021) with additional searches of recent annual ASCO and ESMO conferences. Eligible studies included randomized controlled trials (RCTs), controlled clinical trials, and non-randomized clinical trials of any pharmacologic treatments licensed by the FDA or EMA among patients (≥18 years age, Eastern Cooperative Oncology Group performance score 0 or 1) previously treated for advanced gastric or GEJ cancer and who had progressed on prior treatment (i.e., ≥2L). A meta-analysis of objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were conducted among RCTs of relevant therapies for ≥2L gastric cancers. The ORR meta-analysis was performed using the Freeman-Tukey double arcsine transformation. For time-to-event outcomes, published Kaplan-Meier curves for OS and PFS were digitized to create pseudo- individual patient data. A meta-analysis of the resulting pooled survival curves for OS and PFS were conducted following the methodology of Combescure et al. (2014). Results: Of the 214 studies identified, 42 RCTs (77 trial arms) evaluating relevant therapies including 7,256 participants were included in the meta-analysis of ORR. The random effects pooled estimate of ORR was 15.0% (95% confidence interval [CI]: 12.7-17.5%). Median PFS (32 studies; 61 survival curves) was 3.5 months (95% CI: 3.2-3.7) with PFS rates at 6, 12, and 24 months of 25.8% (95% CI: 23.1-28.8%), 7.3% (95% CI: 6.0-8.9%), and 0.7% (95% CI: 0.4-1.0%), respectively. Median OS (34 studies; 64 survival curves) was 7.9 months (95% CI: 7.4-8.5) with OS rates at 6, 12, and 24 months of 62.5% (95% CI: 59.0-66.2%), 30.4% (95% CI: 27.7-33.3%), and 6.7% (95% CI: 5.4-8.4%), respectively. Conclusions: The standard treatments have demonstrated limited efficacy in previously treated patients with advanced gastric or GEJ cancers. Newer treatments (e.g., immunotherapies) to address this unmet medical need should be thoroughly investigated and evaluated.

Analysis of anti-apoptotic PVT1 oncogene and apoptosis-related proteins (p53, Bcl2, PD-1, and PD-L1) expression in thyroid carcinoma.

BackgroundAn aberrant expression of long non‐coding RNA PVT1 has been associated with apoptosis in various cancer types. We aimed to explore the PVT1 and four apoptosis‐related proteins (p53, Bcl2, and PD‐1/PD‐L1) signature in thyroid cancer (TC).MethodsThe PVT1 expression level was measured in 64 FFPE TC paired samples by real‐time quantitative PCR. Overall and stratified analyses by different clinicopathological features were done. The apoptotic proteins were evaluated by immunohistochemistry staining.ResultsOverall analysis showed significant PVT1upregulation in TC tissues (p < 0.001). Similarly, subgroup analysis by BRAF V600E mutation showed consistent results. Lower expression of p53 was associated with mortality (p = 0.001). Bcl2 overexpression was associated with greater tumor size (p = 0.005). At the same time, HCV‐positive cases were associated with repressed Bcl2 expression levels (54.3% in HCV‐negative vs. 6.9% in HCV‐positive cases, p = 0.011). PD‐1 expression was associated with lymph node metastasis (p = 0.004). Enhanced PD‐L1 expression in the tumor was associated with a higher tumor stage, lymphovascular invasion, and mortality risk. Kaplan–Meier curves for overall survival showed that low p53 and high PD‐L1 expressions were associated with lower survival time. The p53‐positive staining is associated with a 90% decreased mortality risk (HR = 0.10, 95%CI = 0.02–0.47, p = 0.001), while patients with high PD‐L1 were five times more likely to die (HR = 4.74, 95%CI = 1.2–18.7, p = 0.027).ConclusionOur results confirm the upregulation of PVT1 in TC. The apoptosis‐related proteins (p53, Bcl2, and PD‐1/PD‐L1) showed different prognostic utility in TC patients; in particular, low p53 and high PD‐L1 expressions associated with low survival times. Further large‐scale and mechanistic studies are warranted.

Right ventricular remodelling in patients with significant tricuspid regurgitation undergoing tricuspid valve surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background Inconsistent changes in right ventricular (RV) dimensions and function have been observed after tricuspid valve (TV) surgery and their associations with long-term outcomes have not been explored. Purpose To evaluate RV remodelling and RV function in patients with significant (moderate or severe) tricuspid regurgitation (TR) undergoing TV surgery and their association with outcome. Methods A total of 121 patients (mean age 63 ± 12 years, 47% male) with significant TR treated with TV surgery and who had an echocardiogram between 3 months and 1 year of follow-up, were included for this analysis. Remodelling was assessed by comparing dimensions and function at follow-up to baseline values. The population was stratified by tertiles of percentage reduction of RV end-systolic area (RVESA) and absolute change of RV fractional area change (RVFAC). Five-year mortality rates were compared across the tertiles of RV remodelling and the independent associates of mortality were investigated. Results Reduction in RVESA and improvement in RVFAC were significantly associated with better survival after TV surgery, whereas reduction in RV end-diastolic area was not (Figure 1). One third of the patients presented with a reduction in RVESA of at least 17.2% and improvement in RVFAC of at least 2.3%, constituting the third tertiles for comparison. Kaplan-Meier curves for overall survival according to RVESA- and RVFAC-tertiles are shown in Figure 2. Cumulative survival rates were significantly better in patients in the third tertile of RVESA reduction: 49%, 69%, and 90% for tertile 1, tertile 2, and tertile 3, respectively (log-rank chi-square: 12.526; p = 0.002); as well as according to RVFAC improvement: 57%, 65%, and 87% for tertile 1, tertile 2, and tertile 3, respectively (log-rank chi-square: 7.784; p = 0.02). Tertile 3 of RVESA-reduction as well as tertile 3 of RVFAC-change were both independently associated with better survival after TV surgery compared to tertile 1 (hazard ratio: 0.221 [95% CI: 0.074 to 0.658] and 0.327 [95% CI: 0.118 to 0.907], respectively). Conclusion The magnitude of RV reverse remodelling (based on reduction in RVESA) and improvement in RVFAC were associated with better survival at 5 years’ follow-up after TV surgery for significant TR. Abstract Figure 1: Spline curves Abstract Figure 2: KM curves for overal survival

Abstract PO-200: Border differences on breast cancer incidence and survival between non-Hispanic white and Hispanic patients: A Texas population-based study

Abstract Background: Breast cancer (BC) is the leading cause of cancer related deaths in Hispanic women. Hispanics make up an estimated 82% of the US/Mexico border, a region characterized by socioeconomic inequity and barriers to healthcare access. Identifying disparities associated with BC incidence and overall survival (OS) is a priority for allocating resources and optimizing care in this medically underserved population. We hypothesized that differences in Hispanics and Non-Hispanic Whites (NHW), proximity to the border, BC subtype, and treatment are associated with poor outcomes. Methods: BC data was obtained from the Texas Cancer Registry (1996-2016). Kaplan-Meier curves of OS by ethnicity, location (border, non-border), subtype (ER+, PR+, HER2+, Triple Negative (TN)), age group (18-39, 40-69, &amp;gt;70 years), and treatments were constructed. Other covariates included rurality, insurance status, poverty indicators, and comorbidities. Adjustment of these variables for effect on relative risk and OS were assessed with Mantel-Haenszel and Cox regression methods. Results: Univariate Cox analysis noted significantly higher Hazard Ratios (HR) for age &amp;gt;65 years, HER2+ and TN subtype (HR 1.76 and 2.21, p&amp;lt;0.0001), and use of biologic response modifiers (HR 1.09, p=0.004). Lower HR were observed for patients in El paso compared to the rest of Texas (HR 0.73, p&amp;lt;0.0001), and use of hormone therapy, chemotherapy and radiation (HR 0.92, 0.96, 0.82, p&amp;lt;0.0001). Surgery and transplant/endocrine procedures were not associated with mortality. Kaplan Meier curves showed increased median survival (MS) for Hispanic patients compared to NHW (16 and 14 years, p&amp;lt;0.0001). Similar trends were seen for patients in El Paso compared to the rest of Texas (MS 8 and 6 years, p&amp;lt;0.0001). With ER+ and PR+ subtypes, Hispanics and NHWs had similar OS, while patients in El Paso had improved OS compared to the rest of Texas (ER+: MS of 7 and 5 years, p&amp;lt;0.00001; PR+: MS of 6 and 4 years, p&amp;lt;0.00001). Non-significant differences in OS were noted for HER2+ subtype. No difference in OS was found for Hispanics and NHWs with TN subtype while OS was higher in El Paso compared to the rest of Texas (MS 4 versus 2 years, p=0.024). Older adults had lower OS (MS 22, 19, and 8 years for patients 18-39, 40-69, and &amp;gt;70 years, p&amp;lt;0.00001). Hispanics age 18-39 and 40-69 had worse OS (p&amp;lt;0.00001). ER+ and PR+ Hispanics across age groups had similar OS compared to NHW. HER2+ and TN Hispanics 18-39 years had worse OS (p=0.0193 and p&amp;lt;0.00001), while those ages 40-69 had similar OS for HER2+ compared to NHWs but improved OS with TN (p&amp;lt;0.00001). Similar OS was seen across age groups for patients in El Paso compared to the rest of Texas. Smaller sample sizes of patients in El Paso and loss to follow-up, especially for ages 18-39 may affect interpretation of results. Conclusion: Overall, Hispanics had comparable OS to NHW patients. Those in the border region seem to have improved OS compared to the rest of Texas. Efforts should focus on screening, detection, and follow-up for patients with HER2+ and TN subtypes. Citation Format: Vutha Nhim, Alfonso E. Bencomo-Alvarez, Alok K. Dwivedi, Shrikanth S. Gadad, Anna M. Eiring. Border differences on breast cancer incidence and survival between non-Hispanic white and Hispanic patients: A Texas population-based study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-200.