Surveillance, Epidemiology, And End Results Database Analysis Research Articles

Racial Disparity in Incidence and Survival for Gastrointestinal Stromal Tumors (GISTs): an Analysis of SEER Database

Gastrointestinal tumors (GISTs) represent the most common mesenchymal tumors of the gastrointestinal tract. There has been limited data on GIST incidence and survival disparities between ethnic groups. Assess disparities in incidence and survival among race in the USA in the era of available GIST histologic codes and treatment. We queried Surveillance, Epidemiology, and End Results (SEER) database for GIST from 2002 to 2015, with diagnostic code 8936. Of the 7204 patients identified, 4928 (68.4%) were White, 1308 (18.2%) African American (AA), and 968 (13.4%) were classified as "Other" (American Indian/Alaskan Native, Asian/Pacific Islander). The overall incidence rate (IR) was 0.75 per 100,000. IR was highest among AA at 1.37/100,000, but 0.65/100,000 for Whites, 1.10/100,000 for Asians/Pacific Islanders, and 0.28/100,000 for American Indians/Alaskan Natives. The GIST incidence was twice as high for AA as for Whites (rate ratio [RR]: 2.12; 95% CI: 1.98-2.26; p < 0.001). There was higher proportion of Whites than AA, who underwent surgical extirpation. Median overall survival (OS) and GIST specific survival (GSS) were not reached for all race, which indicates more than half of the patients were still alive at end of follow-up period. In multivariate Cox model, belonging to "Other" had better OS (adjusted hazard ratio [aHR]; 0.73, 95% CI: 0.55-0.95, P = 0.021) for GIST, but no difference in prognosis and OS for AA and White [(aHR for whites; 0.84, 95% CI: 0.69-1.02, P = 0.071), AA = reference]. There was no difference in GSS among races. Significant racial disparity in incidence and overall survival for GIST exists, and efforts should be made to bridge this gap and improve outcomes for all races. The overall incidence rate for GIST was noted to be 7.5 per 1 million, and IR of GIST was twice as high for African Americans as compared to Whites. The "Other" racial group (American Indians/Alaskan Natives, Asians, and Pacific Islanders) had superior OS as compared to African Americans and Whites.

Impact of Insurance Status on Stage, Treatment, and Survival in Patients with Colorectal Cancer: A Population-Based Analysis.

BackgroundThis study aimed to analyze data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients with colorectal cancer (CRC) who had specific insurance details and the effects of stage at diagnosis, definitive treatment, and survival outcome with insurance status.Material/MethodsBetween 2007 and 2009, SEER database analysis identified 54,232 patients with CRC. Logistic models examined the associations between insurance status and disease stage and definitive treatment. Kaplan-Meier analysis, the Cox model, and the Fine and Gray model were used to compare the tumor cause-specific survival (TCSS) for patients with different insurance status.ResultsInsured patients were more likely to have earlier tumor stage at diagnosis when compared with patients receiving Medicaid (adjusted OR, 1.318; 95% CI, 1.249–1.391; P<0.001) and when compared with uninsured patients (adjusted OR, 1.479; 95% CI, 1.352–1.618; P<0.001). Insured patients were significantly more likely to undergo definitive treatment when compared with patients receiving Medicaid (adjusted OR, 0.591; 95% CI, 0.470–0.742; P<0.001) and compared with patients who were uninsured (adjusted OR, 0.404; 95% CI, 0.282–0.579; P<0.001). Insured patients had a significantly increased TCSS when compared with patients receiving Medicaid (HR, 1.298; 95% CI, 1.236–1.363; P<0.001) and compared with patients who were uninsured (HR 1.195, 95% CI, 1.100–1.297; P<0.001).ConclusionsInsurance status was a significant factor that determined early diagnosis, definitive treatment, and clinical outcome and was an independent factor for TCSS in patients with CRC.

Role of wedge resection in bronchial carcinoid (BC) tumors: SEER database analysis

There is a paucity of data regarding the role of wedge resection (WR) in the management of bronchial carcinoid (BC) tumors. In this study, we queried the Surveillance, Epidemiology, and End Results (SEER) database to compare the oncologic outcomes of patients with BC tumors treated with WR or anatomic resection. The SEER database was retrospectively reviewed for patients with BC treated with surgical resection between 1973-2013. Patients who underwent WR were compared to those who underwent lobectomy or segmentectomy (Lob/Seg). Patients with multiple primaries and those who underwent pneumonectomy or have an unspecified surgical procedure were excluded. Differences in demographics and clinicopathological data were compared using Chi (χ2) test or Mann Whitney U test. Overall and cancer specific survival (OS, CSS) were estimated using Kaplan-Meier method and differences were compared using log-rank test. Cox-regression multivariable analysis (MVA) was performed to explore factors associated with worse CSS. Propensity-score matching analysis was done to compare survival differences between WR and Lob/Seg. A total of 22,350 patients with BC were identified, of them 4,450 met our inclusion criteria (3,511 Lob/Seg, vs. 939 WR). The median age was 59.0 years [interquartile range (IQR) =49.0-68.0], 67.6% were females and the median tumor size was 2 cm (1.5-3 cm). 4,119 patients had typical carcinoid (TC) and 331 had atypical carcinoid (AC). WR was performed more frequently in elderly patients, females, lower lobe tumors, TC's and in earlier stage disease. For patients with TC, there was no difference in CSS between WR and Lob/Seg in both the entire cohort (P=0.654) and in the propensity matched groups (P=0.900). However, for patients with AC, Lob/Seg was associated with better CSS compared to WR both in the entire cohort (P<0.001) and in the propensity matched groups (P=0.001). On MVA of the entire cohort, elderly patients, males, blacks, AC and advanced stages had worse CSS. While, the type of the procedure (WR vs. Lob/Seg) was not associated with CSS (HR =1.16, 95% CI: 0.85-1.60). A WR may offer equivalent CSS in well-selected patients with early-stage TC. An anatomic resection appears warranted in AC.

Clinicopathologic features, incidence, and survival trends of gynecologic neuroendocrine tumors: a SEER database analysis

Primary gynecologic neuroendocrine tumors are uncommon malignant neoplasms associated with poor prognosis. Clinically, these tumors present a significant challenge because of the lack of standardized management guidelines. The objective of this study is to evaluate the clinicopathologic features, incidence, and survival trends in gynecologic neuroendocrine tumors. The Surveillance, Epidemiology and End Results (SEER) cancer registry was queried for women diagnosed with primary gynecologic neuroendocrine tumors from 1987 to 2012. Data regarding stage, grade, presence of extrauterine disease, receipt of adjuvant radiation, surgical intervention, incidence, and overall survival were extracted. Patients were classified as having early-stage disease (International Federation of Gynecology and Obstetrics Stage I/II) or advanced-stage disease (Stage III/IV). Extrauterine disease was defined as either regional or distant metastasis. χ2 Tests, Pearson correlation, and Kaplan-Meier curves were used for statistical analysis. In all, 559 cases of gynecologic neuroendocrine tumors were identified during the study period: 242 cervical, 160 ovarian, 118 uterine, and 39 vulvar/vaginal. The majority of patients in all subsets of gynecologic neuroendocrine tumors presented with poorly differentiated tumors, extrauterine disease spread, and advanced-stage disease. Poorly differentiated tumors represented 65.0% of cervical tumors, 45.3% of ovarian tumors, and 57.4% of uterine tumors. Extrauterine disease at the time of diagnosis was present in the case of 66.9% of cervical tumors, 83.5% of ovarian tumors, and 83.6% of uterine tumors. The overall incidence of gynecologic neuroendocrine tumors increased 4-fold during the study period, from 0.3 in 1987 to 1.30 per million in 2012. The study period was divided into two 13-year periods (1987-1999 and 2000-2012) for time trend mean survival analysis. We observed no significant change in overall survival across all gynecologic neuroendocrine tumor subtypes. The mean survival time of cervical neuroendocrine tumors was 74.3 vs 45.4 months (P= .31), ovarian neuroendocrine tumors 47.8 vs 41.2 months (P= .56), and uterine neuroendocrine tumors 42.9 vs 47.7 months (P= .44) for each time period, respectively. Neuroendocrine tumors of the gynecologic tract are uncommon aggressive malignancies. These poorly differentiated tumors present at advanced stage, with a high incidence of extrauterine disease. Despite 25 years of advances in cancer therapy, we observed no improvement in overall survival.

Incidence of gastroesophageal junction cancer continues to rise: Analysis of Surveillance, Epidemiology, and End Results (SEER) database.

40 Background: Gastroesophageal junction (GEJ) cancer can be endoscopically resected and/or ablated in its early tumor stage. Despite significant effort to address the epidemiology and populations at risk for distal esoaphgeal cancer, very limited effort has been undertaken to assess such in GEJ cancer. Methods: A SEER database analysis was performed for the study period 1973 – 2013. Inclusion criteria were GEJ cancer (microscopically confirmed primary site of malignancy with ICD-O-3 histology of adenocarcinoma). Data was stratified by years 1973-82, 1983-92, 1993-2002 and 2003-2012, patient age, gender, and race. A Kaplan-Meier curve for the 5-year survival analysis of GEJ cancer was calculation. Further, GEJ cancer data was compared with the epidemiology of distal esophageal cancer (ICD-10). Results: 32,073 patients with GEJ cancer were included in the SEER database between 1973 and 2015 (female 19%, Caucasian race 88.7%). The incidence of GEJ cancer increased significantly over the four decades between 1973 and 2013, 15.7%, 25.3%, 26.9% and 32% (p = 0.001). The rising prevalence was particularly accounted in the patient age cohorts 65-74 years and 75+ years and in white male patients followed by black male patients. The 5-year survival analysis showed a median survival during the four analyzed decades of 8, 10, 11, and 14 months, respectively (Log rank test p &lt; 0.001). During the last decades (1993-2002 and 2003-2012) GEJ cancer and distal esophageal cancer had comparable incidences. Conclusions: GEJ cancer incidence is rising over the last four decades and is in fact comparable with the incidence of distal esophageal cancer. This is particularly true for white male patients and patients older than 65 years. Given that early GEJ cancer is endoscopically treatable, more effort is warranted to address its risk factors and to identify populations at risk who could benefit from early cancer detection programs.

Metastatic patterns and prognostic significance of signet ring cell carcinoma of the colon: Retrospective analysis of SEER database.

488 Background: Signet ring cell carcinoma of the colon (SRCC) represents less than 1% of all colon carcinomas. We retrospectively examined the metastatic patterns and prognosis of SRCC in comparison to adenocarcinoma (AC) of the colon. Methods: A total of 763 patients diagnosed with SRCC and 42,875 patients with AC of the colon from 2010 to 2012 were identified from the Surveillance, Epidemiology and End Results (SEER) database. Age, race, gender, primary site, grade, stage, metastatic site and survival data were collected. Results: Out of 43,638 patients, 78.7% were white, 12.5% black and 8.8% other races. Median age of diagnosis was 67.5 years for SRCC as compared to 69.1 years for AC . SRCC was more likely to be grade III or IV (92% vs 21.6%; p &lt; 0.001), to be found in the right colon (63.7% vs 49.4%; p &lt; 0.001) and to present as advanced stage (40.2% vs 29.4% for stage III and 37.1% vs 22.3% for stage IV; p &lt; 0.001). SRCC was more likely to present with metastases to the brain (11.0% vs 1.3%; p &lt; 0.001) and bone (6.4% vs 4.1%; p &lt; 0.001), while AC subjects were more likely to present with metastases to the liver (77.0% vs 22.1%; p &lt; 0.001) and lung (21.2% vs 5.8%; p &lt; 0.001). The 5 year overall survival rate (5-YSR) was 28.2% (CI, 24.5% to 32.4%) for SRCC compared to 50.8% (CI, 50.1% to 51.6%) for AC (Hazard ratio for death, 1.38; CI, 1.26 to 1.52; P &lt; 0.001). The differences in stage specific 5-year survival rates for SRCC and AC were not statistically significant for stage I and stage II. However, SRCC had a lower 5-YSR for stage III (34.5% vs 55.4%) and stage IV (3.3% vs 10.8%). Conclusions: SRCC of the colon has worse survival rates for advanced stages when compared to AC. SRCC presents at earlier age, with advanced tumor grade and stage at diagnosis. The metastatic behavior of SRCC is different than AC with a higher incidence of brain and bone metastases at diagnosis.

Trends in survival of patients with stage I/II Burkitt lymphoma in the United States: A SEER database analysis.

The treatment strategy for management of Burkitt lymphoma (BL) has evolved during the past decades and the clinical outcome for this disease as a whole has also improved. Due to limited information reported on survival trends of patients with stage I/II (limited‐stage) BL, here we used the Surveillance, Epidemiology, and End Results (SEER) database to conduct our study. The time period was divided into two eras (1983‐2001 and 2002‐2014) as the recent era reflected more intensive chemotherapy regimens, the availability of rituximab, the widespread use of antiretroviral therapy (ART) and improvements in supportive care. Patients with limited‐stage BL had a significantly better 5‐year overall survival (OS) in the 2002‐2014 era in both univariate analysis and multivariate analysis, compared with those in the 1983‐2001 era (64.1% vs 57.4%). However, clinical outcomes of elderly patients (≥60 years) and children patients (0‐19 years) did not significantly improve. Older age and race of black were correlated with poorer OS in multivariate analysis, whereas sex, primary sites, and application of radiotherapy did not significantly influence OS. In conclusion, the prognosis of patients with limited‐stage BL has improved in the 2002‐2014 era, but the outcome was still much poorer in elderly patients, which needs to be improved by identifying newly molecular‐targeted drugs and developing novel personalized therapeutic approaches.

Adjuvant radiation therapy for T4 non-rectal colon adenocarcinoma provides a cause-specific survival advantage: A SEER database analysis

PurposeWhile there is no level 1 evidence supporting the use of adjuvant radiotherapy (RT) for non-rectal colon cancer in the modern chemotherapy era, there are studies that suggest a local control benefit. This treatment modality is not part of standard treatment recommendations, and we hypothesized that adjuvant RT provides a benefit in locally advanced disease. Due to the limited number who receive post-operative RT, a national database was searched to provide sufficient power. Materials and methodsA retrospective analysis using the Surveillance, Epidemiology, and End Results (SEER) database was performed. Inclusion criteria were: non-rectal colon cancer, AJCC 6th or 7th edition T4 and M0, oncologic resection, and 1st cancer site. Patients were excluded for RT prior to or during surgery, or if the sequence of RT was unknown. Using a Cox proportional hazard model, the relative risk of cause-specific mortality for “RT after surgery” versus “No RT” was calculated. Results21,789 patients were identified who met the inclusion criteria. Of these, only 1001 received adjuvant RT, and 64% were node-positive (53% RT vs. 65% no RT). When comparing RT vs. no RT, after adjusting for sex, age, N stage, and grade, we determined the relative risk of death from cancer was 0.8849 (95% CI: 0.8008–0.9779; p = 0.0165), suggesting that only 14 patients with T4 disease need receive adjuvant radiation to spare a cancer-related death. ConclusionsAdjuvant RT is not routinely utilized for definitive treatment of T4 non-rectal colon cancer, but this analysis shows a significant cause-specific survival benefit.

Validation of the american joint commission on cancer (AJCC) 8th staging edition in patients with pancreatic adenocarcinoma: a SEER database analysis

Background: The 8th edition AJCC staging system for pancreatic cancer incorporated several significant changes. We sought to evaluate this staging system and assess its strengths and weaknesses relative to the 7th edition system. Methods: Using the Surveillance, Epidemiology and End Results (SEER) database (2004-2013), 8,960 patients undergoing surgical resection for non-metastatic pancreatic adenocarcinoma were identified. Overall survival was estimated using the Kaplan- Meier method and compared using log-rank tests. Concordance indices were calculated to evaluate the discriminatory power of both staging systems. Cox proportional hazards model were used to determine the impact of T and N classification on overall survival. Results: The concordance index for AJCC 8th staging system (0.60,CI95% 0.59-0.61) was comparable to that for the 7th AJCC staging system (0.59,CI95% 0.58-0.60). Stratified analyses for each N classification system demonstrated diminishing impact of T classification on overall survival with increasing nodal involvement. The corresponding concordance index for N0, N1 and N2 classifications were 0.58 (CI95%:0.55-0.60), 0.53 (CI95%:0.51-0.55), and 0.53 (CI95%:0.50-0.56) respectively. Conclusion: This is the first large-scale validation of the AJCC 8th edition staging system for pancreatic cancer. The revised system provides similar discrimination as compared to the 7th edition system. However, the 8th edition system allows finer stratification of patients with resected tumors according to extent of nodal involvement.

Validation of the American Joint Commission on Cancer (AJCC) 8th Staging Edition in Patients with Pancreatic Adenocarcinoma: A SEER Database Analysis

Background: The 8th edition AJCC staging system for pancreatic cancer incorporated several significant changes. We sought to evaluate this staging system and assess its strengths and weaknesses relative to the 7th edition system. Methods: Using the Surveillance, Epidemiology and End Results (SEER) database (2004-2013), 8,960 patients undergoing surgical resection for non-metastatic pancreatic adenocarcinoma were identified. Overall survival was estimated using the Kaplan- Meier method and compared using log-rank tests. Concordance indices were calculated to evaluate the discriminatory power of both staging systems. Cox proportional hazards model were used to determine the impact of T and N classification on overall survival. Results: The concordance index for AJCC 8th staging system (0.60,CI95% 0.59-0.61) was comparable to that for the 7th AJCC staging system (0.59,CI95% 0.58-0.60). Stratified analyses for each N classification system demonstrated diminishing impact of T classification on overall survival with increasing nodal involvement. The corresponding concordance index for N0, N1 and N2 classifications were 0.58 (CI95%:0.55-0.60), 0.53 (CI95%:0.51-0.55), and 0.53 (CI95%:0.50-0.56) respectively. Conclusion: This is the first large-scale validation of the AJCC 8th edition staging system for pancreatic cancer. The revised system provides similar discrimination as compared to the 7th edition system. However, the 8th edition system allows finer stratification of patients with resected tumors according to extent of nodal involvement.

Treatment and survival of osteosarcoma and Ewing sarcoma of the skull: a SEER database analysis

BackgroundCommon primary bone tumors include osteosarcomas (OSC) and Ewing sarcomas (EWS). The skull is a rare site, and literature about their treatment and survival is scarce. Using the Surveillance, Epidemiology, and End Results (SEER) database, this study aims to assess the treatment and survival of skull OSC and skull EWS, as well as predictors for survival.MethodsSkull OSC and EWS cases were obtained from the SEER database. Patient and tumor characteristics, treatment modalities, and survival were extracted. Overall survival (OS) was assessed using multivariable Cox proportional hazard regression stratified by tumor histology. Kaplan-Meier curves were constructed for OS comparing OSC and EWS, as well as histological subtypes in OSC.ResultsA total of 321 skull OSC and 80 skull EWS patients were registered from 1973 to 2013. EWS was more common in younger patients (p < 0.001). Resection was the predominant treatment strategy (80.1%), frequently in combination with adjuvant radiotherapy (30.4%). The 5-year survival rate varied significantly between OSC and EWS (51.0% versus 68.5%, p = 0.02). Kaplan-Meier curves show that EWS had a significantly better survival compared to OSC. Comparing histological subtypes of skull OSC, chondroblastic OSC had the best OS, Paget OSC the worst. Older age, tumor advancement, no surgical treatment, and the use of radiotherapy were identified as independent predictors of decreased OS in skull OSC.ConclusionOverall prognosis is better for EWS compared to OSC. Chondroblastic OSC have the best overall survival, while OSC associated with Paget’s disease of the bone has the poorest overall survival.

P003 Prognosis of Advanced Lung Cancer by Age Groups: A SEER Database Analysis

Lung cancer is very common in malignancies, it is the main cause of cancer death. Lung cancer usually occurs in the elderly, and it is late for diagnosis. However, there are few studies on the prognosis of advanced lung cancer by age groups. The purpose of this study is to investigate the effect of age on the prognosis of advanced lung cancer. We extracted the data of lung cancer patients diagnosed stage IV between 2010 and 2014 from the Surveillance, Epidemiology and End Results (SEER) database in which data of patients with unknown age were excluded. We divided the patients into three groups: younger group (age <50 years old), middle-aged group (age between 50-69 years old) and elder group (age >69 years old). Pearson’s χ2 test were used to compare the clinical characteristics of patients in different age groups. We identified the factors associated with overall survival (OS) and lung cancer specific survival (LCSS) by Cox regression. Data of total 120,444 patients were collected including 5,156 in younger group, 55,389 in middle-aged group, 59,899 in elder group. For both OS and LCSS, younger patients were better than middle-aged patients, middle-aged patients were better than elder patients. Besides, the LCSS of middle-aged and elderly patients was significantly lower than OS. In addition, male, white, small cell lung cancer, no radiotherapy, poorly differentiated lung cancer were associated with poor prognosis of lung cancer. The prognosis of advanced lung cancer declined as the increase of age.

Secondary Skin Involvement in Non-Hodgkin's Lymphoma Does Not Impact Outcomes: SEER Database Analysis

Background:Non-Hodgkin's Lymphoma (NHL) comprises a diverse group of malignancies with varied presentations and clinical behavior. Different prognostic factors have been defined including age, LDH, gender, CNS involvement and molecular/genetic characteristics. We aim to study the incidence and impact of skin involvement as a secondary site in patients with mature B and T-cell NHLs.Methods:The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients (≥18 years) diagnosed with mature B/T/NK-cell NHL with skin as secondary site of involvement between 1973 and 2014. B-cell and T-cell lymphomas of all stages were included. Overall survival (OS) was estimated using the Kaplan-Meier method, and compared using Log-Rank test.Results:Total of 6429 patients were included with secondary skin involvement. B-cell NHL was more common with 76%. Median age for B-cell and T-cell NHL was 65 years (48-82), and 64 years (46-82), respectively. Slight male preponderance was noted in both subtypes (B-cell-56.7%% and T-cell-61.7%). Diffuse large B cell lymphoma (DLBCL) was the most common histology among B-cell NHLs, (DLBCL, N=1920 39.6%), followed by follicular (FL, N=1381, 28.5%) and extra nodal marginal zone (EN MZL, N=1314, 27.1%) Among T cell NHL histologies, peripheral T-cell NOS was the most common (PTCL, N=819, 51.6%) followed by anaplastic large cell ALK+ (ALCL+, N=341, 21.5%), and Sezary syndrome (N=293, 18.5%) Median overall survival was 6.1 [5.2 - 7.2.; 95% CI] years in T-cell population compared to B-cell population which was 13.3 [12.6-14.0; 95% CI] years. Survival was different by histologic subtype and correlated with SEER database relative survival for the overall population described in the SEER Cancer Statistics Review 1973-2011.Conclusion:-Skin involvement is relatively common in both B and T-cell NHLs. DLBCL, FL, MZL, PTCL-NOS and ALCL+ are the more commonly involved subtypes, correlating with their relative incidences. Outcomes in patients with secondary skin involvement tends to mimic known survival patterns in different histological subtypes conferring no additional prognostic significance. Skin as an extra nodal site of involvement should not change management for these patients. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

MS18.02 Treatment of Elderly Patients with SCLC

MS18.02 Treatment of Elderly Patients with SCLC

Treatment and survival differences across tumor sites in malignant peripheral nerve sheath tumors: a SEER database analysis and review of the literature.

Currently, literature is scarce on differences across all possible tumor sites in malignant peripheral nerve sheath tumors (MPNSTs). To determine differences in treatment and survival across tumor sites and assess possible predictors for survival, we used the Surveillance, Epidemiology, and End Results (SEER) database. MPNST cases were obtained from the SEER database. Tumor sites were recoded into: intracranial, spinal, head and neck (H&N), limbs, core (thorax/abdomen/pelvis), and unknown site of origin. Patient and tumor characteristics, treatment modalities, and survival were extracted. Overall survival (OS) was assessed using univariable and multivariable Cox regression hazard models. Kaplan-Meier survival curves were constructed per tumor site for OS and disease-specific survival (DSS). A total of 3267 MPNST patients were registered from 1973 to 2013; 167 intracranial (5.1%), 119 spinal (3.6%), 449 H&N (13.7%), 1022 limb (31.3%), 1307 core (40.0%), and 203 unknown (6.2%). The largest tumors were found in core sites (80.0 mm, interquartile range [IQR]: 60.0-115.0 mm) and the smallest were intracranial (37.4 mm, IQR: 17.3-43.5 mm). Intracranial tumors were least frequently resected (58.1%), whereas spinal tumors were most often resected (83.0%). Radiation was administered in 35.5% to 41.8%. Independent factors associated with decreased survival were: older age, male sex, black race, no surgery, partial resection, large tumor size, high tumor grade, H&N site, and core site (all P < .05). Intracranial and pediatric tumors show superior survival (both P < .05). Intracranial tumors show superior OS and DSS curves, whereas core tumors have the worst (P < .001). Superior survival is seen in intracranial and pediatric MPNSTs. Core and H&N tumors have a worse prognosis.

Role of radiation therapy in primary breast diffuse large B-cell lymphoma in the Rituximab era: a SEER database analysis.

Primary breast diffuse large B‐cell lymphoma (PB‐DLBCL) is an uncommon extranodal non‐Hodgkin's lymphoma (NHL), which was traditionally treated with anthracycline‐containing regimens followed by consolidative radiation therapy (RT) to add therapeutic benefits. The introduction of anti‐CD20 antibody rituximab for the treatment of B‐cell NHLs has significantly improved the clinical outcome of these malignant diseases. It is unclear, however, whether consolidative RT could still add therapeutic benefits for PB‐DLBCL patients treated with rituximab. To answer this important question, we used the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the impact of RT on the clinical outcomes of PB‐DLBCL patients in the rituximab era. Information on patient age, year of diagnosis, stage, race, laterality, and RT status for PB‐DLBCL patients diagnosed between 2001 and 2014 were extracted. Kaplan–Meier survival curves were plotted, and log‐rank test was used to compare the potential survival difference. Multivariate analysis using Cox proportional hazards model was employed to determine the impact of RT and other factors such as age, race, tumor laterality, stage, and year of diagnosis on survival. Among the 386 patients identified, the median follow‐up time was 45 months (range, 0–167 months); the median age was 64 years (range, 19–93 years); 33.9% of the patients were younger than 60 years of age; 69.9% of the patients were stage I; 79.0% were white; 51.8% received RT. The 5‐year OS and cause‐specific survival (CSS) for the whole cohort were 72.3% and 82.5%, respectively. The 5‐year OS was significantly superior for patients who received RT compared to those who did not receive RT (78.1% vs. 66.0%, P = 0.031). In multivariable analysis, RT remained significantly associated with improved OS (P = 0.026). In summary, our study suggests that RT still adds significant therapeutic benefits for patients with PB‐DLCBL in the rituximab era.

A modified TNM staging system for non-metastatic colorectal cancer based on nomogram analysis of SEER database

BackgroundTo revise the American Joint Committee on Cancer TNM staging system for colorectal cancer (CRC) based on a nomogram analysis of Surveillance, Epidemiology, and End Results (SEER) database, and to prove the rationality of enhancing T stage’s weighting in our previously proposed T-plus staging system.MethodsTotal 115,377 non-metastatic CRC patients from SEER were randomly grouped as training and testing set by ratio 1:1. The Nomo-staging system was established via three nomograms based on 1-year, 2-year and 3-year disease specific survival (DSS) Logistic regression analysis of the training set. The predictive value of Nomo-staging system for the testing set was evaluated by concordance index (c-index), likelihood ratio (L.R.) and Akaike information criteria (AIC) for 1-year, 2-year, 3-year overall survival (OS) and DSS. Kaplan–Meier survival curve was used to valuate discrimination and gradient monotonicity. And an external validation was performed on database from the Second Affiliated Hospital of Zhejiang University (SAHZU).ResultsPatients with T1-2 N1 and T1N2a were classified into stage II while T4 N0 patients were classified into stage III in Nomo-staging system. Kaplan–Meier survival curves of OS and DSS in testing set showed Nomo-staging system performed better in discrimination and gradient monotonicity, and the external validation in SAHZU database also showed distinctly better discrimination. The Nomo-staging system showed higher value in L.R. and c-index, and lower value in AIC when predicting OS and DSS in testing set.ConclusionThe Nomo-staging system showed better performance in prognosis prediction and the weight of lymph nodes status in prognosis prediction should be cautiously reconsidered.

Clinical correlates and prognostic value of different metastatic sites in patients with malignant melanoma of the skin: a SEER database analysis

Background: Population-based data on the clinical correlates and prognostic value of the pattern of metastases among patients with cutaneous melanoma are needed.Methods: Surveillance, Epidemiology and End Results (SEER) database (2010–2013) has been explored through SEER*Stat program. For each of six distant metastatic sites (bone, brain, liver, lung, distant lymph nodes, and skin/subcutaneous), relevant correlation with baseline characteristics were reported. Survival analysis has been conducted through Kaplan–Meier analysis, and multivariate analysis has been conducted through a Cox proportional hazard model.Results: A total of 2691 patients with metastatic cutaneous melanoma were identified in the period from 2010 to 2013. Patients with isolated skin/subcutaneous metastases have the best overall and melanoma-specific survival (MSS) followed by patients with isolated distant lymph node metastases followed by patients with isolated lung metastases. Patients with isolated liver, bone, or brain metastases have the worst overall and MSS (p < .0001 for both end points). Multivariate analysis revealed that age more than 70 at diagnosis (p = .012); multiple sites of metastases (p <.0001), no surgery to the primary tumor (p <.0001), and no surgery to the metastatic disease (p < .0001) were associated with worse overall survival (OS). For MSS, nodal positivity (p = .038), multiple sites of metastases (p < .0001), no surgery to the primary tumor (p < .0001), and no surgery to the metastatic disease (p < .0001) were associated with worse survival.Conclusions: The prognosis of metastatic cutaneous melanoma patients differs considerably according to the site of distant metastases. Further prospective studies are required to evaluate the role of local treatment in the management of metastatic disease.

Risk of cardiac death among cancer survivors in the United States: a SEER database analysis

ABSTRACTBackground: Population-based data on the risk of cardiac death among cancer survivors are needed. This scenario was evaluated in cancer survivors (>5 years) registered within the Surveillance, Epidemiology and End Results (SEER) database.Methods: The SEER database was queried using SEER*Stat to determine the frequency of cardiac death compared to other causes of death; and to determine heart disease-specific and cancer-specific survival rates in survivors of each of the 10 most common cancers in men and women in the SEER database.Results: For cancer-specific survival rate, the highest rates were related to thyroid cancer survivors; while the lowest rates were related to lung cancer survivors. For heart disease-specific survival rate, the highest rates were related to thyroid cancer survivors; while the lowest rates were related to both lung cancer survivors and urinary bladder cancer survivors. The following factors were associated with a higher likelihood of cardiac death: male gender, old age at diagnosis, black race and local treatment with radiotherapy rather than surgery (P < 0.0001 for all parameters).Conclusion: Among cancer survivors (>5 years), cardiac death is a significant cause of death and there is a wide variability among different cancers in the relative importance of cardiac death vs. cancer-related death.

Subsequent thoracic cancers among patients diagnosed with lung cancer: a SEER database analysis

Background: Population-based data on the development of subsequent thoracic cancers following the initial diagnosis of lung cancer are scarce. We evaluated this clinical scenario in lung cancer patients registered within the Surveillance, Epidemiology and End Results (SEER) database.Methods: The SEER database (1988–2013) was queried using the SEER*Stat program to determine the clinico-pathological features of lung cancer patients who develop subsequent thoracic cancers as well as the characteristics of these subsequent cancers. Associations were ascertained with chi-squared tests and survival analysis was performed using Kaplan–Meier methods. Standardized incidence ratios (SIRs) were calculated to determine the risk of each type of subsequent cancer.Results: A total of 223,274 lung cancer patients were identified and included in the current study. In this cohort, 6387 patients developed subsequent thoracic cancers. The following were associated with a higher likelihood of second cancers: female gender, younger age, white race, adenocarcinoma histology, married, lower AJCC stage, earlier year of diagnosis and local treatment with surgery rather than radiotherapy (p < .0001 for all parameters). In the subset of patients with subsequent thoracic cancers, survival was best for patients with second primary breast cancer followed by patients with lung or esophageal cancer (p < .0001). SIR analyses showed an excess risk for the development of esophageal cancer and second primary lung cancer following an initial diagnosis of lung cancer. This risk persists regardless of gender or receipt of radiotherapy (p < .05 for all scenarios).Conclusion: There is an excess risk for the development of esophageal cancer and second primary lung cancer following an initial lung cancer diagnosis. This risk is present irrespective of gender or receipt of radiotherapy.