Racial Differences In Overall Survival Research Articles

Clinical characteristics and outcomes of extrapulmonary small cell cancer: A retrospective analysis of the SEER database.

e20616 Background: Extrapulmonary small cell cancer (EPSCC) accounts for only 5-10% of small cell carcinoma, with the rest consisting of small cell lung cancer (SCLC). The incidence of this entity has been rising due to better diagnosis, however it is not well described and data is limited. We performed a Surveillance, Epidemiology and End Results (SEER) database analysis to further characterize the biology and clinical aspects of this entity, in comparison to SCLC. Methods: The Surveillance, Epidemiology and End Results (SEER) 18 database was used to obtain data on age, gender, ethnicity, survival, and tumor characteristics of n = 9,712 US patients diagnosed with EPSCC between 2000-2018 and these were compared to n = 118,514 patients with SCLC diagnosed during the same period. Results: Among the EPSCC cohort 58.1 % were males while in the SCLC cohort 50.3% were males. Median age of diagnosis was 65.50 years for EPSCC and 66.81years for SCLC. Among the EPSCC patients, 75.9 % were Caucasians, 9.2 % were African-Americans, and 8.8% were Hispanics. Amongst SCLC patients, Caucasians made up 83.1% of the patients, while African-Americans made up 8.6% and Hispanics made up 4.5 % of the patients. Most common sites for EPSCC were urinary bladder (20.2%), prostate (7%), cervix uteri (6.2%), pancreas (4.5%), rectum (3%), and ovaries (2.6%). Median OS for EPSCC was 8 months (95% CI: 8 - 8), while median overall survival for SCLC was 7 month (95% CI: 7 - 7). Hazard ratio for death for EPSCC: 0.77 (95% CI: 0.75 - 0.79), p < 0.001. The survival at 12 months, 24 months and 60 months was 36%, 22%, and 13 % for EPSCC and 29%, 13%, and 5% for SCLC. There were no significant gender or racial differences in overall survival (OS). Conclusions: EPSCC has better overall and 5-year survival as compared to SCLC. There are no significant differences in survival outcomes in EPSCC patients based on location of primary, gender or race.

Prognostic factors, and survival difference in gastrointestinal extrapulmonary small cell carcinoma using SEER database.

e16170 Background: Gastrointestinal extrapulmonary small cell carcinoma (GI EPSCCa) is a rare and aggressive tumor. Current treatment guidelines are extrapolated from small cell lung cancer. Factors affecting survival, and the role of primary tumor location are currently unknown. Methods: Using the SEER database to identify patients diagnosed from 2000 to 2018, we used Cox proportional hazard models to assess prognostic factors based on primary tumor location. Results: Of the 1,687 patients included in the analysis, 79.7% were White and 56.9% male. Distribution of the primary location were 31.5% colorectal (CRC), 22.1% Esophagus, 20.6% pancreas, 13.3% hepatobiliary (HB), 10.6% stomach, and 1.8% small intestine (SI). Patients ≥65 years were more likely to have esophago-gastric, SI, HB and pancreatic EPSCCa (P<0.001). Males were more likely to have esophago-gastric, CRC and pancreatic EPSCCa (P<0.001). While Blacks were more likely to have esophago-gastric and SI EPSCCa, Whites were more likely to have CRC, HB and pancreas EPSCCa (P=0.012). There were no racial differences in overall survival (OS) for GI EPSCCa. Male gender (adjusted Hazard Ratio(aHR)=1.12, 95%CI:1.00-1.24, P=0.042), and age ≥65 (aHR)=1.21, 95%CI:1.09-1.35, P=0.001) were associated with inferior OS. Advanced stage at presentation, or not receiving radiation therapy/ chemotherapy were also associated with worse OS. Surgical intervention, and treatment period after 2006 were associated with superior OS (Table) Regarding GI site, HB EPSCCa was associated with inferior OS compared with esophageal EPSCCa (aHR)=1.21, 95%CI:1.00-1.46, P=0.048). SI EPSCCa had a trend toward improved OS (compared to esophageal EPSCCa) (P= 0.237). Conclusions: Chemotherapy, surgery, radiation therapy, female gender, younger age were associated with superior OS for GI EPSCCa, while advanced stage, HB sites (compared to esophageal EPSCCa) were associated with poorer outcome. OS for GI EPSCCa has improved over time. Prospective studies are needed to guide therapy for this aggressive tumor. [Table: see text]

National and local racial disparities in triple-negative breast cancer (TNBC) survival: Local outcomes counter the myth of national averages.

e18588 Background: Real-world studies comparing racial differences in overall survival (OS) outcomes between African American (AA) and White (W) patients (pts) with TNBC have yielded mixed findings. This exploratory study assessed differences between national and county-level OS estimates-comparing AA vs. W pts, and identifying counties with greater racial disparities for future research. Methods: This retrospective cohort study used the Surveillance Epidemiology and End Result (SEER) cancer registry to assess county-level OS among non-hispanic AA and W pts ≥18 years of age who were diagnosed with TNBC 2011-2016. Counties with low levels of racial diversity (< 30 AA or W TNBC pts) were excluded. Five-year OS was evaluated using Kaplan-Meier and multilevel parametric OS models with a Weibull distribution. By county, OS differences between AA and W pts were tested using linear hypothesis tests after model estimation. OS models were adjusted for age at diagnosis, year of diagnosis, marital status, insurance type, surgery type, stage, grade and metastasis at brain, bone, liver and lung. Results: Among 46,125 TNBC pts in SEER, 15,723 pts (33.4% AA, 66.6% W) residing in 8 States and 47 Counties met inclusion criteria. W pts were older (mean 60; ∓14 vs 57∓13 for AA) and more likely to be married (57% vs 33%), insured (49% vs 45%) and diagnosed at an earlier stage (stage I 37% vs 29%). Controlling for potential confounders, AA pts were more likely to experience 5-year mortality compared to W pts (Hazard Ratio [HR] = 1.16; 95%CI = 1.07, 1.26). Among 47 included counties, only 4 counties demonstrated a statistically significant 5-year OS racial disparities after adjusting for confounders. The difference in HRs between AA and W pts in these 4 counties ranged from 1.49 to 2.26 as depicted in the result table (p value < 0.05). Removing these 4 counties (n = 2,929) from the final analytic cohort yielded statistically non-significant estimates (HR = 1.06; 0.97,1.16). Conclusions: There is clinically meaningful OS variation between AA and W pts with TNBC across U.S. counties included in SEER. Measuring disparities at the national or state level may mask important OS disparities at the county level. Using a county-level analytic approach, we were able to identify localities that disproportionately contribute to OS disparities at the national level. Our findings will facilitate better targeting of local interventions to address TNBC racial disparities. Future analyses should also assess counties excluded (n = 13,032) for small population sizes and/or low levels of racial diversity, as well as states not represented in SEER.[Table: see text]

Racial disparities in survival among women with endometrial cancer in an equal access system

ObjectiveThe mortality rate for Black women with endometrial cancer (EC) is double that of White women, although the incidence rate is lower among Black women. Unequal access to care may contribute to this racial disparity. This study aimed to assess whether survival varied between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women with EC in the Military Health System (MHS) which provides equal access care to its beneficiaries despite racial/ethnic background. MethodsThe study was conducted using data from the U.S. Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). Study subjects included NHB and NHW women with histologically confirmed and surgically managed EC diagnosed between 1988 and 2013. The study outcome was all-cause death. Overall survival between NHB and NHW women was compared using multivariable Cox modeling. ResultsThe study included 144 NHB and 1439 NHW women with EC. Kaplan-Meier curves showed NHB women had worse survival than NHW women (log-rank P < 0.0001). The disparity in survival between NHB and NHW women persisted after adjusting for age, diagnosis period, tumor stage, tumor histology/grade, and adjuvant treatment (HR = 1.64, 95% CI = 1.19 to 2.27). Multivariable analyses stratified by tumor features or treatment showed that the racial disparity was confined to women with low-risk features (stage I/II disease or low-grade EC) or no adjuvant treatment. ConclusionThere were racial differences in overall survival between NHB and NHW women with EC in the MHS equal access healthcare system, suggesting that factors other than access to care may be related to this racial disparity.

Abstract PS7-53: Assessing racial differences in patients with metastatic triple-negative breast cancer: Real-world evidence from US community oncology practices

Abstract Background: Metastatic triple-negative breast cancer (mTNBC) is an aggressive tumor phenotype with a poor prognosis and few treatment options. The prevalence of mTNBC is disproportionately higher among African American (AA) women, compared with white women. Data identifying the drivers of racial differences in mTNBC or characterizations of treatment patterns and clinical outcomes in AA patients with mTNBC are limited. Methods: This retrospective study used the Flatiron Health electronic health record-derived de-identified database (January 2011-March 2020). Adult AA and white female patients with confirmed mTNBC treated in US community oncology practices were included. Differences in mTNBC prevalence among AA and white patients were assessed by age, health insurance coverage, geographic region and stage at initial diagnosis. Descriptive statistics were used to analyze clinical characteristics, treatment patterns and time to treatment initiation between AA and white patients. Racial differences in overall survival (OS) were examined using Kaplan-Meir analysis and a multivariate Cox regression model. Results: Of the 21,804 Flatiron patients diagnosed with metastatic breast cancer (mBC), 2116 eligible patients with mTNBC were identified; 383 (18%) were AA and 1155 (55%) were white. TNBC prevalence was twice as high among AA patients (23%) than white patients (12%). Racial differences in TNBC prevalence (AA vs white patients) were particularly higher among patients aged 45 to 65 y (26% vs 13%), patients in the Northeast (27% vs 11%) and those with initial diagnosis at Stage II (30% vs 13%) or Stage III (27% vs 15%). AA patients with TNBC were younger (mean age: 60 vs 63 y; P &amp;lt; 0.001) and more likely to have Medicaid at the time of diagnosis (10% vs 3%; P &amp;lt; 0.001) than white patients. Clinical characteristics were generally similar between AA and white patients, including the distribution of staging at initial diagnosis, disease recurrence, Eastern Cooperative Oncology Group performance status (ECOG PS), and sites and number of metastases. Regardless of race, 25% of all patients with mTNBC had no documentation of receiving anti-cancer treatment in the database. Untreated patients in both race groups were older, had poorer ECOG PS and were less likely to have visceral metastases than treated patients (all P &amp;lt; 0.001); they also had poorer survival than treated patients (median OS: 4.7 vs 13.1 months from diagnosis for all treated patients; unadjusted hazard ratio [HR], 0.51 [95% CI: 0.46, 0.57]). Among both AA and white treated patients, single-agent chemotherapy was the most prevalent first-line treatment (most common agent: capecitabine). More than half of treated patients initiated treatment in &amp;lt; 30 days, and median time-to-treatment initiation did not differ by race. Although OS was numerically lower in AA patients (median OS, 10.3 vs 11.9 months in white patients), the difference was not significant when adjusted for prognostic and treatment factors (adjusted HR, 1.09 [95% CI: 0.95, 1.25]). Conclusions: The prevalence of mTNBC was twice as high among AA compared with white patients in US community oncology practices. Unlike prior research, race did not show an association with OS in this population. Regardless of race, 1 in every 4 patients with mTNBC had not received documented anti-cancer treatment, potentially due to poor PS and concerns about treatment tolerance. OS was poor for both AA and white patients with mTNBC, particularly for untreated patients. Effective treatment remains a substantial unmet need for all patients with mTNBC. In light of the lack of racial differences in this patient cohort, prospective studies are needed to further elucidate underlying biological differences that may have predictive or prognostic significance for AA patients with TNBC. Citation Format: Amie Tan, Vincent Shen, Luciana Preger, Bann-mo Day, Edith P. Mitchell. Assessing racial differences in patients with metastatic triple-negative breast cancer: Real-world evidence from US community oncology practices [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-53.

Abstract PO-102: Racial disparities in outcomes following neoadjuvant chemotherapy by breast cancer subtype: Analyses from the National Cancer Database, 2010- 2016

Abstract Introduction: Pathologic complete response (pCR) following neoadjuvant chemotherapy for breast cancer is associated with improved prognosis in patients with aggressive subtypes. Our purpose was to describe racial disparities in pCR rate and overall survival among breast cancer patients treated with neoadjuvant chemotherapy. Methods: We conducted a retrospective cohort study of women with stages I-III breast cancer in the National Cancer Database who received neoadjuvant chemotherapy between 2010 and 2016. We collected demographic information, clinical characteristics, county-level socioeconomic factors, insurance status, type of treatment facility and overall survival. Breast cancer subtypes were categorized according to joint hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. Response to neoadjuvant therapy was categorized as (i) pathologic complete response (absence of invasive carcinoma in the breast and ipsilateral axillary lymph nodes) and (ii) partial or no response. Associations between race/ethnicity and rates of pCR by subtype were determined using modified Poisson regression models to estimate rate ratios (RR) and 95% confidence intervals (CI) with robust standard errors adjusted for age, T and N status, grade, histology, county- level education and median income, comorbidity score, facility type, geographic region and insurance status. Racial differences in overall survival by pCR status were determined using Kaplan-Meier survivor functions and multivariable Cox proportional hazards models to estimate adjusted hazard ratios and 95% CI. Results: A cohort of 73,950 breast cancer patients with a median follow up of 36 months included 70% non-Hispanic white, 16% non-Hispanic black, 8% Hispanic and 4% non- Hispanic Asian/Pacific Islander. Overall, 35% of women had pCR, which differed according to subtype (luminal A, HR+/HER2- 17%; luminal B, HR+/HER2+ 44%; triple negative, HR-/HER2- 44%; HER2-enriched, HR-/HER2+ 64%). Compared to whites, black women with aggressive subtypes had significantly lower rates of pCR (triple- negative, RR 0.92, 95% CI 0.88-0.96; HER2-enriched, RR 0.87, 95% CI 0.82-0.92), but no significant differences in pCR rate for luminal A (RR 1.07, 95% CI 0.99-1.16) and B (RR 0.95, 95% CI 0.89-1.02) tumors. Racial disparities in overall mortality were observed among black women without a pCR following neoadjuvant chemotherapy (hazard ratio 1.17, 95% CI 1.09-1.25) but there were no differences among those who achieved a pCR (hazard ratio 1.00, 95% CI 0.86-1.18). Conclusions: Racial disparities in pCR rate are limited to aggressive breast cancer subtypes. Independent of subtype, black women who do not experience pCR following neoadjuvant chemotherapy are at greater risk for all-cause mortality. These results should inform risk-stratified treatment decisions following neoadjuvant chemotherapy, and future clinical studies of neoadjuvant therapy should investigate potential racial differences in chemoresistance. Citation Format: Gregory S. Calip, Kent F. Hoskins, Naomi Y. Ko. Racial disparities in outcomes following neoadjuvant chemotherapy by breast cancer subtype: Analyses from the National Cancer Database, 2010- 2016 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-102.

Clinical characteristics and outcomes of signet ring cell carcinoma of the stomach: A retrospective analysis of SEER database.

e16572 Background: Signet ring cell carcinoma (SRCC) of the stomach accounts for 8 to 30% of all gastric cancers, however the incidence has been rising. We performed a Surveillance, Epidemiology and End Results (SEER) database analysis to further characterize the biology and clinical aspects of this entity, in comparison to gastric adenocarcinoma (AC). Methods: Surveillance, Epidemiology and End Results (SEER) 18 database was used to obtain data on age, gender, ethnicity, survival, and tumor characteristics of 5,424 US patients diagnosed with gastric SRCC between 2012-2016 and these were compared to 40,657 patients with other gastric adenocarcinoma (AC) subtypes diagnosed during the same period. Results: The gender distribution of both types of cancer was similar with males making up 51.8% of gastric SRCC and 48.3% of gastric AC patients. Median age of diagnosis was 63 years for gastric SRCC as compared to 65 years for gastric AC patients. The age of diagnosis distribution for both types was similar with patient &lt;40 years (7.2% versus 6.2% respectively), 40-60 years (34% versus 32% respectively), 60-80 years (44.6% versus 45.15% respectively) and at &gt; 80 years (14.4% versus 16.6% respectively). Among the SRCC patients, 70.9 % were Caucasians, 15.5% were Asians/Pacific Islanders, and 11.6% were African-Americans. Amongst gastric AC patients, Caucasians made up 76% of the patients, while African-Americans made up 12.9% and Asian/Pacific Islanders made up 9.2 % of the patients. Median OS was 10 months for gastric SRCC compared to 24 months (p &lt; 0.001) for gastric AC. Racial differences in overall survival (OS) was noted. The median OS in Caucasians, African-American, Asian/Pacific Islander, and Native American populations was 11,11,15,7 months respectively (p &lt; 0.001). Conclusions: Gastric SRCC has significantly worse survival as compared to AC with median OS of 10 months vs 24 months. It is more common in patients with Asian/Pacific Islander ancestry as compared to gastric AC. There is a significant racial disparity in survival outcomes with significantly shorter survival in patients with Native american ancestry.

Race and overall survival in men diagnosed with prostate cancer in the Department of Defense Military Health System, 1990-2010.

In the U.S. general population, black men experience poorer survival after prostate cancer (CaP) diagnosis compared to white men, and findings may be impacted by unequal access to healthcare. The objective of the study is to investigate racial differences in overall survival (OS) among Department of Defense beneficiaries diagnosed with CaP. A retrospective cohort study was conducted utilizing the Automated Central Tumor Registry within the Military Healthcare System, a system designed to provide equal access. Men diagnosed with primary prostate adenocarcinomas between 1990 and 2010 [n = 18,484; 24% Non-Hispanic black (NHB), 76% Non-Hispanic white (NHW)] were followed through 2013 for vital status. Unadjusted Kaplan-Meier estimation curves and multivariable Cox proportional hazards (PH) regression models were used to examine racial differences in OS. Age-specific Kaplan-Meier analyses showed equivalent OS for NHW and NHB men in all age groups, except for 75+, where NHB had poorer OS (p = 0.0048). Multivariable Cox PH models revealed no significant differences in OS for race (HR 1.02; 95% CI 0.95-1.08), except in men aged ≥ 75 years, where NHB men had poorer OS (HR 1.27; 95% CI 1.08-1.49). Findings suggest that in a healthcare system designed for equal access, disparities in OS among men diagnosed with CaP may not exist.

Racial Differences in Time to Breast Cancer Surgery and Overall Survival in the US Military Health System

Racial disparities in time to surgery (TTS) after a breast cancer diagnosis and whether these differences account for disparities in overall survival have been understudied in the US population. To compare TTS in non-Hispanic black (NHB) and non-Hispanic white (NHW) women with breast cancer and to examine whether racial differences in TTS may explain possible racial disparities in overall survival in a universal health care system. Retrospective cohort identified from the Department of Defense Central Cancer Registry and Military Health System Data Repository linked databases containing records between January 1, 1998, and December 31, 2008, of 998 NHB women and 3899 NHW women who received a diagnosis of stages I to III breast cancer and underwent breast-conserving surgery (BCS) or mastectomy in the US Military Health System during the study period. Data analyses were conducted from July 5, 2017, to December 29, 2017. The main outcome was time to breast cancer surgery. Non-Hispanic black and NHW women were compared at the 25th, 50th (median), 75th, and 90th percentiles of TTS by using multivariable quantile regression. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for all-cause death in NHB compared with NHW women after controlling for potential confounders first without and then with TTS. Among the 4887 NHB and NHW women in the cohort, the mean (SD) age was 50.0 (9.4) years. The median TTS was 21 days (95% CI, 20.6-21.4 days) among NHW women and 22 days (95% CI, 20.6-23.4 days) among NHB women. Non-Hispanic black women had a significantly greater estimated TTS at the 75th (3.6 days; 95% CI, 1.6-5.5 days) and 90th (8.9 days; 95% CI, 5.1-12.6 days) percentiles than NHW women in multivariable models. The estimated differences were similar by surgery type. Non-Hispanic black women had a higher adjusted risk for death (HR, 1.45; 95% CI, 1.06-2.01) compared with NHW women among patients receiving breast-conserving surgery. The risks were similar between races among those receiving mastectomy (HR, 1.06; 95% CI, 0.76-1.48). The HRs remained similar after adding TTS to the Cox proportional hazards regression models. This study's results indicate that time to breast cancer surgery was delayed for NHB compared with NHW women in the Military Health System. However, the racial differences in TTS did not explain the observed racial differences in overall survival among women who received breast-conserving surgery.

Trends in multiple myeloma presentation, management, cost of care, and outcomes in the Medicare population: A comprehensive look at racial disparities.

Outcomes have improved significantly in multiple myeloma (MM), but racial disparities in health care access and survival exist. A comprehensive analysis exploring MM care and racial disparities is warranted. Patients with MM from 1991 to 2010 in the Surveillance, Epidemiology, and End Results-Medicare database were evaluated for racial trends in clinical myeloma-defining events (MDEs), the receipt of treatment (drugs and stem cell transplantation; [SCT]), the cost of care, and overall survival (OS). Among 35,842 patients, the frequency of all MDEs at diagnosis increased over time; whereas, in recent years (2006-2010), all MDEs with the exception of renal dialysis decreased. Blacks had highest rates for all MDEs except bone fractures, which were highest in whites. Over time, the proportion of patients who received any treatment, multiple agents, and SCT increased significantly, and the largest increase was observed in the receipt of immunomodulatory drugs and steroids. There was greater receipt of bortezomib and SCT among whites and blacks and higher receipt of immunomodulatory drugs among Hispanics and Asians (P < .001). Medicare claims were highest during first 6 months after MM diagnosis for blacks and at any time after MM diagnosis for Hispanics. Over time, Medicare claims increased most steadily for Hispanics (P < .001). Hypercalcemia, renal dysfunction, and bone fractures were associated with inferior OS. Blacks and Asians had superior OS compared with whites, but racial differences in OS became less pronounced during 2006 through 2010 (P = .182) compared with prior years (P < .01). Better OS was noted among patients who had higher median incomes. The current results indicate that there have been significant changes in the management of patients with MM over time and provide an in-depth understanding of the factors that may help explain racial disparities. Cancer 2018;124:1710-21. © 2018 American Cancer Society.

Racial Differences in the Overall Survival of Hairy Cell Leukemia in the United States: A Population-Based Analysis of the Surveillance, Epidemiology, and End Results Database.

Several studies have reported excellent long-term overall survival (OS) of patients with hairy cell leukemia (HCL) without racial disparity. Studies in other cancers have demonstrated worse mortality among African American (AA) individuals. We used the Surveillance, Epidemiology, and End Results 18 database to identify HCL patients diagnosed between 1978 and 2011. Kaplan-Meier curves were plotted to estimate OS. Univariate analysis using the life table method and multivariate Cox regression model were used to determine the independent effect of race on OS. The study population included 78% men and had a median age of 56 years. Race included 93% white, 3.5% Asian/Pacific Islander, and 3.5% AA. The 10-year OS was significantly less for AA as compared with white and Asian/Pacific Islander individuals (54% vs. 72% vs. 75%; P < .001). A Kaplan-Meier survival curve showed a significantly worse OS for AA versus other races (P < .001). In a multivariate analysis, AA race remained an independent predictor for a worse OS (hazard ratio 1.77; 95% confidence interval, 1.30-2.40; P < .001) after adjusting for age, sex, year of diagnosis, and marital status. In this population-based study, only half of AA patients but more than two-thirds of HCL patients from other racial groups were alive at 10 years. Such drastic racial differences in OS of HCL patients at the population level mandates further evaluation of the contributory biological, socioeconomic, health system, and other factors. Understanding and overcoming such racial disparities might close the racial differences in OS of this potentially curable disease.

Abstract A91: Prevalence and effectiveness of treatment patterns for early-stage lung cancer

Abstract Background: Disparities in resection rates and survival for patients with lung cancer are well-documented. It is suggested that lower survival rates among blacks are largely due to lower rates of resection and that equivalent outcomes are possible for blacks and whites with similar treatment. The objective of this study was to determine the extent of racial variation in patterns of initial therapy and treatment-specific outcomes. Methods: We conducted a retrospective analysis of a national cohort of patients in the Veterans Affairs Central Cancer Registry diagnosed with Stage I/II non-small cell lung cancer (NSCLC) between 2001 and 2008. Descriptive and chi-square statistics were used to compare the prevalence of treatment and outcomes in Whites and Blacks. Cox proportional hazards models were used to estimate hazard ratios (HR) with 95% confidence intervals (95%CI). Results: Among 14,445 patients with stage I/II NSCLC, 57% received surgery (17% diagnosed at surgery, 40% received surgery within 6 months after diagnosis), 22% received radiation therapy and/or chemotherapy, and 21% had no treatment. The proportion of blacks and whites diagnosed at surgery was similar (both 17%), whereas the proportion of blacks receiving surgery post-diagnosis (34%) was significantly less than whites (41%) (p&amp;lt;0.0001). There was no racial difference in receipt of radiation therapy or chemotherapy among those who did not have surgery; however, blacks were more likely than whites to have no treatment (25% vs. 20%, p&amp;lt;0.0001). Among all surgical patients, rates of lobectomy, wedge resection, and pneumonectomy did not vary significantly by race, yet the frequency of other types of resection (e.g. segmentectomy) was greater among blacks (6%) than whites (4%) (p=0.0005). Approximately 17% of surgery patients had neoadjuvant or adjuvant therapy, which was similar in both race groups. Whites had a significantly greater prevalence of 90-day post-operative mortality than blacks (6% vs 3%, p&amp;lt;0.0001). Among all patients, blacks and whites had equivalent rates of 4-year survival. The adjusted HR for blacks compared to whites was 0.97 (95%CI 0.92-1.02) in the total population. Adjusted HRs also indicated no association between race and survival in each of the following treatment subgroups: diagnosed at surgery, surgery after diagnosis, and no treatment. The type of resection and the addition of neoadjuvant or adjuvant therapy did not impact the race-survival association. Black race correlated with better survival among patients receiving nonsurgical treatment (HR: 0.84, 95%CI 0.75-0.93, p=0.0007). Conclusion: Racial differences in receipt of surgery are limited to patients diagnosed prior to surgical treatment, which emphasizes the need to understand the impact of knowledge of the diagnosis on decision-making regarding surgery. The lower post-operative mortality observed among blacks is partially explained by the greater frequency of less extensive resection among blacks. Equal treatment generally confers similar outcomes in blacks and whites, and despite lower rates of post-diagnostic surgery, there were no racial differences in overall survival. There remains the need to identify factors that affect the association between race and short vs long-term clinical and patient-reported outcomes. Note: This abstract was withdrawn after the Proceedings was printed and was not presented at the conference. Citation Format: Christina D. Williams. Prevalence and effectiveness of treatment patterns for early-stage lung cancer. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A91. doi:10.1158/1538-7755.DISP13-A91

Racial differences in outcomes of triple-negative breast cancer

African American (AA) women have a higher incidence of triple-negative breast cancer (TNBC: negative for the expression of estrogen receptor, progesterone receptor, and HER2 gene amplification) than Caucasian (CA) women, explaining in part their higher breast cancer mortality. However, there have been inconsistent data in the literature regarding survival outcomes of TNBC in AA versus CA women. We performed a retrospective chart review on 493 patients with TNBC first seen at the Washington University Breast Oncology Clinic (WUBOC) between January 2006 and December 2010. Analysis was done on 490 women (30 % AA) for whom follow-up data was available. The median age at diagnosis was 53 (23-98) years and follow-up time was 27.2 months. There was no significant difference between AA and CA women in the age of diagnosis, median time from abnormal imaging to breast biopsy and from biopsy diagnosis to surgery, duration of follow-up, tumor stage, grade, and frequency of receiving neoadjuvant or adjuvant chemotherapy and pathologic complete response rate to neoadjuvant chemotherapy. There was no difference in disease free survival (DFS) and overall survival (OS) between AA and CA groups by either univariate or multivariate analysis that included age, race, and stage. The hazard ratio for AA women was 1.19 (CI 0.80-1.78, p = 0.39) and 0.91 (CI 0.62-1.35, p = 0.64) for OS and DFS, respectively. Among the 158 patients who developed recurrence or presented with stage IV disease (AA: n = 36, CA: n = 122), no racial differences in OS were observed. We conclude that race did not significantly affect the clinical presentation and outcome of TNBC in this single center study where patients received similar therapy and follow-up.

Racial Disparities in Surgical Resection and Survival among Elderly Patients with Poor Prognosis Cancer

Reports indicate that black patients have lower survival after the diagnosis of a poor prognosis cancer, compared with white patients. We explored the extent to which this disparity is attributable to the underuse of surgery. Using the Surveillance, Epidemiology, and End Results program and Medicare database, we identified 57,364 patients, ages 65 years and older, with a new diagnosis of nonmetastatic liver, lung, pancreatic, and esophageal cancer, from 2000 to 2005. We evaluated racial differences in resection rates after adjustment for patient, tumor, and hospital characteristics using hierarchical logistic regression. Cox proportional hazards regression was used to assess racial differences in survival after adjusting for patient, tumor, and hospital characteristics, and receipt of surgery. Compared with white patients, black patients were less likely to undergo surgery for liver (adjusted odds ratio [aOR] = 0.49; 95% CI, 0.29-0.83), lung (aOR = 0.62; 95% CI, 0.56-0.69), pancreas (aOR = 0.53; 95% CI, 0.41-0.70), and esophagus cancers (aOR = 0.64; 95% CI, 0.42-0.99). Hospitals varied in their surgery rates among patients with potentially resectable disease. However, resection rates were consistently lower for black patients, regardless of the resection rate of the treating hospital. Although there were no racial differences in overall survival with liver and esophageal cancer, black patients experienced poorer survival for lung (adjusted hazard ratio = 1.05; 95% CI, 1.00-1.10) and pancreas cancer (adjusted hazard ratio = 1.15; 95% CI, 1.03-1.30). In both instances, there were no residual racial disparities in overall survival after adjusting for use of surgery. Black patients are less likely to undergo surgery after diagnosis of a poor prognosis cancer. Our findings suggest that surgery is an important predictor of overall mortality, and that efforts to reduce racial disparities will require stakeholders to gain a better understanding of why elderly black patients are less likely to get to the operating room.

Racial Disparities in Prostate Cancer Incidence, Biochemical Recurrence, and Mortality

Racial Disparities in Prostate Cancer Incidence, Biochemical Recurrence, and Mortality

Pediatric brain tumors in Non-Hispanics, Hispanics, African Americans and Asians: differences in survival after diagnosis

Racial differences in survival for children with brain tumors have not been well studied, particularly in Hispanics and Asians. The objective of this study was to assess racial differences in survival of children with brain tumors, focusing on Hispanics, African Americans and Asians compared to Non-Hispanics. Subjects identified through the SEER Program were 2799 children, < or =19 years old at diagnosis, newly diagnosed between 1973 and 1996 with primary, malignant brain tumors. Chi-square tests were used to evaluate prognostic variables by race. Kaplan-Meier models and Cox proportional hazards models were used to assess racial differences in overall survival and in survival by histological type of tumor. The distribution histological type of tumor varied significantly by race. Overall survival was similar for Hispanics, African Americans, Asians compared to Non-Hispanics, although trends of increased risk of death for the minority groups were noted when stratifying by histological type of tumor. Racial differences in survival could exist by histological type of tumor, but further work is necessary for a more complete understanding of these differences.