Patients In National Cancer Database Research Articles

Utilization of KRAS mutation status testing in stage IV colorectal cancer (CRC) patients in the United States: National Cancer Data Base (NCDB) analysis.

e15172 Background: KRAS mutation status is considered a predictive biomarker of personalized treatment in advanced stage CRC. Its testing is recommended by the National Comprehensive Cancer Network guidelines for stage IV CRC, since it determines the benefit of addition of anti-epidermal growth factor receptor therapy in wild-type KRAS CRC. Data on utilization of the test in the clinical practice across the US are lacking. Methods: Utilization of KRAS testing across the US is presented in a retrospective observational study of NCDB patients (pts) from 2010-2014. Demographics of stage IV CRC pts with recorded KRAS results were analyzed using frequency statistics and logistic regression analysis. Results: 479399 pts had CRC, 93514 (19.5%) were stage IV. 57208/93514 pts with known KRAS testing status entered our study. Mean age was 63.3 years; 51.2% were males. Only 33% (18867/57208) of stage IV CRC pts underwent KRAS testing. Testing was significantly ( p<.001) influenced by pts age and socioeconomic status but not by race or facility type in which pts were treated (Table 1 - see adjusted odds ratio [AOR] and 95% CI). Conclusions: KRAS testing of stage IV CRC pts is underutilized in the US. Impact of its underutilization on outcomes of these pts requires further study. [Table: see text]

Preoperative Prediction of Node-Negative Disease After Neoadjuvant Chemotherapy in Patients Presenting with Node-Negative or Node-Positive Breast Cancer.

Axillary node status after neoadjuvant chemotherapy (NAC) influences the axillary surgical staging procedure as well as recommendations regarding reconstruction and radiation. Our aim was to construct a clinical preoperative prediction model to identify the likelihood of patients being node negative after NAC. Using the National Cancer Database (NCDB) from January 2010 to December 2012, we identified cT1-T4c, N0-N3 breast cancer patients treated with NAC. The effects of patient and tumor factors on pathologic node status were assessed by multivariable logistic regression separately for clinically node negative (cN0) and clinically node positive (cN+) disease, and two models were constructed. Model performance was validated in a cohort of NAC patients treated at our institution (January 2013-July 2016), andmodel discrimination was assessed by estimating the area under the curve (AUC). Of 16,153 NCDB patients, 6659 (41%) were cN0 and 9494 (59%) were cN+. Factors associated with pathologic nodal status and included in the models were patient age, tumor grade, biologic subtype, histology, clinical tumor category, and, in cN+ patients only, clinical nodal category. The validation dataset included 194 cN0 and 180 cN+ patients. The cN0 model demonstrated good discrimination, with an AUC of 0.73 (95% confidence interval [CI] 0.72-0.74) in the NCDB and 0.77 (95% CI 0.68-0.85) in the external validation, while the cN+ patient model AUC was 0.71 (95% CI 0.70-0.72) in the NCDB and 0.74 (95% CI 0.67-0.82) in the external validation. We constructed two models that showed good discrimination for predicting ypN0 status following NAC in cN0 and cN+ patients. These clinically useful models can guide surgical planning after NAC.

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 ...

Clinical impact of prolonged diagnosis to treatment interval (DTI) among patients with oropharyngeal squamous cell carcinoma

We examined practice patterns using the National Cancer Data Base (NCDB) to determine risk factors for prolonged diagnosis to treatment interval (DTI) and survival outcomes in patients receiving chemoradiation for oropharyngeal squamous cell carcinoma (OPSCC). We identified 6606 NCDB patients with Stage III-IV OPSCC receiving chemoradiation from 2003 to 2006. We determined risk factors for prolonged DTI (>30days) using univariate and multivariable logistic regression models. We examined overall survival (OS) using Kaplan Meier and multivariable Cox proportional hazards models. 3586 (54.3%) patients had prolonged DTI. Race, IMRT, insurance status, and high volume facilities were significant risk factors for prolonged DTI. Patients with prolonged DTI had inferior OS compared to DTI⩽30days (Hazard Ratio (HR)=1.12, 95% CI 1.04-1.20, p=0.005). For every week increase in DTI there was a 2.2% (95% CI 1.1-3.3%, p<0.001) increase in risk of death. Patients receiving IMRT, treatment at academic, or high-volume facilities were more likely to experience prolonged DTI (High vs. Low volume: 61.5% vs. 51.8%, adjusted OR 1.38, 95% CI 1.21-1.58; Academic vs. Community: 59.5% vs. 50.6%, adjusted OR 1.26, 95% CI 1.13-1.42; non-IMRT vs. IMRT: 53.4% vs. 56.5%; adjusted OR 1.17, 95% CI 1.04-1.31). Our results suggest that prolonged DTI has a significant impact on survival outcomes. We observed disparities in DTI by socioeconomic factors. However, facility level factors such as academic affiliation, high volume, and IMRT also increased risk of DTI. These findings should be considered in developing efficient pathways to mitigate adverse effects of prolonged DTI.

Lymph node yield and survival in gastric carcinoma.

4012 Background: Although the extent of lymph node (LN) dissection in gastric cancer remains controversial, it is recommended that at least15 LN be examined for accurate staging. Existing data suggest that many gastrectomies performed in the US do not achieve this benchmark. This study examines trends in LN yield over time in patients undergoing curative surgery for gastric cancer and the relationship between LN yield and survival. Methods: Under IRB waiver, all National Cancer Database patients who underwent total, distal or proximal gastrectomy for gastric cancer from 1998-2011 were examined. Patients with metastatic disease or for whom treatment was indicated to be palliative were excluded from this study. Wilcoxan rank-sum test was used to compare LN yield. Cox proportional hazards models were used to compare overall survival. Results: 73,674 patients met inclusion criteria. 7,938 (10.8%) had neoadjuvant therapy. Patients who received neoadjuvant therapy had higher median LN yield than patients who di...

Comparison of Cases Captured in the National Cancer Data Base with Those in Population-based Central Cancer Registries

The National Cancer Data Base (NCDB) is a large, geographically diverse hospital-based cancer registry that has been used to study factors related to cancer diagnosis, treatment, and survival. The primary purpose of this study was to compare the case counts and characteristics of patients in NCDB with population-based registries reported in the United States Cancer Statistics (USCS). Cancer case counts from NCDB were compared to case counts from USCS to measure NCDB's case coverage, or the percentage of cases captured. Case coverage was examined by a variety of characteristics, including state of residence, race/ethnicity, age, and primary cancer site. The overall NCDB case coverage was 67.4%, ranging from a high of 88.7% for Delaware to a low of 27.1% for Arizona. Case coverage for white, black, and Asian/Pacific Islander cases was high (64.7% to 67.4%), but it was much lower for American Indians/Alaskan Natives (32.8%) and those of Hispanic ethnicity (51.1%). Among the elderly (aged 65+years), case coverage is much lower compared to persons younger than 65 (63.0% and 73.0%, respectively). Case coverage also varied widely by site, with the highest being cervix (77.9%) and the lowest being melanoma (50.6%). This study highlights the geographic- and site-specific variation in NCDB case coverage, primarily as a result of NCDB facility presence and data collection and processing protocols. These findings illustrate the strengths and limitations of NCDB as a resource for nationwide data on cancer diagnosis, treatment, and survival.