Nationwide Cancer Registry Research Articles

Trends in cancer burden in Pakistan: A 30-year analysis from the global burden of disease study (1990-2019).

e22541 Background: Cancer is a leading cause of mortality worldwide, with significant regional disparities in its burden. In Pakistan, the sixth most populous country, cancer contributes significantly to the healthcare burden, yet comprehensive epidemiological studies are limited. Methods: A population-based analysis was conducted using GBD 2019 data. This study aimed to analyze trends in cancer incidence, mortality, and disability-adjusted life years (DALYs) in Pakistan from 1990 to 2019, using data from the GBD study. Cancer metrics, including incidence, mortality, and DALYs, were extracted and stratified by age, gender, cancer type, and geographic region. Annual average percent changes (AAPC) were calculated to evaluate temporal trends. Results: Total cancer incidence increased from 1.28 million cases (1990) to 2.77 million cases (2019), with an annual average percent change (AAPC) of 0.11%. Pancreatic cancer exhibited the highest growth (AAPC: 3.39%). Mortality rose from 73,424 deaths (ASR: 122.16) to 179,773 deaths (ASR: 153.52) (AAPC: 0.79%), and DALYs increased from 2.41 million (ASR: 3,363.75) to 6.27 million (ASR: 3,439.9) (AAPC: 0.85%). Breast cancer remained the leading contributor to the disease burden, accounting for 51,438 cases, 32,118 deaths, and 1.12 million DALYs in 2019. Pancreatic cancer showed the highest growth in incidence (AAPC: 3.39%), while ovarian cancer exhibited the largest increases in mortality (AAPC: 3.16%) and DALYs (AAPC: 5.85%). Punjab reported the highest burden, with 1.49 million cases in 2019. Female cancer incidence and mortality consistently exceeded male figures, with an AAPC of 0.15% in incidence and 1.07% in mortality. Age-specific analyses revealed that leukemia was the leading cancer in children aged 0–14, while lung cancer dominated among males over 50 years. Conclusions: The rising cancer burden in Pakistan underscores the need for a robust, nationwide cancer registry and targeted interventions. Public health policies must address risk factors such as smoking, hepatitis infections, and socio-economic disparities to curb this escalating crisis.

Trends in Surgical Overtreatment of Prostate Cancer

Overtreatment of prostate cancer is a public health concern that undermines prostate cancer screening efforts. To assess trends in pathologic grade on prostatectomy during the past 2 decades as a surrogate for overtreatment. This retrospective cohort study examined the grade of prostate cancer on final pathology reports among patients undergoing prostatectomy between January 1, 2010, and September 1, 2024, in 2 parallel cohorts: Surveillance, Epidemiology, and End Results (SEER), a nationwide cancer registry, and Michigan Urological Surgery Improvement Collaborative (MUSIC), a statewide clinical registry. The presence of higher-risk features among patients who underwent grade group 1 prostatectomy during this period was also assessed. The primary exposure of interest was year of radical prostatectomy. The primary outcome was the proportion of all prostatectomies that were pathologic grade group 1 (pGG1) on final pathology reports. The secondary outcome was the proportion of pGG1 prostatectomies with a higher-risk preoperative feature, assessed as a binary variable and including at least 1 of the following: more than 50% of biopsy cores positive, prostate-specific antigen of 10 ng/mL or higher, or grade group 2 on biopsy. A total of 162 558 male patients in SEER (median [IQR] age, 63 [57-67] years) and 23 370 in MUSIC (median [IQR] age, 64 [59-69] years) underwent prostatectomy. The proportion of radical prostatectomies resulting in pGG1 on final pathology reports decreased from 32.4% (5852 of 18 071) to 7.8% (978 of 12 500) between 2010 and 2020 in SEER and from 20.7% (83 of 401) to 2.7% (32 of 1192) between 2012 and 2024 in MUSIC. A more recent prostatectomy was associated with a lower likelihood of a pGG1 prostatectomy while controlling for age and race within SEER (odds ratio [OR] per 5 years, 0.41; 95% CI, 0.40-0.42; P < .001) and MUSIC (OR per 5 years, 0.39; 95% CI, 0.36-0.43; P < .001). Within a subset analysis of those prostatectomies that were final pGG1, a more recent prostatectomy was associated with the presence of a higher-risk preoperative feature, including more than 50% of biopsy cores positive, prostate-specific antigen of 10 ng/mL or higher, and grade group 2 on prior biopsy within SEER (OR per 5 years, 1.60; 95% CI, 1.54-1.67; P < .001) and MUSIC (OR per 5 years, 1.60; 95% CI, 1.34-1.90; P < .001). This cohort study found that since 2010, the frequency of pGG1 prostatectomies markedly decreased, and those few that were performed were more likely to have a higher-risk feature. This reduction in the proportion of prostatectomies that are pGG1 likely reflects improved diagnostic pathways, adherence to active surveillance protocols for low-risk cases, and ongoing efforts at both the state and national levels to minimize unnecessary surgical interventions in patients diagnosed with clinically insignificant prostate cancer.

Abstract 2332: Ductal carcinoma in situ: Potential to metastasize? A nationwide cancer registry-based study

Abstract Background: The current clinical paradigm around Ductal Carcinoma in Situ (DCIS) is that it consists of malignant cells confined to the breast ducts, and therefore cannot metastasize. Nonetheless, several studies have reported DCIS with metastasis in the sentinel lymph node (SN+). For accurate risk communication and management, we aimed to assess to what extent registered “metastatic spread” in DCIS could be explained by limitations in registration or missed invasive breast cancer at time of diagnosis. Methods: Data from the nationwide cancer registry and national pathology database on women diagnosed with DCIS SN+ in the Netherlands, spanning from 2005 to 2020, was curated and reviewed, taking into account their histories of prior DCIS, invasive breast cancer, or other malignancies. Cases were excluded from further analysis if pathology data indicated registration errors, DCIS mixed with other lesion types, or diagnostic uncertainties. Next, hematoxylin and eosin-stained tissue slides of eligible DCIS SN+ cases were independently reviewed by two pathologists to assess the presence of invasive breast cancer and SN status. Additional immunohistochemical staining (CK 5/6 or CK 8/18) was performed when findings were unclear. Inter-observer agreement was evaluated using the linearly weighted Kappa statistic. Results: A total of 30, 863 patients were identified with a DCIS diagnosis between 2005 and 2020, of which 16, 070 (52%) underwent SN biopsy according to cancer registry data. SN+ was registered in 454 (3 %) patients: 47 (10%) had macrometastases (&amp;gt;2 mm), 78 (17%) had micrometastases (&amp;gt;0.2 to &amp;lt;= 2 mm), and 329 (73%) were positive for isolated tumor cells (&amp;lt;= 0.2 mm). Out of the 454 registered DCIS SN+ cases, 273 (60%) were excluded from further investigation based on pathology data, including registration errors (n=44), DCIS mixed with other lesions (n=147), and diagnostic uncertainties (n=82). Tissue material of 46 (37%) out of 125 registered cases with macro- and micrometastases was reviewed. Observer variability in assessing the presence of invasive breast cancer was high (k= 0.14; 95% CI 0.08 - 0.34; p = 0.12) and additional CK 5/6 staining was requested for 38 cases. Two cases were classified as primary invasive breast cancer, 25 as pure DCIS, while 19 remained inconclusive, due to variation in tissue sections or suboptimal tissue quality. In six cases the SN was scored as negative by pathology revision, likely due to tissue section variability. Conclusions: Our study indicates that DCIS in itself has minimal to no metastatic potential. Ongoing clonality analysis of 9 cases with macrometastases aims to determine whether the SN metastases are clonally related to the DCIS lesions. Citation Format: Merle van Leeuwen, Sandra van den Belt- Dusebout, Petra Kristel, Lennart Mulder, Joyce Sanders, Carmen Vlahu, Esther H. Lips, Jelle Wesseling. Ductal carcinoma in situ: Potential to metastasize? A nationwide cancer registry-based study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2332.

Development of radiomics-based models on mammograms with mass lesions to predict prognostically relevant characteristics of invasive breast cancer in a screening cohort.

Optimizing breast-screening performance involves minimizing overdiagnosis of prognostically favorable invasive breast cancer (IBC) that does not need immediate recall and underdiagnosis of prognostically unfavorable IBC that is not recalled timely. We investigated whether mammographic features of masses predict prognostically relevant IBC characteristics. In a screening cohort, we obtained pathological information of 1587 IBCs presenting as a mass through the nationwide cancer registry and pathology databank. We developed models based on mammographic tumor appearance to predict whether IBC was prognostically favorable (T1N0M0 luminal A-like) or unfavorable. Models were based on 1095 positive screening mammograms (possible overdiagnosis), or on 603 last negative mammograms with in retrospect visible masses (possible underdiagnosis). We calculated performance metrics using cross-validation. 23.5% of masses were prognostically favorable IBC. Using 1095 positive mammograms, the model's predictions to have prognostically favorable IBC (10th-90th percentile range 8.7-47.0%) yielded AUC 0.75 (SD across repeats 0.01), slope 1.16 (SD 0.07). Performance in 603 last negative screening mammograms with masses was poor: AUC 0.60 (SD 0.02), slope 0.85 (SD 0.28). Mammography-based models from masses representing IBC at time of recall (possible overdiagnosis) predict prognostically relevant characteristics of IBC. Models based on in retrospect visible masses (possible underdiagnosis) performed poorly.

Development and validation of a dynamic prognostic nomogram for conditional survival in hepatocellular carcinoma: an analysis from the Korea Liver Cancer Registry

Compared to overall survival, conditional survival is a more relevant measure of prognosis in surviving patients over time. This study developed and validated a nomogram-based dynamic prognostic model to predict the conditional survival estimates of patients with hepatocellular carcinoma (HCC) through an analysis of a nationwide cancer registry. This retrospective cohort study included 2492 patients with HCC registered in the Korea Liver Cancer Registry. Patients underwent hepatic resection (HR) from 2008 to 2017, were followed up until December 2019, and were divided into development and validation cohorts. Univariate and multivariate Cox regression analyses were conducted to determine the risk factors for conditional survival of patients who underwent HR. The patients were scored based on the Cox regression coefficients; the nomogram was predicted by calculating the survival probability with Cox model. Our dynamic prognostic model nomogram for predicting conditional overall survival demonstrated Harrell’s C-index of 0.622 and 0.674 in the development and validation sets; for conditional disease-specific survival, it was 0.623 and 0.686 in the development and validation sets. The prediction power of the model is applicable in clinical practice. Factors incorporated in our nomogram included age, albumin, the ADV score, lymph node metastasis, and T stage in American Joint Commission on Cancer staging system. We developed and validated a nomogram to predict conditional survival estimates for overall survival and disease-specific survival. The proposed nomogram incorporating the ADV score presents a more accurate and useful prognostic prediction for patients with HCC who received HR.

Hepatocellular carcinoma in Korea: an analysis of the 2016-2018 Korean Nationwide Cancer Registry.

Hepatocellular carcinoma (HCC) is the sixth most common cancer and second leading cause of cancer-related deaths in South Korea. This study evaluated the characteristics of Korean patients newly diagnosed with HCC in 2016-2018. Data from the Korean Primary Liver Cancer Registry (KPLCR), a representative database of patients newly diagnosed with HCC in South Korea, were analyzed. This study investigated 4,462 patients with HCC registered in the KPLCR in 2016-2018. The median patient age was 63 years (interquartile range, 55-72). 79.7% of patients were male. Hepatitis B infection was the most common underlying liver disease (54.5%). The Barcelona Clinic Liver Cancer (BCLC) staging system classified patients as follows: stage 0 (14.9%), A (28.8%), B (7.5%), C (39.0%), and D (9.8%). The median overall survival was 3.72 years (95% confidence interval, 3.47-4.14), with 1-, 3-, and 5-year overall survival rates of 71.3%, 54.1%, and 44.3%, respectively. In 2016-2018, there was a significant shift toward BCLC stage 0-A and Child-Turcotte-Pugh liver function class A (P<0.05), although survival rates did not differ by diagnosis year. In the treatment group (n=4,389), the most common initial treatments were transarterial therapy (31.7%), surgical resection (24.9%), best supportive care (18.9%), and local ablation therapy (10.5%). Between 2016 and 2018, HCC tended to be diagnosed at earlier stages, with better liver function in later years. However, since approximately half of the patients remained diagnosed at an advanced stage, more rigorous and optimized HCC screening strategies should be implemented.

121P Comprehensive cancer genome profiling as supportive tool for treatment decision-making in patients with metastatic solid tumors: Real-world evidence-based meta-analysis and nationwide cancer registry data implementation

121P Comprehensive cancer genome profiling as supportive tool for treatment decision-making in patients with metastatic solid tumors: Real-world evidence-based meta-analysis and nationwide cancer registry data implementation

Survival improvements in esophageal and gastric cancers in the Nordic countries favor younger patients.

Esophageal cancer (EC) and gastric cancer (GC) are fatal cancers with a relatively late age of onset. Age is a negative risk factor for survival in many cancers and our aim was to analyze age-specific survival in EC and GC using the recently updated NORDCAN database. NORDCAN data originate from the Danish, Finnish, Norwegian, and Swedish nationwide cancer registries covering years 1972 through 2021 inviting for comparison of 50-year survival trends between the countries. Relative 1- and 5-year survival and 5/1-year conditional survival (i.e., survival in those who were alive in Year 1 to survive additional 4 years) were analyzed. Survival in EC showed large gains for patients below age 80 years, 5-year survival in Norwegian men reaching 30% and in women over 30% but for 80-89 year old survival remained at 10%. In contrast, hardly any gain was seen among the 80-89 year patients for 1-year survival and small gains in 5 year and 5/1-year survival. Survival gaps between age-groups increased over time. For GC there was also a clear age-related negative survival gradient but the survival gaps between the age groups did not widen over time; Norwegian male and female 5-year survival for 80-89 year old was about 20%. The age-specific survival difference in GC arose in Year 1 and did not essentially increase in 5-year survival. While there were differences in survival improvements between the countries, poor survival of the 80-89 year old patients was shared by all of them. To conclude, survival has improved steadily in younger GC and EC patients in most Nordic countries. While the 80-89 year old population accounts for nearly a quarter of all patients and their poor survival depressed overall survival, which can therefore be increased further by improving diagnostics, treatment and care of elderly EC and GC patients.

Higher relative survival in breast cancer patients treated in certified and high-volume breast cancer centres – A population-based study in Belgium

Higher relative survival in breast cancer patients treated in certified and high-volume breast cancer centres – A population-based study in Belgium

Natural Language Processing Algorithm to Extract Multiple Myeloma Stage From Oncology Notes in the Veterans Affairs Healthcare System.

Stage in multiple myeloma (MM) is an essential measure of disease risk, but its measurement in large databases is often lacking. We aimed to develop and validate a natural language processing (NLP) algorithm to extract oncologists' documentation of stage in the national Veterans Affairs (VA) Healthcare System. Using nationwide electronic health record (EHR) and cancer registry data from the VA Corporate Data Warehouse, we developed and validated a rule-based NLP algorithm to extract oncologist-determined MM stage. To that end, a clinician annotated MM stage within over 5,000 short snippets of clinical notes, and annotated MM stage at MM treatment initiation for 200 patients. These were allocated into snippet- and patient-level development and validation sets. We developed MM stage extraction and roll-up algorithms within the development sets. After the algorithms were finalized, we validated them using standard measures in held-out validation sets. We developed algorithms for three different MM staging systems that have been in widespread use (Revised International Staging System [R-ISS], International Staging System [ISS], and Durie-Salmon [DS]) and for stage reported without a clearly defined system. Precision and recall were uniformly high for MM stage at the snippet level, ranging from 0.92 to 0.99 for the different MM staging systems. Performance in identifying for MM stage at treatment initiation at the patient level was also excellent, with precision of 0.92, 0.96, 0.90, and 0.86 and recall of 0.99, 0.98, 0.94, and 0.92 for R-ISS, ISS, DS, and unclear stage, respectively. Our MM stage extraction algorithm uses rule-based NLP and data aggregation to accurately measure MM stage documented in oncology notes and pathology reports in VA's national EHR system. It may be adapted to other systems where MM stage is recorded in clinical notes.

Disease relapse in relation to lymph node sampling in lung carcinoid patients.

The predictive value of the extent of peri-operative lymph node (LN) sampling in relation to disease relapse in patients with pulmonary carcinoid (PC) is unknown. Furthermore, post-surgery follow-up recommendations rely on institutional retrospective studies with short follow-ups. We aimed to address these shortcomings by examining the relation between LN sampling and relapse in a population-based cohort with long-term follow-up. By combining the Dutch nationwide pathology and cancer registries, all patients with surgically resected PC (2003-2012) were included in this analysis (last update 2020). The extent of surgical LN dissection was scored for the number of LN samples, location (hilar/mediastinal), and completeness of resection according to European Society of Thoracic Surgeons (ESTS) guidelines. Relapse-free interval (RFI) was evaluated using Kaplan Meier and multivariate regression analysis. 662 patients were included. The median follow-up was 87.5 months. Relapse occurred in 10% of patients, mostly liver (51.8%) and locoregional sites (45%). The median RFI was 48.1 months (95% CI 36.8-59.4). Poor prognostic factors were atypical carcinoid, pN1/2, and R1/R2 resection. In 546 patients LN dissection data could be retrieved; at least one N2 LN was examined in 44% and completeness according to ESTS in merely 7%. In 477 cN0 patients, 5.9% had pN1 and 2.5% had pN2 disease. In conclusion, relapse occurred in 10% of PC patients with a median RFI of 48.1 months thereby underscoring the necessity of long-term follow-up. Extended mediastinal LN sampling was rarely performed but systematic nodal evaluation is recommended as it provides prognostic information on distant relapse.

Temporal trends of cancer incidence rates for the most frequent cancer sites in Cyprus (2004-2017).

Cancer is one of the leading causes of morbidity and mortality, worldwide. Little information is available for the temporal trends of cancer in the Mediterranean region, including Cyprus. We aimed to analyze cancer incidence trends overall and by sex for the period 2004-2017 regarding the five most common cancer sites for the population of Cyprus. Data were obtained from the nationwide cancer registry dataset that included 27 017 total cancer cases in Cyprus (2004-2017). We estimated the crude, sex-, and age-specific, as well as age-standardized (ASR) cancer incidence rates and we analyzed the time trends of ASR using the joinpoint regression program. For the general population (0-85+ years of age), the most common cancer sites in descending order, were breast, prostate, lung, colorectal, and thyroid cancer. During the study period, breast and thyroid cancer ASR presented a significant (p < .05) increasing temporal trend. Lung cancer ASRs seemed to stabilize (no increase or decrease) during the more recent years (2009 onwards) for both sexes; a similar pattern was observed for colorectal cancer in males. The ASRs of prostate cancer in men were in steady decline from 2012 onwards and the same was observed for the female ASRs of colorectal cancer from 2007 onwards. The colorectal cancer ASR temporal patterns overall, during the whole study period appeared unchanged. This temporal analysis would feed into cancer surveillance and control programs that focus on prevention, early detection, and treatment, particularly for cancer sites of higher mortality rates or those with temporally increasing trends.

Proton pump inhibitors are detrimental to overall survival of patients with glioblastoma: Results from a nationwide real-world evidence database.

Proton pump inhibitors (PPIs) are often prescribed to manage corticosteroid-induced gastrointestinal toxicity during glioblastoma (GBM) treatment, but were recently identified as strong inducers of aldehyde dehydrogenase-1A1 (ALDH1A1). ALDH1A1 is a primary metabolic enzyme impacting the outcome of chemotherapy, including temozolomide. High expression of ALDH1A1 is associated with poor prognosis in multiple cancers, suggesting PPIs may have a negative impact on survival. Real-world data on GBM patients was annotated from electronic medical records (EMR) according to the prospective observational study, XCELSIOR (NCT03793088). Patients with known IDH1/2 mutations were excluded. Causal effects on survival were analyzed using a multivariate, time-varying Cox Proportional Hazard (CPH) model with stratifications including MGMT methylation status, age, sex, duration of corticosteroid use, extent of resection, starting standard-of-care, and PPI use. EMR data from 554 GBM patients across 225 cancer centers was collected, with 72% of patients receiving care from academic medical centers. Patients treated with PPIs (51%) had numerically lower median overall survival (mOS) and 2-year OS rates in the total population and across most strata, with the greatest difference for MGMT-methylated patients (mOS 29.2 vs. 40.1 months). In a time-varying multivariate CPH analysis of the above strata, PPIs caused an adverse effect on survival (HR 1.67 [95% CI: 1.15-2.44], P = .007). Evidence from a nationwide cancer registry has suggested PPIs have a negative impact on OS for GBM patients, particularly those with MGMT promoter methylation. This suggests PPIs should be avoided for prophylactic management of gastrointestinal toxicity in patients with GBM receiving chemoradiotherapy.

Abstract 4839: Ethnicity dictates survival benefit in Hispanics diagnosed with diffuse large B-Cell lymphoma survival: A national cancer database analysis

Abstract Background: Diffuse Large B-Cell Lymphoma (DLBCL) is the most common Non-Hodgkin lymphoma in the United States (US) but there is limited evidence showing ethnic disparities affecting overall survival (OS) (Blood10.1182/blood-2022-159201, Blood10.1182/blood-2021-151816). This is the largest nationwide cancer registry analysis evaluating ethnic differences for HI vs Non-Hispanics (NH) with DLBCL in the US. Methods: Data were analyzed using the National Cancer Database from 2004-2019. Sociodemographic characteristics were compared between ethnic groups. Kaplan-Meier and Cox regression analyses were used to compare OS between HI and NH. Multivariate analysis and propensity score matching were performed with adjustment for age, stage, comorbidity score, and insurance status, type of facility, and great circle distance Results: 239,391 patients (HI n=18,290, NH n=221,101) were diagnosed with DLBCL. Male sex predominated for both and the majority of patients were Whites. HI were diagnosed at a median age of 62 years (y) vs 68 y for NH [p&amp;lt;0.001]. For HI and NH, most of the patients were diagnosed from 2016-2019. For both groups, the majority of patients had a Charlson-Deyo Score of 0, stage IV at diagnosis and unknown HIV status. The primary payer at diagnosis was government sponsored for HI and NH. In HI the median income based on the Median Income Quartile for 2000 corresponded to the highest level of &amp;gt;$46,000 and from 2008-2012 it was similarly distributed. For NH, for both time periods the majority of the patient were in the highest bracket. Most patients in the HI and NH were located in metropolitan area and were more likely to be treated at a comprehensive cancer center with a great circle distance (miles) of 7.3 for HI and 9.7 for NH. The median survival for HI was 11 y vs 6.8 y for NH. The survival probability at 2, 5 and 10 y for HI corresponded to 69%, 61% and 52%, while for NH it was 66%, 55% and 41%, respectively. The OS probability at 10 y was statistically significant favoring HI [p&amp;lt;0.0001]. Independently, on multivariate analysis, not insured status was associated with worse OS (HR 1.2, CI 1.13-1.28, [p&amp;lt;0.01]) and private insurance type was associated with better OS (HR 0.81, CI 0.77-0.84, [p&amp;lt;0.01]) Conclusion: This nationwide cancer registry study identified better OS in HI diagnosed with DLBCL in the US. Both cohorts had similar sociodemographic and clinical results; however, HI were diagnosed at younger age. This finding may not only help to explain a unique trait towards development of cancer at an earlier age, but also an enhanced response to therapy. Regarding median income there wasn’t a tendency noted for HI, which support the unique complex interactions in socioeconomic status. Further studies examining intrinsic biologic differences are needed to better understand improved OS for HI, which could also help the rational development of targeted therapies. Citation Format: Carolina Velez-Mejia, Esteban Toro Velez, Daniel Rosas, Qianqian Liu, Joel E. Michalek, Enrique Diaz Duque. Ethnicity dictates survival benefit in Hispanics diagnosed with diffuse large B-Cell lymphoma survival: A national cancer database analysis [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 4839.

Penile cancer care in the Netherlands: increased incidence, centralisation, and improved survival.

To evaluate penile squamous cell carcinoma (PSCC) incidence and centralisation trends in the Netherlands over the past three decades, as well as the effect of centralisation of PSCC care on survival. In the Netherlands PSCC care is largely centralised in one national centre of expertise (Netherlands Cancer Institute [NCI], Amsterdam). For this study, the Netherlands Cancer Registry, an independent nationwide cancer registry, provided per-patient data on age, clinical and pathological tumour staging, follow-up, and vital status. Patients with treatment at the NCI were identified and compared to patients who were treated at all other centres. The age-standardised incidence rate was calculated with the European Standard Population. The probability of death due to PSCC was estimated using the relative survival. Multivariable Cox regression analysis was performed to evaluate predictors of survival. A total of 3160 patients were diagnosed with PSCC between 1990 and 2020, showing a rising incidence (P < 0.001). Annual caseload increased at the NCI (1% in 1990, 65% in 2020) and decreased at other (regional) centres (99% to 35%). Despite a relatively high percentage of patients with T2-4 (64%) and N+ (33%) at the NCI, the 5-year relative survival was higher (86%, 95% confidence interval [CI] 82-91%) compared to regional centres (76%, 95% CI 73-80%, P < 0.001). Patients with a pathological T2 tumour were treated with glans-sparing treatment more often at the reference centre than at the regional centres (16% vs 5.0%, P < 0.001). After adjusting for age, histological grading, T-stage, presence of lymph node involvement and year of diagnosis, treatment at regional centres remained a predictor for worse survival (hazard ratio 1.22, 95% CI 1.05-1.39; P = 0.006). The incidence of PSCC in the Netherlands has been gradually increasing over the past three decades, with a noticeable trend towards centralisation of PSCC care and improved relative survival rate.

Incidence and survival rates of primary cutaneous malignancies in Korea, 1999-2019: A nationwide population-based study.

Primary cutaneous malignancies are among the most commonly diagnosed types of cancer worldwide. We aimed to examine the incidence and 5-year survival rates of all types of primary cutaneous malignancies in the Korean population. Data from the Korean Nationwide Cancer Registry from 1999 to 2019 were analyzed. The crude incidence rates, age-standardized incidence rates, and 5-year relative survival rates of each type of skin cancer were calculated. A total of 89 965 patients were diagnosed with primary cutaneous malignancies, which was a 7-fold increase from 1999 to 2019. The age-standardized incidence rates increased 3.4-fold in basal cell carcinoma (3.7/100 000 person-years), 2.0-fold in squamous cell carcinoma (1.6/100 000 person-years), 12.0-fold in Bowen disease (1.2/100 000 person-years), and 1.8-fold in malignant melanoma (0.7/10 000 person-years) in 2019. Average annual percentage changes in age-standardized incidence rates were statistically significant in basal cell carcinoma (15.8%), Bowen disease (5.8%), squamous cell carcinoma (5.1%), malignant melanoma (1.2%), melanoma insitu (1.1%), dermatofibrosarcoma protuberans (1.2%), mycosis fungoides (0.5%), primary cutaneous CD30+ T-cell proliferations (0.5%), adnexal and skin appendage carcinoma (0.4%), extramammary Paget's disease (0.2%), and Merkel cell carcinoma (0.2%). The 5-year relative survival rates were the highest in basal cell carcinoma (103.3%), followed by dermatofibrosarcoma protuberans (99.7%) and mycosis fungoides (96.6%), and lowest in angiosarcoma (24.7%). The 5-year relative survival rates steadily increased in extramammary Paget's disease (23.6%), cutaneous B-cell lymphoma (21.3%), mycosis fungoides (20.2%), extranodal NK/T-cell lymphoma, nasal type (18.1%), and malignant melanoma (16.1%) from 1996-2000 to 2015-2019. Most primary cutaneous malignancies have increased in incidence and survival rates in the Korean population, but to varying extents depending on the type of skin cancer.

Survival benefit of surgery in elderly patients with locally advanced rectal cancer.

Neoadjuvant therapy followed by radical surgery is standard for locally advanced rectal cancer (LARC). However, compared to younger patients, elderly patients often had multiple commodities and may refuse surgery due to being medically unfit or the high risk of operative mortality. This study aims to explore the effects of surgery on short- and long-term mortality in elderly LARC patients using a nationwide cancer registry. The cohort included 6211 patients aged over 65, with 2556 matched through propensity scoring for comparison between surgery (N = 1704) and non-surgery (N = 852) groups. The Cox proportional hazard model compared mortality between these groups. Our results showed that the elderly LARC patients who underwent surgery were more likely to be younger (65-75 years), have clinically-positive lymph nodes, and no comorbidities. Surgery was associated with significantly lower 3-month, 6-month, and 5-year mortality rates, with a greater absolute survival benefit (adjusted hazard ratio [aHR], 4.78; 95% CI, 2.71-8.43; aHR, 4.50; 95% CI, 3.07-6.58 and aHR, 3.81; 95% CI, 3.21-4.51). In stratified analysis, surgery remains provide significantly survival benefit according different age, gender and clinical classification. Furthermore, among non-surgical patients, those receiving chemoradiation had better survival outcomes compared to those receiving radiation, chemotherapy, or no treatment (all P < 0.001). This study highlights the survival advantage of surgery in elderly LARC patients and offers valuable guidance for clinical decision-making.

Comparative survival analysis of bladder preservation therapy versus radical cystectomy in muscle-invasive bladder cancer.

Bladder preservation therapy is an alternative to radical cystectomy in patients with muscle-invasive bladder cancer (MIBC). The purpose of this study is to compare survival outcomes between bladder preservation therapy and radical cystectomy in MIBC patients using an Asian nationwide cancer registry database. From the Taiwan Cancer Registry database and the Taiwan National Health Insurance Research Database, we identified bladder cancer patients from 2008 to 2018. The patients with urothelial carcinoma and clinical stage T2-T4aN0-1 M0 were included. Propensity score matching by age, gender, clinical stage, cT classification, and Charlson Comorbidity Index score was used between those receiving bladder preservation therapy or radical cystectomy. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were compared using the Kaplan-Meier method. Multivariate Cox regression models were used to determine the predictive factors of OS, CSS, and DFS. Following the propensity score matching, 393 MIBC patients were analyzed, 131 (33.3%) receiving bladder preservation therapy and 262 (66.7%) receiving radical cystectomy. After 5 years of the follow-up period the overall duration was with a median of 15.6 months. The treatment groups did not differ significantly in OS, CSS, and DFS (p = 0.2681, 0.7208, and 0.3616, respectively). In multivariable Cox regression models, bladder preservation therapy remained non-inferior to radical cystectomy in OS (adjusted hazard ratio [aHR] 1.08; 95% confidence interval [CI], 0.77-1.50; p = 0.6689), CSS (aHR, 1.06; 95% CI, 0.72-1.57; p = 0.7728), and DFS (aHR, 0.76; 95% CI, 0.46-1.27; p = 0.2929). Additionally, among patients ≥80 years, the use of bladder preservation therapy compared with radical cystectomy resulted in an equivalent OS, CSS and DSS. In Asian populations, bladder preservation therapy yielded similar survival outcomes as radical cystectomy in MIBC patients. Based on the results, it is evident that a multidisciplinary approach and shared decision-making are recommended for bladder cancer treatment.

Upfront Autologous Stem Cell Transplantation in Myeloma Patients >65 Years: A Population-Based Study from the Nordic Myeloma Study Group

Upfront Autologous Stem Cell Transplantation in Myeloma Patients >65 Years: A Population-Based Study from the Nordic Myeloma Study Group

Global Registry of Acute Coronary Events Score Underestimates Post-Acute Coronary Syndrome Mortality among Cancer Patients

Background Patients with prior cancer are at increased risk of acute coronary syndrome (ACS) with poorer post-ACS outcomes. We aimed to ascertain if the Global Registry of Acute Coronary Events (GRACE) score accurately predicts mortality risk among patients with ACS and prior cancer. Methods We linked nationwide ACS and cancer registries from 2007 to 2018 in Singapore. A total of 24,529 eligible patients had in-hospital and 1-year all-cause mortality risk calculated using the GRACE score (2471 prior cancer; 22,058 no cancer). Results Patients with prior cancer had two-fold higher all-cause mortality compared to patients without cancer (in-hospital: 22.8% versus 10.3%, p &lt; 0.001; 1-year: 49.0% vs. 18.7%, p &lt; 0.001). Cardiovascular mortality did not differ between groups (in-hospital: 5.2% vs. 4.8%, p = 0.346; 1-year: 6.9% vs. 6.1%, p = 0.12). The area under the receiver operating characteristic curve of the GRACE score for prediction of all-cause mortality was less for prior cancer (in-hospital: 0.64 vs. 0.80, p &lt; 0.001; 1-year: 0.66 vs. 0.83, p &lt; 0.001). Among patients with prior cancer and a high-risk GRACE score &gt; 140, in-hospital revascularization was not associated with lower cardiovascular mortality than without in-hospital revascularization (6.7% vs. 7.6%, p = 0.50). Conclusions The GRACE score performs poorly in risk stratification of patients with prior cancer and ACS.