Surveillance, Epidemiology, And End Results Analysis Research Articles

Abstract 6135: Racial and ethnic differences in site of de novo metastases in patients with colorectal cancer: A SEER analysis

Abstract Purpose: Disparities in colorectal cancer (CRC) mortality may be driven by differences in access to care, tumor biology, and propensity to spread to distant sites. We examine differences in patterns of de novo metastases by race/ethnicity and age. Methods: We identified 248,732 CRC patients listed in the Surveillance, Epidemiology, and End Results (SEER) database diagnosed with a first primary invasive CRC from 2010-2020, aged 20+ years at diagnosis, with complete data on SEER summary stage, and not diagnosed only by autopsy/death certificate. Outcomes included de novo metastatic site (no metastasis, liver, lung, brain, bone) and pattern (no metastasis, liver only, lung only, liver and lung, other). We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between 1) demographic and tumor characteristics (site, side, T stage, N stage) and site of de novo metastases , and 2) race/ethnicity and site of de novo metastases stratified by age (20-49, 50-74, 75+). We used multinomial logistic regression to assess the association between demographic and tumor characteristics and pattern of metastasis. Models adjusted for age, race/ethnicity, sex, site (colon, rectum), side (left, right), T stage, and N stage. Results: 62,844 stage IV CRC cases were diagnosed from 2010-2020, and liver was the most common metastatic site (72%). Relative to age 50-74, age 20-49 at diagnosis was more strongly associated with de novo liver metastases (OR: 1.07; 95% CI: 1.02-1.11) and less with lung (OR: 0.86; 95% CI: 0.80-0.92) or brain (OR: 0.69; 95% CI: 0.52-0.93) metastases. Relative to Non-Hispanic White (NHW) patients, Non-Hispanic American Indian/Alaskan Native (AI/AN) patients had a higher risk of lung metastases (OR: 1.33; 95% CI: 1.07-1.65), Non-Hispanic Asian/Pacific Islander (API) patients had lower risks of liver (OR: 0.87; 95% CI: 0.83-0.92) and brain (OR: 0.67; 95% CI: 0.48-0.95) metastases, and Non-Hispanic Black (NHB) patients had higher risks of liver (OR: 1.35; 95% CI: 1.29-1.41), lung (OR: 1.36; 95% CI: 1.27-1.45), and bone (OR: 1.23; 95% CI: 1.08-1.41) metastases. In age-stratified analyses, the risks for NHB patients persisted across groups, while lower risks for API patients were not observed in the 20-49 group. API patients aged 20-49 had a higher risk of de novo lung (OR: 1.31; 95% CI: 1.06-1.61) and bone (OR: 1.63; 95% CI: 1.13-2.37) metastases, and the increased risk of lung metastases for AI/AN patients was larger in magnitude (OR: 2.26; 95% CI: 1.39-3.68). Age 20-49 was more strongly associated with a liver-only pattern (OR: 1.14; 95% CI: 1.09-1.19) and with less common distant sites (OR: 1.33; 95% CI: 1.25-1.41). Conclusions: Racial/ethnic differences in de novo metastatic CRC patterns exist overall and across age groups. These findings are consistent with disparities in risk of stage IV CRC and can inform surveillance priorities in CRC survivors. Citation Format: Nicole C. Loroña, Mariana C. Stern, Stephanie L. Schmit, Jane C. Figueiredo. Racial and ethnic differences in site of de novo metastases in patients with colorectal cancer: A SEER 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 6135.

Racial disparities in the management and outcomes of primary osseous neoplasms of the spine: a SEER analysis.

Primary osseous neoplasms of the spine, including Ewing's sarcoma, osteosarcoma, chondrosarcoma, and chordoma, are rare tumors with significant morbidity and mortality. The present study aims to identify the prevalence and impact of racial disparities on management and outcomes of patients with these malignancies. The 2000 to 2020 Surveillance, Epidemiology, and End Results (SEER) Registry, a cancer registry, was retrospectively reviewed to identify patients with Ewing's sarcoma, osteosarcoma, chondrosarcoma, or chordoma of the vertebral column or sacrum/pelvis. Study patients were divided into race-based cohorts: White, Black, Hispanic, and Other. Demographics, tumor characteristics, treatment variables, and mortality were assessed. 2,415 patients were identified, of which 69.8% were White, 5.8% Black, 16.1% Hispanic, and 8.4% classified as "Other". Tumor type varied significantly between cohorts, with osteosarcoma affecting a greater proportion of Black patients compared to the others (p < 0.001). A lower proportion of Black and Other race patients received surgery compared to White and Hispanic patients (p < 0.001). Utilization of chemotherapy was highest in the Hispanic cohort (p < 0.001), though use of radiotherapy was similar across cohorts (p = 0.123). Five-year survival (p < 0.001) and median survival were greatest in White patients (p < 0.001). Compared to non-Hispanic Whites, Hispanic (p < 0.001) and "Other" patients (p < 0.001) were associated with reduced survival. Race may be associated with tumor characteristics at diagnosis (including subtype, size, and site), treatment utilization, and mortality, with non-White patients having lower survival compared to White patients. Further studies are necessary to identify underlying causes of these disparities and solutions for eliminating them.

Epidemiologic Characteristics, Treatment Patterns, and Survival Analysis of Plasmablastic Lymphoma in the United States: A SEER and NCDB Analysis

BackgroundPlasmablastic Lymphoma (PBL) is a rare aggressive B-cell lymphoma that primarily affects immunocompromised individuals, including those living with HIV. Historically, survival estimates are dismal and range from 8 to 15 months. We aimed to evaluate epidemiologic characteristics, treatment patterns and survival trends on a national scale. Patients and MethodsPatients diagnosed with PBL from 2010 to 2020 were identified in the National Cancer Database (NCDB) and in the Surveillance, Epidemiology, and End Results (SEER) program. Incidence rates were calculated using SEER. Demographic features, treatment characteristics, and overall survival (OS) were identified using the NCDB. ResultsWe identified 1153 patients in the SEER database and 1822 patients in the NCDB. The incidence of PBL is 0.07 cases per 100,000 US population per year. PBL is more common in males (77%), and white patients (77%), with 50% of cases in patients with HIV. Patients who were treated with multiagent chemotherapy had a median OS of 58.6 months. On multivariate Cox regression, we found that HIV status did not have a significant impact on OS. Factors associated with worse OS included advancing age and stage. ConclusionWe present the largest study to date on PBL. Among treated patients, we described a median OS of 58.6 months, greatly improved from previously reported estimates. We found that HIV status did not have a significant impact on OS. While OS remains poor, therapeutic advances over the last decade are promising and highlight the need for continued clinical advances aimed at improving therapeutic options for this rare lymphoma.

Clinicopathological features and prognostic significance of pulmonary adenocarcinoma with signet ring cell components: meta-analysis and SEER analysis.

Pulmonary adenocarcinoma is a common type of lung cancer that has been on the rise in recent years. Signet ring cell components (SRCC) can be present in various patterns of pulmonary adenocarcinoma, including papillary, acinar, and solid patterns. "Signet ring cell carcinoma" is a distinct subtype in the 2014 WHO classification of lung neoplasms, subsequent WHO classifications in 2015 and 2021 have deemed signet ring cells as accompanying morphological features with no clinical significance. The prognostic and clinical implications of SRCC in pulmonary adenocarcinoma remain controversial. Therefore, we conducted a meta-analysis to investigate the clinicopathological features and prognostic factors of SRCC in pulmonary adenocarcinoma. We conducted a comprehensive search in PubMed, EMBASE, and Web of Science to identify studies that examined the clinicopathological features and prognostic implications of pulmonary adenocarcinoma with SRCC. We used both fixed- and random-effects models to analyze the data and calculate the pooled hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (CIs). Additionally, we explored the prognostic significance of SRCC in pulmonary adenocarcinoma using the Surveillance, Epidemiology, and End Results (SEER) database. Our meta-analysis included 29 studies with pulmonary adenocarcinoma and SRCC components. The results showed that pulmonary adenocarcinoma with SRCC was associated with larger tumor size (OR = 1.99; 95% CI, 1.62-2.44, p < 0.001), advanced overall stage (OR = 5.18, 95% CI, 3.28-8.17, p < 0.00001) and lymph node stage (OR = 5.79, 95% CI, 1.96-17.09, p = 0.001), and worse overall survival (OS) compared to those without SRCC (HR = 1.80, 95% CI, 1.50-2.16, p < 0.00001). Analysis using the SEER dataset confirmed these findings. Our meta-analysis provides evidence that pulmonary adenocarcinoma with SRCC is associated with distinct clinicopathological features and a poorer prognosis. These findings have important implications for the management and treatment of patients. However, further studies are needed to validate these findings and explore the significance of SRCC in various subtypes of pulmonary adenocarcinoma.

Effect of known pathological risk factors on the incidence of metastatic lymph nodes and survival in early-stage vulvar cancer: SEER analysis.

The current study was performed to evaluate the incidence of positive lymph nodes (LNs) in relation to known pathological risk factors, specifically among patients with apparent low-grade, small tumors. We used the Surveillance, Epidemiology, and End Results (SEER) database to retrospectively identify patients with vulvar squamous cell carcinoma (SCC) diagnosed between January 1, 2000, and December 31, 2019, with known tumor size and regional LN examined. A comparison between patients who had positive and negative LNs was conducted to identify risk factors for LN metastases in relation to survival. Subgroup analysis was conducted in patients with diagnosed grade 1 vulvar SCC and tumor size up to 2 cm according to the status of LNs. Multivariate analysis found that both grade of disease and tumor size were significant factors in predicting LN status. Among patients with low-grade small tumors up to 2 cm, the odds ratio for positive LNs was 2.5 for those with tumor size larger than 1 cm. In a multivariate survival analysis, older age, larger tumor size, and positive LNs were independently associated with decreased survival. The current study confirms that among small tumors, those larger than 1 cm have a significantly increased risk for positive nodes compared with those smaller than 1 cm, and, among this specific group, patients with positive nodes have decreased survival. Future studies are needed to answer the question of whether, in the era of the sentinel node procedure, it is safe to omit LN evaluation altogether.

Risk of developing glioblastoma following non-CNS primary cancer: a SEER analysis between 2000 and 2018.

Patients with a prior malignancy are at elevated risk of developing subsequent primary malignancies (SPMs). However, the risk of developing subsequent primary glioblastoma (SPGBM) in patients with a prior cancer history is poorly understood. We used the Surveillance, Epidemiology, and End Results (SEER) database and identified patients diagnosed with non-CNS malignancy between 2000 and 2018. We calculated a modified standardized incidence ratio (M-SIR), defined as the ratio of the incidence of SPGBM among patients with initial non-CNS malignancy to the incidence of GBM in the general population, stratified by sex latency, and initial tumor location. Of the 5,326,172 patients diagnosed with a primary non-CNS malignancy, 3559 patients developed SPGBM (0.07%). Among patients with SPGBM, 2312 (65.0%) were men, compared to 2,706,933 (50.8%) men in the total primary non-CNS malignancy cohort. The median age at diagnosis of SPGBM was 65years. The mean latency between a prior non-CNS malignancy and developing a SPGBM was 67.3months (interquartile range [IQR] 27-100). Overall, patients with a primary non-CNS malignancy had a significantly elevated M-SIR (1.13, 95% CI 1.09-1.16), with a 13% increased incidence of SPGBM when compared to the incidence of developing GBM in the age-matched general population. When stratified by non-CNS tumor location, patients diagnosed with primary melanoma, lymphoma, prostate, breast, renal, or endocrine malignancies had a higher M-SIR (M-SIR ranges: 1.09-2.15). Patients with lung cancers (M-SIR 0.82, 95% CI 0.68-0.99), or stomach cancers (M-SIR 0.47, 95% CI 0.24-0.82) demonstrated a lower M-SIR. Patients with a history of prior non-CNS malignancy are at an overall increased risk of developing SPGBM relative to the incidence of developing GBM in the general population. However, the incidence of SPGBM after prior non-CNS malignancy varies by primary tumor location, with some non-CNS malignancies demonstrating either increased or decreased predisposition for SPGBM depending on tumor origin. These findings merit future investigation into whether these relationships represent treatment effects or a previously unknown shared predisposition for glioblastoma and non-CNS malignancy.

Nomogram for predicting survival after lymphatic metastasis in esophageal cancer: A SEER analysis.

Lymphatic metastasis (LM) is a significant mechanism for the spread of esophageal cancer (EC) and predicts the poor prognosis of EC patients. This research aimed to assess the survival of patients with LM from EC by developing a nomogram. In this retrospective study, EC patients with LM from 2004 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were divided by year of diagnosis into a training cohort and a validation cohort. Univariate and multivariate Cox regression analyses were employed to determine the prognostic factors of LM, and a nomogram was constructed. The discrimination and calibration of the nomogram were compared by the C-index, area under the curve value, and calibration plots. The survival time difference was compared using Kaplan-Meier curves. A total of 11,695 patients with EC were included in this analysis. LM occurred in 56.5% (n = 6614) of EC patients. In the post-propensity score matching (PSM) cohort, patients with LM had significantly lower median overall survival (OS) than those without LM. Multivariate Cox regression was used to identify the eleven independent prognostic factors. The C-index was 0.709 in both the training and test sets, revealing the good predictive performance of the nomogram. Based on the results of calibration plots and the receiver operating characteristic (ROC) curve, we demonstrate the great performance of the prognostic model. The survival time of EC patients with LM was remarkably lower than that of EC patients without LM. The nomogram model established in this study can precisely predict the survival of EC patients with LM.

Metastatic Testicular Cancer Patterns and Predictors: A Contemporary Population-based SEER Analysis

To elucidate clinical and demographic predictors of metastatic testicular cancer (TC) at presentation and study the impact of these factors on prognosis. Patients with metastatic TC experience poorer outcomes than those with localized or locoregional disease. Social determinants of health may compound this trend. The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify 16,528 patients aged ≥18 with TC diagnosed from 2010 to 2016. Descriptive statistics were analyzed using Fisher exact test and Pearson chi-square test for continuous and categorical variables. Predictors of specific metastases and factors impacting cancer-specific mortality (CSM) were evaluated using multivariate logistic regression analysis and competing risks regression, respectively. Of 16,474 patients with complete data, 1877 (11.39%) had distant metastases at diagnosis. These patients more commonly featured disease-specific and demographic variables associated with worse health outcomes (all P<.001). Lung metastases were the predominant site of synchronous and solitary metastases. Disease-specific predictors of metastasis included T stage, histology, tumor size, lymphovascular invasion, and cryptorchidism. Patient-specific predictors included age, geography, ethnicity, race, marital status, and socioeconomic status. Nearly one-fourth of patients with metastases died. Poor CSM was predicted by histology, age, insurance status, and socioeconomic status. All metastatic sites except bone were associated with worse CSM, with lung metastases conferring the greatest risk. This cross-sectional study identifies variables associated with TC metastasis and survival, particularly highlighting the importance of social determinants of health in TC mortality. These findings can facilitate a risk-stratified approach to staging and management while supporting new approaches to target disparities.

Incidence and characteristics of ovarian cancer following endometrial cancer in the emerging era of conservative management of endometrial cancer-Implications for counseling-A SEER analysis.

To assess the ovarian cancer (OC) risk following endometrial cancer (EC) in patients who underwent ovarian preservation as part of the EC staging. With permission of the Surveillance, Epidemiology and End Results (SEER) program of the United States National Cancer Institute, clinicopathological information of women diagnosed with EC and following OC were analyzed. Incidence of OC and survival according to the surgical approach were studied. Primary analysis was conducted in women up to and including the age of 49 years. A total of 116 patients up to the age of 49 years were diagnosed with EC and following OC. In this group of patients, no differences in incidence (IRR 0.9, CI 0.56-1.49, p = 0.66) or survival rates (p = 0.71) were found comparing ovarian preservation and bilateral salpingo-oophorectomy (BSO) performance. In an overall analysis of women diagnosed with EC and following OC at any age, incidence of OC did not differ between groups (IRR 1.07, CI 0.83-1.39, p = 0.59) yet when including patients older than 49 years old survival rates were shorter in ovarian preservation patients compared to patients with BSO performed as part of their EC treatment. Ovarian preservation in EC patients under the age of 49 years may be considered safe, with no impact on OC incidence or survival, benefiting longer natural hormonal status.

Investigation of cancer predisposition in Fanconi anemia heterozygotes: A DiscovEHR cohort population study.

10589 Background: Fanconi anemia (FA) is a cancer predisposition syndrome caused by biallelic pathogenic variants in one of 22 genes involved in DNA intrastrand crosslink repair. 20 of these genes have an autosomal recessive inheritance pattern. Of the FA genes, 5 ( BRCA1, BRCA2, BRIP1, PALB2, RAD51C) are known cancer predisposition genes (CPG) when inherited in monoallelic autosomal dominant manner, though the heterozygous predisposition status of the remaining 15 remains unclear. Large population-level exome sequencing projects with linked health records such as the DiscovEHR cohort serve as promising tools to establish sufficient power to investigate all FA genes. Quantifying cancer risk is important for the counseling and surveillance of FA heterozygotes, especially with the ever-increasing use of genetic testing identifying these individuals. Methods: 170,503 individuals enrolled in the DiscovEHR Cohort were analyzed for pathogenic/likely pathogenic variants in 22 FA genes and identified 5834 subjects, the case group. ICD10 phenotype classifications for these subjects were curated to Phecodes and ICD-O-3 Site Recodes for two control arms of analysis. The first control arm included all DiscovEHR subjects excluding the case group and those with a variant of uncertain significance in the genes of interest with a deleterious in-silico score. The second control arm included individuals from the Surveillance, Epidemiology, and End Results (SEER) database. Phecode analysis yielded odds ratios adjusted for age, sex, race, smoking status, and BMI. SEER analysis yielded Standardized Incidence Ratio scores adjusted for age, sex, and birth cohort. When both arms of the analysis were completed Phecodes and SEER analyses were matched and positive signals for cancer risk were defined by statistically significant ratios in both. Results: The 5 known CPGs demonstrated multiple signals for cancer predisposition as expected (p &lt; 0.0001). Results for FANCA (p = 0.4231) and FANCC (p = 0.8142) heterozygotes validated recent results from our group showing no increased risk of cancer in relatives of FA patients with these genotypes. Ten other FA genes also showed no increased risk of cancer. 3 genes suggested a possible increased risk of specific cancers in heterozygotes and are currently being evaluated in a second large population exome cohort to validate these findings. Conclusions: This is the largest study to date on the cancer predisposition risk in Fanconi anemia heterozygotes. We have confirmed the known risk in 5 well-described CPGs and the lack of risk amongst FANCA and FANCC heterozygotes, the most common in population. Further analysis via an additional large population cohort is underway to validate any possible novel cancer predispositions in 3 genes. For the remaining FA genes, this population analysis supports previous literature on known CPGs and the lack of cancer predisposition in most FA genes.

Survival outcomes of metastasectomy and primary site resection in melanoma patients with isolated brain metastasis: A SEER analysis.

e21541 Background: Approximately 40–50% of Stage IV melanoma patients eventually develop brain metastases which is associated with poor prognosis. Breakthroughs in targeted and immunotherapies have improved long-term survival in advanced melanoma patients. In this new era, there is a paucity of evidence for the role of metastatectomy for melanoma patients with brain metastasis. Here, we investigate the survival benefit of metastasectomy and primary site resection in melanoma patients with isolated brain metastasis. Methods: A total of 636 patients with melanoma with isolated brain metastasis at diagnosis were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2019. Patients younger than 18 years, cases with missing information including age, gender, race, unknown stage, unknown primary site resection status, unknown metastasis site, or known metastasis to the lung, liver, or bones were excluded. Cox regression analysis estimated the prognostic value of metastasectomy and primary site resection, presented by hazard ratios (HR), among melanoma patients. Survival ratios were controlled for age, race, gender, and type of melanoma. All analyses were performed on STATA v17. Results: About 49.37% of melanoma patients with isolated brain metastasis underwent metastasectomy. Of the included sample, 25% (n = 159) underwent primary site resection. Cox regression demonstrated that metastasectomy was associated with improved survival outcomes in melanoma patients with isolated brain metastasis (HR 0.51, CI 0.42 – 0.63, p &lt; 0.001). Pooled primary site resection procedures were associated with improved survival (HR 0.64, CI 0.49 – 0.83, p = 0.001) compared to not having a primary site resection. When stratified per procedure type, “wide excision or re-excision of lesions with margins &gt; 1 cm and microscopically negative margins” was associated with improved survival (HR 0.27, CI 0.133 – 0.56, p &lt; 0.001) compared to not having surgical resection, all other primary site resection procedures had no significant improvement in survival with p &gt; 0.05. Conclusions: Metastasectomy and primary site resection significantly improved survival in melanoma patients with isolated brain metastasis. Wide excision with &gt; 1cm negative margins presents itself as the most effective surgical treatment modality in terms of improving survival for these patients. Thus, it should be attempted whenever feasible.

Adjuvant therapy in localized vs regional biliary tract cancers: A SEER analysis.

e16221 Background: Biliary Tract Cancers (BTC) are aggressive malignancies. Treatment of early-stage disease involves surgical resection, but whether adjuvant therapy offers a clear survival benefit remains inconclusive. This study aims to explore the impact of demographic factors and adjuvant therapy on survival outcomes at a population level through the lens of the latest SEER (Surveillance, Epidemiology, and End Results) registries. Methods: Cases were filtered by the following criteria: histologic type (adenocarcinoma), anatomic location (gallbladder, intrahepatic, extrahepatic), stage (local and regional), microscopically confirmed diagnosis, and confirmed surgical resection. Cases with incomplete entries were excluded. A Cox proportional hazard model was used to analyze survival in the context of race, gender, income, and type of adjuvant therapy (none, chemotherapy (AC), chemo-radiotherapy (CRT), and radiation (RT)). Data analysis was performed in RStudio. Results: Between 2005 and 2019, 3565 patients were identified. Patients with regional BTC demonstrated improved median survival with AC (27 vs 23 months, HR 0.72, CI 0.63-0.82, p ≤.05) and CRT (28 vs 23 months, HR 0.63, CI 0.56-0.72, p ≤.05). Median survival in localized BTC was 52 months. Adjuvant therapy of any type did not impact survival for localized BTC. Analysis of race as a covariate in localized BTC showed that all minority groups had improved survival compared to non-Hispanic whites (Asian, HR 0.33; Black, HR 0.50; Hispanic, HR 0.38, p≤.05). In regional gallbladder BTC, this survival benefit was limited to Asians only (HR 0.52, p≤.05). Conclusions: Our data show that AC and CRT may improve survival in patients with regional BTC across all anatomic subtypes. In our cohort, adjuvant therapy had no impact on survival in localized BTC. Differences in outcomes may exist among racial groups for different subtypes of BTC. Future adjuvant clinical trials for BTC should consider stratifying for regional and localized disease. [Table: see text]

Surgery with adjuvant chemotherapy versus chemoradiation for early-stage large cell neuroendocrine cancer (LCNEC) of the lung: A SEER plus based analysis.

e20616 Background: LCNEC of the lung is a rare and highly aggressive tumor with neuroendocrine differentiation. Given its rare occurrence and lack of data from large randomized trials, treatment recommendations are based on the extrapolation of data, primarily from small-cell lung cancer studies. We conducted this study to evaluate the survival difference among patients with LCNEC with an N1 disease between those who received surgery and adjuvant chemotherapy versus definitive chemotherapy and radiotherapy. Methods: We utilized Surveillance, Epidemiology, and End Results (SEER) plus 18 registries database to identify patients diagnosed with LCNEC with tumor stage of T1, T2, or T3 and nodal stage of N1. The study population included patients, 18 years and above, who underwent surgical resection followed by adjuvant chemotherapy and patients who received definitive chemo-radiotherapy for early stage LCNEC. Kaplan-Meier and log rank test were used to compare overall survival (OS) and Cancer specific survival (CSS). Multivariate survival analysis was done using the cox proportional hazards regression model. Results: A total of 178 patients were included, 57.3% (n = 102) were &lt; 65-year-old, 50.56% (n = 90) were male, mostly Caucasian 87.08% (n = 155) and identified as non-Hispanic 93.26% (n = 166). Out of them, 70.22% (n = 125) underwent surgery plus adjuvant chemotherapy and 29.78% (n = 53) underwent chemoradiation. Patients who underwent surgery with adjuvant chemotherapy had higher overall survival (OS) than chemoradiation (37 vs. 11 months respectively). 3-year (49.9% vs. 15.7%) and 5-year OS rates (36.7% vs. 10.4%) were also higher in the earlier group. On multivariate analysis after adjusting for age, gender, race and origin, patients who received chemoradiation had higher hazards as compared to those who received surgery and adjuvant chemotherapy (Hazard ratio: 2.91, 95% Confidence interval (CI):1.93,4.37, P value &lt; 0.001). When examining the cancer specific survival (CSS), similar results were observed with higher CSS in the surgery with adjuvant chemotherapy group (18 vs. 8 months) reaching a statistical significance of P &lt; 0.001 and higher hazards in chemoradiation group (Hazard ratio: 3.33, 95% Confidence interval (CI):2.09,5.28, P value &lt; 0.001). 3-year survival (26.47% vs. 2.7 %) and 5-year CSS rates (11.76% vs. not reached) were also pronounced in the patients treated with surgery with adjuvant chemotherapy. Conclusions: Our study demonstrates that patients with early stage LCNEC (T1-3 N1) disease treated with surgery and adjuvant chemotherapy had statistically significant overall and cancer specific survival rates compared to those treated with chemoradiation.

Abstract 4: A SEER Analysis of Demographic Factors Associated With Ceruminous Adenocarcinoma, 2000-2019

Abstract Purpose: Ceruminous adenocarcinoma (CA) is an uncommon malignancy that arises from the ceruminous glands located in the external auditory canal. Although rare, 25% of patients with CA die of the disease within 2 years of presentation. CA has a 10-year survival rate of 60% with radiation treatment and 30% without radiation treatment. The rarity of this tumor type, combined with a lack of published data, makes it difficult to fully understand its clinical characteristics and optimal management strategies. A study on its epidemiology could offer valuable insight into the diagnostic trend of the disease. The Surveillance Epidemiology and End Results (SEER) database was analyzed to determine the demographic factors in patients diagnosed with CA. Methods: A retrospective cohort analysis utilizing the SEER database from 2000 to 2019 included patients with a confirmed diagnosis of CA (N=45). Cross-tabulation of the demographic factors (age, sex, race, marital status, and Hispanic origin) was analyzed by Pearson’s chi-squared test (p=0.05) and incidence trends were interpreted in regression analysis. Results: There has been a downward trend in incidence rates of patients diagnosed with CA since 2007 (R2=0.139) with an average of 2.25 diagnoses per year. A total of 45 patients were identified in the database with a confirmed diagnosis of CA. The average age of diagnosis was 60.0 years (SD=15.4, range=26–88 years). The top primary site was the external ear (69%), followed by skin of the trunk (8.9%) and skin of the lower limb (6.7%). The majority of the patients were male (53%), non-Spanish-Hispanic-Latino (91%), and White (82%) followed by Black (8.9%), and Asian/Pacific Islanders (6.7%). More patients (40%) were married at the time of diagnosis than those who were widowed (13%), single (9%), or divorced (7%), with the rest having unknown marital status (31%). There were no statistically significant differences between the demographic factors and the primary site at which CA presents. Conclusion: The majority of CA patients tend to be non-Hispanic White males with a declining number of cases each year. Further research is needed to better understand the impact of demographic factors on the diagnosis and overall survival of patients with CA, as well as the reason for the decreased incidence and possible underdiagnosis of the disease. Citation Format: Beau Hsia, Darby Keirns, Peter Silberstein, Xinxin Wu. A SEER Analysis of Demographic Factors Associated With Ceruminous Adenocarcinoma, 2000-2019 [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 4.

Racial and ethnic disparities in surgery for kidney cancer: a SEER analysis, 2007–2014

ABSTRACT Background and Objectives: Compared with White patients, Black and American Indian/Alaskan Native (AI/AN) patients experience higher rates of kidney cancer incidence, and Black, AI/AN, and Hispanic patients face later stages of disease at diagnosis, poorer survival rates, and greater risk of mortality. Despite the importance that appropriate treatment has in ensuring positive outcomes, little is known about the association between race and ethnicity and receipt of treatment for kidney cancer. Accordingly, the aim of this study was to explore differences in receipt of treatment and patterns of refusal of recommended treatment by race and ethnicity. Design: 96,745 patients ages 45–84 with kidney cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) program between 2007 and 2014. Logistic regression models were used to examine the association of race and ethnicity with treatment and with patient refusal of recommended treatment. Outcomes of interest were (1) receiving any surgical procedure, and (2) refusing recommended surgery. Results: Relative to White patients, Black and AI/AN patients had lower odds of undergoing any surgical procedure (OR = 0.76; 95% CI: 0.72–0.81; p < 0.001, and OR = 0.92; 95% CI: 0.76–1.10; p = 0.36, respectively) after adjusting for gender, age, insurance status, stage at diagnosis, unemployment status, education status, and income as additive effects. Black and AI/AN patients also had higher odds of refusing recommended surgery (OR = 1.93; 95% CI: 1.56–2.39; p < 0.001, and OR = 1.99; 95% CI: 1.05–3.76; p = 0.035, respectively). Hispanic patients had slightly higher odds of undergoing any surgical procedure (OR = 1.10; 95% CI: 1.04–1.17; p = 0.001) and lower odds of refusal (OR = 0.67; 95% CI: 0.50–0.90; p = 0.007, respectively). Conclusions: Compared with White patients, Black patients were less likely to receive potentially life-saving surgery, and both Black and AI/AN patients were more likely to refuse recommended surgery.

Surgical resection of primary tumors improves survival in patients with lung metastases: a population-based SEER analysis.

The lung is a common site for cancer metastasis. Some cancer patients would develop lung metastases throughout the course of their illness. However, choosing surgical resection of the primary tumor (SRPT) or palliative treatment in patients with lung metastases remains controversial. Lung metastatic patients diagnosed from 2010 to 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Selected patients were divided into two subgroups (surgery and non-surgery). Further, all the 58 tumor types were classified into 13 subtypes. The clinical and demographic features were examined by the Fisher's exact test, chi-squared test, or z-test. Overall survival (OS) was analyzed using the Kaplan-Meier (K-M) estimator and a log-rank test for each primary tumor type. Multivariable survival analyses of OS were performed using the Cox proportional hazards model. Among the 118,088 patients selected for study, 18,688 (15.83%) patients had undergone surgery. The analyses demonstrated that there was a significant association between SRPT and better OS in patients with lung metastases. The median survival time increased from 4.0 months in the non-surgery group to 19.0 months in the surgery group. Multivariate Cox regression analyses further validated that patients who underwent SRPT had an improved OS. The current study demonstrated that patients with lung metastases can benefit from SRPT. SRPT should be considered in patients with lung metastases. Properly designed prospective randomized clinical trials would be required to further verify the conclusion.

PD20-08 TRENDS IN PROSTATE CANCER SPECIFIC MORTALITY BY RACE OVER TIME: A SEER ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD20-08 TRENDS IN PROSTATE CANCER SPECIFIC MORTALITY BY RACE OVER TIME: A SEER ANALYSIS Davuluri Meenakshi, Gina Demeo, Himanshu Nagar, Leonardo Borregales, and Jim Hu Davuluri MeenakshiDavuluri Meenakshi More articles by this author , Gina DemeoGina Demeo More articles by this author , Himanshu NagarHimanshu Nagar More articles by this author , Leonardo BorregalesLeonardo Borregales More articles by this author , and Jim HuJim Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been demonstrated there was an increase in metastatic prostate cancer diagnosis from 2004 to 2013 in a previous SEER analysis. Our goal was to evaluate trends in prostate cancer specific mortality (PCSM) during this time period to determine if increased metastatic disease correlated with increased mortality rates. METHODS: Using Surveillance, Epidemiology, and End Results (SEER) registry database, we identified men diagnosed with prostate cancer from 2004-2013. Men were stratified by age at diagnosis, race (White, Black, Hispanic, Asian, Native American, and Other), and stage at diagnosis. Number of deaths were identified and PCSM mortality was calculated. Descriptive statistics were used. RESULTS: We identified 497,166 men in SEER who met our inclusion criteria from 2004-2013. In this time period, the overall cohort PCSM decreased from 9.65% in 2004 to 5.95% in 2013 (Figure 1). We then stratified PCSM by race (Figure 2). We found that across all races PCSM decreased from 2004 to 2013 with the largest decrease in Native American men (18.0% to 10.4%) followed by Black men (11.6% to 7.0%). We further sub-stratified PCSM for men with distant metastasis at time of diagnosis (Figure 3). In this cohort of men, again a decrease in PCSM across all races was seen. The differences in PCSM from 2004 to 2013 are 3.9%, 8.9%, 5.9%, 13.2% and 22.8% for White, Black, Hispanic, Asian, and Native American men respectively. The largest decrease of PCSM was seen in Native American men with a 22% reduction of death rates in men diagnosed with metastatic disease from 2004 to 2013. CONCLUSIONS: PCSM has decreased overtime despite previous findings of increasing metastatic disease at time of diagnosis. This may be due to improved treatment options for metastatic disease. PCSM has decreased across all races, however Native American and Black men continue to have higher rates PCSM compared to other races. As more interventions are implemented to address disparities, longitudinal studies will be required to determine the impacts on survival outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e586 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Davuluri Meenakshi More articles by this author Gina Demeo More articles by this author Himanshu Nagar More articles by this author Leonardo Borregales More articles by this author Jim Hu More articles by this author Expand All Advertisement PDF downloadLoading ...

Surgery and postoperative radiotherapy affect the prognosis of esophageal cancer: A SEER analysis.

The principal treatment modalities for esophageal cancer are radiation, chemotherapy and surgery or a combination of them. In some sense, technological advances have tremendously heightened patients' survival rates. Nevertheless, the debate on the prognostic value of postoperative radiotherapy (PORT) has never ceased. On that account, this study made an effort to probe deep into the effects of PORT and surgery on the prognosis of stage III esophageal cancer. Our study included patients diagnosed with stage III esophageal cancer between 2004 and 2015 through the Surveillance, Epidemiology, and End Results (SEER) program. We performed propensity score matching (PSM) on the basis of whether surgery was carried out and whether PORT conducted. We identified the independent risk factors by multivariate Cox regression and constructed a nomogram model. In this research, we included 3940 patients, and the median follow-up is 14 months: 1932 cases without surgery; 2008 cases with surgery, and 322 cases of them underwent PORT. In the postPSM patient cohort, patients who underwent surgery had a median overall survival rate (OS) of 19.0 (95% confidence interval [CI] 17.2-20.8) and a median cancer-specific survival rate (CSS) of 23.0 (95% CI 20.6-25.3) months, which were remarkably higher than those without surgery (P < .001). The OS（P < .05）and CSS（P < .05）of the patients who underwent PORT were lower than those who did not. Similar results were obtained in the groups of N0 and N1. This study revealed surgery can heighten patients' survival rate, while PORT could not elevate patients' survival rate in stage III esophageal cancer patients.

Effect of Chemotherapy in Stage II–IV Large-Cell Lung Carcinoma and Construction of Its Predictive Nomograms: A SEER Analysis

Objectives: Large-cell lung carcinoma (LCLC) is generally poorly differentiated with a poor prognosis. This study aimed to explore the impact of chemotherapy on the prognosis of patients with stage II–IV LCLC and to construct nomograms to predict overall survival (OS) and cancer-specific survival (CSS). Methods: Propensity score matching analysis was used to balance the effects of baseline characteristics. The Kaplan-Meier method was used to analyze the prognostic impact of chemotherapy on LCLC patients. Cox regression analysis was used to identify prognostic risk factors, and then nomograms were constructed and validated. Results: Overall, we identified 2,532 patients with LCLC from the Surveillance, Epidemiology, and End Results (SEER) database. The chemotherapy group showed better OS and CSS compared to the non-/unknown chemotherapy group for stage II–IV LCLC patients (p < 0.05). Two nomograms were plotted based on the results of Cox regression analysis. The areas under the curves (AUCs) of 1-, 3-, and 5-year OS were 0.786, 0.824, and 0.837, and the AUCs of CSS were 0.785, 0.821, and 0.836, respectively. The calibration curves showed excellent agreement between the prediction and the actual observation, and the decision curve analysis demonstrated good clinical utility. Conclusions: Chemotherapy could improve the prognosis among stage II–IV LCLC patients. In addition, the nomograms showed good predictive ability, which could be useful in making clinical decisions.

Exploring the intersectionality of race/ethnicity with rurality on breast cancer outcomes: SEER analysis, 2000–2016

PurposeDisparities in breast cancer survival have been observed within marginalized racial/ethnic groups and within the rural–urban continuum for decades. We examined whether there were differences among the intersectionality of race/ethnicity and rural residence on breast cancer outcomes.MethodsWe performed a retrospective analysis among 739,448 breast cancer patients using Surveillance Epidemiology and End Results (SEER) 18 registries years 2000 through 2016. We conducted multilevel logistic-regression and Cox proportional hazards models to estimate adjusted odds ratios (AORs) and hazard ratios (AHRs), respectively, for breast cancer outcomes including surgical treatment, radiation therapy, chemotherapy, late-stage disease, and risk of breast cancer death. Rural was defined as 2013 Rural–Urban Continuum Codes (RUCC) of 4 or greater.ResultsCompared with non-Hispanic white–urban (NH-white–U) women, NH-black–U, NH-black–rural (R), Hispanic–U, and Hispanic–R women, respectively, were at increased odds of no receipt of surgical treatment (NH-black–U, AOR = 1.98, 95% CI 1.91–2.05; NH-black–R, AOR = 1.72, 95% CI 1.52–1.94; Hispanic–U, AOR = 1.58, 95% CI 1.52–1.65; and Hispanic–R, AOR = 1.40, 95% CI 1.18–1.67), late-stage diagnosis (NH-black–U, AOR = 1.32, 95% CI 1.29–1.34; NH-black–R, AOR = 1.29, 95% CI 1.22–1.36; Hispanic–U, AOR = 1.25, 95% CI 1.23–1.27; and Hispanic–R, AOR = 1.17, 95% CI 1.08–1.27), and increased risks for breast cancer death (NH-black–U, AHR = 1.46, 95% CI 1.43–1.50; NH-black–R, AHR = 1.42, 95% CI 1.32–1.53; and Hispanic–U, AHR = 1.10, 95% CI 1.07–1.13).ConclusionRegardless of rurality, NH-black and Hispanic women had significantly increased odds of late-stage diagnosis, no receipt of treatment, and risk of breast cancer death.