National Cancer Database Analysis Research Articles

Efficacy of chemotherapy followed by chemoradiation versus initial chemoradiation as part of the total neoadjuvant therapy for patients with locally advanced rectal cancer: An NCDB analysis.

e15629 Background: Results from multiple trials lead to modern management for locally advanced rectal cancer, with total neoadjuvant therapy (TNT) followed by surgery. However, the best sequence of different treatment modalities is unclear. Methods: We used the National Cancer Database (NCDB) to identify patients with locally advanced rectal adenocarcinoma. We divided patients into different categories based on the timing of chemo and radiation therapy relative to surgery. We used chi-square and Wilcoxon rank test for unadjusted comparison. To compare treatment efficacy with initial chemotherapy to concurrent chemoradiation in downstaging (clinical to pathological stage), we used a linear mixed effect model (LME) with adjustments on age, sex, race, facility type, and year of diagnosis. Also, we evaluated the probability of having positive lymph nodes in the pathological specimen (N+) in the multivariable logistic regression model with adjustment on the clinical stage in addition to the previously mentioned variables. All analyses were done using R 4.6.2. Results: A total of 100509 patients were identified. Only 695 patients received six cycles of neoadjuvant chemotherapy before concurrent chemoradiation (TNT chemotherapy), and 8677 patients received upfront radiation therapy with neoadjuvant chemotherapy administered within 12 weeks of neoadjuvant radiation therapy (TNT radiation). Patients whose start date of chemotherapy or radiation after surgery were excluded. The median age of participants was 63 (IQR = 54-63), and 83% were white. Patients who had TNT chemotherapy were younger (56.4 VS 59.5, P-value < 0.01), had clinically and pathologically advanced stage (IIIB, IIIC) compared to TNT radiation (64%VS 37% and 33%VS 29%, P-value < 0.01). Patients who received TNT radiation had an upgrade in their pathological stage compared to their clinical stage by 0.67 points in the LME (P value < 0.01). In multivariable logistic regression. TNT chemotherapy had a 17% lower risk of (N+) with an OR of 0.83 (0.95 CI 0.59-1.16). However, it was not statistically significant. The two groups had no difference in OS, with a median OS of 137 months (0.95 CI 110 -NR) and 143 (0.95 CI 137-151), respectively. Conclusions: Upfront chemotherapy before starting chemoradiation could be associated with more significant downstaging. Future trials to validate our finding is warranted. [Table: see text] [Table: see text]

Spindle cell rhabdomyosarcoma: A study of demographics and socioeconomic factors using NCDB.

e23539 Background: Spindle cell rhabdomyosarcoma (SC-RMS) is a rare malignancy characterized by elongated spindle cells displaying eosinophilic and fibrillar cytoplasm, resembling smooth muscle fibers. SC-RMS is primarily diagnosed in children with particular involvement of the nasopharynx, parotid gland, nasal cavity, and paratesticular regions. Though surgical resection and chemotherapy are the current recommendations, definitive treatment guidelines remain unestablished. Because SC-RMS is a novel cancer type, evaluating the diagnostic trend of the disease has the potential to provide valuable insights into its epidemiology. An analysis of the National Cancer Database (NCDB) was conducted to identify the demographic factors associated with patients who have been diagnosed with SC-RMS. Methods: A retrospective cohort analysis of the 2004–2020 NCDB, using ICD-O-3 code 8912/3, included patients with a histologically-confirmed diagnosis of SC-RMS (N = 132). Demographic factors (age, sex, race, Hispanic status, educational attainment, insurance status, facility type, distance from facility, and Charles/Deyo score) were analyzed by descriptive statistics and incidence trends were interpreted in regression analysis. Results: A total of 132 patients with a confirmed diagnosis of SC-RMS were identified, with a declining incidence of diagnoses per year (R² = 0.4507). The average age of diagnosis was 33.9 years (SD = 27.2, Range = 1-90). SC-RMS was more commonly observed among males (63%), with a majority of patients being non-Hispanic (87%) and White (74.2%). The top primary site was the testis (20%). Most patients (83%) had a Charlson/Deyo comorbidity score of 0. The majority (69%) of patients received surgery as their primary treatment. Most patients were privately insured (49%) and resided in metropolitan areas with a population greater than 1 million (48%). More (29%) patients were in the highest quartile of income earners of $74,063 or greater. Patients were treated most often at an academic/research program (19%) or comprehensive community care program (12%). Patients lived an average of 68.2 miles (SD = 267.9, Range = 0.6 - 2403.1) from the treatment facility. Conclusions: To the best of our knowledge, this is the first NCDB analysis on SC-RMS. Our analysis revealed that the majority of SC-RMS patients were young males with primary involvement of the testis, supporting previous studies. Analysis of the socioeconomic factors of SC-RMS patients revealed that more patients were privately insured, resided in densely populated metropolitan areas, and were part of the top quartile of income earners. Further research is supported to better understand the impact of socioeconomic factors on diagnosis, treatment options, and overall mortality rates associated with SC-RMS.

Pagetic osteosarcoma: An analysis of the National Cancer Database.

e23503 Background: Pagetic osteosarcoma (Pagetic OS) is a rare cancer typically originating at bones affected by Paget disease. Pagetic OS may present as metachronous multifocal lesions primarily affecting the pelvis, proximal femur, and proximal humerus. There are currently no available sociodemographic descriptions of patients with Pagetic OS. Analyzing sociodemographic factors through the National Cancer Database may unveil important information about its epidemiology and guide future treatment. Methods: A retrospective cohort analysis utilizing the 2004–2020 National Cancer Database (NCDB) included patients with a histologically-confirmed diagnosis of Pagetic osteosarcoma (N = 128) using ICD-O-3 code 9184. Demographic factors (age, sex, race, Hispanic status, educational attainment, insurance status, facility type, distance from facility, and Charles/Deyo score) were analyzed by descriptive statistics. Incidence trends were interpreted in regression analysis. Results: In the NCDB, 128 patients were identified with a confirmed diagnosis of Pagetic osteosarcoma (Pagetic OS) between 2004 and 2020, with a steady incidence of diagnoses per year (R2 = 0.0). The average age of diagnosis was 68.9 years (SD = 13.4, range = 11-90 years). Men were more likely to be diagnosed than women (57% and 43%, respectively). Most patients were non-Hispanic White (71%), insured by Medicare (56%), and lived in a metropolitan area (85%). When compared individually, more patients were in the top median household income quartile (31%). The top two primary sites were the long bones of the lower limb including their associated joints (27%) and the pelvic bones excluding the sacrum, coccyx, and symphysis pubis (27%). Within the cohort, 31 patients received chemotherapy as primary treatment (24%) while 28 patients received primary radiation therapy (22%). Most patients (63%) did not undergo primary site surgery while 39 patients (31%) did receive surgery as primary treatment. The 90-day mortality included 15% of patients, who died 90 or fewer days after surgery was performed. The 2-year survival was 82% while the 5-year survival was 53% and the 10-year survival was significantly lower at approximately 11%. Most individuals (76%) had Charlson-Deyo comorbidity scores of 0. Conclusions: To the best of our knowledge, this NCDB analysis on Pagetic osteosarcoma (Pagetic OS) is the first of its kind on this specific subset of osteosarcoma. Previous research suggests the broader osteosarcoma occurs most frequently in adolescents. This data reveals that Pagetic OS is primarily diagnosed later in life (68.9 years), while still affecting a significantly wide age range (range = 11-90 years). Most patients were non-Hispanic White (71.1%), lived in a metropolitan area (85.2%), and belonged to the top median household income quartile (31.3%). Further research could unveil additional guidance on best practice in diagnosing and treating this cancer.

Analysis of demographic and socioeconomic factors in adamantinoma using data from the National Cancer Database (NCDB).

e23501 Background: Adamantinoma is a rare low-grade primary malignant bone tumor accounting for less than 1% of all malignant bone tumors. It largely presents in the tibia of young adults, is locally aggressive, and can metastasize. Definitive diagnosis is primarily established by histopathological examination. This rare tumor with uncertain histogenesis remains under-studied. Therefore, exploring trends in diagnoses may provide insight into its epidemiology. The National Cancer Database (NCDB) was examined to reveal the demographic factors in patients diagnosed with Adamantinoma. Methods: A retrospective cohort analysis utilizing the 2004–2020 NCDB included 206 patients with a histologically-confirmed diagnosis of adamantinoma (ICD-O-3 Code 9261). Demographic factors such as age, sex, race, Hispanic status, insurance status, facility type, distance from facility, and Charlson-Deyo score were analyzed via descriptive statistics. Trends in incidence were interpreted using regression analysis. Results: A total of 206 patients were identified in the NCDB with a confirmed diagnosis of adamantinoma of long bones between 2004-2020. Incidence remained relatively stable over this time period (R² = 0.009). The most common primary site of diagnosis were the long bones of lower limb and associative joints (97%). Most individuals (88%) had a Charlson-Deyo comorbidity score of 0. The majority of patients (66%) were classified as Stage 1 AJCC staging. Men were more likely to be diagnosed (56%) compared to women (44%). Most patients were White (78%) and non-Hispanic (85%). A higher percentage of patients were privately insured (67%) and lived in metropolitan areas (87%). Treatment facilities primarily were academic programs (74%). Almost all of the patients were treated surgically (92%) with the most common approach being lymph node dissection (61%) more so than local tumor excision or removal of adjacent organs. Following surgery, the patients observed had a very good prognosis, with a 99% ninety-day survival, a 93% five-year survival, and an 89% ten-year survival. Conclusions: Adamantinoma has a risk for recurrent and metastatic disease. This first NCDB analysis on adamantinoma’s demographics addresses a significant knowledge gap on this topic. The primary site of diagnosis were lower extremity long bones, most commonly treated with surgical intervention, and had a high survival rate which is consistent with earlier studies. The majority of patients included in this study tend to be White, non-Hispanic, and privately insured. This may suggest a demographic and socioeconomic factor that plays a part in diagnosis, prognosis, and treatment of individuals with adamantinoma. Future research should focus on the understanding of factors that impact the course of one’s health and the etiology of this rare pathology.

Adenocarcinoma in multiple adenomatous polyps: An analysis of demographic and socioeconomic factors.

e15619 Background: Adenocarcinoma in multiple adenomatous polyps (AMAP) is a form of gastrointestinal cancer characterized by adenomatous polyps in the gastrointestinal mucosa and distinct lesions found outside the intestines. A rare form of cancer, AMAP can be traced back to mutations in the APC gene, with higher rates of mutation correlating with worse prognosis. There is an association with familial adenomatous polyposis, which can lead to colorectal cancer in patients as young as 15. Examining demographic statistics on AMAP from the National Cancer Database (NCDB) sheds light on this rare form of colorectal cancer, unlocking new possibilities for diagnostics and treatment. Methods: A retrospective cohort analysis identified 193 patients with AMAP from the 2004-2020 NCDB using ICD-O-3 Code 8221 to identify them. Demographic factors such as age, sex, treatment type, and Charles/Deyo score were explored with descriptive statistics. Linear regression analysis was utilized to study incidence trends. Results: A total of 193 cases of histologically confirmed AMAP were retrieved from the 2004-2020 NCDB with a slight decline in incidence rates during this time (R² = 0.39). The majority of patients were male (55%), White (86%), privately insured (46%), and resided in metropolitan areas with a population size of at least one million (60%). Most patients also comprised the top two income quartiles based on median household income (64%). The mean age at diagnosis was 56.5 years (SD = 19.15, range = 15 - 90). The top primary sites affected were the Colon (26%), Sigmoid Colon (16%), and Rectum (11%). Furthermore, most patients were treated surgically (88%) with the average tumor size of 35.3 mm (SD = 20.5, range = 5.0 - 77.0). More patients received chemotherapy (28%) than radiation therapy (10.4%), with few patients receiving hormone therapy (0.5%) and none receiving immunotherapy. Over half (51%) of the patients were categorized as experiencing Stage 0 and Stage 1 cancer according to the NCDB Analytic Stage Group. The vast majority of patients (74%) had no comorbidities (Charlson-Deyo = 0) and did not receive any palliative care (97%). Conclusions: Our NCDB analysis on AMAP is a novel examination that provides insight into various demographics to better understand the disease. The majority of patients were males with adenocarcinoma lesions most commonly diagnosed in the colon and rectal areas, consistent with previous studies on multiple adenomatous polyps. Our analysis revealed that the majority of patients diagnosed with AMAP tend to be White, privately insured, reside in metropolitan areas, and hail from the top two quartiles of median household income. Additional research is required to gain a greater understanding of the demographic and socioeconomic factors that are important for accurate diagnosis, effective treatments, and improved outcomes.

Myofibroblastic sarcoma: A study of demographic and socioeconomic factors.

e23545 Background: Myofibroblastic sarcoma is a type of non-rhabdomyosarcoma soft tissue sarcoma originating from spindle cells of mesenchymal origin with myofibroblastic differentiation. First described in 1998, there is little known about the prognostic factors of this rare and relatively new cancer. This typically non-metastasizing tumor is primarily found in the head, neck, or extremities. Treatment focuses on tumor excision, and the 5-year overall survival of low-grade myofibroblastic sarcoma cancer is 72%. This study analyzed data from the National Cancer Database (NCDB) to understand how demographic factors contribute to the treatment and prognosis of myofibroblastic sarcoma. Methods: A retrospective cohort analysis was conducted on demographic factors of patients with confirmed myofibroblastic sarcoma (ICD-8825-3) using the NCDB from 2004-2020. Regression analysis was used to study trends of patient age, sex, race, education, insurance status, distance from facility, and Charles/Deyo score within this population. Results: A total of 111 patients (N = 111) were identified in the database with a confirmed diagnosis of myofibroblastic sarcoma from 2004 to 2020 with an increasing frequency of diagnoses per year (R^2 = 0.6283). The average age of diagnosis was 47.3 (SD = 24.17, range = 0 - 90 years). Although Myofibroblastic sarcoma appeared throughout the body, the most prominent sites were the long bones of the lower limb and associative joints (6%) followed by the uterus (5%). The majority of patients were white (83%), non-Hispanic (86%), and female (63%). A higher percentage of patients lived in metropolitan areas with a population greater than 1 million (58%) compared to smaller metropolitan, urban, or rural counties (42%). Most of the patients were treated at an academic/research program (30%) followed by a comprehensive community cancer program (21%). More facility locations were based in the Pacific (15%) and the Middle Atlantic (11%) regions. The primary payer at diagnosis was private insurance/managed care (44%) followed by Medicare (32%) and Medicaid (19%). Few patients (5%) received palliative care. Conclusions: To the best of our knowledge, this is the first NCDB analysis on Myofibroblastic sarcoma. Based on our dataset, Myofibroblastic sarcoma tends to occur in the long bones of the lower limb and associative joints which differed slightly from what we found in previous reports, which described the head and neck as the two areas of highest prevalence. This is the first time the socioeconomic factors have been described in the literature: these patients are more likely to be non-Hispanic, female individuals, living in smaller towns. This study offers insight on how much further investigation is required to better understand the impact of demographic and socioeconomic factors on early diagnosis and treatments.

Impact of race/ethnicity on the MammaPrint genomic assay risk and prognosis in early breast cancer (EBC): A National Cancer Database (NCDB) analysis.

564 Background: The 21-gene Oncotype DX Recurrence Score (RS) and 70-gene MammaPrint (MP) assays provide prognostic information for distant recurrence and are used to guide chemotherapy use in hormone receptor (HR)-positive, HER2-negative EBC. Previous reports have demonstrated that Black women with low genomic risk (RS 0-25) have a higher recurrence risk than White women in the TAILORx (PMID: 32986828) and RxPONDER trials (SABCS 2023, abstract GS1-01), and that Black race was associated with worse overall survival (OS) in multivariate models including RS in the NCDB registry (PMID: 33649322).The goal of this study was to evaluate the impact of race/ethnicity on MP risk distribution and prognostic information provided by the MP assay in the NCDB cohort. Methods: Women with HR-positive EBC with tumor size up to 5 centimeters (T1-T2), 0-3 involved lymph nodes (LNs, N0-N1), diagnosed between 2009-2018, and who had available information on MP testing and OS in the NCDB 2019 dataset were identified. Patients (pt) were stratified by MP result of high or low risk. T-tests and chi-square tests were used to compare pt characteristics, while log-rank tests assessed differences in OS between the high- and low-risk MP groups, as well as across different racial/ethnic categories. Results: 6096 eligible women were included of whom 41.0% (N=2502) were MP high-risk and 59.0% (N=3594) MP low-risk. Overall, 82.7% of pts were Non-Hispanic White (NHW), 8.7% Non-Hispanic Black (NHB), 4.7% Hispanic (H), and the remainder other/unknown (O). A higher proportion of H and NHB pts had high MP results, p<0.0001. The MP high-risk group had a greater proportion of pts </= 50 years (p=0.0013) and larger tumors (p<0.0001) and higher grade (p<0.0001), but not LN positive (p=0.7649). The 5-year OS rates (and 95% Confidence Intervals) for the MP high and low-risk groups were 92.6% (91.6% - 93.7%) and 96.6% (95.9% - 97.2%), respectively, p<0.0001. There were no differences in OS based on race/ethnicity in the low-risk group with 5-year OS rates of 98.4% (96.1%-100%), 95.9% (93.3% - 98.6%), 96.4% (95.7% - 97.1%), and 99.2% (97.7% - 100%) for H, NHB, NHW and O, respectively, p=0.34. Similarly, in MP high-risk, race/ethnicity did not impact prognosis with OS rates of 92.6% (88.2% - 97.1%), 90.8% (87.2% - 94.5%), 92.8% (91.7% - 94.1%), and 95.8% (91.2% - 100%) for H, NHB, NHW and O groups, respectively, p=0.45. There was no significant interaction between race and MP for OS when accounting for age, tumor grade, tumor size, and LN status, p=0.75. Conclusions: NHB and H women were more likely to have high-risk MP results compared with NHW women in this NCDB cohort, although race/ethnicity did not impact prognosis for 5-year OS in either MP risk group. Limitations of this analysis include absence of information on recurrence and short follow up, as about one-half of recurrences in HR-positive EBC occur after 5 years.

The epidemiology and demographic statistics of serrated adenocarcinoma.

e15645 Background: Serrated adenocarcinoma (SAC) is a recently-recognized variant of colorectal cancer (CRC) arising from precursor lesions of the serrated neoplastic pathway. Despite its novelty, SAC makes up around 10% of all CRCs and demonstrates worse patient prognosis than other forms. As rates of CRC, one of the most common cancers worldwide, continue to rise, further investigation must be done into new variants like SAC to improve its survivability and patient quality of life. This National Cancer Database (NCDB) analysis aims to evaluate the epidemiological factors and clinical characteristics of patients diagnosed with SAC. Methods: The 2004-2020 NCDB records were searched for patients with histologic diagnosis of SAC (N = 171) with the ICD-O-3 code 8213. This study utilized descriptive statistics to analyze demographics factors including age, sex, race, Hispanic status, educational attainment, insurance status, facility type, and Charlson-Deyo score. Results: From 2005-2020, 171 patients with an average age at diagnosis of 70.5 ± 11.3 years were diagnosed with serrated adenocarcinoma, with most (88%) cases demonstrating invasive behavior in the ascending colon (37%) or cecum (21%). The size of the tumors ranged from 1 - 200 mm, with an average size of 30.0 mm. The overwhelming majority of patients were white (93%) women (60%) living on average no more than 20 miles away from a hospital in metropolitan areas with populations over a million (49%). More patients were insured through Medicare (66%), receiving treatment at comprehensive community cancer (37%) or academic research programs (30%). Nearly all patients (95%) underwent surgery at the primary site, with a ninety-day survival rate of 88%. Among these, the most common procedure was subtotal colectomy or hemicolectomy (43%) followed by partial colectomy with segmental resection (22%), with 84% of patients showing no residual tumor after surgery. Alternate treatments included were chemotherapy (19%) and radiation therapy (8%). After five years, 68% of patients were alive, with the number falling to 35% after ten years. Conclusions: This study is the first on SAC to analyze NCDB data, presenting a larger sample than prior literature. With the commonality of colorectal cancer, the lack of research on SAC represents a significant knowledge gap. Interestingly, the data suggests that SAC predominantly develops in the ascending colon and cecum, conflicting with prior literature which suggested its tumors were more evenly distributed. Demographically, its diagnosed patients are mostly elderly, non-Hispanic whites insured by Medicare living in dense metropolitan areas near hospitals. These findings implicate that rural, aging communities could be impacted more severely by SAC, as they lack the healthcare infrastructure to obtain a proper diagnosis. To better define the link between demographic factors and effective diagnosis and treatment, further research is needed.

An NCDB analysis of patient treatment trends in soft tissue angiosarcoma.

e23563 Background: Angiosarcoma is a rare subtype of soft tissue sarcoma associated with a generally poor prognosis and high mortality rate. Median survival of patients with angiosarcoma typically ranges from 15 to 24 months, with a 5-year survival of 12-33%. Angiosarcomas have a high propensity for local recurrence, metastasis, and multiple organ involvement as they originate from vascular endothelial cells. Though surgical excision currently plays a central role in the treatment of angiosarcoma, no significant study has analyzed NCDB for treatment trends in these patients. This study aims to characterize the effect of different treatment modalities on overall survival of angiosarcoma patients. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with angiosarcoma from 2004 to 2020 using histology code 9120 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, Chi-Square, Cox Proportional Hazards and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05. Results: 3560 patients with angiosarcoma of the soft tissue were queried. The most common primary site for a tumor was the head, neck, or face (920 patients, 31.3%). Of the initial sample, 1889 ( 53.1%) patients received surgery alone, 450 ( 12.6%) patients received adjuvant chemotherapy, 55 ( 1.54%) received adjuvant radiation, and 30 ( 0.84%) patients received adjuvant chemoradiation. Surgery alone conferred the greatest median survival; no surgery conferred the least ( 31.4 months vs. 7.2 months; p < 0.001). In the crude and adjusted logistic regression models, combined chemoradiation (OR = .210; 95% CI:.100-.400) and surgery alone were associated with the lowest odds of death (OR = .271; 95% CI: .224-.329) relative to no surgical procedure of the primary site. This finding persisted once the model was adjusted for age, stage, and tumor size. Surgery alone conferred the lowest hazard ratio (HR = .352; 95% CI: .323-.384) relative to no surgery. Conclusions: In angiosarcoma patients, surgical excision at the primary site alone was associated with the greatest median survival and the lowest hazard ratio. Additionally, angiosarcoma patients who did not receive surgery had the least median survival. Surgery with adjuvant chemoradiation and surgery alone had the lowest odds of death. These findings affirm that surgical excision at the site of the primary tumor plays a key role in increasing the survival of angiosarcoma patients. Further research is necessary in characterizing treatment trends in angiosarcoma patients to supplement current standardized treatment protocols and improve the mortality of this lethal cancer.

Mixed liposarcoma: A study of socioeconomic and demographic factors.

e23527 Background: Mixed Liposarcoma (LS) is an extremely rare subtype of LS, with characteristics often spanning 2 or more of the other LS subtypes such as myxoid, round cell, or well-differentiated LS. To date, the cytologic features of this uncommon tumor has yet to be described. Analyzing trends in diagnoses may produce valuable information about its epidemiology. The National Cancer Database (NCDB) was analyzed to uncover the demographic factors in patients diagnosed with mixed LS. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 199 patients were found with a histologically confirmed diagnosis of mixed LS (ICD-8855-3). Race, gender, Hispanic origin, type of treatment facility, insurance coverage, and distance from patient residence to treatment facility were analyzed via descriptive statistics, and trends in incidence were interpreted using regression analysis. Results: The majority of patients were white (89%) and non-Hispanic (83%) with a relatively equal split of males (56%) and females (44%). The most common primary site of mixed LS was the retroperitoneum (72%), and the frequency of diagnosis decreased from 2004 to 2020 (R2 = 0.4568). Patients were treated at academic/research programs (45%), comprehensive community cancer programs (25%) and integrated network cancer programs (18%) that were generally located in the Middle Atlantic (19%), South Atlantic (18%), and East North Central (16%). The two primary payers at diagnosis include private insurance/managed care (45%) and Medicare (43%). Most patients were from counties in metro areas with a population of at least 1 million (57%) followed by metro counties with a population of 250,000 to 1 million (18%). The largest median household income quartile was $74,063 or more (38%), followed by $46,227 - $57,856 (22%). Most patients had a Charlson-Deyo Score of 0 (83%) with a NCDB analytic stage of either I (28%), III (26%), or not applicable (21%). Conclusions: To the best of our knowledge this NCDB analysis on mixed LS is the first of its kind and therefore addresses a significant knowledge gap. Most patients tend to be white and non-Hispanic. Mixed LS most commonly is found in the retroperitoneum, which is similar to case reports. We found that mixed LS patients have a relatively high household income, most often live in high populated metro areas, and are most frequently treated at academic/research programs. These findings are significant because these socioeconomic factors have not been noted before in literature. Further examination of these demographic and socioeconomic factors is required to understand how they impact treatment, diagnosis of, and survival of patients with mixed LS.

Malignant chondroblastoma: NCDB analysis of demographic and socioeconomic factors.

e23500 Background: Malignant chondroblastomas are atypical forms of the rare benign chondroid-producing neoplasm known as a chondroblastoma. Chondroblastomas account for less than 1% of all bone tumors and arise in the epiphyses of long bones in young adults. Unlike conventional chondroblastoma, the majority of patients diagnosed with malignant chondroblastomas tend to be older and tumors present at atypical body sites. Therefore investigating trends in diagnosis may yield important insight into its epidemiology. The National Cancer Database (NCDB) was explored to analyze the demographic factors in patients diagnosed with malignant chondroblastoma. Methods: A retrospective cohort analysis utilizing the 2004–2020 National Cancer Database (NCDB) included 67 patients with a histologically-confirmed diagnosis of malignant chondroblastoma (ICD-O-3 Code 9230). Demographic factors (age, sex, race, Hispanic status, insurance status, facility type, distance from facility, and Charlson-Deyo score) were analyzed by descriptive statistics, and incidence trends were interpreted using regression analysis. Results: Between 2004 – 2020, the NCDB identified 67 patients with a confirmed malignant chondroblastoma diagnosis. There was a slightly increasing incidence of patients diagnosed per year (R² = 0.471). The most common primary site was the frontal lobe (60%). Males and females were affected equally (49% and 51%, respectively) with a mean age at diagnosis of 46.5 years (SD = 15.3, Range = 21 – 74 years). The majority of patients were White (90%), non-Hispanic (87%), lived in metropolitan areas (82%), and were privately insured (63%). Treatment facilities primarily consisted of academic programs (48%). Patients lived an average of 27 miles away from the facility (SD = 49, Range = 356.3 miles). Most individuals (76%) had Charlson-Deyo comorbidity scores of 0. Primary treatment methods involved administering radiation therapy (52%). 60 patients (90%) underwent surgical intervention. For valid data, post-surgery survival rates were 100% after 30 days and 93% after 90 days. About half of the patients (57%) survived 5 years after their initial diagnosis. Conclusions: Malignant chondroblastoma is locally aggressive and has metastatic potential. Surgical intervention was the most common treatment (90%), which is consistent with the previous literature. In this study, AJCC staging was not applicable to almost all of the patients (99%). To the best of our knowledge, this is the first NCDB analysis of malignant chondroblastoma patient demographic and socioeconomic factors which addresses a significant gap in knowledge. Most patients were White, non-Hispanic, lived in metropolitan areas and were privately insured. Additional investigation is required to enhance our understanding of how demographic and socioeconomic factors influence the diagnosis, staging, and treatment of individuals with malignant chondroblastoma.

Analysis of demographic and socioeconomic factors in mixed type rhabdomyosarcoma using NCDB.

e23538 Background: Mixed type rhabdomyosarcoma is a rare soft tissue tumor characterized by the presence of two histologically different subtypes of rhabdomyosarcoma, commonly found in the testis. Despite a majority of the patients undergoing aggressive treatment, the prognosis is poor. Analysis of its diagnostic trends could prove valuable in understanding mixed type rhabdomyosarcoma’s epidemiology. The 2004-2020 National Cancer Database (NCDB) was analyzed to determine the demographic factors of patients with mixed type rhabdomyosarcoma. Methods: A retrospective cohort analysis of the 2004–2020 NCDB, using ICD-O-3 code 8902/3, included patients diagnosed with mixed type rhabdomyosarcoma (N = 94). Descriptive statistics were used to analyze various demographic factors such as sex, age, race, Hispanic status, educational background, insurance status, facility type and location, distance from facility, and Charlson-Deyo score. Incidence trends were examined through regression analysis. Results: The NCDB identified a total of 94 patients with a confirmed diagnosis of mixed type rhabdomyosarcoma from 2004-2020, with a slight decline in incidences diagnosed per year (R² = 0.0903). Females had a slightly higher likelihood of being diagnosed (55%) compared to males (45%), with average age at diagnosis being 40.06 years (SD = 2.8, Range = 1-90). The majority of patients were White (72%) and of non-Hispanic descent (82%). The top primary site was the testis (23%), with endometrium being another major site (15%). Most (83%) patients had a Charles/Deyo comorbidity score of 0. All patients received immunotherapy as primary treatment. Most (46%) patients were privately insured. A majority (26%) of patients received treatment at an academic/research program. A greater number (53%) of patients resided in metropolitan counties with a population larger than 1 million. Most (40%) patients belonged to the highest quartile of income earners of $74,063 or greater. Conclusions: Our research on mixed type rhabdomyosarcoma, the first NCDB analysis of its kind, aims to address a notable knowledge gap on the topic. Similar to information presented in earlier studies, our analysis revealed mixed type rhabdomyosarcoma has a relatively poor prognosis and is mostly observed in White, Non-Hispanic individuals. Analysis on the demographics of this patient population revealed most patients were top quartile income earners, resided in a metropolitan location, and were more likely to be treated at an academic/research program. Further research should aim to better understand the impact of such demographic and socioeconomic features on the diagnosis, treatment plans, and overall mortality rates of patients with mixed type rhabdomyosarcoma.

Juxtacortical chondrosarcoma: An NCDB analysis of demographics and socioeconomic factors.

e23505 Background: Juxtacortical chondrosarcoma (JCC) is a rare cartilaginous tumor—accounting for less than 2% of all chondrosarcomas—and typically appears on the external surfaces of long bones. The prognosis of JCC is relatively promising compared to other chondrosarcomas, with the current therapy of choice being en-bloc resection. However, a significant amount of information regarding JCC remains unknown. Therefore, exploring diagnostic trends may provide greater insight into this cancer’s epidemiology and potential forms of treatment. The National Cancer Database (NCDB) was assessed to uncover the demographic factors in patients diagnosed with JCC. Methods: A retrospective cohort analysis utilizing the 2004–2020 National Cancer Database (NCDB) included 131 subjects with a histologically-confirmed diagnosis of JCC (ICD-0-3 code 9221). Demographic factors (age, sex, race, Hispanic status, insurance status, facility type, distance from facility, and Charleson-Deyo comorbidity score) were analyzed by descriptive statistics and incidence trends were interpreted in regression analysis. Results: Between 2004 and 2020, the NCDB reported a total of 131 patients with a confirmed diagnosis of JCC. This data indicated a rising incidence of patients diagnosed per year (R² = 0.0855), with an average age of diagnosis of 45 years (SD = 18, range = 8-88). Patients with JCC were more likely to be White (82%), of non-Hispanic origin (86%), and male (63%). The tumor was most commonly found in the long bones of the lower limbs (35%). Surgical removal was the primary treatment for the majority of patients (95%), while others received radiation (7%) or chemotherapy (4%). Most patients (83%) had a Charlson-Deyo comorbidity score of 0. Patients were commonly treated at academic and research facilities (61%), and no patients received palliative care. More than half of individuals were privately insured (57%) and resided in a metropolitan area with a population size of at least 1 million (59%). The mean distance between patient residence and treatment site was 104.1 miles (SD = 221, range = 11-1194 miles). Conclusions: To the best of our knowledge, this is the first study on juxtacortical chondrosarcoma utilizing NCDB data to address the significant lack of research on this subject. The majority of JCC patients are non-Hispanic, White, and have a primary site of diagnosis at the long bones of the lower limbs. This paper is the first to describe the socioeconomic factors of patients diagnosed with JCC: patients tend to be privately insured, live in large metropolitan areas, and are mostly treated in academic research facilities. Additional research is necessary to comprehend how socioeconomic and demographic factors influence the manner in which JCC patients are diagnosed and treated.

Small cell osteosarcoma: An NCDB analysis of demographic and socioeconomic factors of diagnosed patients.

e23504 Background: Small cell osteosarcoma (SCOS) is a rare subtype of osteosarcoma accounting for roughly 1.5% of all osteosarcomas. Its prognosis is slightly worse than conventional osteosarcoma. Exploring demographic trends in patients with a confirmed SCOS diagnosis may provide insight into its epidemiology and allow for earlier diagnosis. The National Cancer Database (NCDB) was analyzed to research the demographic factors in patients diagnosed with SCOS. Methods: A retrospective cohort analysis utilizing the 2004–2020 National Cancer Database (NCDB) included patients with a histologically-confirmed diagnosis of SCOS (ICD-O-3 9185). Demographic factors (age, sex, race, Hispanic status, educational attainment, insurance status, facility type, distance from facility, and Charles-Deyo score) were analyzed via descriptive statistics. Incidence trends were interpreted in regression analysis. The mean survival was compared using the Log Rank (Mantel-Cox) test. Results: A cohort of 102 cases of SCOS were retrieved from the NCDB between 2004–2020. The primary sites for SCOS were the long bones of the lower limb (41%). Most patients were male (69%), White (63%), non-Hispanic (84%) with a mean age for diagnosis of 28 (SD = 18). The mean survival for males was 117 months (95% CI [93,141]), more than twice as long as females with 58 months (95% CI [31,85]). The Log Rank (Mantel-Cox) test reported a chi-square (χ²) value of 6.434, indicating a statistically significant difference between survival curves of males and females (p = 0.01). Residence in a metropolitan area (86%) was more common than other rural or urban areas. The greatest proportion of patients lived in the Middle or South Atlantic region of the United States (68%). The majority of patients were insured (86%), with the most covered by private insurance (64%) or Medicaid (22%). The median household income for each patient was most commonly in the highest quartile of over $74,063 (29%). Patients were diagnosed with SCOS at a steady rate between 2004 to 2020 (R² = 0.0956). Using the AJCC Cancer Staging System, most patients were Stage II (40%) or Stage IV (21%) at diagnosis. As a primary treatment, 87% of patients received chemotherapy. Most patients (91%) had no comorbidities with a Charlson-Deyo score of 0. Conclusions: This is the first time that demographic and socioeconomic factors of SCOS patients have been analyzed from the NCDB, revealing that the mean survival time of patients after receiving a diagnosis was more than double for males than females. SCOS patients are also more likely to live in metropolitan areas, particularly within the Middle or South Atlantic United States. Consistent with earlier reports, SCOS is typically diagnosed in young adults in the long bones of lower limbs. To better understand the impact of demographic factors on the diagnosis, treatment, and overall survival of patients with SCOS, further research is recommended.

Demographics and socioeconomic factors of adenocarcinoma with apocrine metaplasia.

e12588 Background: Adenocarcinoma with apocrine metaplasia (AAM) is an invasive form of carcinoma distinguishable by the conversion of malignant glandular cells to apocrine sweat cells with abundant granular eosinophilia. Although AAM has a favorable prognosis, early treatment, including surgical intervention or radiation therapy, is still required to decrease metastasis or resurgence. Due to the rarity of this disease, the impact of demographic factors has not yet been explored and could be essential to understand its epidemiology. Demographic trends of patients were analyzed within the National Cancer Database (NCDB). Methods: Within this retrospective cohort analysis, 155 patients were identified from the 2004–2020 NCDB with a confirmed AAM diagnosis using code 8573 from the International Classification of Diseases for Oncology (ICD-8573-3). Their demographic factors including sex, age, race, Hispanic status, Charleson-Deyo score, distance to facility, educational attainment, and household income were analyzed using incidence trends and descriptive statistics via regression analysis. Results: The average age at diagnosis was 62.7 years (SD = 14.3, range = 18 - 90 years) with a 58% ten-year survival rate. The incidence steadily decreased from 2004–2020 (R2 = 0.3051). The majority of patients (85%) had no comorbidities (Charleson-Deyo = 0). Surgical treatment (73%) as a primary procedure was common and was combined with chemotherapy (57%) or radiation therapy (38%). The primary sites included the upper-outer quadrant (28%) and overlapping lesions of the breast (25%). The average tumor size at surgery was 30.7 mm (SD = 17.9 mm, range = 1.00–64.0 mm). The majority of patients were female (96%), White (72%), and non-Hispanic (88%). Patients tended to have household income greater than $57,857 (55%) and hailed from a metropolitan area with a population greater than 1 million (55%). The Western Central (53%) and Atlantic (24%) regions of the USA comprised most diagnoses. Patients traveled an average of 81.5 mi (SD = 184, range = 0.20–1110 mi) to receive care from an academic or research program (61%) or a comprehensive community cancer program (23%). Conclusions: The findings of this research support previous studies demonstrating that most patients tend to be over 60 years old and White. We reported an average tumor size of 30.7 mm, usually found in the upper-outer quadrant or overlapping regions in the breast. Patients typically underwent chemotherapy after surgical treatment at an academic hospital. Most patients lived in densely populated areas within the Western Central and Atlantic regions, which may suggest an ease of access to treatment. This is the first NCDB analysis of AAM, and thus fills an important gap in cancer research. Future work should identify the influence of demographic and socioeconomic factors on the diagnostic factors, cancer prognosis, treatment regimen, and overall survival rates of patients.

High-grade surface osteosarcoma: A National Cancer Database study of demographic characteristics.

e23508 Background: High-grade surface osteosarcoma (HGSO) is an extremely rare malignant subtype of osteosarcoma. HGSO often affects long bones, particularly the femur, and is the rarest subtype of surface osteosarcomas. Though data is limited, current information suggests this cancer presents with a poor prognosis, generally affecting adults aged 20 to 40. Current treatment standards involve wide resection and chemotherapy. The National Cancer Database (NCDB) was examined to establish the demographic factors among HGSO patients and identify diagnostic and treatment trends. Methods: A retrospective cohort study from 2005-2020 was conducted using the NCDB. A total of 99 patients were found with a histologically confirmed diagnosis of high-grade surface osteosarcoma (ICD-9194-3). Factors such as gender, age, race, insurance status, rural/urban residence, treatments, mortality rates, and Charles/Deyo scores were analyzed using descriptive statistics, and trends in incidence were interpreted via regression analysis. Results: Yearly HGSO incidence rates increased from 2005 to 2020 (R2 = 0.19). The average age of diagnosis was 41 years (SD = 24.9, range = 10-90) with men diagnosed (54%) slightly more than women. The majority of patients were non-Hispanic white (73%), had private insurance (55%), and lived in a metropolitan area with over 250,000 in population (89%). The average patient was diagnosed at a hospital 40.4 miles away from their home (SD = 84.9, range 0.4-648.4 miles). Most patients (55%) were in stage II at diagnosis, and 86% of patients had a Charlson-Deyo comorbidity score of 0. The most common primary site of this malignancy was the long bones of the lower limb and associated joints (67%), while the upper extremities (8%) and pelvic bone (8%) served as less common primary sites. Surgery was the most common primary treatment (62%). Data from 69 patients revealed the 90-day mortality post-surgery was 3%. The mean survival rate was 70% at two years and 52% at five years. Conclusions: To the best of our knowledge, this study represents the first NCDB analysis of HGSO. Our analysis demonstrated that HGSO occurs most often, but not exclusively, within the lower extremity long bones, which may be an important diagnostic distinction. It was previously indicated that the average age at HGSO diagnosis is 20-40 years, but our analysis suggested it is closer to 40. Our analysis revealed a five-year survival rate of 52% which is worse than prior studies have indicated. Demographic data has revealed the majority of patients were non-Hispanic white, privately insured, and living within a metropolitan area. This trend may suggest access to healthcare resources is influencing this cancer’s diagnosis and treatment. Further research is warranted to explore whether the demographic patterns seen in HGSO are indicative of biological causes or socioeconomic factors that are significantly influencing diagnosis.

Periosteal osteosarcoma: A study of demographic and socioeconomic factors.

e23506 Background: Periosteal Osteosarcoma (PO) is a rare primary malignant bone cancer that typically affects the tibia or femur of young adults in their second and third decades of life. This soft-tissue mass causes extrinsic erosion of thickened underlying diaphyseal cortex and perpendicular periosteal reaction extending into soft-tissue components. Despite the rarity of PO, 29% of diagnosed patients do not survive past 10 years following treatment. Further investigation into the diagnostic trends of PO may produce valuable information about its epidemiology. The National Cancer Database (NCDB) was analyzed to identify the demographic factors of patients diagnosed with PO. Methods: A retrospective cohort analysis that utilized data from the 2004–2020 NCDB included 138 patients with a histologically-confirmed diagnosis of PO (ICD-9193-3). Demographic factors (age, sex, race, Hispanic status, educational attainment, insurance status, facility type, distance from facility, and Charlson/Deyo score were analyzed by descriptive statistics, and incidence trends were interpreted via regression analysis. Results: A total of 138 individuals had a confirmed diagnosis of PO between the years 2004-2020 with a relatively constant rate of diagnosis each year (R2 = 0.1749). The average age of diagnosis was 29.7 (SD = 17.5, range = 6-86 years). Males and females were affected at rates of 58% and 42%, respectively. The majority of patients diagnosed with PO identified as White (73%) and non-Spanish/non-Hispanic (86%). The primary sites of diagnosis were the long bones of the lower limb (77%), with an average tumor size of 94.4 mm (SD = 54.2). Most patients (73%) utilized surgical treatment options such as radical excision or resection of the lesion with limb salvage. A higher percentage of patients were privately insured (62%), lived in a metropolitan area (75%), and were treated at an academic/research program (59%). Many individuals (91%) had no concurrent comorbidities (Charlson-Deyo comorbidity score = 0). Following treatment, the survival rates of patients were 91% at 2 years, 78% at 5 years, and 71% at 10 years. Conclusions: To our knowledge, this is the first NCDB analysis concentrating on PO, addressing a substantial gap in our understanding. In congruence with earlier descriptions of PO in case reports, a majority of patients are White and of non-Spanish/non-Hispanic origin and the primary site of diagnosis presents on the lower limbs. This is the first instance in the literature where the socioeconomic factors of PO patients have been clarified: PO patients are more likely to live in densely populated metropolitan areas, receive treatment in academic programs, and have private insurance. Further research is needed to elucidate the influence of demographic and socioeconomic factors on the diagnosis, treatment approaches, and survival outcomes of individuals with PO.

Characteristics and variations in young adults with cutaneous melanoma: A national cancer database analysis.

Many cancers in young adulthood differ in terms of biology, histologic variation, and prognosis compared to cancer in other older age groups. Differences in cutaneous melanoma among young adults compared to other older age groups, as well as between sexes in young adults are not well studied. The National Cancer Database was queried for patients diagnosed with cutaneous melanoma between 2004 and 2017. Patient characteristics, disease factors, and treatment were stratified by age-based cohorts and compared using standard univariate statistics. The Kaplan-Meier method and log-rank tests were used to evaluate overall survival (OS) between age-based cohorts and young adult sexes. Of the 329 765 patients identified, 10.5% were between 18 and 39 years of age at diagnosis. Compared with other older age groups, young adult patients were more likely to be female and uninsured with higher proportions of superficial spreading melanoma, melanoma of the trunk and extremities, and earlier-stage disease. Young adults had improved OS compared to other older age groups. Young male patients had a greater proportion of no insurance, nodular melanoma, higher-stage disease, and decreased OS compared to young female patients. Additionally, while the 5-year OS difference was statistically significant across all stages of disease between young males and females, the clinical significance is likely limited to later stages. Age and sex-specific differences in cutaneous melanoma highlight distinct patterns and characteristics, emphasizing the need for tailored approaches to screening, diagnosis, and treatment.

Trends in Early-Stage Cervical Cancer Management in the US: A National Cancer Database Analysis.

The Laparoscopic Approach to Cervical Cancer (LACC) trial was published in 2018 and demonstrated that minimally invasive surgery (MIS) yields inferior survival outcomes in early-stage cervical cancer compared to open surgery. This study investigates how the results of the LACC trial have impacted the selection of the primary treatment modality and adjuvant radiation utilization in early-stage cervical cancer. Using the National Cancer Database (NCDB), we compared patients with stage IA2-IB1 cervical cancer before (1/2016-12/2017) and after (1/2019-12/2020) the LACC trial. A total of 7930 patients were included: 4609 before and 3321 after the LACC trial. There was a decline in MIS usage from 67% pre-LACC to 35% thereafter (p < 0.001). In both the pre- and post-LACC periods, patients undergoing radical MIS more frequently had small volume disease (pre-LACC tumors ≤ 2 cm, 48% MIS vs. 41% open, p = 0.023; post-LACC stage IA2, 22% vs. 15%, p = 0.002). Pre-LACC, MIS radical hysterectomy was associated with White race (82% vs. 77%, p = 0.001) and private insurance (63% vs. 54%, p = 0.004), while there was no difference in socioeconomic factors in the post-LACC period. Although the proportion of patients treated with primary chemoradiation remained stable, the post-LACC cohort had a younger median age (52.47 vs. 56.37, p = 0.005) and more microscopic disease cases (13% vs. 5.4%, p = 0.002). There was no difference in the rate of radiation after radical hysterectomy before and after the trial (26% vs. 24%, p = 0.3). Conclusions: Post-LACC, patients were less likely to undergo MIS but received adjuvant radiation at similar rates, and primary chemoradiation patients were younger and more likely to have microscopic disease.

Overall Survival and Prognostic Factors in Metastatic Triple-Negative Breast Cancer: A National Cancer Database Analysis.

Metastatic triple-negative breast cancer (TNBC) is aggressive with poor median overall survival (OS) ranging from 8 to 13 months. There exists considerable heterogeneity in survival at the individual patient level. To better understand the survival heterogeneity and improve risk stratification, our study aims to identify the factors influencing survival, utilizing a large patient sample from the National Cancer Database (NCDB). Women diagnosed with metastatic TNBC from 2010 to 2020 in the NCDB were included. Demographic, clinicopathological, and treatment data and overall survival (OS) outcomes were collected. Kaplan-Meier curves were used to estimate OS. The log-rank test was used to identify OS differences between groups for each variable in the univariate analysis. For the multivariate analysis, the Cox proportional hazard model with backward elimination was used to identify factors affecting OS. Adjusted hazard ratios and 95% confidence intervals are presented. In this sample, 2273 women had a median overall survival of 13.6 months. Factors associated with statistically significantly worse OS included older age, higher comorbidity scores, specific histologies, higher number of metastatic sites, presence of liver or other site metastases in those with only one metastatic site (excluding brain metastases), presence of cranial and extra-cranial metastases, lack of chemotherapy, lack of immunotherapy, lack of surgery to distant sites, lack of radiation to distant sites, and receipt of palliative treatment to alleviate symptoms. In the multivariate analysis, comorbidity score, histology, number of metastatic sites, immunotherapy, and chemotherapy had a statistically significant effect on OS. Through NCDB analysis, we have identified prognostic factors for metastatic TNBC. These findings will help individualize prognostication at diagnosis, optimize treatment strategies, and facilitate patient stratification in future clinical trials.