National Cancer Database Review Research Articles

A comparison of endoscopic endonasal versus open approaches for skull base chordoma: a comprehensive National Cancer Database analysis.

The authors of this study aimed to investigate independent prognostic factors of survival with a particular focus on comparing the safety and efficacy of endoscopic endonasal versus open approaches in the surgical management of skull base chordoma. A retrospective National Cancer Database review of skull base chordoma patients was performed to capture resection cases from 2010 to 2020, evaluating overall survival (OS), early postoperative mortality, readmission rates, and hospital length of stay (LOS) between surgical approaches and the independent prognostication of death utilizing Cox multivariate regression analysis. Among the 736 patients included in the cohort, 456 patients (62.0%) and 280 patients (38.0%) underwent endoscopic endonasal and open resection, respectively. These values represent a rate of change over the study period of +4.1 versus -0.14 cases per year, respectively. Gross-total resection was achieved in 32.5% of cases. A positive margin status was found in 51.8% of cases. There was no association between extent of resection and surgical approach (p = 0.257). There was no difference in OS (p = 0.562), 30- and 90-day mortality (p = 0.209 and 0.126, respectively), and 30-day readmission (p = 0.438) between the two surgical groups. The mean LOS was reduced by 2.1 days in the endoscopic cohort (p = 0.013) compared with the open approach cohort. Finally, multivariate analysis revealed a tumor size ≥ 4 cm (HR 4.03, p = 0.005) and public insurance (HR 2.76, p = 0.004) as negative predictors of survival and treatment at an academic center (HR 0.36, p = 0.043) as a positive prognosticator of survival. The endoscopic endonasal approach has been increasingly utilized over time and touts noninferiority with respect to safety and efficacy with a marked improvement in LOS, which carries substantial implications for both healthcare costs and enhanced patient recovery. Future prospective studies are necessary to further delineate trends and surgical outcomes for skull base chordoma.

Pediatric, Adolescent and Young Adult (AYA) Peritoneal and Pleural Mesothelioma: A National Cancer Database Review

PurposeMalignant peritoneal and pleural mesothelioma are rare in young patients, with a paucity of data regarding clinical characteristics and outcomes. We aimed to describe the clinical characteristics, treatment strategies, and outcomes for pediatric and adolescent/young adult (AYA) patients. MethodsThe National Cancer Database (NCDB) was queried for malignant peritoneal and pleural mesothelioma in pediatric and AYA patients (ages 0–39) from 2004 to 2019. Stratification was performed for pediatric (age 0–21) and young adult (age 22–39) patients. Chi-squared, multivariable cox regression, and Kaplan–Meier analyses were performed. ResultsWe identified 570 total patients, 46 pediatric and 524 young adult, with mesothelioma (363 peritoneal and 207 pleural). There were significant differences in sex distribution as patients with peritoneal mesothelioma were more frequently female (63.1%). Patients with peritoneal mesothelioma were more likely to have radical surgery compared to pleural mesothelioma (56.7% v. 24.6%, respectively). A majority of patients with peritoneal and pleural mesothelioma received chemotherapy (66.4% and 61.4%, respectively). For peritoneal mesothelioma, surgical resection was associated with improved overall survival, whereas male sex, neoadjuvant chemotherapy, and radiation were associated with worse overall survival. For pleural mesothelioma, intraoperative chemotherapy was associated with improved overall survival, whereas Black race was associated with worse overall survival. Mean overall survival was greater for patients with peritoneal mesothelioma (125 months) compared to those with pleural mesothelioma (69 months), which remained significant after stratification of pediatric and young adult patients. ConclusionBy analyzing a large cohort of pediatric and AYA mesothelioma, this study highlights clinical, prognostic, and survival differences between peritoneal and pleural disease. Level of EvidenceLevel III. Type of studyRetrospective

Survey of Palliative Care Use in Primary Malignant Bone Tumors: A National Cancer Database Review.

Background/Objectives: Palliative care (PC) has been associated with reduced patient symptom burden, improved physician satisfaction, and reduced cost of care. However, its use in primary bone tumors has not been well classified. Design/Setting and Subjects: Patients diagnosed with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma, and chordoma) between 2004 and 2018 were identified in the National Cancer Database. Cross tabulations with chi-square analysis were performed to evaluate frequencies of PC use by patient, facility, and tumor characteristics. Multivariate logistic binary regression was performed to evaluate relationships between patient, treatment facility, and tumor characteristics and the use of PC. Results: Around 24,401 patients were identified. Overall, 2.52% had any form of PC utilization. Of those receiving PC, 55.5-65.1% were treated with only noncurative surgery, radiation, chemotherapy, or any combination of these modalities. Odds of PC utilization were decreased for patients with chordomas, patients living >24 miles from the treatment facility, or patients with private insurance, Medicare, or unknown insurance status. Odds of PC utilization were increased in patients with greater tumor diameter or unknown tumor size, tumors in midline, increased tumor grade, stage IV tumors, or living in urban areas. Conclusion: PC use in patients with primary bone tumors increases with tumor stage, tumor grade, tumor size, and if the tumor is midline, and in patients living in urban areas. However, overall utilization remains markedly low. Future studies should be done to investigate these patterns of care and help expand the utilization of PC.

Utilization of Palliative Care in Osteosarcoma: A National Cancer Database Review.

Background: Osteosarcoma is the most common form of bone cancer, but the utilization of palliative care (PC) in patients with this cancer has not previously been investigated in the National Cancer Database (NCDB). Methods: Patients diagnosed with osteosarcoma (2004-2017) were identified within the NCDB. Cross tabulations with Chi-square analysis were performed to evaluate frequencies of palliative care use by patient, facility, and tumor characteristics. Multivariate logistic binary regression was performed to evaluate relationships between patient, treatment facility, and tumor characteristics and the use of palliative care. Results: A total of 7498 patients were analyzed with 2.8% of patients diagnosed having any form of palliative care utilization. Of this group, 53.37% received PC within the first 12 months after diagnosis. Of the 2.8% of patients receiving PC the most common forms of PC utilized were non-curative symptom-directed surgery, radiation, or chemotherapy, or a combination of these modalities (56.7%). Palliative care usage was increased in patients with greater tumor diameter, tumors in the bones of the midline, or stage IV tumors. Palliative care usage was decreased in patients living within 25-49 miles of their treatment facility, those living in pacific states, those with chondroblastic osteosarcoma, or those with private insurance. Conclusion: Palliative care use in patients with osteosarcoma increases with tumor stage, tumor size, or more proximal tumors, but overall utilization remains markedly low. Future studies should further define these patterns of care and help expand the utilization of PC.

Facility type and late-stage Thyroid Hürthle Cell Adenocarcinoma: A NCDB Review.

e18074 Background: Hürthle cell adenocarcinoma, or oxyphilic adenocarcinoma, is a rare and invasive cancer accounting for 3-4% of all thyroid malignancies. Surgical removal is the most common treatment. Survival differences based on treatment facility have been identified in other cancers, but this has not yet been studied in Hürthle cell adenocarcinoma. This study utilizes the National Cancer Database (NCDB) to investigate facility survival differences. Methods: Using the NCDB, 2,900 patients with stage III or IV oxyphilic adenocarcinoma of the thyroid were identified with ICD-O-3 histology code 8290/3 and primary site C739 between years 2004 and 2016. Facility types included community cancer, comprehensive community cancer, academic/research, and integrated network cancer programs. Between-facility type survival differences were estimated by the Kaplan-Meier method and associated log-rank tests. Descriptive statistics of race, sex, stage, facility location, urban/rural 2013, primary payer, median income quartile, and Charlson-Deyo score were used. All analysis was conducted using SPSS statistical software version 27. Results: Survival data was available for 2,017 stage III patients and 644 stage IV patients. In stage III, survival was lower in community programs when compared to academic/research (p = .011) and integrated network programs (p = .017). In stage IV, survival was also lower in community programs when compared to academic/research (p = .007) and integrated network programs (p = .011). No significant difference was seen within other comparisons. In both stages, the highest percentage of patients were white, had a Charlson-Deyo score of 0, and were treated in an urban metro area. Sex and facility location were variable among all stages and facilities. In stage III, private insurance was most common overall and for academic/research programs, but Medicare was the majority for other facility types. In stage IV, Medicare was most common overall and for each facility. The median income quartile was > $63,000 across all facility types for stage III and overall for stage IV, although stage IV treated in community and integrated network programs were most commonly between $48,000-$62,999. Conclusions: Patients with late-stage Hürthle cell adenocarcinoma have worse survival when treated in a community program than other facility types. Most demographics were consistent across stage and facility type, except for sex, primary insurance, median income, and facility location. This data contributes to a developing understanding of differences in cancer survival.[Table: see text]

Survey of palliative care use in primary malignant bone tumors: An NCDB review.

e23514 Background: Palliative care has been associated with reduced patient symptom burden, improved physician satisfaction, and reduced cost of care. However, its use in primary bone tumors has not been well classified. Methods: This study retrospectively evaluated the use of palliative care in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma & chordoma) diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2018. Patients were identified by ICD-O-3 coding and patients with other malignancies were excluded. Cross Tabulations with Chi-square analysis was performed to evaluate frequencies of different patient and tumor characteristics. Multivariable logistic binary logistic regression was performed to evaluate relationships between patient and tumor characteristics and the use of palliative care. Results: 24,401 patients with primary malignant bone tumors were identified. Overall, only 2.52% had any form of palliative care utilization. Of those receiving palliative care, 55.5-65.1% were treated with only non-curative surgery, radiation, chemotherapy, or any combination of these modalities. Odds of palliative care were decreased for patients with chordomas, patients living more than 24 miles from the treatment facility, patients living in west-south-central or pacific states, or patients with private insurance, medicare, or unknown insurance status. Odds of palliative care were increased in patients with greater tumor diameter or unknown tumor size, tumors in the midline, increased tumor grade, stage 4 tumors, or patients living in urban areas. Conclusions: Palliative care use in patients with primary bone tumors increases with tumor stage, tumor grade, tumor size, midline tumors, or in patients living in urban areas, but overall utilization remains markedly low. Future studies should be done to investigate these patterns of care and help expand the utilization of palliative care.

Effects of Socioeconomic and Geographic Factors on Outcomes in Ewing Sarcoma: A National Cancer Database Review.

Purpose: Ewing sarcoma is a primary malignant bone tumor that manifests predominantly in the proximal long bones and pelvis and traditionally presents with nonspecific symptoms. This tumor preferentially affects children and young adults, occurring most often in patients of European descent. The most important established prognostic factor is the presence of metastasis at the time of diagnosis followed by primary site, size of the primary neoplasm, patient age, and lactate dehydrogenase (LDH) levels. To the authors’ knowledge, this is the first study focused on the effects of socioeconomic and geographic factors on overall survival in Ewings sarcoma.Methods: A total of 3,920 patients diagnosed with Ewing sarcoma were identified in the National Cancer Database (NCDB) using the International Classification of Diseases for Oncology, Third Edition (ICD-O-3) code 9260. Of these, 3,238 met the inclusion criteria and were analyzed. Descriptive statistics, Kaplan-Meier survival curves, and Cox regression tables were all performed using IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States).Results: Univariate analysis showed greater mortality for patients of increasing age at the time of diagnosis, at two, five, and 10 years of follow-up, Black race patients at two years, Medicare insurance status at two years, urban or rural residence at two and 10 years, more advanced tumor stage at two and five years, and patients with a comorbidity score of ≥2 at two years. Multivariate analysis showed greater mortality at two years with increasing age, Black race, uninsured status, urban or rural residence, and increasing tumor stage. Mortality also increased for patients at five years of follow-up in patients with increasing age or more advanced tumor stage. Conclusion: Patient mortality in the first two years after diagnosis is increased for patients of the Black race, those living in urban or rural areas, and for patients that are uninsured or using Medicare as their primary payor at the time of diagnosis. To improve patient outcomes, clinicians should recognize and address not only the unique biology of patients but also their unique challenges in access to healthcare. Patients and providers should work to elicit changes on an individual and community level to improve their personal health and the health of those around them.

Should Neoadjuvant Chemotherapy Be Considered as a Standard for Elderly Patients with Resectable Pancreatic Adenocarcinoma: A Review of National Cancer Database

Introduction: For resectable pancreatic ductal adenocarcinoma (PDAC) in elderly patients (>80y), timing of chemotherapy and surgery remains poorly defined. Clinical decision making is more challenging in elderly due to presence of comorbidities in addition to disease, which impacts treatment choice.

Human Papillomavirus-Negative Oropharyngeal Cancer Survival Outcomes Based on Primary Treatment: National Cancer Database Analysis.

To compare survival outcomes between primary surgery and primary radiation therapy (RT) in patients with human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC). A retrospective observational cohort study. National Cancer Database. A National Cancer Database review was conducted of 2635 patients with HPV-negative OPSCC who underwent surgery or RT ± chemotherapy between 2010 and 2014. Univariate analysis was performed on all variables and entered into a multivariate model. The main outcome was overall survival (OS). A total of 2635 patients with HPV-negative OPSCC were organized into 4 groups based on cancer staging. In group 1 (T1-2 N0-1; n = 774), up-front surgery had significantly better 5-year OS (76.2%) than RT (56.8%; adjusted hazard ratio [aHR], 1.76; P = .009; 95% CI, 1.15-2.69) and chemoradiation therapy (CRT; 69.5%; aHR, 1.56; P = .019; 95% CI, 1.08-2.26). In group 2 (T3-4 N0-1; n = 327), no significant difference existed between surgery and CRT (5-year OS, 51.3% vs 52.4%; aHR, 0.96; P = .88; 95% CI, 0.54-1.69). In group 3a (T1-2 N2-3; n = 807), surgery with adjuvant treatment showed significantly better 5-year OS than CRT (78.6% vs 68.8%; aHR, 1.51; P = .027; 95% CI, 1.05-2.18). In group 3b (T3-4 N2-3; n = 737), surgery with adjuvant treatment was not statistically associated with better 5-year OS as compared with CRT (61.0% vs 43.7%; aHR, 1.53; P = .06; 95% CI, 0.98-2.39). Primary surgery may provide improved survival outcomes in many cases of HPV-negative OPSCCs. These data should be used in weighing treatment options and may serve as a basis to better delineate treatment algorithms for HPV-negative disease.

Analysis of Post-operative Adjuvant Chemotherapy Versus Adjuvant Chemoradiation Therapy Outcomes in Non-metastatic Cholangiocarcinoma: an NCDB Review

BackgroundEach year, approximately 8000 cases of cholangiocarcinoma are recorded in the USA. Surgical resection is considered to be the only curative option. Despite surgery as a curative approach, many patients will require adjuvant therapies in the form of chemotherapy (ChT) or chemoradiotherapy (CRT). As such, we sought to analyze outcomes in patients with non-metastatic cholangiocarcinoma receiving adjuvant ChT or CRT following surgical resection.MethodsWe queried the National Cancer Database (NCDB) for patients with a diagnosis of non-metastatic cholangiocarcinoma between the years 2010 and 2015 who underwent adjuvant ChT or CRT following surgery. Overall survival (OS) was calculated using Kaplan Meier method. Cox proportional hazard ratios were used to identify predictors of overall survival, and logistic regression was used to identify predictors of receiving each treatment.ResultsA total of 875 patients were identified who met the above eligibility criteria. Of these patients, 818 received adjuvant chemotherapy alone with 57 patients receiving adjuvant chemoradiation therapy. The median OS in patients receiving CRT was 19.8 months versus 11.9 months for ChT (p value < 0.0238). The 1- and 5-year survival rates between ChT and CRT were 50% vs 61% and 6% vs 13%, respectively (hazard ratio 0.7005; 95% CI 0.51–0.97; p value < 0.0294).ConclusionThe results of this study suggest a potential benefit of chemoradiation therapy in the adjuvant setting, although the trends appear to show rare utilization. Given the limitations of our study, prospective corroboration is warranted.

Disparities in ovarian cancer treatment and overall survival according to race: An update

ObjectiveTo determine whether guideline non-adherence is associated with Black race. MethodsA retrospective review of National Cancer Database records of women diagnosed with epithelial ovarian cancer from 2012 to 2016 who identified as “White” or “Black” was performed. Exposure was adherence or non-adherence to National Comprehensive Cancer Network guidelines for treatment. Outcomes were differences in disease characteristics and overall survival in months. ResultsOf the 29,948 eligible patients, 93% (n = 27,744) were White and 7% (n = 2204) were Black. Having stage IV disease (OR 1.45, 95% CI 1.23–1.70; P < 0.001) and treatment in a comprehensive (OR 1.58, 95% CI 1.16–2.15; P = 0.0039) or academic (OR 2.30, 95% CI 1.70–3.12; P < 0.001) treatment facility were associated with Black race. Adherence to guidelines did not predict Black race (OR for adherence 1.0021, 95% CI 0.89–1.13; P = 0.97). Median survival for White patients with adherent care was 63.4 months and 51.4 months for Black patients (P = 0.0001). Median survival for White patients with non-adherent care was 60.5 months and 47.2 months for Black patients (P < 0.0001). Median overall survival was 61.1 months in White patients and 49.3 months in Black patients (P < 0.0001). ConclusionsOur data suggest that while Black patients and patients who receive non-NCCN guideline directed care have worse survival outcomes, guideline adherence is not independently associated with Black race. We must consider other socioeconomic, environmental and system factors that are contributing to the survival discrepancy in Black patients with ovarian cancer.

Disparities in ovarian cancer treatment and overall survival according to race: An update.

5552 Background: It has long been identified that black women with ovarian cancer have worse overall survival when compared to white women. Disparities in the adherence to NCCN guideline-directed treatment and socioeconomic characteristics may be responsible for the differences in these outcomes. Methods: A retrospective review of National Cancer Database (NCDB) was performed to identify patients diagnosed with ovarian cancer from 2012-2016. We defined adherence to NCCN (National Comprehensive Cancer Network) guidelines as having stage and year-appropriate chemotherapy and surgery. Differences in guideline adherence, socioeconomic characteristics and survival outcomes were assessed. Results: In total, 32,163 were identified meeting the study criteria; 27,744 identified their race as “white” and 2,204 identified their race as “black”. Characteristics associated with higher likelihood of black race were advanced stage of disease- stage III (OR = 1.1869, CI = 1.03-1.37) or stage IV disease (OR = 1.4495, CI = 1.23-1.70) and treatment in a comprehensive (OR = 1.5757, CI = 1.16-2.15) or academic (OR = 2.3023, CI = 1.70-3.12) treatment facility. Variables associated with a lower likelihood of black race were higher education level (OR for high school degree &lt; 6.5 % = 0.2501, CI = 0.21-0.30) and higher median household income (OR for income &gt; $63,333 = 0.4218, CI = 0.36-0.49). Whether the care received was adherent to NCCN guidelines did not seem to be associated with black race (OR for adherence = 1.0021, CI = 0.89-1.13). 5-year overall survival for patients who received adherent care was 58% for white patients vs. 49% for black patients. Among those who didn’t receive adherent care, the outcomes were 49% among white patients vs. 38% among black patients. Conclusions: Overall survival remains worse for black patients, regardless of whether their care adhered to NCCN guidelines as defined by our study. This suggests that while receipt of care that is not adherent to NCCN guidelines seems to be negatively associated with overall survival, we must consider and evaluate other socioeconomic, environmental and system factors that are contributing to this continued survival discrepancy in women being treated for ovarian cancer.

Predictors of Postoperative Radiation Following Laser Resection in Early-Stage Glottic Cancer.

Guideline recommendations for the treatment of early-stage glottic cancer are limited to single-modality therapy with surgery or radiation alone. We sought to investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) following laser excision for patients with T1-T2N0 glottic squamous cell carcinoma (SCC). Retrospective observational study of the National Cancer Database. National Cancer Database review from 2004 to 2014. A total of 1338 patients with primary cT1-T2N0M0 glottic SCC undergoing primary laser excision were included. Hospitals were divided into quartiles based on yearly volume of laryngeal laser cases performed. Multivariate logistic regression was performed to identify independent predictors of PORT. The overall rate of PORT was 30.0%. Predictors of PORT included treatment at lower-volume hospitals (adjusted odds ratio [aOR] for quartiles 2-4, 1.32-4.84), positive margins (aOR, 3.83 [95% CI, 2.54-5.78]), and T2 tumors (aOR, 3.58 [95% CI, 2.24-5.74]). PORT utilization demonstrated a strong inverse correlation with hospital volume. Among top-quartile hospitals, the rate of PORT was 11.2%, while rates of PORT at second-, third-, and fourth-quartile institutions were 19.2%, 32.2%, and 37.4%, respectively. Predictors of PORT in multivariable analysis included treatment at lower-volume facilities, positive margins, and T2 disease. This study highlights the importance of treating early-stage glottic carcinoma at high-volume institutions. In addition, there is a need to reevaluate the use of PORT and reduce the rate of dual-modality therapy for patients with early-stage glottic SCC.

2222 Primary Combined Hepatocellular Carcinoma-cholangiocarcinoma: A Case Report for Under-Diagnosed Primary Liver Cancer

INTRODUCTION: Combined hepatocellular carcinoma- cholangiocarcinoma (HCC-CC) was first classified in 1949 by Allen and Lisa et al. It composes less than 1% of primary hepatic malignancies. HCC-CC is being increasingly identified given the advances in immunohistochemistry (IHC) techniques. Due to its rarity, there are no formal treatment guidelines. However, a national cancer database review reported a worse prognosis. CASE DESCRIPTION/METHODS: A 73-year-old man with history of alcohol dependence presented with 2-week history of sharp right upper abdominal pain (RUQ). Review of systems was negative. Examination revealed RUQ tenderness. Hepatitis B and C serology were negative. Abdominal ultrasound showed two heterogeneous, hypoechoic liver lesions. Abdominal MRI showed enhancing masses in the left and right liver lobes. CT-guided liver biopsy confirmed the diagnosis of HCC -CC. The left sided tumor was treated with yttrium 90 radioembolization. Unfortunately, his restaging MRI showed progressive enlargement of the right hepatic lobe tumor and complete venous thrombosis of the portal vein. With rapidly worsening performance status, he was not a candidate for any further treatment and was enrolled in hospice care. DISCUSSION: HCC-CC is a primary liver tumor which presents diagnostic challenges to the pathologist, radiologist and clinician. Adequate tissue sampling is crucial to capture enough tumor to allow recognition of both histologies. Hence, core needle sampling would be preferable to fine needle aspiration. Triphasic CT/ MRI imaging may have characteristics of either tumor type. Tumor markers are often discordant with the imaging findings, which should raise suspicion for this entity. Histology and IHC are the only definitive way to establish diagnosis, which reveal a spectrum from both histologies occurring independently yet concurrently in the liver, to mixed cells of both histologies in same lesion to a fibrolamellar HCC like histology. Notably, the World Health Organization histological classification does not have prognostic or treatment impact. Although the prognosis of HCC-CC tends to be worse than both HCC and CC, there is uncertainty if it should be treated more like HCC or CC. Surgical resection and liver transplantation are the only curative option. For resected patient, survival was substantially worse than those with HCC. Inoperable patient and unresectable tumors can be treated locally with trans-arterial chemoembolization, radioembolization, and systemic therapy.

Digital Rectal Examination Remains a Key Prognostic Tool for Prostate Cancer: A National Cancer Database Review.

Prostate cancer clinical stage T2 (cT2) subclassifications, as determined by digital rectal examination (DRE), are a historic method of staging prostate cancer. However, given the potential discomfort associated with prostate examination and the wide availability of other prognostic tests, the necessity of DRE is uncertain. This study sought to determine the prognostic value of the prostate cancer cT2 subclassifications in a contemporary cohort of patients. The National Cancer Database was used to identify a cohort of men with high-risk clinical T2N0M0 prostate cancer treated with external-beam radiotherapy and androgen deprivation therapies ± surgery from 2004 to 2010. We assessed overall survival from a landmark time of 10 months using Kaplan-Meier and log-rank test analysis. A multivariate proportional hazards model was used to estimate the simultaneous effects of multiple factors, including cT2 subclassification and other well-established prognostic indicators of overall survival in prostate cancer. A total of 5,291 men were included in the final analysis, with a median follow-up of 5.4 years. The cT2a, cT2b, and cT2c subclassifications demonstrated increasing hazard ratios of 1.00 (reference), 1.25 (95% CI, 1.07-1.45; P=.0046), and 1.43 (95% CI, 1.25-1.63; P<.0001), respectively, reflecting a higher probability of death with each incremental increase in cT2 subclassification. This finding was independent of other known prognostic variables on multivariate analysis. Results show that cT2 subclassifications had independent prognostic value in a large and contemporary cohort of men. cT2 classification remains an important, low-cost prognostic tool for men with prostatic adenocarcinoma. The clinical relevance of this test should be appreciated and accounted for by providers treating prostate adenocarcinoma.

Role of pelvic chemoradiation therapy in patients with initially metastatic anal canal cancer: A National Cancer Database review.

Although the management of localized anal canal squamous cell carcinomas is well established, the role of pelvic chemoradiation (CRT) in the treatment of patients presenting with synchronous metastatic (stage IV) disease is poorly defined. This study used a national cancer database to compare the overall survival (OS) rates of patients with synchronous metastatic disease receiving CRT to the pelvis and patients treated with chemotherapy (CT) alone. This study included adult patients with anal canal squamous cell carcinomas presenting with synchronous metastases diagnosed from 2004 to 2012. Multiple imputation and 2:1 propensity score matching were used to create a matched data set for testing. The proportional hazards model was used to estimate the hazard ratio (HR) for the effect of the treatment group on OS. With only patients in the matched data set, the OS of the treatment groups was estimated with the Kaplan-Meier method by treatment group. This study started with an unmatched data set of 978 patients, and 582 patients were selected for the matched data set: 388 in the CRT group and 194 in the CT-alone group. The HR for the group effect was 0.75 (95% confidence interval [CI], 0.61-0.92; P=.006). The median OS was 21.1months in the CRT group (95% CI, 17.4-24.0months) and 14.6months in the CT group (95% CI, 12.2-18.4months). The corresponding 5-year OS rates were 23% (95% CI, 18%-28%) and 14% (95% CI, 7%-21%), respectively. In this large series analyzing OS in patients with stage IV anal cancer, CRT was associated with improved OS in comparison with CT alone. Because of the lack of prospective data in this setting, this evidence will help to guide treatment approaches in this group of patients.

Pediatric gastric adenocarcinoma: A National Cancer Data Base review

PurposeWe sought to compare the presentation, management, and outcomes in gastric adenocarcinoma cancer for pediatric and adult patients. MethodsUsing the 2004 to 2014 National Cancer Database (NCDB), patients ≤21 years (pediatric) were retrospectively compared to >21 years (adult). Chi-squared tests were used to compare categorical variables, and Cox regression was used to estimate hazard ratios (HR) for survival differences. ResultsOf the 129,024 gastric adenocarcinoma cases identified, 129 (0.10%) occurred in pediatric patients. Pediatric cases presented with more advanced disease, including poorly differentiated tumors (81% vs 65%, p = 0.006) and stage 4 disease (56% vs 41%, p = 0.002). Signet ring adenocarcinoma comprised 45% of cases in the pediatric group as compared to 20% of cases in the adults (P < 0.001). Similar proportions in both groups underwent surgery. However, near-total gastrectomy was more common in the pediatric group (16% vs 6%, p < 0.001). The proportions of patients with negative margins, nodal examination, and presence of positive nodes were similar. There was no overall survival difference between the two age groups (HR 0.92, 95% Confidence interval 0.73–1.15). ConclusionWhile gastric adenocarcinoma in pediatric patients present with a more advanced stage and poorly differentiated tumors compared to adults, survival appears to be comparable. Type of studyRetrospective cohort study. Level of evidenceIII

The current treatment patterns of metastatic renal cell carcinoma: A national cancer database review, 2004–2015

Objective: Our objective was to analyze patterns of treatment for metastatic renal cell carcinoma (mRCC) (no treatment (NT), cytoreductive nephrectomy only (CN), systemic therapy only (ST), and both systemic and cytoreductive (ST+CN)), and correlate them with racial or socioeconomic factors. Materials and Methods: Cases of mRCC from 2004–2015 were selected from the National Cancer Database. Our primary outcome was the temporal trend of treatment types. Secondary outcomes included the association of treatment with racial and socioeconomic factors. Logistical regression was performed. Results: In total, 40,372 patients with mRCC were identified. Treatment modalities included 37.0% NT, 13.9% CN only, 31.6% ST only and 17.5% ST+CN. From 2004–2015, NT decreased (53.4 vs. 32.1%, p &lt; 0.001), CN alone decreased (18.1 vs. 12.1%, p &lt; 0.001), ST alone increased (18.1 vs. 36.7%, p &lt; 0.001) and ST+CN increased (10.3 vs. 19.1%, p &lt; 0.001). On logistical regression, we found non-white races (odds ratio 1.29–1.73, p &lt; 0.001), low-volume centers (hazard ratio (HR) 1.18, p &lt; 0.001), no insurance (HR 2.29, p &lt; 0.001) and low income (HR 1.24, p &lt; 0.001) increased the likelihood of receiving NT. Conclusion: More patients are receiving ST and ST+CN; however, racial and socioeconomic factors may affect the treatment patterns for mRCC, and the underlying cause of these health disparities is unknown. Level of Evidence: 2c6

Contemporary treatment patterns and outcomes of salivary gland carcinoma: a National Cancer Database review.

Salivary gland carcinomas (SGC) are rare malignancies and data regarding treatment outcomes stratified by histologic subtype are currently limited. This study aims to examine current, national treatment patterns and overall survival (OS) of patients with the major histologic subtypes of salivary gland carcinoma. A review was performed of the National Cancer Database (NCDB) of patients with confirmed diagnoses of mucoepidermoid carcinoma, acinic cell carcinoma, adenoid cystic carcinoma, adenocarcinoma, or carcinoma ex pleomorphic receiving curative treatment between 2004 and 2014. Univariate and multivariate regression modeling were performed to identify risk factors significantly associated with overall survival (OS). Adjusted survival analyses stratified by treatment and staging were performed with the primary outcome of overall survival (OS) and were further stratified based on histologic subtype. The final analysis included 7342 patients [3547 men (48.3%) and 3795 women (51.7%); mean age 58.3years (range 18-90 years)]. Mucoepidermoid carcinoma was the most common histology encountered [n = 2669 (36.4%)]. Unadjusted and adjusted analysis demonstrated improved survival with surgery and radiation therapy (RT) for adenoid cystic (HR = 0.69; p = 0.029), adenocarcinoma (HR = 0.61; p < 0.001), high-grade mucoepidermoid carcinoma (HR = 0.70; p = 0.026), and carcinoma ex pleomorphic (HR = 0.64; p = 0.028), while surgery with chemoradiation therapy (CRT) was associated with worse OS regardless of histologic subtype. The impact of advanced stage on survival varied amongst the histologic subtypes but portended the worst prognosis for patients with adenocarcinoma and carcinoma ex pleomorphic. The results of this NCDB review demonstrate unique treatment patterns and survival outcomes for SGC based on major histologic subtype.

Wednesday, September 26, 2018 2:00 PM – 3:00 PM Improving Quality of Life for Patients with Tumors: 79. The impact of chemotherapy on primary bone tumors of the vertebral column: a national cancer database review

BACKGROUND CONTEXT Chemotherapy has dramatically improved survival in many primary bone tumors. Bone tumors of the vertebral column (BTVCs) are rarer and the impact of chemotherapy on these tumors is not well established. We investigated the largest registry of primary bone tumors, the National Cancer Database (NCDB). PURPOSE Our goal was to determine the impact of chemotherapy on outcomes in patients with primary BTVCs. STUDY DESIGN/SETTING Retrospective National Cancer Database review. PATIENT SAMPLE All patients identified in the National Cancer Database with primary bone tumors of the vertebral column. These were further stratified based on the use or nonuse of chemotherapy. OUTCOME MEASURES Patient survival was the primary outcome measure. METHODS We retrospectively analyzed patients in the NCDB from 2004 through 2015. Patients were stratified based on chemotherapy use for primary BTVCs; these were further stratified by histologic subtype. Univariate and multivariate analyzes were used to correlate specific outcome measures with these factors. Then, long-term survival between groups was evaluated using the Kaplan-Meier (KM) method with statistical comparisons based on the log-rank test. Multiple variables were analyzed between the two groups. RESULTS We identified 941 patients presenting with primary BTVCs. Thirty-seven patients were treated with chemotherapy alone, 293 were treated with surgery alone, and 72 were treated with both surgery and chemotherapy; 78/127 patients with osteosarcoma (61.4%) and 146/164 patients with Ewing's Sarcoma (89%) underwent chemotherapy as compared to 16/243 patients with chondrosarcoma (6.6%) and 14/407 patients with chordoma (3.4%). Across the entire cohort of patients, patients who received chemotherapy were on average, younger (38 vs. 56 years, p CONCLUSIONS This is the largest patient cohort to date examining the impact of chemotherapy on primary BTVCs. Chemotherapy use was far more likely for Ewing's sarcoma and osteosarcoma than chordoma and chondrosarcoma. Patients with either osteosarcoma or Ewing's sarcoma receiving surgery in addition to chemo had improved overall survival than those undergoing surgery alone. Further investigation is necessary to help improve the appropriate delivery of adjuvant therapies to patients with primary BVTCs. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.