National Cancer Database Databases Research Articles

Comparison of Capture Rates of the National Cancer Database Across Race and Ethnicity

The National Cancer Database (NCDB) is an invaluable and widely used resource for cancer research, but the current state of representation of different racial and ethnic groups compared with the United States Cancer Statistics (USCS) database is unknown. To examine whether Hispanic and American Indian or Alaska Native individuals have lower representation in the NCDB compared with the USCS database. This multicenter, retrospective cohort study assessed individuals diagnosed with breast, colorectal, lung, and prostate cancer from January 1, 2004, to December 31, 2006, and January 1, 2017, to December 31, 2019, in the NCDB and USCS databases. Data analysis was performed from September 2022 to October 2023. Time. The primary outcome was the absolute percentage change (APC) in capture rate across the study period. The cohort included 5 175 007 individuals (0.50% American Indian or Alaska Native, 3.10% Asian or Pacific Islander, 12.01% Black, 6.58% Hispanic, and 77.81% White) who were diagnosed with breast, colorectal, lung, and prostate cancer. Capture rates were the lowest for individuals who were Hispanic (40.83% in 2004-2006 and 54.75% in 2017-2019; P < .001) or American Indian or Alaska Native (20.72% in 2004-2006 and 41.41% in 2017-2019; P < .001). The APCs were positive for both racial categories across all 4 cancers. However, overall APCs for Hispanic individuals (13.92%) remained lower than the overall APCs of White individuals (22.23%; P < .001). The APCs were greater for American Indian or Alaska Native individuals than for White individuals for prostate (14.68% vs 11.57%) and breast (21.61% vs 17.90%) cancer (P < .001), but the APCs for American Indian or Alaska Native individuals were lower than for White individuals for lung cancer (24.54% vs 33.03%; P < .001). In this cohort study of individuals diagnosed with cancer in the NCDB, Hispanic and American Indian or Alaska Native individuals diagnosed with breast, colorectal, lung, and prostate cancer were undercaptured in the NCDB, but their representation improved over time. Increased study is needed to determine where these populations predominantly seek cancer care.

Risk Stratification for Management of Solitary Fibrous Tumor/Hemangiopericytoma of the Central Nervous System.

Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) of the central nervous system (CNS) is a rare meningeal tumor. Given the absence of prospective or randomized data, there are no standard indications for radiotherapy. Recently, the NRG Oncology and EORTC cooperative groups successfully accrued and completed the first prospective trials evaluating risk-adapted adjuvant radiotherapy strategies for meningiomas. Using a similar framework, we sought to develop prognostic risk categories that may predict the survival benefit associated with radiotherapy, using two large national datasets. We queried the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) databases for all newly diagnosed cases of SFT/HPC within the CNS. Risk categories were created, as follows: low risk-grade 1, with any extent of resection (EOR) and grade 2, with gross-total resection; intermediate risk-grade 2, with biopsy/subtotal resection; high risk-grade 3 with any EOR. The Kaplan-Meier method and Cox proportional hazards regressions were used to determine the association of risk categories with overall and cause-specific survival. We then determined the association of radiotherapy with overall survival in the NCDB, stratified by risk group. We identified 866 and 683 patients from the NCDB and SEER databases who were evaluated, respectively. In the NCDB, the 75% survival times for low- (n = 312), intermediate- (n = 239), and high-risk (n = 315) patients were not reached, 86 months (HR 1.60 (95% CI 1.01-2.55)), and 55 months (HR 2.56 (95% CI 1.68-3.89)), respectively. Our risk categories were validated for overall and cause-specific survival in the SEER dataset. Radiotherapy was associated with improved survival in the high- (HR 0.46 (0.29-0.74)) and intermediate-risk groups (HR 0.52 (0.27-0.99)) but not in the low-risk group (HR 1.26 (0.60-2.65)). The association of radiotherapy with overall survival remained significant in the multivariable analysis for the high-risk group (HR 0.55 (0.34-0.89)) but not for the intermediate-risk group (HR 0.74 (0.38-1.47)). Similar results were observed in a time-dependent landmark sensitivity analysis. Risk stratification based on grade and EOR is prognostic of overall and cause-specific survival for SFT/HPCs of the CNS and performs better than any individual clinical factor. These risk categories appear to predict the survival benefit from radiotherapy, which is limited to the high-risk group and, potentially, the intermediate-risk group. These data may serve as the basis for a prospective study evaluating the management of meningeal SFT/HPCs.

Racial disparities in recommendations for surgical resection of primary brain tumours: a registry-based cohort analysis

Disparities in treatment and outcomes disproportionately affect minority ethnic and racial populations in many surgical fields. Although substantial research in racial disparities has focused on outcomes, little is known about how surgeon recommendations can be influenced by patient race. The aim of this study was to investigate racial and socioeconomic disparities in the surgical management of primary brain tumors. In this registry-based cohort study, we used data from the Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) and the American College of Surgeons National Cancer Database (NCDB) in the USA for independent analysis. Adults (aged ≥20 years) with a new diagnosis of meningioma, glioblastoma, pituitary adenoma, vestibular schwannoma, astrocytoma, and oligodendroglioma, with information on tumour size and surgical recommendation were included in the analysis. The primary outcome of this study was the odds of a surgeon recommending against surgical resection at diagnosis of primary brain neoplasms. This outcome was determined using multivariable logistic regression with clinical, demographic, and socioeconomic factors. This study included US national data from the SEER (1975-2016) and NCDB (2004-17) databases of adults with a new diagnosis of meningioma (SEER n=63 674; NCDB n=222 673), glioblastoma (n=35 258; n=104 047), pituitary adenoma (n=27 506; n=87 772), vestibular schwannoma (n=11 525; n=30 745), astrocytoma (n=5402; n=10 631), and oligodendroglioma (n=3977; n=9187). Independent of clinical and demographic factors, including insurance status and rural-urban continuum code, Black patients had significantly higher odds of recommendation against surgical resection of meningioma (adjusted odds ratio 1·13, 95% CI 1·06-1·21, p<0·0001), glioblastoma (1·14, 1·01-1·28, p=0·038), pituitary adenoma (1·13, 1·05-1·22, p<0·0001), and vestibular schwannoma (1·48, 1·19-1·84, p<0·0001) when compared with White patients in the SEER dataset. Additionally, patients of unknown race had significantly higher odds of recommendation against surgical resection for pituitary adenoma (1·80, 1·41-2·30, p<0·0001) and vestibular schwannoma (1·49, 1·10-2·04, p=0·011). Performing a validation analysis using the NCDB dataset confirmed these significant results for Black patients with meningioma (1·18, 1·14-1·22, p<0·0001), glioblastoma (1·19, 1·12-1·28, p<0·0001), pituitary adenoma (1·21, 1·16-1·25, p<0·0001), and vestibular schwannoma (1·19, 1·04-1·35, p=0·0085), and indicated and indicated that the findings are independent of patient comorbidities. When further restricted to the most recent decade in SEER, these inequities held true for Black patients, except those with glioblastoma (meningioma [1·18, 1·08-1·28, p<0·0001], pituitary adenoma [1·20, 1·09-1·31, p<0·0001], and vestibular schwannoma [1·54, 1·16-2·04, p=0·0031]). Racial disparities in surgery recommendations in the USA exist for patients with primary brain tumours, independent of potential confounders including clinical, demographic, and select socioeconomic factors. Further studies are needed to understand drivers of this bias and enhance equality in surgical care. None.

Sentinel Lymph Node Biopsy Alone is Adequate for Chemotherapy Decisions in Postmenopausal Early-Stage Hormone-Receptor-Positive, HER2-Negative Breast Cancer with One to Three Positive Sentinel Lymph Nodes.

The RxPONDER trial randomized patients with cT1-3N0 hormone receptor-positive, HER2-negative (HR+HER2-) breast cancer and one to three positive nodes and Recurrence Score (RS) < 26 to endocrine therapy (ET) or chemoendocrine therapy (CET) with equivalent survival in postmenopausal women. In current practice, cN0 patients with one or two positive sentinel lymph nodes (SLN) do not undergo axillary lymph node dissection (ALND), raising concerns about applying these data in patients who may have additional nodal disease. We identified institutional [Dana-Farber Brigham Cancer Center (DF/BCC), 2016-2020] and national [National Cancer Database (NCDB), 2012-2017] cohorts of women aged 50-75 years with cT1-3N0 HR+HER2- breast cancer and RS < 26 treated with upfront surgery with one to three positive SLN. Axillary nodal burden and outcomes were assessed on the basis of the number of positive nodes and CET use. A total of 197 and 13,499 HR+HER2- eligible patients with one to three positive SLN and RS < 26 were identified in the DF/BCC and NCDB databases, respectively, and 12.7% of DF/BCC and 32.4% of NCDB patients had ALND. Of these, only 12.0 and 4.9% had more than three total positive nodes, respectively. Rates of CET were 6.6% in DF/BCC and 20.9% in NCDB patients. In the NCDB, similar adjusted 4-year overall survival was seen between patients treated with CET or ET for any number of positive nodes (98.1-99.9%, all p > 0.05). Postmenopausal women with cT1-3N0 HR+HER2- breast cancer and RS < 26 with one to three positive SLN are unlikely to have more than three total positive nodes. CET decisions should continue to be based on SLN biopsy as ALND is unlikely to change treatment recommendations or outcomes.

Is the Number of National Database Research Studies in Musculoskeletal Sarcoma Increasing, and Are These Studies Reliable?

Is the Number of National Database Research Studies in Musculoskeletal Sarcoma Increasing, and Are These Studies Reliable?

Does the addition of radiation improve survival compared to chemotherapy alone in women with stage IV endometrial carcinoma? Analysis of the NCDB and SEER databases

ObjectiveTo evaluate whether the addition of radiation to adjuvant chemotherapy is associated with improved survival in women with stage IV endometrial cancer following surgery. MethodsThe National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results Program (SEER) registries were queried for patients with stage IV endometrial cancer from 2004 to 2017. Treatment was categorized as chemotherapy alone, chemotherapy with external beam radiation therapy (EBRT), chemotherapy with vaginal brachytherapy (VBT), or chemotherapy with EBRT+VBT. Multivariable Cox regression models assessed associations between treatment modality and overall survival (OS). ResultsThis analysis included 17,890 (NCDB: 12,812, SEER: 5078) women with stage IV endometrial cancer, including 1757 (9.8%) with IVA disease and 16,133 (90.2%) with IVB. The majority of stage IV patients received chemotherapy alone (NCDB 78.8%, SEER 77.0%). When radiation was utilized in addition to chemotherapy, EBRT was most common (NCDB 15.8%, SEER: 15.4%). In both databases, use of any radiation in addition to chemotherapy was associated with improved OS. Stage IV patients treated with chemotherapy plus EBRT had better survival than those receiving chemotherapy alone [NCDB: HR 0.75 (95% CI 0.70, 0.79), SEER: HR 0.85 (95% CI 0.77, 0.94)]. This benefit was more pronounced in patients with IVA disease [NCDB: HR 0.66 (95% CI 0.55, 0.79), SEER: HR 0.63 (95% CI 0.46, 0.85)]. In histology-stratified analyses, the addition of radiation to chemotherapy was associated with improved OS in all histologies, except clear cell. ConclusionsIn this analysis of the NCDB and SEER registries, the use of multimodality treatment with radiation and chemotherapy was associated with improved OS compared to chemotherapy alone in women with stage IVA and IVB endometrial cancer.

Rectal cancer in young patients: incidence and outcome disparities.

There is an alarming rise in incidence among young patients with rectal cancer. The National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results Analysis (SEER) databases may help identify population level disparities in incidence and cancer-related outcomes. A total of 197,178 patients within the SEER 18 registry and 221,886 patients from the NCDB database with rectal cancer were evaluated in this retrospective cohort study. The analyzed cohort consisted of young (<50), white or African American patients. Indication bias was mitigated by conducting inverse probability of treatment weighted analysis using binary logistic regression modeling to determine propensity score for being white or African American. A total of 6,144 young patients were identified from the SEER 18 registry and a total of 17,819 young patients were identified from the NCDB. From 1990 to 2016, there was a significant change in rectal cancer incidence, with a steadily increasing APC of 3.06 (P<0.05). The was no overall change in age-adjusted APC among young African American patients (APC 0.00, P=1); however, there was a significant increase among young white patients (APC 2.97, P<0.05). There was an increased incidence for both stage III and IV among young rectal cancer patients, with an age-adjusted APC of 5.35 and 3.83, respectively (P<0.05). After propensity score matching and inverse probability of treatment weighting, young African Americans had worse overall survival in both the NCDB and SEER (HR 1.1-1.3, P<0.05) databases. This disparity was also seen for cancer-specific survival (HR 1.5, P=0.002). The current study adds to the growing body of literature demonstrating an alarming increase in incidence of rectal cancer among young patients. Moreover, the incidence appears to be increasing particularly among young white patients and driven by stage III disease.

Connect MM Registry as a national reference for United States multiple myeloma patients.

BackgroundThe Surveillance, Epidemiology, and End Results (SEER) database and National Cancer Database (NCDB) show improved overall survival (OS) in patients with multiple myeloma (MM) over the last 15 years. This analysis evaluated the validity of the largely community‐based Connect MM Registry as a national reference for MM.MethodsBaseline disease characteristics and survival in US newly diagnosed MM patients were examined using the Connect MM Registry as well as SEER and NCDB databases. Baseline characteristics predictive of longer survival in Connect MM were also identified.ResultsAs of February 2017, 3011 patients were enrolled in the Connect MM Registry; 2912 were treated. Median age at time of MM diagnosis and age range were numerically similar from 2010 to 2015 across all 3 registries; SEER had a higher representation of nonwhite racial groups than that in the other 2 registries. OS rates suggest proportionate improvement with year of diagnosis among the 3 registries. A Cox proportional hazards model suggests that younger age (<65 years) is associated with longer survival (vs ≥75; HR, 0.39; 95% confidence interval, 0.34‐0.46) in the Connect MM Registry. However, sex (HR, 0.91; P = .15) and race (black vs white; HR, 0.88; P = .21) were not associated with longer OS.ConclusionsData from the Connect MM Registry appear to be largely representative of national trends, comprehensive, and reliable representations of the national MM population. Baseline characteristics were comparable, and survival similarly improved over time among the 3 registries.ClinicalTrials.gov, identifierNCT01081028.

Primary Central Nervous System Tumors: Comparing Two National Cancer Registries

The National Cancer Database (NCDB) and the SEER (Surveillance Epidemiology and End Results) program are the 2 largest cancer registries in the United States. However, considerable differences exist between them regarding the sampling frame as well as the participating facility characteristics. In this study, NCDB and SEER are compared for primary central nervous system (CNS) tumors with the aims of discussing the implications for researchers and evaluating the generalizability of both databases. Patients with primary CNS (brain and spinal cord) tumors from 2004 to 2013 were identified using the International Classification of Diseases for Oncology, Third Edition topographic codes. Patient demographics, tumor characteristics, and treatment-related variables were compared between the 2 databases using standardized differences, with values >0.1 denoting statistical significance. A total of 588,534 primary brain tumor (NCDB, 416,162; SEER, 172,372) and 34,827 primary spinal cord tumor (NCDB, 26,602; SEER, 8225) cases were identified. We found significant differences regarding age (sd. diff., 0.16 for brain; 0.13 for spinal cord), and Hispanic origin (sd. diff., 0.34 for brain; 0.61 for spinal cord). For NCDB and SEER patients, estimated 5-year overall survival was 59% and 64%, respectively. Analysis of 623,361 patients with primary CNS tumors, which are identified using both the NCDB and SEER databases, showed significant differences in age, histopathologic classification of tumors, tumor behavior, and treatment of tumors between 2 databases. Overall, the differences observed between 2 databases provide helpful points for the researchers who would like to use NCDB or SEER. These observations should be taken into account when researchers design studies using these databases and discuss the generalizability of their findings.

The Era of the Large Databases: Outcomes After Gastroesophageal Surgery According to NSQIP, NIS, and NCDB Databases. Systematic Literature Review.

The term big data refers to databases that include large amounts of information used in various areas of knowledge. Currently, there are large databases that allow the evaluation of postoperative evolution, such as the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), and the National Cancer Database (NCDB). The aim of this review was to evaluate the clinical impact of information obtained from these registries regarding gastroesophageal surgery. A systematic review using the Meta-analysis of Observational Studies in Epidemiology guidelines was performed. The research was carried out using the PubMed database identifying 251 articles. All outcomes related to gastroesophageal surgery were analyzed. A total of 34 articles published between January 2007 and July 2017 were included, for a total of 345 697 patients. Studies were analyzed and divided according to the type of surgery and main theme in (1) esophageal surgery and (2) gastric surgery. The information provided by these databases is an effective way to obtain levels of evidence not obtainable by conventional methods. Furthermore, this information is useful for the external validation of previous studies, to establish benchmarks that allow comparisons between centers and have a positive impact on the quality of care.

A National-Level Validation of the New American Joint Committee on Cancer 8th Edition Subclassification of Stage IIA and B Anal Squamous Cell Cancer.

The 8th edition of the American Joint Committee on Cancer (AJCC) updated the staging system of anal squamous cell cancer (ASCC) by subdividing stage II into A (T2N0M0) and B (T3N0M0) based on a secondary analysis of the RTOG 98-11 trial. We aimed to validate this new subclassification utilizing two nationally representative databases. The National Cancer Database (NCDB) [2004-2014] and the Surveillance, Epidemiology, and End Results (SEER) database [1988-2013] were queried to identify patients with stage II ASCC. A total of 6651 and 2579 stage IIA (2-5cm) and 1777 and 641 stage IIB (> 5cm) patients were identified in the NCDB and SEER databases, respectively. Compared with stage IIB patients, stage IIA patients within the NCDB were more often females with fewer comorbidities. No significant differences were observed between age, race, receipt of chemotherapy and radiation, and mean radiation dose. Demographic, clinical, and pathologic characteristics were comparable between patients in both datasets. The 5-year OS was 72% and 69% for stage IIA versus 57% and 50% for stage IIB in the NCDB and SEER databases, respectively (p < 0.001). After adjustment for available demographic and clinical confounders, stage IIB was significantly associated with worse survival in both cohorts (hazard ratio 1.58 and 2.01, both p < 0.001). This study validates the new AJCC subclassification of stage II anal cancer into A and B based on size (2-5cm vs. > 5cm) in the general ASCC population. AJCC stage IIB patients represent a higher risk category that should be targeted with more aggressive/novel therapies.

Revision of nationwide practice patterns in the management of T2 gallbladder carcinoma

Background: National guidelines recommend en-bloc hepatectomy and lymphadenectomy for stage IB and higher gallbladder cancer (GBC). Compliance with these guidelines has been poor. We sought to assess potential changes in the practice patterns in the surgical management of T2 GBC over the last 3 decades. Methods: A contemporary series from National Cancer Database (NCDB) was queried for patients with T2 disease who underwent resection for GBC from 2004 to 2014 (Period 2). This data was compared with an older large series from SEER (Surveillance Epidemiology End-results) database including T2 GBC patients between 1991 and 2005 (Period 1). Kaplan–Meier log-rank analyses assessed the impact of the definitive surgical approach on survival rates. Results: NCDB and SEER databases identified 11,532 and 2,955 patients, respectively. Among them, 618 (5.3%) and 781 (26.4%) T2 GBC were included in this analysis, respectively. Patients undergoing hepatectomy had improved survival in both periods compared to those who did not undergo hepatectomy (51.7 vs. 25.3 months, p < 0.001 and 53.0 vs. 16.0 months, p < 0.001, respectively). Hepatectomy rates increased by 36% from period 1 to period 2 (13.4% vs. 37.2%, p < 0.001). Portal lymphadenectomy increased by 66.4% between period 1 and period 2 (33.3% vs. 50.1%, p < 0.001). Conclusion: Although there was a significant improvement in the compliance with national guidelines over last 3 decades, major disparities yet exist in the current surgical management of GBC. Only one third of patients with T2 GBC currently undergo appropriate hepatectomy and half of them undergo portal lymphadenectomy. Further studies assessing the impact of noncompliance on outcomes of patients with GBC are warranted. Efforts should be directed towards standardization of nationwide practice patterns in GBC.

Blastic Plasmacytoid Dendritic Cell Neoplasm. a Population-Based Analysis from the SEER and NCDB Databases

IntroductionBlastic plasmacytoid dendritic cell neoplasm (BPDCN) is an extremely rare hematologic malignancy that was grouped with myeloid malignancies in the 2008 WHO classification. The current available literature is limited to small case series and single-institution experiences. This population study using the Surveillance, Epidemiology, and End Results Program (SEER) and the National Cancer Database (NCDB) is the largest to explore epidemiologic and outcome data in BPDCN. SEER collects cancer incidence and survival data from cancer registries covering approximately 26% of the US population. NCDB is a nationwide, facility-based, comprehensive, clinical-surveillance resource for oncology data coming from more than 1500 Commission of Cancer (CoC)-accredited programs.MethodsUsing data from the SEER and NCDB registries, this study respectively identified 379 (years 2000-2013) and 216 (years 2004-2012) adult patients over the age of 20 diagnosed with BPDCN (ICDO-3 coding 9727). We used the SEER registry to estimate incidence rates, ratios and trends and the NCDB registry to study clinical characteristics, survival and outcomes. The JMP statistical software and the SEER*STAT 8.3.2 were used to conduct statistical analysis. We analyzed survival using the Kaplan-Meier method and used log-rank tests to compare survival distributions. The prognostic effect of pertinent clinical variables was studied using multivariate Cox proportional hazards models. All tests of statistical significance were two-sided and P < 0.05 was considered significant.ResultsThe median age at diagnosis for BPDCN was 52 years (20-93). The incidence of BPDCN was found to be 0.45/1,000,000 age-adjusted to the 2000 US standard population with similar trends over the years. No racial disparities were identified. The male:female ratio was 2 (P<0.00001). The bone marrow was the most common primary site of involvement (42%) followed by the skin (20%) and the heart, mediastinum and pleura (13%). The median overall survival for the entire cohort was found to be 23 months (95% CI; 17-34). Survival rates at 1 year, 2 years and 5 years were found to be 66%, 49% and 38% respectively. 20 patients (10%) underwent a hematopoietic stem cell transplantation (HSCT) as part of their initial therapy and the median overall survival for these patients was not reached compared to a median survival of 19 months for patients who did not undergo upfront HSCT (95% CI; 15-30, P=0.006). A univariate and multivariate analysis was performed including age, race, sex, HSCT, insurance status, income, treatment facility (academic versus non-academic) and disease primary site. Young age and HSCT were predictors of better outcomes. 60 years and older was found to be the age cut-off associated with significantly inferior survival based on receiver operating characteristic (ROC) curve analysis.ConclusionBPDCN is a rare hematologic malignancy associated with a poor median survival of less than two years. Males are twice more likely to be affected than females. The bone marrow is the primary site of involvement in most cases. Younger age (<60 years) and HSCT were predictors of significantly better outcomes.Kaplan-Meier survival curve for the entire cohortKaplan-Meier survival curves in patients Age <60 versus > 60Kaplan-Meier survival curves in patients who underwent HSCT versus those who did not [Display omitted] [Display omitted] [Display omitted] DisclosuresAl-Kali:Celgene: Research Funding; Onconova Therapeutics, Inc.: Research Funding.

MP09-07 RISK OF LYMPH NODE METASTASES IN PATHOLOGICAL GLEASON SCORE =6 PROSTATE ADENOCARCINOMA: ANALYSIS OF INSTITUTIONAL AND POPULATION-BASED DATABASES

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2016MP09-07 RISK OF LYMPH NODE METASTASES IN PATHOLOGICAL GLEASON SCORE =6 PROSTATE ADENOCARCINOMA: ANALYSIS OF INSTITUTIONAL AND POPULATION-BASED DATABASES Hannah Wenger, Aria Razmaria, Gladell Paner, Adam Weiner, and Scott Eggener Hannah WengerHannah Wenger More articles by this author , Aria RazmariaAria Razmaria More articles by this author , Gladell PanerGladell Paner More articles by this author , Adam WeinerAdam Weiner More articles by this author , and Scott EggenerScott Eggener More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2294AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the incidence of lymph node metastases (LNM) in pathological Gleason score =6 prostate cancer (PCa) using data generated by the Surveillance, Epidemiology, and End Results (SEER) database, the National Cancer Database (NCDB), and an institutional database at the University of Chicago Medical Center (UCMC). METHODS Using the SEER (2004-2011, n=25,565) and NCDB (2004-2011, n=84,180) databases, we identified patients with pathological Gleason score (pGS) =6 PCa following radical prostatectomy and lymph node dissection. Multivariable logistic regressions were used to analyze factors predicting LNM. At UCMC (2003-2014), men with pGS=6 who did (n=267) and did not receive (n=770) a lymph node dissection were identified. The primary endpoint was LNM at surgery for all cohorts or evidence of metastatic disease on subsequent imaging for the UCMC cohort. Secondary endpoints for the UCMC cohort included biochemical recurrence (BCR) and response to salvage radiation therapy. RESULTS Positive lymph nodes were found in 0.3% of SEER patients and 0.31% of NCDB patients with pGS =6 PCa following radical prostatectomy and lymph node dissection. PSA, pathologic stage, and West and South geographic region were strong predictors of LNM. Among UCMC patients with pGS =6 PCa following radical prostatectomy and lymph node dissection, no LNM were found, and BCR occurred in 3 cases (1%). All 3 patients responded favorably to salvage radiation therapy, suggestive of local recurrence. A total of 21 patients from UCMC who did not receive a lymph node dissection had a BCR and received salvage radiation therapy. Of these, 4 had persistent detectable PSA levels without local or distant evidence of disease at a median of 65 months (range 29-79) following salvage radiation therapy. Of the 3 cases available for contemporary histopathologic review, all 3 were upgraded to pGS 7. CONCLUSIONS LNM from pGS=6 PCa are exceedingly rare (~0.3%) and may be attributable to variability in pathologic grading across institutions. As suggested by both our population-based and institutional analysis, lymph node metastases from Gleason 6 prostate cancer is either extremely rare or non-existent. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e96 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Hannah Wenger More articles by this author Aria Razmaria More articles by this author Gladell Paner More articles by this author Adam Weiner More articles by this author Scott Eggener More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract P5-17-11: Trends in incidence, patient characteristics, and management of lobular carcinoma in situ

Abstract Introduction: Lobular carcinoma in situ (LCIS) is a rare lesion accounting for only 5% of total breast cancer diagnosis; however, the incidence has continued to increase, albeit at a slower rate than was seen in the 1980s and 1990s. Current National Comprehensive Cancer Network (NCCN) guidelines recommend surgical excision of the breast tissue containing LCIS due to risk of concomitant malignancy, but wide variations in treatment exist. Using the Surveillance, Epidemiology, and End Results (SEER) and National Cancer Database (NCDB) participant user files, an extensive survey of women with LCIS breast cancer was completed. Our aim was to identify patient and facility characteristics that are associated with aggressive treatment (mastectomy) or under-treatment (no surgical excision) following LCIS diagnosis. Methods: Women with a diagnosis of LCIS from 1998 to 2011 within the SEER and NCDB databases were identified. Incidence data was gathered from SEER while all other characteristics (patient, facility, and treatment factors) were obtained from the NCDB. A logistic regression model was created to examine factors associated LCIS treatment modalities recorded in the NCDB. Results: The incidence of LCIS increased from 3.85 to 4.46 / 100,000 women between 2000 and 2011. 62,923 female patients with LCIS were identified within the NCDB. The majority of women diagnosed with LCIS were between the ages of 40 and 59 years (66.8%, N=42,044), white (87.4%, N=55,022), and non-Hispanic (86.9%, N=54,679). Following a diagnosis of LCIS, most women underwent surgical excision (71.1%, N=44,731), with an additional 20.7% undergoing mastectomy (N=13,039) or opting for no surgery (8.0%, N=5,023). Logistic regression analysis demonstrated that age over 60 years was associated with no surgical intervention (OR 1.49, p&amp;lt;0.001), while age 40 to 59 were associated with aggressive therapy (OR 1.19, p&amp;lt;0.001). Economic factors associated with no surgical intervention following LCIS diagnosis include: no insurance (OR 1.24, p&amp;lt;0.001), government sponsored insurance (OR 1.48, p&amp;lt;0.001), live in areas with median income less than $63,000 per year (OR 0.744, p&amp;lt;0.001), and live in an area with higher rates of the population lacking high school education (OR 1.19, p&amp;lt;0.001). Patients undergoing aggressive treatment were more likely to be white (OR 1.57, p&amp;lt;0.001) and carry private insurance (OR 1.87, p&amp;lt;0.001). Patients receiving care at an academic center were more likely to receive aggressive treatment (OR 1.22, p&amp;lt;0.001). Living farther from treatment center was associated with increased odds of aggressive therapy, but not under-treatment (p&amp;lt;0.001 vs p=0.906, respectively). Conclusion: Despite being a rare cancer, the incidence of LCIS continues to rise. LCIS is predominantly a cancer diagnosed in white, non-hispanic women. Advanced age, poverty, lack of insurance, low high school graduation rates were factors significantly associated with under-treatment of LCIS. Conversely, white women between 40-59 yo with private insurance and treated at a cancer center were more likely to undergo aggressive treatment. Citation Format: Johnson AT, Guo X, Nygaard RM, Zera RT. Trends in incidence, patient characteristics, and management of lobular carcinoma in situ. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-17-11.

A Population-Based Study of Large Granular Lymphocyte Leukemia: Analysis of 978 Patients Using the SEER and NCDB Databases

Background: Large granular lymphocyte (LGL) leukemia is a lymphoproliferative disorder of mature cytotoxic T- or Natural Killer (NK)-cells. T-cell LGL (T-LGL) leukemia is characterized by accumulation of cytotoxic T-cells in blood and infiltration of the bone marrow, liver, or spleen. T-LGL leukemia may manifest as asymptomatic persistent lymphocytosis or present with a myriad of autoimmune diseases including autoimmune cytopenias. Population-based studies have not been reported in LGL leukemia. Here, we present clinical characteristics, natural history, and risk factors for poor survival in patients with T-LGL leukemia using the Surveillance, Epidemiology, and End Results Program (SEER) and the National Cancer Data Base (NCDB), the two largest national cancer registries in the US. Methods: We queried the SEER and NCDB databases using ICD-O histology code 9831 corresponding to LGL leukemia. The query was further refined to include patients with T-LGL leukemia only. Incidence rates (case/1,000,000) were calculated using 2000-2011 data from SEER and age-adjusted to the US 2000 standard population. Patient level data were obtained from the NCDB and used to describe patient characteristics such as demographics, year of diagnosis, treatment, and survival. Results: The incidence of LGL leukemia was 0.2 cases/1,000,000 individuals. The incidence did not change significantly over the period of time studied. The incidences according to racial groups were (mean, 95%CI): White 0.2 (0.18-0.24), Black 0.14 (0.07-0.24), American Indian/Alaska native 0.24 (0.03-0.8), and Asian/Pacific Islander 0.15 (0.07-0.25). The incidences among Blacks, American Indians/Alaska Natives, or Asian/Pacific Islanders were not significantly different compared to Whites. Patient-level data was available for 978 patients with T-LGL leukemia. The median age at diagnosis was 66.5 years (range, 19-90) with a male to female ratio of 1.05. Females were diagnosed at a younger age compared to males (65 vs. 68 years, p&lt;0.05). Forty-five percent of the patients with T-LGL leukemia required some form of systemic treatment at the time of diagnosis. The vital status of 760 (77.7%) patients was known at the time of last follow up with a median follow up of 32 months (range, 0-152). At the time of last follow up, 75.5% were alive with the median overall survival (OS) of 108.4 months (Figure 1). Multivariate analysis that included age at diagnosis, sex, race, year of diagnosis, and Charlson-Deyo co-morbidity score, showed that older age (&gt;60 years) and higher co-morbidity score (≥2) were independent predictors of poorer survival (Table 1). Conclusions: We present the first population-based study of patients with LGL leukemia, an extremely rare disease. The incidence has remained stable over the last decade and does not vary significantly among races. Most patients with T-LGL leukemia do not require treatment and the overall prognosis is relatively good. Table 1. Multivariable analysis showing predictors of mortality in patients with T-LGL leukemia Parameter Hazard Ratio Lower CI Upper CI P -Value Age &lt;60 vs ≥ 60 years 2.73 1.90 4.04 &lt;.0001 Male vs Female 0.82 0.61 1.09 0.19 White vs Other 0.99 0.97 1.00 0.23 Charlson-Deyo score &lt;2 vs ≥2 2.03 1.29 3.06 0.003 Year of Diagnosis (2001-2006 vs. 2007-2012) 1.11 0.76 1.69 0.58 Figure 1. Overall survival in patients with T-LGL leukemia Figure 1. Overall survival in patients with T-LGL leukemia Disclosures No relevant conflicts of interest to declare.

Comprehensive Databases: A Cautionary Note

Over the last decade, there has been in an increase in the number and availability of registries of cancer patients. Two of the more commonly accessed sources of cancer patient data are the Surveillance Epidemiology and End Results (SEER) and the National Cancer Data Base (NCDB). These two databases differ fundamentally in how patient data are acquired; the NCDB is hospital based, while SEER is population based. Although this difference in method of data acquisition is extremely different, there are commonalities, both positive and negative, when large data sets such as these are queried to ascertain clinical outcomes on cancer patients. The large number of patients available for analysis allows for a broader perspective on treatment patterns and epidemiology. Additionally, it allows the opportunity to study rare cancers and to perform subset analysis of specific groups within a common cancer (i.e., postmastectomy radiotherapy in patients with locally advanced breast cancer; adjuvant chemotherapy in stage II colon cancer). Most recently, these types of data sets are being used to provide cancer-specific outcomes and minimum performance benchmarks, which are being made available for quality assessment and quality improvement. Clearly, the quality of the information obtained from these types of investigations depends on accuracy of the data collected. Questions regarding completeness, accuracy, and selection bias are common to both of these databases. It is important to note that the NCDB is a much larger data set than SEER. With increasing size of the data set, there is a greater potential opportunity for inaccuracies. Data are acquired from 1,500 American College of Surgeons Commission on Cancer (CoC)-approved hospitals, representing approximately 70 % of all newly diagnosed cancer cases in the United States. Another notable difference between the SEER and NCDB databases has been the issue of user access. The SEER database has had public access—that is, since 1975, it has been available to anyone who had the resources and who was willing to submit a signed usage agreement. In contrast, access to the NCDB has been limited. Recently, however, the CoC has undertaken a pilot program allowing access to the NCDB data. This access has been limited to investigators at CoCapproved programs who were selected to participate in an alpha test program to evaluate the potential for a more open access program to the NCDB data set. This pilot program is currently in a beta testing phase and is expected to expand to any CoC-approved program sometime in the next year. As access to large, comprehensive patient databases has increased, so too has the scientific investigation based on this information. There has been a relative explosion of outcomes research based on information obtainable from databases such as SEER and the NCDB. These two frequently used sources of oncologic patient data are maintained by the National Cancer Institute and the Commission on Cancer of the American College of Surgeons, respectively. The comprehensive nature of these databases, along with their large volume of data, almost dictates that they fall under the auspices of a large organization (such as those mentioned), both out of necessity born of the significant resources (financial, personnel, and technical) required, and to permit oversight to maintain standards and accuracy. Additionally, the use of these types of large databases has become so popular that they have spawned a wealth of new societies, degree opportunities, and meeting sections. These have been described by a number of terms including, but not limited to, ‘‘health services research,’’ ‘‘outcomes research,’’ and ‘‘public health research.’’ Along with all of these new meetings, degrees, and societies come new experts in these fields. It appears that as long as there remains access to these type of databases, the number of experts asking questions of these data appears limitless. Unsupervised access to these Society of Surgical Oncology 2013