National Cancer Data Base Cases Research Articles

40342 A Comparison Between Asian Americans and Pacific Islanders with Cutaneous Melanoma: An Analysis of 1,339 National Cancer Database Cases

40342 A Comparison Between Asian Americans and Pacific Islanders with Cutaneous Melanoma: An Analysis of 1,339 National Cancer Database Cases

Do U.S. Screening Guidelines Contribute to Higher Stage and Worse Survival in our Youngest and Oldest Cervical Cancer Patients? (019)

<b>Objectives:</b> To investigate age-related differences in stage at diagnosis and survival in cervical cancer patients to identify possible gaps in current screening guidelines. <b>Methods:</b> Cervical cancer patients diagnosed between 2004-2014 in the population-based SEER-18 program or the hospital-based National Cancer Database (NCDB) were eligible. Analyses in both cohorts were stratified in adolescent/young adults (AYAs: 18-39 years old), middle-aged adults (MAs: 40-64 years old), or the elderly (≥65 years old). The proportion of late (II-IV) versus early (I) stage at diagnosis was compared using the Chi-square test. Survival was compared with log-rank test and Cox modeling. The probability of cancer-related deaths (CRD) and non-cancer deaths (NCD) was estimated in SEER by cumulative incidence function. Early-stage diagnosis, 5-year survival, and adjusted hazard ratio for all-cause death in NCDB cases were estimated for each 5-year increment in age. A dominance analysis from logistic modeling was used to rank the relative importance of demographic and socioeconomic factors on the late stage of diagnosis in NCDB. <b>Results:</b> There were 29,635 cases from SEER (29% AYAs, 55% MAs, and 16% elderly). Late-stage diagnosis increased with age from 33% in AYAs to 54% in MAs and 71% in the elderly (p<i><0.0001)</i>. Five-year survival rates were incrementally worsening with age and were 80%, 65%, and 41% for AYAs, MAs, and the elderly, respectively (p<i><0.0001)</i>. Figures 1A-1C show 5-year CRD (NCD) rates of 19% (1%) in AYAs, 31% (3%) in MAs, and 47% (12%) in the elderly, respectively (p<i><0.0001</i>). These relationships were then further investigated in the 87,834 cases in the NCDB cohort (27% AYAs, 57% MAs and 17% elderly). Late-stage diagnosis again increased with age from 30% in AYAs to 52% in MAs and 68% in the elderly (p<i><0.</i>0001). Figure 1D displays the incremental inferior survival in MAs and the elderly relative to AYAs (p<i><0.</i>0001). Five-year survival for AYAs, MAs, and elderly patients in the NCDB cohort was estimated to be 80%, 67% and 43%, respectively (log-rank p<0.0001). Figures 1E-1F show that the age-dependent reductions in stage I diagnosis and 5-year survival rates mirrored each other. Within AYAs, the youngest patients diagnosed at 18-24 had a similar mortality compared to those diagnosed at 25-29 years old, but had a 25% higher adjusted risk of death over those diagnosed between 30-39 years ld. Within MAs, the adjusted risk of death increased by 15% when diagnosed at ages 45-49 versus 40-44 years, and 31% higher when diagnosed at ages 60-64 versus 40- 4 years old. The adjusted risk of death increased 20%, 47% and 120% in the elderly diagnosed at 70-74, 75-79 and ≥80 relative to 65-69 years old, spectively. A final analysis ranked the relative importance of factors contributing to the late stage at diagnosis (II-IV disease) showing that age and insurance status contributing 62% and 29%, respectively, with minor contributions from socioeconomic status (4.7%), race/ethnicity (2.4%), and comorbidity score (1.2%).Fig. 1 <b>Conclusions:</b> The youngest AYAs and the whole elderly population with cervical cancer in SEER and NCDB had a higher stage at diagnosis and worse survival, suggesting a need to propose age- and insurance-related refinements in screening guidelines to mitigate these disparities.

Associations between lymphovascular space invasion, nodal recurrence, and survival in patients with surgical stage I endometrioid endometrial adenocarcinoma

ObjectiveTo investigate the predictive value of lymphovascular space invasion (LVSI) for nodal recurrence and overall survival (OS) in patients with stage I endometrioid endometrial cancer (EC) following surgical staging that included adequate lymph node sampling.MethodsRetrospective analyses of patients undergoing surgical staging for FIGO stage I endometrioid EC between 1998 and 2015 were performed using an institutional database and the National Cancer Database (NCDB). Using the institutional database, logistic regression modeling identified predictors of nodal recurrence; Cox proportional hazards modeling was used to predict progression-free survival (PFS). Utilizing NCDB, Cox proportional hazards modeling was used to predict OS. The Kaplan-Meier method was used to estimate hazard ratios (HR). Survival curves were compared using the log-rank test.ResultsAmong 275 institutional cases, LVSI was present in 48 (17.5%). There were 11 nodal recurrences: 18.8% (9/48) of cases with LVSI had a nodal recurrence compared to 0.88% (2/227) of those without LVSI. In multivariate analysis of institutional data, LVSI was the only significant predictor of nodal recurrence (p = 0.002). Among 28,076 NCDB cases, LVSI was present in 3766 (13.5%). In multivariate analysis of NCDB, grade 3, LVSI, and depth of invasion (all p < 0.001) were prognostic for OS after adjusting for adjuvant radiation.ConclusionLVSI is an independent prognostic factor for nodal recurrence in stage I endometrial cancer with lymph node assessment. LVSI is associated with lower OS in NCDB. Given these findings, adjuvant therapy could be considered in these patients.

Clinicopathologic features and outcomes of gastrointestinal stromal tumors arising from the esophagus and gastroesophageal junction.

Our aim was to characterize the clinicopathological features and outcomes of gastrointestinal stromal tumors (GISTs) arising from the esophagus and gastroesophageal junction (GEJ) and describe the survival of patients treated at our institution as well as from a national hospital-based registry. Twenty-eight cases were identified using the Mayo Clinic Cancer Registry from 1997 to 2016, and 1,010 cases from the National Cancer Database (NCDB) between 2004 and 2014, with analysis of TNM staging, histopathological features, mitotic index, immunohistochemical studies, and KIT mutational analysis. At Mayo Clinic, the tumors ranged in size from 0.3-13 cm (mean 5.40 cm). IHC results were: CD117 (KIT) in 100% (23/23 cases) and DOG1 in 100% (6/6), followed by CD34 (85.7%, 12/14), smooth muscle actin (27.8%, 5/18), desmin (18.2%, 2/11), and S-100 protein (13.3%, 2/15). Mutational analysis (performed in 10 cases) showed KIT exon 11 mutations in 8 cases; KIT mutation was not identified in 2 cases (presumed wild-type). Two-thirds of patients underwent surgery, of which 70% had an esophagectomy. Fourteen patients received adjuvant imatinib mesylate. Five patients had liver metastases at the time of diagnosis; none had lymph node metastases. A total of 38.9% of cases had recurrent or metastatic disease. Complete clinical follow-up was available for 10 patients (median follow-up duration 31.5 months; range, 10-145 months): one (male) had a local recurrence at the anastomotic site and one (female) suffered a liver metastasis; the others were either disease-free or had stable disease at the time of last follow-up. There was a significant association seen among metastatic disease and mitotic count >5/50 high-powered field (HPF) (P=0.016), with median mitotic rate 90/50 HPF (range, 7-500) for metastatic tumors versus 6/50 HPF (range, 0-100) for non-metastatic tumors. For metastatic disease, median tumor size was 7.3 cm (range, 1-66 cm) compared to 4.8 cm (range, 0.02-71 cm) for non-metastatic disease, which was also statistically significant (P≤0.0001). Two hundred and fifty-eight NCDB cases were risk stratified using the Joensuu criteria. Among 89 low risk category tumors, only 2 (2.2%) were ultimately metastatic. A total of 10.9% (15/138) of high risk category tumors were metastatic. The median overall survival (OS) from the time of diagnosis for the Mayo Clinic cohort was 129.5 months (95% CI, 55.7-not reached), with 5-year OS 85.7%. Median OS for the NCDB cohort was 135.95 months (95% CI, 104.08-not reached) with 5-year OS 68.2%. Superior OS was seen in females (HR 0.67, 95% CI, 0.49-0.89, P=0.006). Among esophageal and GEJ GISTs, metastatic disease was associated with increased mitotic count and increased tumor size. Men were found to have inferior OS. The Joensuu risk criteria were validated for risk stratification of esophageal and GEJ GISTs.

Reliability of the American College of Surgeons Commission on Cancer's Quality of Care Measures for Hospital and Surgeon Profiling

Efforts to improve healthcare quality involve profiling hospitals and providers. Whether cancer-specific measures can be used reliably for profiling purposes has not been reported. Hospitals and surgeons were profiled with 3 measures assessing the adequacy of lymphadenectomy for colon (ie at least 12 regional lymph nodes [12RLN] are removed and pathologically examined for resected colon cancer), gastric (ie at least 15 regional lymph nodes [G15RLN] are removed and pathologically examined for resected gastric cancer), and non-small cell lung (ie at least 10 regional lymph nodes [10RLN] are removed and pathologically examined for American Joint Committee on Cancer stage IA, IB, IIA, and IIB resected non-small cell lung cancer) cancers using hierarchical models. National Cancer Data Base cases spanning 2010 to 2013 were included if they met measure eligibility. Reliability estimates for hospital and surgeon performance across cumulative years of data (2013, 2012 to 2013, 2011 to 2013, and 2010 to 2013) were calculated with and without risk adjustment. Surgeon caseload minimums were projected to achieve reliabilities of 0.40 and 0.70. Reliability estimates tended to increase with longer periods of data collection but at different rates, depending on measure, level of aggregation, and performance outlier status. Profiling hospitals using 12RLN with 2 years of data yielded a median reliability of 0.72 (interquartile range [IQR] 0.55 to 0.83); however, 4 years of data yielded a median reliability of only 0.31 (IQR 0.14 to 0.54) for surgeons. The G15RLN performance was poor overall; 10RLN had high reliability at both hospital (0.74; IQR 0.50 to 0.86) and surgeon (0.61; IQR 0.34 to 0.80) levels using 1 year of data, but the literature questions this measure's validity. Few surgeons could achieve appropriate levels of reliability regardless of increased data collection duration. Profiling hospitals based on measures such as these can achieve acceptable reliability in reasonable timeframes, but does not always. Either lower levels of reliability should be accepted to profile surgeons with these measures or longer timeframes should be used.

Treatment modalities in sinonasal undifferentiated carcinoma: an analysis from the national cancer database.

Sinonasal undifferentiated carcinoma (SNUC) is a rare, aggressive malignancy of unknown etiology with a poor overall prognosis. Its relative rarity has made it difficult to determine the impact of different treatment modalities on survival. Retrospective study of cases in the National Cancer Data Base (NCDB). NCDB cases that were diagnosed as having SNUC between January 1, 2004, and December 31, 2013 were included in the analysis. Outcomes of patients treated with surgery followed adjuvant chemoradiotherapy were compared with definitive chemoradiotherapy. A 5-year survival rate of 42.2% was observed in the 460 patients in the analysis. American Joint Committee on Cancer (AJCC) clinical staging data were available for 304 patients. Of these patients, 60.2% had advanced tumors (AJCC stage 3 or 4). Surgery followed by adjuvant chemoradiotherapy was associated with better survival than definitive chemoradiotherapy (55.8% vs 42.6%, p = 0.007) in the study population. However, in late-stage tumors, there was no difference in survival between the 2 treatment groups (p = 0.22). For late-stage tumors, the time to initiation of adjuvant therapy was 49.2 ± 5.1 days for the surgery plus adjuvant therapy group as compared with 25.9 ± 2.6 days in the definitive chemoradiotherapy group (p < 0.0001), yet this did not appear to affect outcomes. No differences in age, gender, race, Charlson-Deyo score, facility type (academic vs nonacademic), or radiation dose were found between the 2 treatment groups (p > 0.05). Margin status played a critical role in the success of surgical resection, as no patients with positive margin status receiving adjuvant therapy survived to 5 years. Surgery may play a role in a multimodality approach to treatment of late-stage SNUC if the tumor is amenable to surgical resection and negative margins can be reliably obtained. However, in cases where there may be difficulty obtaining negative margins, or this is considered unlikely preoperatively, surgical resection does not appear to provide any additional survival benefit.

Racial Differences in Reasons for Failure to Receive Ovarian Cancer Treatment: An Analysis of National Cancer Database Cases (1998-2012)

Racial Differences in Reasons for Failure to Receive Ovarian Cancer Treatment: An Analysis of National Cancer Database Cases (1998-2012)

A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see commetns

The National Cancer Data Base (NCDB) represents a national electronic registry system now capturing nearly 60% of incident cancers in the U. S. In combination with other Commission on Cancer programs, the NCDB offers a working example of voluntary, accurate, cost-effective "outcomes management" on a both a local and national scale. In addition, it is of particular value in capturing clinical information concerning rare cancers, such as those of the thyroid. For the accession years 1985-1995, NCDB captured demographic, patterns-of-care, stage, treatment, and outcome information for a convenience sample of 53,856 thyroid carcinoma cases (1% of total NCDB cases). This article focuses on overall 10-year relative survival and American Joint Committee on Cancer (AJCC) (3rd/4th edition) stage-stratified 5-year relative survival for each histologic type of thyroid carcinoma. Care patterns also are discussed. The 10-year overall relative survival rates for U. S. patients with papillary, follicular, Hürthle cell, medullary, and undifferentiated/anaplastic carcinoma was 93%, 85%, 76%, 75%, and 14%, respectively. For papillary and follicular neoplasms, current AJCC staging failed to discriminate between patients with Stage I and II disease at 5 years. Total thyroidectomy +/- lymph node sampling/dissection represented the dominant method of surgical treatment rendered to patients with papillary and follicular neoplasms. Approximately 38% of such patients receive adjuvant iodine-131 ablation/therapy. At 5 years, variation in surgical treatment (i.e., lobectomy vs. more extensive surgery) failed to translate into compelling differences in survival for any subgroup with papillary or follicular carcinoma, but longer follow-up is required to evaluate this. NCDB data appeared to validate the AMES prognostic system, as applied to papillary cases. Younger age appeared to influence prognosis favorably for all thyroid neoplasms, including medullary and undifferentiated/anaplastic carcinoma. NCDB data also revealed that unusual patients diagnosed with undifferentiated/anaplastic carcinoma before age of 45 years have better survival. The NCDB system permits analysis of care patterns and survival for large numbers of contemporaneous U. S. patients with relatively rare neoplasms, such as thyroid carcinoma. In this context, it represents an unsurpassed clinical tool for analyzing care, evaluating prognostic models, generating new hypotheses, and overcoming the volume-related drawbacks inherent in the study of such neoplasms. [See editorial on pages 2434-6, this issue.]

The National Cancer Data Base report on gastric carcinoma.

The National Cancer Data Base (NCDB) represents a national electronic registry system now encompassing almost 60% of incident cancers in the United States. In combination with other programs of the American College of Surgeons Commission on Cancer, the NCDB offers a working example of voluntary, accurate, and cost-effective "outcomes management" on a both a local and a national scale. For the accession years 1985-1993, the NCDB has obtained information on demographics, patterns of care, disease stage, treatment, and outcome for a convenience sample of 57,407 gastric carcinoma cases (1.6% of total NCDB cases). In addition to describing trends, this report focuses on 5-year relative survival for a cohort of 1987-1988 cases staged according to the third edition of the American Joint Committee on Cancer's TNM classification, as well as patterns of care for a cohort of 1992-1993 cases. Stage-stratified 5-year relative survival for the 1987-1988 cohort was as follows: IA, 71%; IB, 56%; II, 37%; IIIA, 18%; IIIB, 11%; IV, 5%. Without noteworthy changes in stage distribution, demographics, or other factors, the proportion of patients treated by total gastrectomy is increasing slightly, but proximal gastrectomy for proximal cancers remains surprisingly popular. The proportion of cases receiving postoperative adjuvant treatment has declined slightly. Presumably because of advanced age and/or medical infirmity, a substantial proportion of U.S. patients with disease at every stage receive no treatment for cancer. This analysis of patterns of care has revealed unexplained variations in treatment and opportunities for improvement. Treatment of the elderly, infirm patient with gastric carcinoma appears problematic.