Surveillance, Epidemiology, And End Results Database Analysis Research Articles

The incidence and comparative prognosis of primary cancers with metastasis to non-common sites: A SEER database analysis of 2016-2018.

e22506 Background: Primary tumors can present late with metastasis to uncommon sites (such as adrenals, bone marrow, pleura, malignant pleural effusion, peritoneum, and skin, among others) as well as common sites (such as liver, bone, lung, and distal lymph nodes). Our study aimed to investigate the characteristics and comparative survival for metastasis to uncommon sites at the time of diagnosis using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: We extracted the data from the SEER database for the years 2016-2018 to include all patients presenting with metastasis to uncommon sites at diagnosis without restrictions on age, race, year of diagnosis, or histological type. Uncommon sites of metastasis were coded as other sites in the SEER database and did not involve liver, bone, brain, lung, and distal lymph nodes. We used R software to perform the descriptive analysis for uncommon sites according to the primary sites and co-metastasis along with their survival. Results: A total of 25,345 patients were included with metastasis to uncommon sites with a female predominance of 13,033 (51.4 %); the mean age at diagnosis was 68 ± 17 years. Lung and bronchus primaries represented the largest proportion with metastasized to uncommon sites 10,612 (41.9%), followed by non-Hodgkin's lymphoma-nodal 1,871 (7.4%), pancreas 1,690 (6.6%), stomach 940 (3.7%), and ovarian 885 (3.4%). The incidence was most common in respiratory cancers in ages 61-80 years (25%) and least in breast primaries in ages 18-40 years (0.1%). Whites compared to other races had a higher incidence. Liver cancer had the worst prognosis with a median survival of 1 month, whereas small intestine tumors were associated with a better prognosis with a median survival of 13 months. Further survival data is mentioned in the table. Conclusions: Our study concluded that the lung and bronchus cancers were the most common primaries metastasized to uncommon sites at diagnosis while the liver had the worst survival. These findings will help redirect the available screening tools to improve survival in patients with primary tumors with metastasis at diagnosis and may also play an essential role in future research and achieve a better prognosis for cancer patients.[Table: see text]

Establishment of Prognostic Nomograms for Early-Onset Prostate Cancer Patients: A SEER Database Analysis

Objective Clinical prostate cancer (PCa) is rare in men aged <50 years (early-onset). A well-designed nomogram for prognosis prediction in patients with early-onset PCa has not been studied. Here, we tried to establish nomogram models of overall survival (OS) and cancer-specific survival (CSS) in patients with early-onset PCa. Methods The clinical variables of patients diagnosed with early-onset PCa between 2004 and 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and validation groups at a ratio of 7:3. Multivariate Cox regression analyses were used to select prognostic factors associated with OS or CSS, followed by the construction and validation of nomograms. Results We enrolled 8259 patients with early-onset PCa. New nomograms were established and showed good discriminative abilities. Finally, ROC curve analysis demonstrated that these nomograms were superior to the TNM stage and Gleason score in predicting both OS and CSS for patients with early-onset PCa. Conclusion This is the first study to establish nomograms with effective and high accuracy for prognosis in patients with early-onset PCa.

The Effect of the Appropriate Timing of Radiotherapy on Survival Benefit in Patients with Metastatic Esophageal Cancer Who Have Undergone Resection of Primary Site: A SEER Database Analysis.

Background Metastatic esophageal cancer (MEC) is an advanced stage of esophageal cancer. However, still, resection of primary site and radiotherapy are considered treatment modalities to treat patients with MEC. Hence, this study is aimed at exploring the effect of the appropriate timing of radiotherapy on the survival benefit of these patients by comparing cancer-specific survival (CSS). Method The patient information was obtained from the National Surveillance Epidemiology and End Results (SEER) database between the years 2004 and 2017. We used the SEER∗ STAT (V8.3.9.2) software to search and download data. Patients treated with pre- and postoperative radiotherapy were divided into two groups. The propensity score matching (PSM) analysis was performed to increase the comparability of data within two groups. We used the Kaplan-Meier method to analyze and compare the CSS between the two groups. The Cox risk model was used to analyze variables affecting patient survival. Results A total of 599 patients with MEC who experienced resection of the primary site and radiotherapy were recruited. 144 pairings formed through PSM. The 5-year CSS was 23.0% and 11.7% for patients who have undergone pre- and postoperative radiotherapy, respectively. Patients who have undergone preoperative radiotherapy showed better CSS than those who received postoperative radiotherapy (P < 0.001). The multivariate Cox analysis of the entire cohort showed that age > 60 years at the time of diagnosis (HR = 1.481, 95% CI: 1.1341-1.934, and P = 0.04) and other histological types of esophageal cancer (HR = 1.581, 95% CI: 1.067-2.341, and P = 0.022) increased the risk of cancer-related death. Inversely, marriage (HR = 0.696, 95% CI: 0.514-0.942, and P = 0.019) and preoperative radiotherapy (HR = 0.664, 95% CI: 0.517-0.853, and P < 0.001) reduced the risk of death from cancer. Conclusions For patients with MEC, preoperative radiotherapy might have a significant effect on the survival benefit over those who receive postoperative radiotherapy.

A Nomogram for Predicting Cancer-Specific Survival of Osteosarcoma and Ewing's Sarcoma in Children: A SEER Database Analysis.

BackgroundOsteosarcoma (OSC) and Ewing's sarcoma (EWS) are children's most common primary bone tumors. The purpose of the study is to develop and validate a new nomogram to predict the cancer-specific survival (CSS) of childhood OSC and EWS.MethodsThe clinicopathological information of all children with OSC and EWS from 2004 to 2018 was downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were used to screen children's independent risk factors for CSS. These risk factors were used to construct a nomogram to predict the CSS of children with OSC and EWS. A series of validation methods, including calibration plots, consistency index (C-index), and area under the receiver operating characteristic curve (AUC), were used to validate the accuracy and reliability of the prediction model. Decision curve analysis (DCA) was used to validate the clinical application efficacy of predictive models. All patients were divided into low- and high-risk groups based on the nomogram score. Kaplan-Meier curve and log-rank test were used to compare survival differences between the two groups.ResultsA total of 2059 children with OSC and EWS were included. All patients were randomly divided into training cohort 60% (N = 1215) and validation cohort 40% (N = 844). Univariate and multivariate analysis suggested that age, surgery, stage, primary site, tumor size, and histological type were independent risk factors. Nomograms were established based on these factors to predict 3-, 5-, and 8-years CSS of children with OSC and EWS. The calibration plots showed that the predicted value was highly consistent with the actual value. In the training cohort and validation cohort, the C-index was 0.729 (0.702–0.756) and 0.735 (0.702–0.768), respectively. The AUC of the training cohort and the validation cohort also showed similar results. The DCA showed that the nomogram had good clinical value.ConclusionWe constructed a new nomogram to predict the CSS of OSC and EWS in children. This predictive model has good accuracy and reliability and can help doctors and patients develop clinical strategies.

Racial Disparities in Clinical Features and Survival Outcomes among Patients with Pancreatic Neuroendocrine Tumor: A Contemporary SEER Database Analysis

Objective: The characteristics of clinical features and prognoses among patients with different racial backgrounds have not been clearly studied. We thus investigated the clinical characteristics and overall survival (OS) differences among Asian, White, and Black patients with pancreatic neuroendocrine tumors (pNETs). Materials and Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with pNETs between 1983 and 2015. We performed univariable (UVA) and multivariable logistic regression (MVA) to assess the association between variables and race category. A Kaplan-Meier (KM) plot was used to calculate the OS rates. The Cox proportional hazard regression was used to report the hazard of death. Results: We identified 9,494 patients with a median follow-up of 31 months. There were 5,541 Whites (78.6%), 942 Blacks (13.4%), and 569 Asians (8.1%). Asians were more likely to be younger, married, diagnosed at an earlier stage, and have a tumor located at the head of the pancreas. White patients were less likely to be married and had, on average, a higher percentage of the primary tumor at the tail of the pancreas, while Black patients were generally diagnosed at a much later stage. The median OS of Asians (71 months) was significantly higher than that of Whites (50 months, p = 0.03) and Blacks (53 months, p = 0.01). Multivariable Cox regression showed no OS difference among the three races after adjusting for independent prognostic factors, including age, marital status, primary site, TNM stage and treatment. Subgroup analysis in each race showed that age, M stage, and surgical treatment were independent prognostic factors for survival in all three races while being female, married, and in the N0 stage were positive prognostic factors of OS only in Whites. Among patients with surgery, Asians had the best OS. Conclusions: Asians had the best OS among those who received surgery. Age, M stage, and surgical treatment were the independent prognostic factors for survival across the three races. Female, married, and in the N0 stage were positive predictive factors for survival only in White patients.

The impact of young age at diagnosis (age

PurposeWomen under 40 years old are at increased risk for developing human epidermal growth factor receptor 2 (HER2) positive or triple negative subtype and more advanced breast cancer, yet young age itself has also historically been an independent prognostic factor. MethodsUsing the Surveillance, Epidemiology, and End Results (SEER) Program, we examined data for 271,173 women with stage I-III breast cancer between 2010 and 2015. Using Fine and Gray regression models to account for competing risks, we examined the risk of breast cancer-specific death by age and clinical subtypes, considering grade, hormone receptor (HR) and HER2 status, adjusting for demographic, clinical and treatment variables. ResultsOf 271,173 women eligible for analysis, 14,109 were <40 years of age. Women under 40 years old were more likely to be non-white, uninsured, and to have higher stage, higher grade, HER2-positive and triple-negative subtype disease (all, p < 0.001). Compared to women ages 40–60, women ages <40 had higher breast cancer mortality (hazard ratio, 1.8; 95% confidence interval (CI) 1.6–1.9) in unadjusted analysis. In models controlling for demographic, clinical and treatment factors, young age was significantly associated with an increased risk of breast cancer mortality among women with HR-positive, lower grade disease (hazard ratio 1.7; 95% CI 1.4–2.1) but not for women with high grade/HR-positive, HER2-positive, or triple-negative disease. Women age >75 had increased breast cancer mortality in all subtypes. ConclusionWith modern clinical subtyping, age under 40 remains independently associated with worse outcomes in 30 months follow-up only in HR-positive, lower grade disease.

Adult versus paediatric undifferentiated embryonal sarcoma of the liver: a SEER database analysis.

Undifferentiated embryonal sarcoma of the liver (UESL) is a rare liver tumour that occurs mainly in children. Herein, we aimed to identify any differences in clinical characteristics and survival between adult and paediatric patients with UESL. From 1975 to 2015 in the Surveillance, Epidemiology and End Results (SEER) database, patients diagnosed with UESL were identified and divided into paediatric (<18 years) and adult (≥18 years) groups. We then compared the clinical characteristics, management, and overall survival (OS) of adults and children diagnosed with UESL. We analysed 113 patients with UESL (81 children and 32 adults). UESL was significantly more common in adult male than paediatric male patients (71.9% vs. 48.2%; P=0.022). When compared to adult patients, paediatric patients were more likely to receive chemotherapy (93.8% vs. 65.6%; P < 0.001). Adults had a significantly worse OS than paediatric patients (5-year OS, 30.0% vs. 81.2%; P < 0.001). Univariate analysis found that adult age, surgical therapy and chemotherapy were associated with OS. Multivariate analysis revealed that adult age, SEER summary stage and surgical therapy were independent prognostic factors for OS. UESL had a male predominance among adult patients. Moreover, the prognosis of adult patients with UESL was significantly worse than that of paediatric patients. Surgery and chemotherapy should be considered in the treatment of patients with UESL.

Is Chemotherapy Associated with Improved Overall Survival in Patients with Dedifferentiated Chondrosarcoma? A SEER Database Analysis.

Dedifferentiated chondrosarcoma is a chondrosarcoma subtype associated with high rates of recurrence and a poor prognosis. Others have proposed treatment of dedifferentiated chondrosarcoma using osteosarcoma protocols, including perioperative chemotherapy. However, the rarity of this condition poses difficulties in undertaking single- institution studies of sufficient sample size. Is perioperative chemotherapy associated with improved overall survival in patients with dedifferentiated chondrosarcoma? We queried the Surveillance, Epidemiology, and End Results (SEER) 1973 to 2016 database for patients with a diagnosis of dedifferentiated chondrosarcoma (n = 308). As dedifferentiated chondrosarcoma was only classified as a distinct entity in SEER starting in 2000, only patients treated in 2000 and later were included. We excluded from our analyses those patients with distant disease at diagnosis, a primary site of disease other than bone or joints, and those who did not receive cancer-directed surgery. These criteria yielded 185 dedifferentiated chondrosarcoma patients for inclusion. We used Kaplan-Meier analyses and Cox proportional hazards models to assess the association of clinical, demographic, and treatment characteristics on overall survival (OS). After controlling for confounding variables, including age, sex, tumor size, stage, grade, location, and radiation treatment status, and after adjusting for missing data, no overall survival benefit was associated with receipt of chemotherapy in patients with dedifferentiated chondrosarcoma (hazard ratio 0.75 [95% confidence interval 0.49 to 1.12]; p = 0.16). Chemotherapy treatment of dedifferentiated chondrosarcoma was not associated with improved OS. These results must be viewed cautiously, given the limited granularity of information on chemotherapy treatment, the concerns regarding chemotherapy misclassification in SEER data, and the small sample of patients with dedifferentiated chondrosarcoma, all of which limit the power to detect a difference. Our findings are nevertheless consistent with those of prior reports in which no benefit of chemotherapy could be detected. Lack of clear benefit from perioperative chemotherapy in dedifferentiated chondrosarcoma argues that it should be used only after careful consideration, and ideally in the context of a clinical trial. Level III, therapeutic study.

Neo-adjuvant radiation therapy provides a survival advantage in T3-T4 nodal positive gastric and gastroesophageal junction adenocarcinoma: a SEER database analysis

BackgroundDue to negative results in clinical trials of postoperative chemoradiation for gastric cancer, at present, there is a tendency to move chemoradiation therapy forward in gastric and gastroesophageal junction (GEJ) adenocarcinoma. Several randomized controlled trials (RCTs) are currently recruiting subjects to investigate the effect of neo-adjuvant radiotherapy (NRT) in gastric and GEJ cancer. Large retrospective studies may be beneficial in clarifying the potential benefit of NRT, providing implications for RCTs.MethodsWe retrieved the clinicopathological and treatment data of gastric and GEJ adenocarcinoma patients who underwent surgical resection and chemotherapy between 2004 and 2015 from Surveillance, Epidemiology, and End Results (SEER) database. We compared survival between NRT and non-NRT patients among four clinical subgroups (T1–2N−, T1–2N+, T3–4N−, and T3–4N+).ResultsOverall, 5272 patients were identified, among which 1984 patients received NRT. After adjusting confounding variables, significantly improved survival between patients with and without NRT was only observed in T3–4N+ subgroup [hazard ratio (HR) 0.79, 95% confidence interval (CI): 0.66–0.95; P = 0.01]. Besides, Kaplan-Meier plots showed significant cause-specific survival advantage of NRT in intestinal type (P < 0.001), but not in diffuse type (P = 0.11) for T3–4N+ patients. In the multivariate competing risk model, NRT still showed survival advantage only in T3–4 N+ patients (subdistribution HR: 0.77; 95% CI: 0.64–0.93; P = 0.006), but not in other subgroups.ConclusionsNRT might benefit resectable gastric and GEJ cancer patients of T3–4 stages with positive lymph nodes, particularly for intestinal-type. Nevertheless, these results should be interpreted with caution, and more data from ongoing RCTs are warranted.

Treatment and survival outcomes of ceruminous carcinomas of the external auditory canal: a SEER database analysis and literature review.

Ceruminous carcinomas of the external auditory canal (EAC), encompassing adenoid cystic carcinoma (ACC), ceruminous adenocarcinoma (CA), and mucoepidermoid carcinoma (MEC), are extremely rare with little known regarding the influence of demographics, tumor characteristics, and treatment on survival. This study aimed to summarize existent data and describe prognostic factors affecting survival in ceruminous carcinoma. Cases of ceruminous carcinoma of the EAC in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed to provide demographic, cancer-related, and treatment data and assess their influence on disease-specific and overall survival. A literature review was alsoperformed. No significant difference in overall survival (OS) existed for localized versus regional disease, tumor type, or use of radiation therapy. In those with ACC, distant disease had a lower OS compared to regional disease. On review of the literature, local recurrence was a common finding with a low risk for nodal metastasis in ACC and CA. In conclusion,local recurrence wascommondespite aggressive surgical intervention (± radiation therapy); overall survival was unaffected by radiation therapy, tumor type, or local versus regional disease; and more cases of MEC are needed for analysis.

PCN111 Incidence and Long-Term Survival of Cervical Cancer Patients in the United States, an Analysis of SEER Database

Cervical cancer in the United States has decreased substantially since the implementation of widespread screening and prevention measures. This study examined the patterns in incidence and survival rates for cervical cancer in recent years. Using Surveillance, Epidemiology, and End Results (SEER) population-based data, we identified patients with cervical carcinoma (ICD-03: C53.x) diagnosis between January 01, 2005, and December 31, 2017. We calculated annual, age-adjusted incidence rates of cervical carcinoma per 100,000 individuals by age, race/ethnicity, stage at diagnosis, and histologic type. Kaplan Meier method was used to obtain five-year cancer-specific survival rates. According to SEER, there were 41,378 cervical carcinoma patients between 2005-17. About 81.4% of cervical cancer cases were aged below 65 years. The incidence rates were substantially higher among blacks (8.1; standard error [SE]=0.1) and Hispanics (9.2; SE=0.1) as compared to whites (7.2; SE=0.0). Compared to other stages and histologic types, higher incidence rates were observed for localized stage (3.4; SE=0.0) and squamous cell carcinoma (5.0; SE=0.0). The overall 5-year cancer-specific survival rate was (71.7%; SE=0.3), while it was highest for adenocarcinoma (77.2%; SE=0.5) histology type. Incidence rates and survival rates declined from 7.6 (SE=0.1) in 2005 to 7.0 (SE=0.1) in 2012 and 72.2% (SE=0.8) in 2005 to 70.6% (SE=0.9) in 2012, respectively. However, there was a gradual increase in the incidence rates from 2.8 (SE=0.1) to 13.5 (SE=0.1) amongst women below 50 years. Even though the overall incidence rate is on the decline, there was a noticeable increase in incidence amongst patients under 50 years. A significant decrease in the 5-year survival rate was also observed. These patterns warrant concerted efforts to increase the early prevention and screening of cervical cancer.

Clinical Characteristics and Survival Outcomes in Neuroblastoma With Bone Metastasis Based on SEER Database Analysis.

PurposeClinical features and survival analysis of neuroblastoma (NB) are well explored. However, clinical research of NB patients with bone metastasis is rarely reported. Thus, the current study was performed to analyze the clinical features, survival outcome, and risk factors in those patients.Materials and MethodsWe reviewed the Surveillance, Epidemiology, and End Results (SEER) database to select cases diagnosed with NB with bone metastasis from 2010 to 2016. Overall survival (OS) and cancer-specific survival (CSS) were analyzed through univariate Cox regression analysis. Subsequently, we performed multivariate analysis to determine independent predictors of survival. The Kaplan–Meier method was applied to intuitively show differences in prognostic value between independent risk factors.ResultsWe finally identified 393 NB patients with bone metastasis who were selected for survival analysis. Nearly half of the patients (47.3%) were aged >3 years. The adrenal gland was the primary tumor site, accounting for approximately two thirds of cases (66.2%). The 5-year OS and CSS rates of all patients were 62.1% and 64.1%, respectively. The univariate analysis indicated that age, lung metastasis, and tumor size were significantly associated with OS and CSS. Based on the multivariable analysis, age at 2 and 3 years, lung metastasis, and tumor size >10 cm remained significant negative predictors of OS and CSS.ConclusionFor NB patients with bone metastasis, three independent prognostic risk factors (age, lung metastasis, and tumor size) are helpful to clinicians for predicting prognosis and guiding treatment. Reasonable treatment modalities for these patients should be further investigated to prolong survival.

Survival outcomes of primary mediastinal germ cell malignancies based on clinicopathological characteristics: A SEER database analysis.

e17055 Background: Primary mediastinal germ cell malignancies (PMGCM) account for up to 5% of all germ cell tumors. Different clinical and epidemiological factors have been known to have important prognostic implications as they contribute to a wide range of long term survival in individuals with PMGCM. Methods: We obtained data from the Surveillance, Epidemiology and End Results (SEER) database from years 1975-2016 to include cases with confirmed primary mediastinal germ cell tumors. After complete gathering of selected data, a total of 1,328 number of cohorts were obtained which were stratified by age, sex, race, type of malignancy, size of primary tumor, site, grade etc. and were analyzed by Cox regression using proportional hazard model. Kaplan Meier curves were also obtained to visualize all cause survival and stratified survival according to the types of malignancy. Results: In our study, we found the incidence of PMGCM to be 0.18 per 1,000 people with malignant cancer with a median age at diagnosis of 28 years, the age range being 21-50 years. 92.9% patients were males and 7.1% were females with more common occurrence in White patients (54.5%). Most common type of PMGCM was found to be Seminoma (23.4%) and 56.32% were poorly differentiated (Grade III), excluding unknown cases. About half (52%) of all was found to arise from the anterior mediastinum. 36% of all cases died from primary cancer. 42.7% underwent surgery, however there was no data for chemotherapy or radiotherapy. Mean survival time among all PMGCM was 37.5 months (p &lt;0.05). A significant negative correlation was observed between survival time &amp; age at diagnosis with Rp of 0.12 (p &lt; 0.001). On survival analysis, age was a significant factor for decreased survival time with patients more than 50 years having a HR of 2 (p&lt;0.001). Similarly, choriocarcinoma was associated with decreased survival time with HR 1.71 (p=0.03). Germinoma and seminoma were found to have higher survival time (HR 0.65 &amp; 0.18; p=0.03 and &lt;0.001 respectively). Patients with grade IV PMGCM had significantly lower survival time (HR 1.74, p&lt;0.001). Patients who had undergone surgery had a better survival time compared to those who didn’t get surgery. There was no significant association of sex, race, tumor size or site with the survival time. Conclusions: Our study concludes that among PMGCM, seminomatous tumors have a favorable prognosis compared to non-seminomatous tumors with higher survival time. Age was found to be a significant contributing factor with ages over 50 having lower survival time. Surgical intervention was found to be associated with increased survival time, although it is important to recognize the lack of chemo-radiotherapeutics data.

153P Prevalence and survival of stage IV male breast cancer: A SEER database analysis

Male breast cancer (BC) is a rare disease, accounting for <1% of all BC cases in the United States. Delay in diagnosis can result from lack of awareness of the existence of BC among men. Since it is often late diagnosed, male BC remains a substantial cause of morbidity and mortality. The goal of this study was to evaluate the proportion of stage IV patients and their survival outcomes over time using SEER (Surveillance, Epidemiology, and End Results) data.

MA12.10 Treatment and Survival Differences in Patients with Large Cell Neuroendocrine Carcinoma of the Lung: A SEER Database Analysis

Large cell neuroendocrine carcinoma of the lung (L-LCNEC) is a rare but highly aggressive tumor. We aimed to determine the differences in treatment and survival in L-LCNEC and to identify predictors for survival using Surveillance, Epidemiology, and End-Results (SEER) data. Data of patients diagnosed with L-LCNEC in 2004–2015 were retrieved. Age, sex, race, and tumor site, size, grade, and stage were evaluated. Multivariable logistic and Cox regression were performed to identify factors associated with overall survival (OS) and cancer-specific survival (CSS). Table 1Univariate and multivariate analyses of overall survival (OS) in the eligible patients. A total of 2,838 eligible cases were enrolled at the time of L-LCNEC diagnosis. In total, 1,774 (62.5%), 796 (28.0%), and 268 (9.5%) patients were diagnosed at the ages of 60-79, <60, and ≥80 years, respectively. L-LCNEC incidence (83.6%, N=2,373) was significantly high among Caucasians. Most tumors were in the right (56.2%, N=1,594) upper (53.5%, N=1519) lung lobe. Grade III (34.7%) and stage IV (49.0%) diseases were commonly detected in men (56.1%). Old age (60-79 years, hazard ratio [HR] [95% confidence interval]: 1.352 [1.136-1.609], P=0.001; ≥80 years, 1.841 [1.313-2.582], P<0.0001), stage III (2.053 [1.371-3.074], P<0.0001) and IV (3.878 [2.595-5.796], P<0.0001), and tumor size >5 cm (1.391[1.071-1.808], P=0.013) were independent unfavorable prognostic factors. Surgery (0.553 [0.397-0.770], P<0.0001) and chemotherapy (0.455 [0.392-0.528], P<0.001) were significant independent favorable prognostic factors. Patients treated with surgery, chemotherapy, or surgery plus chemotherapy had the lowest distant metastases rates.View Large Image Figure ViewerDownload Hi-res image Download (PPT) We provide population-based estimates of the incidence and prognosis of L-LCNEC. Surgery and chemotherapy significantly improved the OS and CSS of patients with L-LCNEC.

Clinicopathological Features, Prognostic Factors, Survival Trends, and Treatment of Malignant Ovarian Germ Cell Tumors: A SEER Database Analysis

Objective: The aim of this study was to investigate the clinicopathological prognostic factors of malignant ovarian germ cell tumors (MOGCT) and evaluate the survival trends of MOGCT by histotype. Methods: We extracted data on 1,963 MOGCT cases diagnosed between 2000 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database and the histological classification of MOGCT, including 5 categories: dysgerminoma, embryonal carcinoma (EC), yolk sac tumor, malignant teratoma, and mixed germ cell tumor. We examined overall and disease-specific survival of the 5 histological types. Kaplan-Meier and Cox proportional hazards regression models were used to estimate survival curves and prognostic factors. We also estimated survival curves of MOGCT according to different treatments. Results: There was a significant difference in prognosis among different histological classifications. Age, histotype, grade, SEER stage, and surgery were independent prognostic factors for survival of patients with MOGCT. For all histotypes, 1-, 3-, and 5-year survival rate estimates were >85%, except for EC, which had the worst outcomes at 1 year (55.6%), 3 years (44.4%), and 5 years (33.3%). In the distant SEER stage, both chemotherapy and surgery were associated with improved survival outcomes compared with surgery- and chemotherapy-only groups. Conclusions: Dysgerminoma patients had the most favorable outcomes, whereas EC patients had the worst survival. A young age, low grade, and surgery were all significant predictors for improved survival. In contrast, a distant SEER stage was a risk factor for poor survival. Chemotherapy combined with surgery contributed to longer survival times of patients with MOGCT in the distant SEER stage.

Impact of Tumor Site and Adjuvant Radiotherapy on Survival of Patients with Adenoid Cystic Carcinoma: A SEER Database Analysis.

Simple SummaryAdenoid cystic carcinoma (ACC) is a rare but lethal salivary gland tumor, comprising less than 1% of head and neck neoplasms. It can affect several sites in the head and neck region, but the potential role of tumor site on survival and treatment response remains unclear and, to this day, the role that tumor location plays in treatment planning and survival has not been considered. We sought to address these knowledge gaps via analyses of the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis identified that patients with submandibular gland adenoid cystic carcinomas, particularly those with late-stage disease, had worse survival compared to other sites and benefited the most from adjuvant radiotherapy. In contrast, early-stage and non-submandibular adenoid cystic carcinoma patients showed no survival benefit from adjuvant radiotherapy (aRT). These results underscore the role of tumor site on treatment response and survival of patients with head and neck ACC.Adenoid cystic carcinoma (ACC) is a rare salivary gland tumor, displaying aggressive behavior with frequent recurrence and metastasis. Little information exists regarding the impact of clinicopathological parameters and adjuvant radiotherapy (aRT) on ACC disease specific (DSS) and overall survival (OS). We extracted demographic, treatment, and survival information of 1439 patients with major or minor intraoral salivary gland ACC from the Surveillance, Epidemiology, and End Results (SEER) database. The associations between tumor characteristics and aRT with OS and DSS were estimated using hazard ratios (HR) and 95% confidence intervals (CI). Submandibular gland ACCs had the worst prognosis (adjusted DSS HR = 1.48; 95% CI = 0.99–2.20, compared to parotid), and this difference was more pronounced among patients with advanced-stage tumors (adjusted DSS HR = 1.93; 95% CI = 1.13–3.30). aRT was associated with increased overall survival only among stage III submandibular ACC patients (HR = 0.64; 95% CI = 0.42–0.98) and had no benefit in any other group. In conclusion, submandibular gland ACC carries a worse prognosis than other gland subsites and may benefit from aRT. The different outcomes between submandibular gland and other major or minor gland ACCs warrant further mechanistic investigation.

Survival benefit of perioperative chemotherapy for T1-3N0M0 stage esophageal cancer: a SEER database analysis.

BackgroundThe effect of perioperative chemotherapy on patients with lymph node-negative esophageal cancer (EC) is controversial. This study explored which EC patients, staged under the T1-3N0M0, would benefit from perioperative chemotherapy.MethodsData on patients with diagnosed primary EC were retrieved from Surveillance, Epidemiology and End Results (SEER) database. Propensity score-matched (PSM) method was performed to balance baseline covariates. Multivariate Cox regression analysis and Kaplan-Meier curve were used to assess potential survival difference between patients undergoing surgery plus perioperative chemotherapy (SA + CT) and those undergoing surgery alone (SA).ResultsIn a total of 2,711 EC patients (T1–3N0M0), 166 patients underwent SA + CT and 2,545 patients received SA. In the multivariable analysis, T stage was significantly related to prognosis of EC patients before and after matching. Subgroup analysis showed that perioperative chemotherapy was associated with poor cancer-specific survival (CSS) for stage T1 patients. There was no effect of perioperative chemotherapy on overall survival (OS) or CSS for T2 patients, whereas a remarkable improvement in OS and CSS was observed for T3 patients. Survival analysis showed that T3 stage EC patients obtained survival benefit from SA + CT. Prognosis in the SA group was significantly better than in the SA + CT group for T1 patients. However, T2 patients showed no significant increase in survival after undergoing SA + CT compared with SA.ConclusionsT3 patients benefit more from SA + CT. However, perioperative chemotherapy does not present survival benefit to T1–2 patients, and it is an adverse prognostic factor for T1 patients.

Competing risk analysis of cardiovascular/cerebrovascular death in T1/2 kidney cancer: a SEER database analysis

BackgroundKidney cancer (KC) is associated with cardiovascular regulation disorder and easily leads to cardiovascular and cerebrovascular death (CCD), which is one of the major causes of death in patients with KC, especially those with T1/2 status. However, few studies have treated CCD as an independent outcome for analysis. We aimed to identify and evaluate the key factors associated with CCD in patients with T1/2 KC by competing risk analysis and compared these risk factors with those associated with kidney cancer-specific death (KCD) to offer some information for clinical management.MethodsA total of 45,117 patients diagnosed with first primary KC in T1/2 status were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. All patients were divided into the CCD group (n = 3087), KCD group (n = 3212), other events group (n = 6312) or alive group (n = 32,506). Patients’ characteristics were estimated for their association with CCD or KCD by a competing risk model. Pearson’s correlation coefficient and variance inflation factor (VIF) were used to detect collinearity between variables. Factors significantly correlated with CCD or KCD were used to create forest plots to compare their differences.ResultsThe competing risk analysis showed that age at diagnosis, race, AJCC T/N status, radiation therapy, chemotherapy and scope of lymph node represented different relationships to CCD than to KCD. In detail, age at diagnosis (over 74/1–50: HR = 9.525, 95% CI: 8.049–11.273), race (white/black: HR = 1.475, 95% CI: 1.334–1.632), AJCC T status (T2/T1: HR = 0.847, 95% CI: 0.758–0.946) and chemotherapy (received/unreceived: HR = 0.574, 95% CI: 0.347–0.949) were correlated significantly with CCD; age at diagnosis (over 74/1–50: HR = 3.205, 95% CI: 2.814–3.650), AJCC T/N status (T2/T1: HR = 2.259, 95% CI: 2.081–2.451 and N1/N0:HR = 3.347, 95% CI: 2.698–4.152), radiation therapy (received/unreceived: HR = 2.552, 95% CI: 1.946–3.346), chemotherapy (received/unreceived: HR = 2.896, 95% CI: 2.342–3.581) and scope of lymph nodes (1–3 regional lymph nodes removed/none: HR = 1.378, 95% CI: 1.206–1.575) were correlated significantly with KCD.ConclusionsWe found that age at diagnosis, race, AJCC T status and chemotherapy as the independent risk factors associated with CCD were different from those associated with KCD.

Clinical characteristics of primary hepatic angiosarcoma outcomes: a SEER database analysis.

BackgroundPrimary hepatic angiosarcoma (PHA) is a rare malignant tumor. We explored the demographic features and prognostic factors of PHA.MethodsWe used the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database to extract patients diagnosed with PHA from 1975 to 2016. We used the Kaplan-Meier method and Cox proportional hazards regression to evaluate the risk factors for overall survival (OS) and disease-specific survival (DSS). The nomograms were constructed and validated using the concordance index (C-index) and calibration plots.ResultsIn total, 366 patients were included in this study. The disease onset was hidden, and most patients already had advanced disease when diagnosed. The prognosis of PHA was very poor, and the overall 6-month, 1-year and 2-year survival rates were 20.3%, 12.8% and 9.3%, respectively. Sex, age and surgery were all predictors of both OS and DSS in multivariate analysis. Women had better survival rates than men, and patients aged <60 years benefited from surgery in the multivariate models. The nomograms presented good accuracy, with C-index values of 0.679 and 0.665 for the OS and DSS prognostic models, respectively. The calibration plots showed good agreement between the nomogram predictions and actual observations.ConclusionsPHA has a poor prognosis. Regular physical examinations are essential for the elderly. Patients aged <60 years could benefit from surgery. We constructed accurate nomograms to predict survival that can greatly benefit clinicians.