National Cancer Institute Surveillance Epidemiology Research Articles

Survival after thermal ablation versus wedge resection for stage I non-small cell lung cancer < 1 cm and 1 to 2 cm: evidence from the US SEER database

BackgroundThis study compared the survival outcomes after thermal ablation versus wedge resection in patients with stage I non-small cell lung cancer (NSCLC) ≤ 2 cm.MethodsData from the United States (US) National Cancer Institute Surveillance Epidemiology and End Results (SEER) database from 2004 to 2019 were retrospectively analyzed. Patients with stage I NSCLC and lesions ≤ 2 cm who received thermal ablation or wedge resection were included. Patients who received chemotherapy or radiotherapy were excluded. Propensity-score matching (PSM) was applied to balance the baseline characteristics between patients who underwent the two procedures.ResultsUnivariate and Cox regression analyses were performed to determine the associations between study variables, overall survival (OS), and cancer-specific survival (CSS). After PSM, 328 patients remained for analysis. Multivariable Cox regression analysis revealed, compared to wedge resection, thermal ablation was significantly associated with a greater risk of poor OS (adjusted HR [aHR]: 1.34, 95% CI: 1.09–1.63, p = 0.004) but not CSS (aHR: 1.28, 95% CI: 0.96–1.71, p = 0.094). In stratified analyses, no significant differences were observed with respect to OS and CSS between the two procedures regardless of histology and grade. In patients with tumor size 1 to 2 cm, compared to wedge resection, thermal ablation was significantly associated with a higher risk of poor OS (aHR: 1.35, 95% CI: 1.10–1.66, p = 0.004). In contrast, no significant difference was found on OS and CSS between thermal ablation and wedge resection among those with tumor size < 1 cm.ConclusionsIn patients with stage I NSCLC and tumor size < 1 cm, thermal ablation has similar OS and CSS with wedge resection.

Abstract 4834: Racial disparities in pain and psychiatric medication use in patients with metastatic colorectal cancer

Abstract Background: In the United States, colorectal cancer (CRC) is a public health concern, as it is the second leading cause of cancer-related death, accounting for over 50,000 deaths annually. In addition to its high mortality, CRC is associated with significant comorbidities including pain and psychiatric symptoms, particularly in late-stage disease. Supportive care medications (SCM) are frequently used for symptom management and improving health-related Quality of Life (HRQoL). Racial disparities in clinical outcomes including HRQoL have been reported in CRC. While racial disparities have been described in the use of SCM for some cancer types, no investigation of SCM use in late-stage CRC have been performed. The purpose of our study was to explore the relationship between SCM use and race/ethnicity in patients with metastatic CRC. Methods: We used the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare-linked database to analyze all patients with a CRC diagnosis and a newly initiated outpatient prescription claim for an SCM of interest from 2009-2018. Patients on SCM before cancer diagnosis or who had non-metastatic CRC at diagnosis were excluded. We assessed six SCM classes: opioids, non-opioid analgesics, skeletal muscle relaxants, antidepressants, anxiolytics, and antipsychotics. Results: After application of inclusion/exclusion criteria, 28, 212 patients were included in the final analysis (White: 72.8%, Black: 12.7%, Hispanic: 9.5%, Asian: 4.6%, Native American: 0.4%). After controlling for socioeconomic factors and compared to non-Hispanic White patients, there were significant differences across multiple SCM drug classes. When considering pain medications, these differences were bi-directional. Black patients were less likely to receive opioids (adjusted Odds Ratio [aOR] 0.86, 95% CI: 0.80-0.93), while Hispanic patients were more likely to receive opioids (aOR: 1.12, 95% CI: 1.03-1.22) and non-opioid analgesics (aOR 1.22, 95% CI: 1.06-1.40). Asian patients were more likely to receive non-opioid analgesics (aOR 1.71, 95% CI: 1.45-2.03), but less likely to receive skeletal muscle relaxants (aOR 0.60, 95% CI: 0.43-0.82). When considering psychiatric medications, decreased use among all racial groups was noted for antidepressants (Black: aOR 0.53, 95% CI: 0.50-0.60; Hispanic: aOR 0.82, 95% CI: 0.75-0.90; Asian: aOR 0.48, 95% CI: 0.42-0.56), and anxiolytics (Black: aOR 0.43, 95% CI: 0.38-0.49; Hispanic: aOR 0.76, 95% CI: 0.67-0.85; Asian: aOR 0.45, 95% CI: 0.37-0.55). Among antipsychotics, only Asian patients had less use compared to non-Hispanic White patients. Conclusion: Racial disparities in the use of pain and psychiatric medications among patients with late-stage CRC were present, even after controlling for multiple confounders. Further investigation is needed to understand drivers and their impact on HRQoL outcomes. Citation Format: John M. Allen, Olga M. Trejos Kweyete, Yi Guo, Sherise C. Rogers, Lisa Scarton, David L. DeRemer, Chardae Whitner, Diana J. Wilkie. Racial disparities in pain and psychiatric medication use in patients with metastatic colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4834.

Abstract B026: Exploring differences in supportive care medication use among racial and ethnic minorities with pancreatic and colorectal cancers

Abstract Background: Pancreatic (PC) and colorectal cancer (CRC) are both cancers of the digestive system, with similar symptom profiles. Neurologic and psychiatric symptoms are commonly seen in multiple types of cancer including PC and CRC. Supportive care medications (SCM) are central to symptom management and improving health-related Quality of Life (HRQoL). Examples of SCM used to manage these symptoms include opioid analgesics, non-opioid analgesics, antidepressants, anxiolytics, and antipsychotics. Racial disparities in clinical outcomes including HRQoL have been reported in PC and CRC, respectively. While racial disparities have been separately described in the use of SCM for PC and CRC, no comparisons of SCM use based on cancer type in racial and ethnic minorities has been performed. The purpose of our study was to explore differences in SCM use among racial and ethnic minorities with PC and CRC, respectively. Methods: We used the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare-linked database to analyze all patients with a PC or CRC diagnosis and a newly initiated outpatient prescription claim for an SCM of interest from 2009-2018. Patients on SCM before cancer diagnosis or were not a member of racial or ethnic group were excluded from the analysis. We assessed five SCM classes, including opioids, non-opioid analgesics, antidepressants, anxiolytics, and antipsychotics. Prescription claims were specific to patients diagnosed with PC or CRC, and compared by cancer type. Our objective was to characterize the relationship between cancer type and receipt of SCM in racial and ethnic minorities. Results: After assessment of our inclusion/exclusion criteria, 45,502 patients were included in the analysis (PC- 44.9%; CRC- 55.1%). Racial demographics were as follows: Black/African American: 51.5%, Hispanic- 23.6%, Asian- 23.5%, American Indian/Alaska Native: 1.3%. When comparing cancer types, patients with PC were more likely to receive multiple classes of SCM including opioids (Odds Ratio [OR] 2.17, 95%CI: 2.09-2.25), non-opioid analgesics (OR 1.29, 95%CI: 1.22-1.37), antidepressants (OR 1.19, 95%CI: 1.14-1.24), and anxiolytics (OR 1.45, 95%CI:1.37- 1.54). PC patients were less likely to receive antipsychotics (OR 0.77, 95%CI: 0.72- 0.83). Differences were similar when disaggregated by specific race and ethnicity. Conclusion: Among racial and ethnic minorities, patients with PC were more likely to be prescribed multiple classes of SCM used to treat neurologic and psychiatric symptoms, including opioids, non-opioid analgesics, antidepressants, and anxiolytics. The observed results suggests a heavier overall symptom burden for PC in this population. Citation Format: John M. Allen, MegCholack Awunti, Yi Guo, Sherise C. Rogers, Lisa Scarton, Chardaé Whitner, Diana J. Wilkie. Exploring differences in supportive care medication use among racial and ethnic minorities with pancreatic and colorectal cancers [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B026.

Abstract 754: Exploring racial and ethnic disparities in pain medication use in patients with colorectal cancer

Abstract Background: Pain management is a substantial component of treating patients with colorectal cancer (CRC). CRC-related pain occurs in over 70% of patients and is among the most frequently reported adverse events in this patient population. CRC-related pain is multifactorial and includes nociceptive, neuropathic, and psychogenic origins. CRC-related pain is primarily managed by medications, including opioid and non-opioid analgesics, corticosteroids, and antiepileptics. Among these, opioids are by far the most utilized treatment. Prior literature suggests racial and ethnic differences in the use of some pain medications, including opioids, in patients with cancer, but there is no research confirming these findings in patients with CRC. Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare-linked database, our analysis included all patients with a CRC diagnosis and a newly initiated outpatient prescription claim for pain medications from 2009-2018. Patients on pain medications before CRC diagnosis or of unspecified race or ethnicity were excluded from the analysis. We assessed three classes of pain medications, including opioids, non-opioid analgesics, and neuropathic analgesics. Prescription claims were specific to patients diagnosed with CRC and stratified by self-identified race and ethnicity. Our objective was to characterize the relationship between race and receipt of pain medications in the first year following the diagnosis of CRC. Results: After the application of the inclusion/exclusion criteria, 136,014 patients with CRC were identified and included in the analysis (White: 81.6%; Black/African American: 11.2%; Asian/Pacific Islander: 4.3%; Hispanic: 2.6%; Native American 0.29%). As compared to White patients, Black/African American (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI]: 0.92-0.99) and Asian/Pacific Islander patients (OR 0.75; 95% CI: 0.71-0.79) were less likely to be prescribed an opioid analgesic, while Native American patients were more likely (OR 1.42; 95% CI: 1.16-1.73). Asian/Pacific Islander (OR 1.60; 95% CI: 1.48-1.73) and Hispanic (OR 1.57; 95% CI: 1.42-1.73) patients were more likely to be prescribed a non-opioid analgesic as compared to White patients. Black/African American (OR 1.06; 95% CI: 1.01-1.12) and Native American (OR 1.57; 95% CI: 1.22- 2.03) patients were more likely to be prescribed a neuropathic analgesic compared to White patients. No other differences were noted in pain medication use by race or ethnicity. Conclusion: Our study findings suggest that pain medication usage in patients with CRC varies for patients from historically minoritized racial and ethnic groups compared to White patients. Future research should explore the barriers and facilitators of pain medication usage patterns in patients from historically minoritized racial and ethnic groups with CRC. Citation Format: John M. Allen, MegCholack Awunti, Yi Guo, Sherise C. Rogers, Lisa Scarton, Diana J. Wilkie. Exploring racial and ethnic disparities in pain medication use in patients with colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 754.

Abstract 1932: Evaluation of racial and ethnic psychotropic medication use among patients with colorectal cancer

Abstract Background: Colorectal cancer (CRC) is the 4th most common cancer type in the US. Following CRC treatment, about 37% of CRC survivors experience symptoms associated with anxiety and depression. Additionally, psychosocial distress is especially prevalent among CRC survivors with a stoma, and those reporting CRC-induced sexual dysfunction. Pharmacotherapy is one of the mainstay treatment options for psychological distress among patients with CRC. Research has shown that racial disparities are present with the use of supportive care medications in other cancer types. However, this has not been explored with the use of psychotropic medication for patients with CRC. The purpose of this research is to evaluate the presence of racial disparities in psychotropic medication use among patients with CRC. Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare linked database, our analysis included all patients with a CRC diagnosis and an active outpatient prescription claims for psychotropic medications from 2009-2018. Prescription claims were specific to patients diagnosed with CRC and stratified by self-identified race and ethnicity. Patients who were on psychotropic medications before CRC diagnosis, or unspecified race or ethnicity were excluded from the analysis. Psychotropic medications consisted of anxiolytics, antidepressants, and antipsychotic medications. Results: 136,014 participants were included in the analysis. The racial and ethnic breakdown comprised of 81.56% White, 11.22% African American (AA), 2.66% Hispanic, 4.27% Asian/Pacific Islander (API), and 0.25% Native American (NA). Results are presented as unadjusted odds ratios (OR) and 95% confidence intervals (CI). Compared to White patients, AA (OR 0.53; 95% CI 0.50-0.56), API (OR 0.50; 95% CI 0.46-0.54), Hispanic (OR 0.64; 95% CI 0.58-0.71), and NA (OR 0.59; 95% CI 0.43-0.81) patients had lower utilization of anxiolytic medications. Regarding antidepressant use, AA (OR 0.55; 95% CI 0.53-0.57), API (OR 0.46; 95% CI 0.43-0.49), Hispanic (OR 0.73; 95% CI 0.68-0.79), and NA (OR 0.78; 95% CI 0.63-0.96) had lower utilization compared to White patients. Differences in antipsychotic medication use was observed with Asian/Pacific Islanders (OR 0.71; 95% CI 0.64-0.78) and Native Americans (OR 0.49; 95% CI 0.31-0.76) compared to White patients. No other racial differences in antipsychotic medications were identified. Conclusion: The study showed that racial and ethnic disparities are present with the use of psychotropic medications among patients with CRC. Racial and ethnic minority patients had lower use for most of the drug classes evaluated. Further research is warranted to assess the potential barriers and facilitators of psychotropic medication use among patients belonging to historically minoritized racial and ethnic groups. Citation Format: MegCholack Awunti, Yi Guo, Sherise Rogers, Lisa Scarton, Diana Wilkie, John Allen. Evaluation of racial and ethnic psychotropic medication use among patients with colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1932.

Abstract A026: Disparities in the use of pain medication in patients with pancreatic cancer: Focus on racial and ethnic minorities

Abstract Background: Pain management is a substantial component of the care of patients with pancreatic cancer (PC). PC-related pain occurs in up to 75% of patients at diagnosis, 90% of patients with late-stage disease, and overall is the most frequently reported adverse event in this patient population. PC-related pain is multifactorial and includes visceral, somatic, and neuropathic origins. Furthermore, PC-related pain can be disease-induced or a result of adverse side effects of treatment. PC-related pain is primarily managed by supportive care medications (SCM), including opioid and non-opioid analgesics, corticosteroids, and antiepileptics. Among these, opioids are by far the most utilized treatment. Recent evidence suggests that opioid use in PC patients is associated with increased survival. Previous literature suggests racial/ethnic differences in the use of some SCMs including opioids in patients with cancer, but there is no research confirming these findings in patients with PC. Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare linked database, our analysis included all patients with a PC diagnosis and a newly initiated outpatient prescription claim for pain medications from 2009-2018. Patients who were on pain medications before PC diagnosis, or of unspecified race/ethnicity were excluded from the analysis. We assessed three separate classes of pain medications including opioids, non-opioid analgesics, and neuropathic analgesics. Prescription claims were specific to patients diagnosed with PC and stratified by self-identified race/ethnicity. Our objective was to characterize the relationship between race and receipt of pain medications in the first year following the diagnosis of PC. Results: After application of the inclusion/exclusion criteria, 71,700 patients with PC were identified and included in the analysis (White: 80.3%; Black/African American: 11.8%; Asian/Pacific Islander: 4.5%; Hispanic: 3.1%; Native American 0.25%). As compared to White patients, Black/African American (Relative Risk [RR] 0.97; 95% Confidence Interval [CI]: 0.96-0.99) and Asian/Pacific Islander patients (RR 0.88; 95% CI: 0.85-0.90) were less likely to be prescribed an opioid analgesic. Black/African American (RR 1.09; 95% CI: 1.02-1.16), Asian/Pacific Islander (RR 1.52; 95% CI: 1.41-1.65), and Hispanic (RR 1.45; 95% CI: 1.31-1.59) patients were more likely to be prescribed a non-opioid analgesic. Black/African American (RR: 1.11; 95% CI: 1.05-1.18) patients were more likely to be prescribed a neuropathic analgesic. No other differences were noted in pain medication use by race/ethnicity. Conclusion: Our study findings suggest that pain medication usage in patients with PC varies for racial/ethnic minorities as compared to White patients, in particular for Black/African Americans. Future research should explore the impact of sociocultural, and psychosocial factors on pain medication usage patterns in racial/ethnic minority patients with PC. Citation Format: John M. Allen, MegCholack Awunti, Yi Guo, Sherise Rogers, Lisa Scarton, Diana J. Wilkie. Disparities in the use of pain medication in patients with pancreatic cancer: Focus on racial and ethnic minorities [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A026.

Abstract A027: Evaluation of psychotropic medication usage patterns in patients with pancreatic cancer by race/ethnicity

Abstract Background: Pancreatic cancer (PC) has been associated with detrimental impacts on psychological wellbeing. Reported PC-related depression and anxiety rates are higher than in other types of cancer. A substantial component to improve psychological well-being in patients with PC is the use of drug therapy to provide symptomatic relief. The presence of racial disparities in the utilization of psychotropic medication has been reported in some cancer types. However, despite these known racial disparities and the increased psychiatric symptoms in patients with PC, there has not been an evaluation of racial disparities in psychotropic medication use among patients with PC. The purpose of this study was to describe usage patterns of psychotropic medications by race among patients diagnosed with PC. Methods: Utilizing the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare linked database, our analysis included all patients with a PC diagnosis and an active outpatient prescription claim for psychotropic medications from 2009-2018. Prescription claims were specific to patients diagnosed with PC and stratified by self-identified race/ethnicity. Patients who were on psychotropic medications before PC diagnosis, or unspecified race/ethnicity were excluded from the analysis. Psychotropic pharmacological agents consisted of anxiolytics, antidepressants, and anti-delirium/antipsychotic medications. Results: 71,700 participants were included in the analysis. Racial/ethnic participant breakdown included 80% White, 12% African American/Black, 4.5% Asian/Pacific Islander, 3% Hispanic, and 0.25% Native American. Results are presented as an unadjusted relative risk (RR) and 95% Confidence Interval (CI). As compared to White patients, African American/Black (RR 0.60; 95% CI 0.57-0.64), Asian/Pacific Islander (RR 0.52; 95% CI 0.48-0.58), and Hispanic (RR 0.61; 95% CI 0.55-0.67) patients had lower utilization of anxiolytics. For antidepressant medications, African American/Black (RR 0.74; 95% CI 0.71-0.77), Asian/Pacific Islander (RR 0.61; 95% CI 0.58-0.66), and Hispanic (RR 0.87; 95% CI 0.82-0.92) patients had less utilization compared to White patients. For anti-delirium/antipsychotic agents, African American/Black (RR 1.09; 95% CI 1.01-1.17) had a higher risk of utilization while Asian/Pacific Islander (RR 0.83; 95% CI 0.73-0.95) had less utilization when compared to White patients. No other differences were noted in psychotropic medication use by race/ethnicity. Conclusion: The study showed that utilization patterns of psychotropic agents in patients with PC varied by race/ethnicity. Racial/ethnic minorities had lower utilization rates for most of the drug classes except anti-delirium/antipsychotic agents in which African American/Black had higher utilization rates when compared to White patients. Further research needs to be carried out to examine social and clinical factors causing this phenomenon. Citation Format: MegCholack Awunti, Yi Guo, Sherise Rogers, Lisa Scarton, Diana Wilkie, John Allen. Evaluation of psychotropic medication usage patterns in patients with pancreatic cancer by race/ethnicity [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A027.

Clinical-pathological characteristics and prognostic factors for malignant peritoneal mesothelioma in the elderly

BackgroundMalignant peritoneal mesothelioma (MPM) is a rare disease characterized by atypical symptoms, difficult diagnosis, variable course and poor prognosis, and it develops mainly in elderly individuals. The authors aimed to identify the clinical-pathological characteristics, prognosis, and prognostic factors in elderly MPM patients.MethodsFrom the National Cancer Institute Surveillance Epidemiology End Results (SEER) database, 1492 patients with MPM from 1975 to 2016 were selected and divided into the elderly group (≥ 65) and the adult group (< 65). We compared the clinical-pathological characteristics and treatment methods of the elderly group (N = 665) and the adult group (N = 827). At the same time, we analysed specific selected clinicopathological parameters and prognostic factors for elderly MPM patients.ResultsCompared with the adult group, the elderly group had higher percentages of male patients (P = 0.017) and white patients (P = 0.043) and lower proportions of insured patients (P < 0.001) married patients (P < 0.001), patients with peritoneal tumours (P = 0.006) and patients who underwent surgery (P < 0.001) and chemotherapy (P < 0.001). There was a significant difference in the differentiation grade between the two groups (P = 0.003). Elderly patients had a shorter median survival time than adult patients (6 months vs. 19 months). Uninsured (hazard ratio (HR): 5.187, P = 0.005), sarcomatoid type (HR 3.913, P < 0.001), poorly differentiated (HR 3.900, P < 0.001), distant metastasis (HR 1.735, P = 0.001), no cancer-directed surgery (HR 1.733, P < 0.001), and no chemotherapy (HR 1.532, P < 0.001) were independently associated with poorer prognosis in elderly MPM patients.ConclusionCompared with adult patients, elderly MPM patients had a higher male ratio, poor differentiation and relatively conservative treatment. The cancer-specific survival (CSS) rate of elderly MPM patients was significantly lower than that of adult patients. Insurance status, histology type, differentiation grade, stage, surgery status, and chemotherapy status were all independent prognostic factors for elderly MPM patients.

EPID-03. COMPARISON OF SURVIVAL IN ADULT AND PEDIATRIC PATIENTS WITH MEDULLOBLASTOMA: A 2018 SEER BASED ANALYSIS

Medulloblastoma (MB) is the most common high-grade primary brain malignancy in children and accounts for 1% of adult brain tumors. Previous studies have compared survival in pediatric and adult MB from the National Cancer Institute Surveillance Epidemiology and End Results (SEER) database finding no difference. However, diagnostic subgroup analyses are limited. We examined survival in children (age 0–19) and adults (20–79) coded as MB in the 2018 SEER database (2000–2016), using Kaplan Meier analysis, log-rank test and Cox proportional hazard ratios (HR) with 95% confidence intervals (CI).). MB in SEER-18 is defined as ICD-O-3 histology codes 9470–9474 (n=1,728). ICD 9473, supratentorial PNET (sPNET, n=97) is biologically distinct so was analyzed separately. 5-year survival for MB, excluding sPNET, was similar in children (n = 1,091, 75.3%) and adults (n= 488, 79.1%) (HR=0.97, CI: 0.79 – 1.17, p=0.50). Subtype analyses showed no survival difference comparing adults and children with desmoplastic nodular MB (n=222, p=0.09), large cell MB (n=73, p=0.46), or MB NOS (n=1330, p=0.10). In contrast, children with sPNET had improved survival (n=65, 72.3%) compared to adults (n=29, 51.7%) (HR = 2.0, CI: 1.10 – 3.92; p=0.02,). In conclusion, 2018 SEER data for MB continue to show no survival difference between adults and children, suggesting adult patients could appropriately be entered on pediatric MB treatment protocols. Further analyses of the 2018 data are ongoing adjusting for sex, race, and treatment. Comparison of adults and children with MB and sPNET will be re-evaluated using the new 2016 World Health Organization classification.

Survival in adult and pediatric patients with medulloblastoma: A 2018 SEER-based analysis.

e14529 Background: Medulloblastoma (MB) is a malignant neuroectodermal tumor accounting for 30% of pediatric and only 1% of adult brain tumors. In previous studies comparing survival in pediatric and adult MB from the National Cancer Institute Surveillance Epidemiology and End Results (SEER) database no difference has been found. However, diagnostic subgroup analyses have been limited. Methods: We examined survival in children (age 0-19) and adults (20-79) coded as MB in the 2018 SEER database (2000-2016). We used Kaplan Meier analysis, log-rank test and Cox proportional hazard ratios (HR) with 95% confidence intervals (CI). MB in SEER-18 is defined as ICD-O-3 histology codes 9470–9474 (n = 1,728). ICD 9473, supratentorial PNET (sPNET, n = 97) is biologically distinct and therefore it was analyzed separately. Results: We found that 5-year survival for MB, excluding sPNET, was similar in children (n = 1,091, 75.3%) and adults (n = 488, 79.1%) (HR = 0.97, CI: 0.79 – 1.17, p = 0.50). Furthermore, subtype analyses showed no survival difference comparing adults and children with desmoplastic nodular MB (n = 222, p = 0.09), large cell MB (n = 73, p = 0.46), or MB NOS (n = 1330, p = 0.10). Yet, children with sPNET had improved 5-year survival (n = 65, 72.3%) compared to adults (n = 29, 51.7%) (HR = 2.0, CI: 1.10 – 3.92; p = 0.02,). These findings indicate that while survival in patients with MB is similar across age groups, children with sPNET have improved outcomes. Conclusions: In summary, 2018 SEER data for MB continue to show no survival difference between adults and children, suggesting adult patients could appropriately be entered on pediatric MB treatment protocols. Further analyses of the 2018 data are ongoing adjusting for sex, race, and treatment (chemotherapy or radiation). For sPNET, the apparent improved outcomes for children merit further detailed investigation and will be re-evaluated using the new 2016 World Health Organization classification.

MTE02.01 Update on WHO Classification and Staging of Lung Cancer

The most significant changes in the 2015 WHO classification of the lung tumors include classification criteria for small biopsy and cytology specimens, use of immunohistochemistry, integration of molecular testing, adoption of the IASLC/ATS/ERS adenocarcinoma classification and a strict definition of large cell carcinoma limited to surgical resection specimens only. 1,2 Tumors that show unequivocal morphology of adenocarcinoma or squamous cell carcinoma on a small specimen should be diagnosed without immunohistochemistry. Immunohistochemical work up of poorly differentiated tumors should be limited to TTF-1and p40/p63, while neuroendocrine markers should be used only if morphologically indicated. This approach should reduce the diagnosis of NSCC, NOS to less than 5% and preserve tissue for molecular testing. 1,2 Major changes in the adenocarcinoma classification for resected specimens include addition of adenocarcinoma in situ (AIS) to preinvasive group that already includes atypical adenomatous hyperplasia. Minimally invasive adenocarcinoma (MIA) defined as a solitary, lepidic predominant adenocarcinoma presenting measuring in gross size 3 cm or less and with invasion of ≤ 5 mm was added as a new category. These tumors are also recognized by the 8th edition of the AJCC staging of lung cancer and include Tis(adenocarcinoma) and T1a-mi. T stage of non-mucinous lepidic predominant adenocarcinomas is based on the microscopic size of invasion, but gross size should be recorded in the pathology reports. Multifocal ground glass opacities/lung nodules most frequently present as MIAs and should be classified by the T category of the lesion with the highest T along with the number of lesions (#) or simply (m) for multiple indicated in parentheses, and with a single N and M category that applies to all of the multiple tumor foci. This approach should be applied to grossly or microscopically identified lesions occurring in the same or in different ipsilateral or contralateral lobes.3 For non-lepidic adenocarcinoma T stage is determined by gross size in 1.0 cm increments as each size subgroup carries prognostic significance. Former mucinous BAC are reclassified as invasive mucinous adenocarcinoma, excluding tumors that meet criteria for AIS or MIA. Signet ring and clear cell carcinomas are considered to represent cytologic variants rather than specific subtypes. Invasive adenocarcinomas should be subtyped by semi-quantitatively estimating the percentage of the various subtypes in 5% increments. 1,2 Reproducibility for lung adenocarcinoma predominant subtypes among pulmonary pathologists was good to moderate (κ-values 0.44 to 0.72).4 For untrained pathologists, κ-values were lower ranging from 0.38 to 0.47, but these improved after a training session and particularly for individual reviewer. 5 The 2015 WHO classification defines large cell carcinomas based on morphology, as carcinomas without morphologic evidence of glandular, squamous or neuroendocrine differentiation, and also based on null immunophenotype and genotype. 1This change in definition reflect what was already happening in the pathology practice. According to National Cancer Institute (NCI) Surveillance Epidemiology and End Results registry the diagnosis of large cell carcinoma started to decline about the time that TTF-1 was introduced into clinical diagnosis. 6 Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart. Lyon: International Agency for Research on Cancer, 2015. Travis WD. Et al. The 2015 World Health Organization Classification of Lung Tumors Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol 2015; 10 (9); 1243-1260 Frank C. Detterbeck, MD et al. The IASLC Lung Cancer Staging Project: Summary of Proposals for Revisions of the Classification of Lung Cancers with Multiple Pulmonary Sites of Involvement in the Forthcoming Eighth Edition of the TNM Classification . J Thorac Oncol 2016;11(5): 639-650 Thunnissen E, Beasley MB, Borczuk AC, et al. Reproducibility of histopathological subtypes and invasion in pulmonary adenocarcinoma. An international interobserver study. Mod Pathol 2012;25:1574–1583. Warth A, Cortis J, Fink L, et al.; Pulmonary Pathology Working Group of the German Society of Pathology. Training increases concordance in classifying pulmonary adenocarcinomas according to the novel IASLC/ ATS/ERS classification. Virchows Arch 2012;461:185–193. Lewis DR, Check DP, Caporaso NE, Travis WD, Devesa SS. US lung cancer trends by histologic type. Cancer 2014;120:2883–2892. lung carcinoma- WHO classification- staging

Minimally invasive vs open nephrectomy in the modern era: does approach matter?

To evaluate if the widespread adoption of a minimally invasive approach to radical nephrectomy has affected short- and long-term patient outcomes in the modern era. A retrospective cohort study of patients who underwent radical nephrectomy from 2001 to 2012 was conducted using the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) Program and Medicare insurance program database. Patients who underwent open surgery were compared to those who underwent minimally invasive surgery using propensity score matching. 10,739 (85.9%) underwent open surgery and 1776 (14.1%) underwent minimally invasive surgery. Minimally invasive surgery increased from 18.4% from 2001-2004 to 43.5% from 2009 to 2012. After median follow-up of 57.1months, minimally invasive radical nephrectomy conferred long-term oncologic efficacy in terms of overall (HR 0.84; 95% CI 0.75-0.95) survival and cancer-specific (HR 0.68; 95% CI 0.54-0.86) survival compared to open radical nephrectomy. Minimally invasive surgery was associated with lower risk of inpatient death [risk ratio (RR) 0.45 with 95% CI: (0.20-0.99), p=0.04], deep vein thrombosis [RR: 0.35 (0.18-0.69), p=0.002], respiratory complications [RR: 0.73 (0.60-0.89), p=0.001], infectious complications [RR: 0.35 (0.14-0.90), p=0.02], acute kidney injury [RR: 0.66 (0.52-0.84), p<0.001], sepsis [RR: 0.55 (0.31-0.98), p=0.04], prolonged length of stay (18.6 vs 30.0%, p<0.001), and ICU admission (19.7 vs 26.3%, p<0.001). Costs were similar between the two approaches (30-day costs $15,882 vs $15,564; p=0.70). After widespread adoption of minimally invasive approaches to radical nephrectomy across the United States, oncologic standards remain preserved with improved perioperative outcomes at no additional cost burden.

Colorectal cancer survivors’ surveillance patterns and experiences of care: A SEER-CAHPS study.

229 Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer, generally treated with surgical resection, followed by complex surveillance for recurrence. We examined associations between experiences of care and adherence to surveillance Medicare fee-for-service beneficiaries with a history of CRC. Methods: Using linked data from the National Cancer Institute Surveillance Epidemiology and End Results (SEER) cancer registry program, Medicare claims and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience surveys (SEER-CAHPS), we identified survivors ages 65+, diagnosed with local/regional first primary colorectal cancer 1999-2009 who underwent surgical resection and completed CAHPS survey within 36 months of diagnosis. Adherence to guidelines for a three-year observation period was defined as receiving a colonoscopy; at least 2 carcinoembryonic antigen (CEA) tests; and more than 2 office visits and 1 computer tomography (CT) imaging test each year. We dichotomized CAHPS ratings into 9 or 10 out of 10 versus 0-9 for analysis (higher ratings mean better quality). Results: Most of the 314 participants reported ratings of 9 or 10 for overall care (55%), personal doctor (59%), and health plan (60%). Slightly less than half (47%) gave their specialist doctor ratings of 9 or 10. Adherence to surveillance was 76% for office visits, 36.9% for CEA testing, 48.1% for colonoscopy, and 10.3% for CT Imaging. Sixty-two percent of the sample were categorized as adherent (receiving ≥ 2 surveillance guidelines). In multivariable models, adherence to office visits was positively associated with ratings of personal doctor (OR = 2.0; 95% CI = 1.1, 3.5) and specialist doctor (OR = 2.7; 95% CI = 1.4, 4.9), and overall adherence was associated with ratings of personal doctor (OR = 2.1; 95% CI = 1.2, 3.6). Conclusions: Findings point to the important role of patient-provider relationships in adherence to CRC post-resection surveillance guidelines. As adherence to surveillance may increase survival among CRC survivors, further investigation is needed to identify specific components of this relationship, as well as other potential modifiable drivers of surveillance guidelines.

Changes in thyroid cancer incidence, post-2009 American Thyroid Association guidelines.

The thyroid cancer incidence rate has tripled in the United States since the 1980s, especially among women and small-sized tumors. This trend has been attributed to increased detection due to the availability of ultrasound and fine-needle aspiration technology. In 2009, the American Thyroid Association (ATA) released revisions to their guidelines for well-differentiated thyroid cancers. To examine trends in thyroid cancer incidence rates by tumor size and gender following the 2009 ATA guideline revisions. Cases of differentiated thyroid cancer diagnosed from 2000 to 2012 were analyzed from the National Cancer Institute Surveillance Epidemiology and End Results program, 18 registries. Trends in incidence rates based on gender (males, females) and tumor size (< 1.0 cm, 1.0-2.9 cm, 3.0-3.9 cm, ≥ 4.0 cm) were analyzed using Joinpoint Regression and reported as the annual percentage change (APC). From 2000 to 2009, overall thyroid cancer incidence rates increased rapidly by about 8% per year in both sexes. Incidence rates increased across all tumor sizes, but especially in tumors 1.0 to 2.9 cm (men, APC = 7.7; women, APC = 7.8) and < 1.0 cm (men, APC = 7.8; women = 10.9) for both genders. Since 2009, the trend slowed in men (APC = 3.0) and women (APC = 2.8). The deceleration among females was confined to tumors less than 2.9 cm. Trends for all size groups in males remained constant from 2000 to 2012. The rapid increase in thyroid cancer incidence rates over the past three decades has recently slowed, especially among small-sized cancers and women, which coincides with the 2009 ATA guideline revisions. 2c. Laryngoscope, 127:2437-2441, 2017.

Polycyclic aromatic hydrocarbons: determinants of residential carpet dust levels and risk of non-Hodgkin lymphoma.

To investigate the risk of non-Hodgkin lymphoma (NHL) associated with residential carpet dust measurements of polycyclic aromatic hydrocarbons (PAHs). We evaluated the relationship between residential carpet dust PAH concentrations (benz(a)anthracene, benzo(a)pyrene, benzo(b)fluoranthene, benzo(k)fluoranthene, chrysene, dibenz(a,h)anthracene, and indeno(1,2,3-c,d)pyrene, and their sum) and risk of NHL (676 cases, 511 controls) in the National Cancer Institute Surveillance Epidemiology and End Results multicenter case-control study. As a secondary aim, we investigated determinants of dust PAH concentrations. We computed odds ratios (OR) and 95 % confidence interval (CI) for associations between NHL and concentrations of individual and summed PAHs using unconditional logistic regression, adjusting for age, gender, and study center. Determinants of natural log-transformed PAHs were investigated using multivariate least-squares regression. We observed some elevated risks for NHL overall and B cell lymphoma subtypes in association with quartiles or tertiles of PAH concentrations, but without a monotonic trend, and there was no association comparing the highest quartile or tertile to the lowest. In contrast, risk of T cell lymphoma was significantly increased among participants with the highest tertile of summed PAHs (OR = 3.04; 95 % CI, 1.09-8.47) and benzo(k)fluoranthene (OR = 3.20; 95 % CI, 1.13-9.11) compared with the lowest tertile. Predictors of PAH dust concentrations in homes included ambient air PAH concentrations and the proportion of developed land within 2 km of a residence. Older age, more years of education, and white race were also predictive of higher levels in homes. Our results suggest a potential link between PAH exposure and risk of T cell lymphoma and demonstrate the importance of analyzing risk by NHL histologic type.

Assessment of weighted quantile sum regression for modeling chemical mixtures and cancer risk.

In evaluation of cancer risk related to environmental chemical exposures, the effect of many chemicals on disease is ultimately of interest. However, because of potentially strong correlations among chemicals that occur together, traditional regression methods suffer from collinearity effects, including regression coefficient sign reversal and variance inflation. In addition, penalized regression methods designed to remediate collinearity may have limitations in selecting the truly bad actors among many correlated components. The recently proposed method of weighted quantile sum (WQS) regression attempts to overcome these problems by estimating a body burden index, which identifies important chemicals in a mixture of correlated environmental chemicals. Our focus was on assessing through simulation studies the accuracy of WQS regression in detecting subsets of chemicals associated with health outcomes (binary and continuous) in site-specific analyses and in non-site-specific analyses. We also evaluated the performance of the penalized regression methods of lasso, adaptive lasso, and elastic net in correctly classifying chemicals as bad actors or unrelated to the outcome. We based the simulation study on data from the National Cancer Institute Surveillance Epidemiology and End Results Program (NCI-SEER) case–control study of non-Hodgkin lymphoma (NHL) to achieve realistic exposure situations. Our results showed that WQS regression had good sensitivity and specificity across a variety of conditions considered in this study. The shrinkage methods had a tendency to incorrectly identify a large number of components, especially in the case of strong association with the outcome.

Second primary cancer risk - the impact of applying different definitions of multiple primaries: results from a retrospective population-based cancer registry study.

BackgroundThere is evidence that cancer survivors are at increased risk of second primary cancers. Changes in the prevalence of risk factors and diagnostic techniques may have affected more recent risks.MethodsWe examined the incidence of second primary cancer among adults in the West of Scotland, UK, diagnosed with cancer between 2000 and 2004 (n = 57,393). We used National Cancer Institute Surveillance Epidemiology and End Results and International Agency for Research on Cancer definitions of multiple primary cancers and estimated indirectly standardised incidence ratios (SIR) with 95% confidence intervals (CI).ResultsThere was a high incidence of cancer during the first 60 days following diagnosis (SIR = 2.36, 95% CI = 2.12 to 2.63). When this period was excluded the risk was not raised, but it was high for some patient groups; in particular women aged <50 years with breast cancer (SIR = 2.13, 95% CI = 1.58 to 2.78), patients with bladder (SIR = 1.41, 95% CI = 1.19 to 1.67) and head & neck (SIR = 1.93, 95% CI = 1.67 to 2.21) cancer. Head & neck cancer patients had increased risks of lung cancer (SIR = 3.75, 95% CI = 3.01 to 4.62), oesophageal (SIR = 4.62, 95% CI = 2.73 to 7.29) and other head & neck tumours (SIR = 6.10, 95% CI = 4.17 to 8.61). Patients with bladder cancer had raised risks of lung (SIR = 2.18, 95% CI = 1.62 to 2.88) and prostate (SIR = 2.41, 95% CI = 1.72 to 3.30) cancer.ConclusionsRelative risks of second primary cancers may be smaller than previously reported. Premenopausal women with breast cancer and patients with malignant melanomas, bladder and head & neck cancers may benefit from increased surveillance and advice to avoid known risk factors.

Malignant head and neck paragangliomas: Treatment efficacy and prognostic indicators

PurposeMalignant head and neck paragangliomas (MHNPs) are rare and occur in 6%–19% of all HNPs. We sought to identify predictors of survival and compare efficacy of treatment modalities to inform management of this rare disease. Materials and methodsWe performed a retrospective cohort study of MHNP cases in the National Cancer Institute Surveillance Epidemiology and End Results database (SEER) from 1973 to 2009. We identified 86 patients with MHNP who had documented regional or distant tumor spread with a median follow-up of 74months. We used Cox proportional hazard models to assess the significance of demographic factors and treatment on five-year overall survival. ResultsThe most common treatment was surgery alone (36.0 %), followed by surgery with adjuvant radiation (33.7%). Five-year overall survival was 88.1% for surgery alone and 66.5% for adjuvant radiation (p=0.2251). In univariate analysis, regional (vs. distant) spread (HR 0.23, p<0.0001), surgery alone (HR 0.29, p<0.0001) and primary site in the carotid body (HR 0.32, p=0.006) conferred significant survival advantage whereas age>50 (HR 4.04, p<0.0001) worsened survival. Regional (vs. distant) spread (HR 0.42, p=0.046) and age>50 (HR 2.98, p=0.005) remained significant in multivariate analysis. In patients with regional-only disease, five-year overall survival was 95.4% for surgery alone compared to 75.6% for surgery with radiation (p=0.1055). ConclusionsThis is the largest and most contemporary series of MHNP patients. Age and tumor stage are significant factors in predicting survival. Surgical resection significantly improves survival outcomes. From this analysis, the value of adjuvant radiation is not clear.

Residential proximity to industrial combustion facilities and risk of non-Hodgkin lymphoma: a case-control study.

BackgroundResidence near municipal solid waste incinerators, a major historical source of dioxin emissions, has been associated with increased risk of non-Hodgkin lymphoma (NHL) in European studies. The aim of our study was to evaluate residence near industrial combustion facilities and estimates of dioxin emissions in relation to NHL risk in the United States.MethodsWe conducted a population-based case–control study of NHL (1998–2000) in four National Cancer Institute-Surveillance Epidemiology and End Results centers (Detroit, Iowa, Los Angeles, Seattle). Residential histories 15 years before diagnosis (similar date for controls) were linked to an Environmental Protection Agency database of dioxin-emitting facilities for 969 cases and 749 controls. We evaluated proximity (3 and 5 km) to 10 facility types that accounted for >85% of U.S. emissions and a distance-weighted average emission index (AEI [ng toxic equivalency quotient (TEQ)/year]).ResultsProximity to any dioxin-emitting facility was not associated with NHL risk (3 km OR = 1.0, 95% CI 0.8-1.3). Risk was elevated for residence near cement kilns (5 km OR = 1.7, 95% CI 0.8-3.3; 3 km OR = 3.8, 95% CI 1.1-14.0) and reduced for residence near municipal solid waste incinerators (5 km OR = 0.5, 95% CI 0.3-0.9; 3 km OR = 0.3, 95% CI 0.1-1.4). The AEI was not associated with risk of NHL overall. Risk for marginal zone lymphoma was increased for the highest versus lowest quartile (5 km OR = 2.6, 95% CI 1.0-6.8; 3 km OR = 3.0, 95% CI 1.1-8.3).ConclusionsOverall, we found no association with residential exposure to dioxins and NHL risk. However, findings for high emissions and marginal zone lymphoma and for specific facility types and all NHL provide some evidence of an association and deserve future study.

Chronic Kidney Disease After Nephrectomy in Patients with Small Renal Masses: A Retrospective Observational Analysis

ContextChronic kidney disease (CKD) is a worldwide health threat associated with increased cardiovascular disease and mortality. ObjectiveTo examine postoperative CKD in patients with small renal masses (SRMs) treated with partial nephrectomy (PN) or radical nephrectomy (RN). Design, setting, and participantsA US National Cancer Institute Surveillance Epidemiology and End Results (SEER)–Medicare-linked retrospective cohort of 4633 T1aN0M0 renal cell carcinoma (RCC) patients who underwent PN or RN. Outcome measurements and statistical analysisThe primary outcome of interest was the onset of CKD stage ≥3. Secondary end points comprised acute renal failure (ARF), chronic renal insufficiency (CRI), anemia in CKD, and end-stage renal disease (ESRD). Kaplan-Meier and Cox regression analyses were performed. Results and limitationsPostpropensity matching resulted in 840 RN and PN patients. In multivariable analyses, RN patients were 1.9-, 1.4-, 1.8-, and 1.8-fold more likely to have an occurrence of CKD, ARF, CRI, and anemia in CKD, respectively (all p ≤ 0.004). The risk of ESRD between treatment groups failed to achieve statistical significance (p=0.06). ConclusionsPN is associated with more favorable postoperative renal function outcomes relative to RN in the setting of SRMs.