Specific Primary Cancer Research Articles

Survival after surgery for spinal metastases: a population-based study.

Background:There are limited published data on population estimates of survival after spinal surgery for metastatic disease. We performed a population-based study to evaluate survival and complications among patients with cancer who underwent surgery for spinal metastases in Ontario, Canada, between 2006 and 2016.Methods:We used health administrative databases to identify all patients who underwent surgery for spinal metastases in Ontario between Jan. 1, 2006, and Dec. 31, 2016. We assessed overall survival, mortality rates according to primary cancer lesion and complications after surgery. We contrast the results to those for a comparable cohort from 1991 to 1998.Results:A total of 2646 patients (1194 women [45.1%]; mean age 62.5 yr [standard deviation 12.2 yr]) were identified. The median survival time was 236 (interquartile range 84–740) days. Mortality was highest for patients with melanoma, upper gastrointestinal cancer and lung cancer, with 50% dying within 90 days of surgery. The longest median survival times were observed for primary cancers of the thyroid (906 d) and breast (644 d), and myeloma (830 d). Overall 90-day and 1-year mortality rates were 29% and 59%, respectively.Conclusion:We identified differential survivorship based on primary tumour type and a shift in the distribution of operations performed for specific primary cancers over the past 2 decades in Ontario. Overall reductions in mortality associated with this shift in treatment may reflect the use of adjuvant therapies and more personalized treatment approaches.

Management of Pulmonary Nodules in Oncologic Patients: AJR Expert Panel Narrative Review.

Cancer survivors are at higher risk than the general population for development of a new primary malignancy, most commonly lung cancer. Current lung cancer screening guidelines recommend low-dose chest CT for high-risk individuals, including patients with a history of cancer and a qualifying smoking history. However, major lung cancer screening trials have inconsistently included cancer survivors, and few studies have assessed management of lung nodules in this population. This narrative review highlights relevant literature and provides expert opinion for management of pulmonary nodules detected incidentally or by screening in oncologic patients. In patients with previously treated lung cancer, a new nodule most likely represents distant metastasis from the initial lung cancer or a second primary lung cancer; CT features such as nodule size and composition should guide decisions regarding biopsy, PET/CT, and CT surveillance. In patients with extrapulmonary cancers, nodule management requires individualized risk assessment; smoking is associated with increased odds of primary lung cancer, whereas specific primary cancer types are associated with increased odds of pulmonary metastasis. Nonneoplastic causes, such as infection, medication toxicity, and postradiation or postsurgical change, should also be considered. Future prospective studies are warranted to provide evidence-based data to assist clinical decision-making in this context.

Abstract IA25: Disparities in survivors of pediatric, adolescent, and young adult cancers

Abstract Outcome disparities in pediatric, adolescent, and young adult cancer are multifaceted. While disparities are commonly described along racial/ethnic lines, the underlying causes of these differences in outcome are often rooted in socioeconomic status, host genetics, disease biology, health literacy lifestyle factors, health behaviors, and comorbidities. Nonetheless, by the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the U.S. population. This temporal shift in the racial/ethnic composition of the U.S. population demands a close examination of the observed disparities in both the quality and quantity of survival in pediatric, adolescent, and young adult cancer. In this talk we describe the differences in overall and event-free survival by race/ethnicity as well as by age (children vs. adolescent and young adult) across a variety of cancer types. We examine the causes of the difference in these outcomes. We describe the burden of morbidity carried by cancer survivors across racial/ethnic and socioeconomic lines and present the current evidence for the causes of observed differences in morbidity. We speculate that any racial/ethnic differences in outcome are likely to be multifactorial, and draw on extant literature to illustrate the various contributors (socioeconomic characteristics, health behaviors, disease biology, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, we outline challenges in conducting race/ethnicity-specific survivorship research, demonstrating that there are limited absolute numbers who are diagnosed and survive histologically distinct cancers in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Citation Format: Smita Bhatia. Disparities in survivors of pediatric, adolescent, and young adult cancers [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA25.

Childhood cancer survivorship research in minority populations: A position paper from the Childhood Cancer Survivor Study.

By the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the US population. This temporal shift in the racial/ethnic composition of the US population demands a close look at the race/ethnicity-specific burden of morbidity and premature mortality among survivors of childhood cancer. To optimize targeted long-term follow-up care, it is essential to understand whether the burden of morbidity borne by survivors of childhood cancer differs by race/ethnicity. This is challenging because the number of minority participants is often limited in current childhood cancer survivorship research, resulting in a paucity of race/ethnicity-specific recommendations and/or interventions. Although the overall childhood cancer incidence increased between 1973 and 2003, the mortality rate declined; however, these changes did not differ appreciably by race/ethnicity. The authors speculated that any racial/ethnic differences in outcome are likely to be multifactorial, and drew on data from the Childhood Cancer Survivor Study to illustrate the various contributors (socioeconomic characteristics, health behaviors, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, the authors outlined challenges in conducting race/ethnicity-specific childhood cancer survivorship research, demonstrating that there are limited absolute numbers of children who are diagnosed and survive cancer in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Cancer 2016;122:2426-2439. © 2016 American Cancer Society.

Efficacy of petrosectomy in malignant invasion of the temporal bone

We present the outcomes of lateral, subtotal, and total petrosectomies in patients with invasion of the temporal bone by specific primary cancers, with particular emphasis on survival in the advanced stages of disease. We made a retrospective study of 20 consecutive patients (squamous cell carcinoma of the temporal bone, n=11, and primary cancer of the parotid gland with infiltration of the lateral skull base, n=9) treated by total, subtotal, or lateral petrosectomy at the University Department of Otolaryngology, a tertiary referral centre, between June 2006 and December 2010. Fourteen of the 20 patients were alive at the time of analysis, and follow-up ranged from 36-60 months. Six of seven patients whose disease relapsed (4 local and 3 distant metastases) died. The three-year, disease-free survival was 65% and the overall survival 68%. Survival between those with temporal bone and parotid tumours did not differ significantly. The combined group survival was affected by involvement of invaded resection margins (n=6, p=0.03). Involved margins were significant in the development of recurrence (p=0.03). Tumour stage, nodal involvement, type of operation, sex, age, skin involvement, facial palsy, and previous history of disease had no impact on prognosis. There was a significant difference in the survival curves of patients with carcinoma of the temporal bone with and without facial paresis (n=6 compared with n=5; p=0.046). Two of 11 free flaps required revision of the anastomoses, but none was lost.

An Evaluation of Algorithms for Identifying Metastatic Breast, Lung, or Colorectal Cancer in Administrative Claims Data

Administrative health care claims data are used for epidemiologic, health services, and outcomes cancer research and thus play a significant role in policy. Cancer stage, which is often a major driver of cost and clinical outcomes, is not typically included in claims data. Evaluate algorithms used in a dataset of cancer patients to identify patients with metastatic breast (BC), lung (LC), or colorectal (CRC) cancer using claims data. Clinical data on BC, LC, or CRC patients (between January 1, 2007 and March 31, 2010) were linked to a health care claims database. Inclusion required health plan enrollment ≥3 months before initial cancer diagnosis date. Algorithms were used in the claims database to identify patients' disease status, which was compared with physician-reported metastases. Generic and tumor-specific algorithms were evaluated using ICD-9 codes, varying diagnosis time frames, and including/excluding other tumors. Positive and negative predictive values, sensitivity, and specificity were assessed. The linked databases included 14,480 patients; of whom, 32%, 17%, and 14.2% had metastatic BC, LC, and CRC, respectively, at diagnosis and met inclusion criteria. Nontumor-specific algorithms had lower specificity than tumor-specific algorithms. Tumor-specific algorithms' sensitivity and specificity were 53% and 99% for BC, 55% and 85% for LC, and 59% and 98% for CRC, respectively. Algorithms to distinguish metastatic BC, LC, and CRC from locally advanced disease should use tumor-specific primary cancer codes with 2 claims for the specific primary cancer >30-42 days apart to reduce misclassification. These performed best overall in specificity, positive predictive values, and overall accuracy to identify metastatic cancer in a health care claims database.

Comparison of Imaging Characteristics of CT, MRI, PET, and EUS in the Evaluation of Metastasis to the Pancreas: Results From a Single Tertiary Cancer Center

Introduction: Metastasis to the pancreas is less than 5% of all tumors detected in the pancreas. Differentiating a metastatic implant from a primary pancreatic carcinoma is important for management and prognosis. The purpose of the study was to identify the clinical presentation and imaging characteristics of metastastic lesions to the pancreas. Methods: The study was approved by the institutional review board. Retrospective review was conducted to identify all patients suspected to have a metastatic lesion to the pancreas on imaging (CT, MRI, PET) and confirmed on FNA (EUS-FNA or IR-guided biopsy) between 2002 and 2014. Results: A total of 70 patients (median age: 64 years [range: 35-83 years); males 43 [61%]) were found to have synchronous metastatic pancreatic lesions (n=6) or metachronous metastatic pancreatic lesions (n=64) detected after a median of 35 months after primary cancer (range: 1-304 months). The common primary cancers to metastasize to the pancreas were renal (29), melanoma (8), lung (9), colon (3), and breast (3). The majority of patients (n=60; 85%) were asymptomatic. Surveillance CT scan detected the pancreatic lesion in all patients. Of the 70 patients, CT showed multiple pancreatic lesions in 26, diffuse infiltration in 1, and a single lesion in 43: head (19), body (11), and tail (13). MRI detected pancreatic lesions in 11/13 patients. PET scan showed increased uptake in the lesions in 26/31. EUS showed pancreatic lesions in 54/54. Of the 54 patients, EUS showed multiple lesions in 22, and a single lesion in 32: head (15), body (9), tail (8). One patient had a purely cystic lesion (1 anechoic), 43 had solid lesions (41 hypoechoic, 1 heterogenous, and 1 isoechoic), and 10 had solid-cystic lesions (3 hypoechoic, 1 isoechoic, and 6 heterogenous). The border of the lesion was well defined (31 patients) and irregular (23 patients). Thirteen patients had PD dilation: head (6), body (3), tail (1), and multiple (3). Most of the patients (25/29) with pancreatic metastasis from renal cancer had well-defined borders. CBD dilation was seen in 8 patients (3 had multiple lesions and 5 with single lesions all located in the head). Five patients had both CBD and PD dilation. No specific primary cancer was associated with PD or CBD dilation. A total of 13 patients underwent metastatectomy. Four of 13 patients who underwent surgery died (median 120 months; range: 66-412). Conclusion: Metastasis to the pancreas can occur after several years of remission of the primary cancer, especially in RCC and is often found on routine surveillance CT as a pancreatic mass. Metastasis to the pancreas is usually solitary with no predilection for the location in the pancreas. Metastasis from RCC is most common and has a well-defined border on EUS.

Follow up after primary treatment: curable diseases primarily treated with surgery

There is considerable debate at the present time concerning the role and relevance of follow-up following primary surgical treatment with curative intent in patients presenting with cancer. There are many factors which govern the aims of follow-up programmes and also the determinants of success of individualised follow-up. Clearly different tumour types have different levels of aggressiveness and will therefore have differing disease-free interval and survival figures. Even if one looks at individual cancer types, taking breast cancer as an example, prognosis will depend on many factors such as grade, stage and size of tumour. The primary aim of follow-up is to detect at an early stage either local or systemic recurrence of the primary rumour. The second aim of follow-up is to detect new primary cancers of the contralateral side or in specific cancers to look for other cancer types which occur more commonly in patients who were diagnosed with specific primary cancers. In certain instances follow-up is also designed to look for complications after primary treatment and finally there is a body of opinion to suggest that follow-up is of benefit in the management of psychological problems which occur in patients with a diagnosis of cancer. The real issue at stake when developing protocols for follow-up is an assessment of the determinants of success. Foremost is the extent to which follow-up programmes will detect either local or systemic recurrence. Furthermore, the issue relates to whether such recurrences are detected at the time of the visit to the follow-up clinic or in fact are found by the patient who is then referred by the GP to the follow-up clinic with a suspected recurrence. This raises the important point of the cost of follow-up. The cost effectiveness of follow-up in cancer is very difficult to determine as it is almost impossible to match cost of follow-up with the increased number of years of survival in each case. Finally it makes sense to match the frequency of follow-up with the risk of recurrent disease — the greater the risk of recurrence then the greater should be the frequency of follow-up. In determining protocols therefore, it seems logical that each patient should be individualised, or each risk category of every cancer should be categorised, according to risk of recurrence. One obvious example of this would be whether follow-up of patients with ductal carcinoma in situ of the breast should be different from those with invasive adenocarcinoma of the breast. Whilst it seems logical to follow this schedule, there are major practical difficulties in individualising follow-up programmes according to levels of risk. Therefore, in deciding on frequency of follow-up there must be a balance between determining risk of recurrence and also deciding what type of follow-up programme is manageable and easy to follow in individual units.