Surveillance, Epidemiology, And End Results Program Database Research Articles

Abstract 16756: Trends of Cardiovascular Deaths in Patients With Melanoma From 2005 to 2019: An Analysis Based on SEER Program Database

Introduction: Melanoma is the fifth most common cancer diagnosis in the United States. With recent advances in treatment modalities, including immune checkpoint inhibitors (ICIs), targeted therapies, there has been improvement in survival among melanoma patients. However, increasing resistance and treatment related adverse effects (TrAEs) are being reported including cardiovascular side effects. Objectives: To evaluate the trend of cardiovascular specific death rate among patients with melanoma. Methods: We used Surveillance, Epidemiology, and End Results (SEER) Program database 17 registries from 2000 to 2019 and SEER*Stat Version 8.4.1 software to analyze the data using the rate session. Joinpoint software, version 4.7.1.0 was used to create log-linear time trends annually. Results: Our study included 301,632 patients with melanoma from 2005 to 2019. The annual percentage change (APC) of melanoma was 0.46% (95% CI -1.45 to 1.07, p>0.05) annually from 2005 to 2011 and 3.33% (95% CI 1.79 to 4.27, p<0.05) annually from 2011 to 2014 and the incidence rate decreased by 0.06% (95% CI -1.44 to 0.5, p>0.05) annually from 2014 to 2019. Melanoma specific mortality rate increased annually by 2.03 % (95% CI 0.78 to 3.94, P <0.05) from 2005 to 2013 and decreased by 5.49% annually (95% CI -8.65 to -3.65, P <0.05) from 2013 to 2019. Cardiovascular disease specific mortality rate increased by 7.08% annually (95% CI 4.66 to 9.64, P <0.05) from 2005 to 2019. (Figure 1) Conclusion: Our study shows that there has been an annual increase in cardiovascular specific mortality rate from 2005 to 2019, while there was annual decrease in melanoma specific mortality rate from 2013 to 2019. Increase in cardiovascular specific death rates could be due to the direct toxicity of newer therapies and prolonged survival, which further could be due to advancement in diagnostics and newer therapies.

Role of Radiation Therapy in Liver-Only Oligometastatic Disease: A SEER Analysis

Radiation therapy (RT) for oligometastasis has the potential to prolong survival in certain disease sites. There is a paucity of data regarding the benefit of RT for overall survival (OS) or disease-specific survival (DSS) in patients with liver-only oligometastatic disease. The Surveillance, Epidemiology and End Results Program (SEER) includes comprehensive metastasis data for patients from 2016-2019. The SEER database was queried for patients with liver-only metastatic disease at diagnosis by selecting stage IV cases with liver-only metastasis, without metastatic disease in bone, brain, lung, distant lymph nodes, or other sites. OS and DSS were estimated using Kaplan-Meier with log-rank analysis to compare patients who received RT versus no RT. Cox proportional hazards regression was applied to identify potential confounders. Subgroup analysis was used to explore the benefit of RT in different primary tumor sites including pancreas (N = 8846), followed by colon (N = 6535), lung (N = 3075), rectum (N = 1739), and stomach (N = 1448). A total of 29,422 patients with liver-only metastatic disease treated from 2016-2019 were included. The median age was 67 years old and 77.0% of the patients were Caucasian. 2448 (8.3%) patients were confirmed to have received RT. Patients who received RT had better OS (median survival, RT vs no RT: 18 vs 6 months, P<0.001) and DSS (18 vs 7 months, P<0.001). On multivariable analyses, RT still significantly improved both OS (HR: 0.705, 95% CI: 0.665-0.747, P<0.001) and DSS (HR: 0.390, 95% CI: 0.378-0.402, P<0.001) after adjusting for potential confounders, including age, tumor size, lymph node status, and chemotherapy. RT was significantly associated with improved OS and DSS (all P<0.001) in all primary tumors sites queried except for stomach primary for which RT did not impact OS (P = 0.122) and DSS (P = 0.229). In patients who received chemotherapy, RT also prolonged OS (P<0.001) and DSS (P<0.001). In the SEER database of patients with liver-only oligometastatic disease, RT improves OS as well as DSS, however the benefit varies for the different primary tumor sites. Prospective studies could help further clarify the survival benefits of RT in liver-only oligometastatic disease.

Pediatric Plasma Cell Neoplasms: A Population-Based Study.

Plasma cell neoplasms are exceptionally rare in the pediatric population; the demographic characteristics and the clinical outcomes of plasma cell neoplasms in this population are currently poorly understood. The aim of this study was to provide a comprehensive analysis of pediatric plasma cell neoplasms, based on the United-States Surveillance, Epidemiology, and End Results (SEER) program registries. All pediatric patients (aged less than 20 years) diagnosed with a malignant plasma cell neoplasm were retrieved from the SEER Program database (18 registries), collecting patient records between 2000 and 2018. The plasma cell neoplasm type, sex, age at diagnosis, year of diagnosis, race and origin, primary disease site, follow-up duration, and vital status at the last known contact were retrieved and analyzed. The age-adjusted incidence rate of plasma cell neoplasms for 1,000,000 person-years was 0.06 for the pediatric population (compared with 90.6 for the adult population). The types of pediatric plasma cell neoplasms predominantly consisted of plasmacytomas, with 11 solitary extraosseous plasmacytoma (42.3%) and 7 solitary bone plasmacytoma (26.9%), while plasma cell myelomas represented only a minority of the neoplasms (8 patients; 30.8%). Most plasmacytomas were localized in the head and neck region. Hispanic patients represented 50% of the pediatric plasma cell neoplasm cases (but only 11.1% of adult cases, P < .01). Female-to-Male ratio was 1.36. Five-year overall survival rates were 88.2% (95% confidence interval [95% CI]: 74.2%-100%) for pediatric plasmacytoma and 36.5% (95% CI: 12.4%-100%) for pediatric plasma cell myeloma (P = .013). This first population-based study of pediatric plasma cell neoplasms underlines the rarity of this entity and demonstrates its unique characteristics, including the significant predominance of plasmacytomas, of female patients, and of patients from hispanic origin, and the poor clinical outcomes of pediatric plasma cell myeloma patients.

Derivation and validation of a risk classification tree for patients with synovial sarcoma.

Synovial sarcoma (SS) accounts for 8%-10% of all soft-tissue sarcomas. Clinical presentation and outcomes vary, yet discrete risk groups based on validated prognostic indices are not defined for the full spectrum of patients with SS. We performed a retrospective cohort study using data from the SEER (surveillance, epidemiology, and end results program) database of SS patients who were <70 years of age at diagnosis. We constructed a recursive partitioning model of overall survival using a training cohort of 1063 patients with variables: Age at diagnosis, sex, race, ethnicity, primary site, tumor size, tumor grade, and stage. Based on this model, we grouped patients into three risk groups and estimated 5-year overall survival for each group. We then applied these groups to a test cohort (n= 1063). Our model identified three prognostic groups with significantly different overall survival: low risk (local/regional stage with either <21 years of age OR tumor <7.5cm and female sex), intermediate-risk (local/regional stage, age ≥ 21 years with either male sex and tumor <7.5cm OR any sex with appendicular anatomic location) and high risk (local/regional stage, age ≥ 21 years, tumor size ≥7.5cm and non-appendicular location OR distant stage). Prognostic groups were applied to the test cohort, showing significantly different survival between groups (p< 0.0001). Our analysis yields an intuitive risk-classification tree with discrete groups, which may provide useful information for researchers, patients, and clinicians. Prospective validation of this model may inform efforts at risk-stratifying treatment.

Race, Ethnicity, and Socioeconomic Status Are Associated With Prolonged Time to Treatment After a Diagnosis of Colorectal Cancer: A Large Population-Based Study

Race, Ethnicity, and Socioeconomic Status Are Associated With Prolonged Time to Treatment After a Diagnosis of Colorectal Cancer: A Large Population-Based Study

Abstract P2-08-19: Disparities in triple negative breast cancer survival in the United States by patient characteristics: A population-based study from SEER database, 2010 - 2015

Abstract Introduction: Efforts to improve the outcomes of triple negative breast cancer (TNBC) have been hampered by the inability to identify the key risk factors for prognosis. We focus solely on female TNBC and explored its survival by age, marital status, treatment and race. Data from Surveillance, Epidemiology and End Results Program (SEER) Database 18 of National Cancer Institute were used to assess TNBC survival by the above factors. Results: A total of 26,413 female patients diagnosed with TNBC from 2010 to 2015 were included in the current study, including 15840 (60.0%) Non-Hispanic white women. The follow up time ranges: 0 to 83 months. Younger (≤ 49) and elderly (≥ 65) age is associated with poorer survival, with reference to middle age group (50-64). The breast cancer specific survival (BCSS) rate for the three age groups (≤ 49, 50-64 and ≥ 65) are 78.6%, 81.0% and 78.1%, respectively; hazard ratio (HR) (95% confidence interval [CI]): 1.17 (1.08-1.27) in ≤ 49 and 1.24 (1.15-1.34) in ≥ 65 patients, individually. We further categorized elderly group into two strata: aged 65 -74 (age group recommended by U.S. Preventive Services Task Force to have breast cancer [BC] screening) and ≥75 (not recommended for BC screening). Our data revealed that the BCSS rate of 65-74 cohort rises to 81.9%; HR (95% CI): 0.97 (0.88-1.07), not significantly different from group aged 50-64. In contrast, the ≥75 group, as against middle age cohort, has the worst BCSS rate of 71.6%; HR (95% CI): 1.74 (1.58-1.92). In patients ≥75, there is highest proportion of metastatic disease (2.9%) at diagnosis and advanced lymph node involvement (N2 + N3 = 11.9%); their percentage of receiving perioperative chemotherapy (CT) and radiation therapy (RT) is lowest across all age groups: 33.3% and 43.6%, respectively. The mean age of single (never married), married and widowed patients at diagnosis was 52 ± 13, 56 ± 12 and 72 ± 11, respectively. The single cohort has the second worst BCSS rate of 76.1% [HR (95% CI): 1.46 (1.34-1.59)], in comparison with married women (BCSS rate of 81.6%). The BCSS rate of single patients is only better than that of widowed population (74.7%), who have significantly advanced age. Our analyses also showed that single patients have the highest percentage of Black women (37.7%) that are known to have unfavorable prognosis of TNBC. Also, single female patients have high proportion of large tumor (T3 + T4 = 18.5%, highest among all women in study) and metastatic disease (2.9%, secondary to widowed group only). Single group compared with married group, tends to have lower percentage of completing RT: 49.9% versus 53.4%, respectively. Conclusion: Advanced age is associated with worse BCSS. However, discontinuation of BC screening may partly account for the phenomenon that ≥ 75-year-old patients lost survival benefits (i.e., highest metastatic disease at diagnosis and worst BCSS), that is maintained in patients aged 65-74, who are recommended for BC screening. Further, low adherence to receive or complete adjuvant therapy may attenuate the survival in elderly patients aged ≥ 75. The poor outcome in single women with relatively young age indicates that both biological and socioeconomic factors and their interactions (e.g., high proportion of black women and low proportion of receiving RT) may influence TNBC prognosis. Our findings suggest a greater need for early and extended BC screening in the above two populations. Citation Format: Zikun Wang, Zheyu Lu, Maitri Kalra, Zhongxue Chen, Yi Dong. Disparities in triple negative breast cancer survival in the United States by patient characteristics: A population-based study from SEER database, 2010 - 2015 [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-19.

Abstract P4-17-07: Demographics and survival in male breast cancer: An updated analysis of SEER database

Abstract Background: Male breast cancer is rare accounting for less than 0.5% of all cancer diagnoses in men. Previous epidemiological studies reported conflicting results regarding the prognosis of male breast cancer in comparison to female breast cancer. As treatment for breast cancer has improved significantly, we conducted this study to evaluate male breast cancer characteristics and mortality. Methods: All patients diagnosed with breast cancer between 2010 and 2015 from the population-based cancer registries of the Surveillance Epidemiology and End Results program (SEER) were analyzed. Descriptive statistics, Kaplan-Meier analysis and COX regression model were used to examine the data. Results: A total of 380,116 cases of breast cancer were found including 2,978 cases of male breast cancer. The age-adjusted incidence rate for male breast cancer during the study period was 1.2 per 100,000 individuals per year which is slightly higher than the rate during the 10 years period preceding our study date (1.1 per 100,000 per year). Out of all male breast cancer patients, 80.7% of them were white, 14.6% black and 4.7% from other races. The median age of diagnosis was 68. 34% of male breast cancer patients were diagnosed with stage I, 41.6% with stage II, 16.2% with stage III and 8.2% with stage IV. 97% of male breast cancer cases were ER/PR positive and 11.9% were HER2 positive. 5-year survival rate for male breast cancer patients was 90% for stage I, 86% for stage II, 78% for stage III and 28% for stage IV. Cox proportional-hazards model revealed a slight increase in mortality associated with male breast cancer in comparison to female breast cancer (adjusted hazard ratio, 1.15; 95% confidence interval, 1.06 to 1.24; P&amp;lt;0.01). Conclusions: Male breast cancer represents less than 1% of breast cancer cases. Its age-adjusted incidence rate has slightly increased. It is mostly diagnosed as early stage with positive hormone receptors status. After controlling for other risk factors, male breast cancer patients have a worse survival outcome than female patients. Citation Format: John Khoury, Nwabundo Anusim, David Macari, Ishmael Jaiyesimi. Demographics and survival in male breast cancer: An updated analysis of SEER database [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-17-07.

3011 Metastatic Pancreatic Cancer in 19-Year-Old

INTRODUCTION: Pancreatic cancer is a highly aggressive cancer. Worldwide, pancreatic cancer is the eighth leading cause of cancer deaths in both men (226,910 deaths annually) and women (205,332 deaths annually). Five-year survival rate even for node negative R0 pancreaticoduodenoectomy is only 30 percent and it is worse in case of node positive cancer at 10%.1 Here we present an extremely rare case of advanced metastatic cancer with metastasis to central nervous system at the age of 18 with no familial history. CASE DESCRIPTION/METHODS: 19-year-old obese male presented as a transfer from outside hospital for increasing weakness and worsening confusion. His past medical history is significant for metastatic pancreatic cancer and smoking. On physical he was found to be lethargic, disoriented unable to answer questions with more than one word. Labs were CA 19-9 of 5423 and CEA of 244. MRI showed leptomeningeal enhancement and 3.8 cms mass at pancreatic head. Lumbar puncture was performed and CSF analysis showed the presence of malignant cells. He was now referred to hospice as he was no longer a treatment candidate. DISCUSSION: SEER (surveillance, epidemiology and end results program) database the incidence of pancreatic cancer in the age group our patient was in was 0.1% per 100,000 cases.2 In the NCRAS (National cancer registration and analysis service) database from 1998 to 2006 there were only 6 registered cases of pancreatic cancer.4 Early onset pancreatic cancer patients usually have an aggressive presentation and survivals are shorter with same tumor size.

415P - Trends in incidence and survival analyses of adult-onset medulloblastoma

BackgroundMedulloblastoma (MB) is a rare central nervous system malignancy in adult. For its rarity, most previous studies are limited on patient populations and ascertainment bias. We aimed to explore the population-level trends in incidence and assess potential predictors of overall survival (OS). MethodsWe utilized the Surveillance, Epidemiology and End Results Program (SEER) database between 1973 and 2015, to estimate the epidemiological trends of adult MB in the United States. Propensity-score matching was used to balance potential selection biases and Cox proportional hazard modeling was used to determine predictors of OS. ResultsThe age-adjusted incidence was stable in MB patients aged 20 years old and elder in total (annual percent change (APC)=0.15). The age-adjusted incidence rate in males was slightly higher than that in females (0.065 vs. 0.049 per 100,000). Compared to whites, the rate was nearly doubled to blacks (0.063 vs. 0.033 per 100,000). There was obvious differ between the younger group and the elder group (aged 20-39: 0.107 vs. aged≥40: 0.025 per 100,000). According to multivariable Cox analysis, age (P<0.001) and surgical resection (P=0.002) were independently prognostic factors. Moreover, subgroup analysis showed that the benefits of radiotherapy (P=0.048) and chemotherapy (P=0.045) were observed in the patients without gross total resection (GTR). After propensity-score matching (n=582), factors impacting OS were age (P<0.001), surgical resection (P=0.012), histology (P=0.031), insurance status (P=0.014) and marital status(P=0.040). ConclusionsFrom the SEER database, race, gender and age disparities were found in incidence of adult MB patients. The survival analysis demonstrated the benefits of the GTR and younger patients. As for patients without GTR, radiotherapy and chemotherapy may improve the long-term survival. Legal entity responsible for the studyFeifei, Lin. FundingThe Fujian Province Natural Science Foundation (2017J01260), Joint Funds for the Innovation of Science and Technology, Fujian province (2017Y9074), and the Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing (2017 Open Project-9). DisclosureAll authors have declared no conflicts of interest.

Comparison of the seventh and eighth editions of the American Joint Committee on Cancer (AJCC) staging for oropharyngeal squamous cell carcinomas (OPSCC): A Surveillance, Epidemiology and End Results Program (SEER) database analysis.

e17538 Background: The recently released eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual, Head and Neck Section, incorporates significant changes to the prior seventh edition. The changes reflect the improved understanding of tumor biology, prognostic factors and molecular markers that effect outcomes in Head and Neck cancers. A key update restages OPSCC by human papilloma virus (HPV) positive and negative cancers as data demonstrated that these tumors have significantly different biology and outcomes. Methods: Using SEER data from 2004 – 2014, we identified male patients with squamous cell carcinomas of the tonsil, base of tongue and soft palate aged between 21 and 64 years old (those clinical characterizes were considered as surrogate markers for HPV positive status). We classified them by the AJCC 8th edition staging for HPV positive OPSCC and by AJCC 7th edition staging. The prediction performance by two staging editions were compared regarding overall survival (OS) and Disease free survival (DFS). Kaplan-Meier method and Cox proportional hazard model were applied, and the discrimination performance was measured by the concordance statistics (C-statistics). Results: A total of 8202 eligible patients were included in the analysis with a median follow up period of 51 months. 7415 (90.4%) patients had previously received radiation and 7038 (85.8%) patients had previously received chemotherapy. The median age of patients was 56 years. Distribution of stage I disease increased from 2% to 19.6% in AJCC 8th edition. 10-year overall survival (OS) for AJCC 8th stages I (74%), II (78%), III (55%) and IV (32%). Using Stage I as reference, the hazard ratio for stage II, III, and IV is 0.98 (95%CI: 0.87-1.09), 2.29 (95%CI: 2.04-2.57), and 5.88 (95%CI: 4.96-6.98). Similar results were noted for ten year disease free survival. The C-statistics measured overall discrimination for 8th edition is 0.68 and 0.63 for the 7th edition (P &lt; 0.001). Conclusions: Based on this SEER analysis, the overall performance of discrimination improved from AJCC 7th to 8th edition; but in this study population, AJCC 8th edition does not distinguish stage I and II sufficiently as expected as it does for stages III and IV disease. Limitations of the SEER database include the surrogate for P16 status and under reported and incomplete data.

Demographics and Survival in Primary Effusion Lymphoma: SEER Database Analysis

Background: Primary effusion lymphoma (PEL) is one of the least common of the AIDS-related lymphomas, accounting for less than 4% of cases. The optimal treatment for primary effusion lymphoma (PEL) remains unclear and there is a paucity of data regarding this neoplasm, which carries a uniformly poor prognosis. Antiretroviral therapy in addition to chemotherapy has shown to improve survival in a few small retrospective studies.Methods: Between 2002 and 2014, all cases of PEL were extracted from the population-based cancer registries of the Surveillance Epidemiology and End Results program (SEER). Instances of PEL were identified with the ICD-O-3 (9678) histological code. Frequency, demographics, and survival data were assessed using SPSS statistical software.Results: A total of 117 cases of PEL were identified. PEL was significantly more prevalent in men (89.7%) and in Caucasians (77.8%) with median age at diagnosis of 49 years. Median overall survival in the entire cohort was 6 months; CI, 3.7 to 8.2 months. Of all PEL cases, 62.4% received chemotherapy and 37.6% did not. Those who received chemotherapy had a median overall survival of 10 months vs less than one month when compared to subjects who did not receive chemotherapy (p = 0.002). PEL was the cause of death in 40.2% of the cases. PEL-specific median overall survival was markedly higher (29.000 months) than that of the entire cohort. Multivariable analysis demonstrated that age and race were not associated with mortality. Chemotherapy was associated with decreased mortality risk (HR, 0.45; CI, 0.28 -0.74; p = 0.002)Conclusions: In confirmation of previously published data, the highest incidence of PEL was found in Caucasian males. Subjects who received chemotherapy were found to have improved overall survival outcome. Other factors not related to PEL were associated with early mortality in this population. DisclosuresNo relevant conflicts of interest to declare.

Cancer in primary immunodeficiency diseases: Cancer incidence in the United States Immune Deficiency Network Registry

We evaluated the overall and site-specific incidence of cancer in subjects with primary immunodeficiency diseases (PIDD) enrolled in the United States Immune Deficiency Network (USIDNET) registry compared with age-adjusted cancer incidence in the Surveillance, Epidemiology and End Results Program (SEER) database. We hypothesized that subjects with PIDD would have an increased incidence of cancer due to impaired immune function. Overall and site-specific cancer incidence rates were evaluated in subjects with PIDD (n=3658) enrolled in the USIDNET registry from 2003 to 2015 and compared with age-adjusted incidence rates in the SEER database. We observed a 1.42-fold excess relative risk of cancer in subjects with PIDD compared with the age-adjusted SEER population (P<.001). Men with PIDD had a 1.91-fold excess relative risk of cancer compared with the age-adjusted male population (P<.001), while women with PIDD had similar overall cancer rates compared with the age-adjusted female population. Of the 4 most common malignancies in men and women in SEER (lung, colon, breast, and prostate cancers), we found no significant increase in these diagnoses in subjects with PIDD. Significant increases in lymphoma in both men (10-fold increase, P<.001) and women (8.34-fold increase, P<.001) with PIDD were observed. Excess incidence of cancer occurred in subjects with PIDD. An excess of lymphoma in specific PIDD populations principally drove this increased incidence, while no increased risk of the most common solid tumor malignancies was observed. These data point to a restricted role of the immune system in protecting from specific cancers.

Bayesian pretest probability estimation for primary malignant bone tumors based on the Surveillance, Epidemiology and End Results Program (SEER) database

In the diagnostic process of primary bone tumors, patient age, tumor localization and to a lesser extent sex affect the differential diagnosis. We therefore aim to develop a pretest probability calculator for primary malignant bone tumors based on population data taking these variables into account. We access the SEER (Surveillance, Epidemiology and End Results Program of the National Cancer Institute, 2015 release) database and analyze data of all primary malignant bone tumors diagnosed between 1973 and 2012. We record age at diagnosis, tumor localization according to the International Classification of Diseases (ICD-O-3) and sex. We take relative probability of the single tumor entity as a surrogate parameter for unadjusted pretest probability. We build a probabilistic (naïve Bayes) classifier to calculate pretest probabilities adjusted for age, tumor localization and sex. We analyze data from 12,931 patients (647 chondroblastic osteosarcomas, 3659 chondrosarcomas, 1080 chordomas, 185 dedifferentiated chondrosarcomas, 2006 Ewing's sarcomas, 281 fibroblastic osteosarcomas, 129 fibrosarcomas, 291 fibrous malignant histiocytomas, 289 malignant giant cell tumors, 238 myxoid chondrosarcomas, 3730 osteosarcomas, 252 parosteal osteosarcomas, 144 telangiectatic osteosarcomas). We make our probability calculator accessible at http://ebm-radiology.com/bayesbone/index.html . We provide exhaustive tables for age and localization data. Results from tenfold cross-validation show that in 79.8% of cases the pretest probability is correctly raised. Our approach employs population data to calculate relative pretest probabilities for primary malignant bone tumors. The calculator is not diagnostic in nature. However, resulting probabilities might serve as an initial evaluation of probabilities of tumors on the differential diagnosis list.

Prognostic factors for survival in patients with Ewing's sarcoma using the surveillance, epidemiology, and end results (SEER) program database

BackgroundThe current study aims to determine cause-specific survival in patients with Ewing's sarcoma while reporting clinical risk factors for survival. MethodsThe Surveillance, Epidemiology, and End Results (SEER) Program database was used to identify patients with osseous Ewing's sarcoma from 1991 to 2010. Patient, tumor, and socioeconomic variables were analyzed to determine prognostic factors for survival. ResultsThere were 1163 patients with Ewing's sarcoma identified in the SEER Program database. The 10-year cause-specific survival for patients with non-metastatic disease at diagnosis was 66.8% and 28.1% for patients with metastatic disease. Black patients demonstrated reduced survival at 10 years with an increased frequency of metastatic disease at diagnosis as compared to patients of other race, while Hispanic patients more frequently presented with tumor size>10cm. Univariate analysis revealed that metastatic disease at presentation, tumor size>10cm, axial tumor location, patient age≥20 years, black race, and male sex were associated with decreased cause-specific survival at 10 years. Metastatic disease at presentation, axial tumor location, tumor size>10cm, and age≥20 years remained significant in the multivariate analysis. ConclusionsPatients with Ewing's sarcoma have decreased cause-specific survival at 10 years when metastatic at presentation, axial tumor location, tumor size>10cm, and patient age≥20 years.

Increased risk and pattern of secondary malignancies in patients with invasive extramammary Paget disease

Extramammary Paget disease (EMPD) is often associated with underlying or distant synchronous malignancies. The prognosis for affected patients is generally favourable; however, the risk of secondary malignancies is unknown. The goal of the study was to analyse the incidence, prognosis and pattern of secondary malignancies for patients with invasive EMPD using data from the Surveillance, Epidemiology and End Results (SEER) Program. We searched the SEER Program database for patients diagnosed with invasive EMPD between 1973 and 2008. Demographic data, outcome and secondary malignancies more than 1 year after the initial diagnosis of invasive EMPD were included in the analysis. We calculated the standardized incidence ratio (SIR) and estimated the excess absolute risk (EAR) per 10,000 person-years (PY). There were 1439 patients who were diagnosed with invasive EMPD. Most patients (80.4%) had localized disease, while 17.1% had locoregional spread and 2.5% presented with distant disease. The SIR for secondary malignancies in patients with invasive EMPD was significantly elevated with an EAR of 97.4 additional malignancies per 10,000 PY. The excess risk was mostly due to a significantly increased incidence of colorectal and anal malignancies. The initial site of disease predicted the site of the secondary malignancies, with patients with colorectal, anal, vulvar and scrotal disease showing an increased risk of colorectal, anal, vulvar and scrotal malignancies, respectively. Our study identified a long-term increased risk of developing secondary malignancies in patients with invasive EMPD that are mainly related to the site of origin of this disease. Patients with invasive EMPD require prolonged follow-up and screening for these malignancies.

Ovarian cancer. Age contrasts in incidence, histology, disease stage at diagnosis, and mortality.

Age comparisons for incidence, histology, disease stage at initial diagnosis, and mortality of more than 20,000 ovarian cancer patients diagnosed between 1973-1987 are the focus of this descriptive epidemiologic study. This paper highlights key issues and concerns regarding ovarian cancer in women 65 years and older as a frame of reference for the proceedings of the working conference, "Perspectives on Ovarian Cancer in Older-Aged Women," co-sponsored by the National Institute on Aging, National Cancer Institute, and American Cancer Society held at the National Institutes of Health, November, 1991. Data are from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program and the National Center for Health Statistics. The SEER Program database represents approximately 9.6% of the U.S. population. Ovarian cancer affects women in the age group 65 years and older more frequently than younger women. More than 48% of all ovarian cancers occur in women in this age group. Age-adjusted rates increase as age advances, peaking at 54.0 per 100,000 in the age group 75-79 years. Time trends also indicate increases in age-specific incidence rates. This malignancy takes its toll in mortality in women 65 years and older with 64% of all deaths due to this neoplasm (in 1989). Moreover, older women are more likely to be initially diagnosed with advanced disease. Important questions about ovarian cancer in older-aged women need urgent attention from the research community. New strategies for diagnostic leads have to be developed for older women.

Second primary cancers after thymoma

Second primary cancers after thymoma

Second nonbreast malignancies after conservative surgery and radiation therapy for early-stage breast cancer

Purpose : Breast cancer patients treated with conservative surgery and radiation therapy are at risk of developing second nonbreast malignancies (SNBMs). The purpose of this study was to determine the incidence of all SNBMs and SNBMs by specific location among long-term survivors and to compare the risk of these events to the age-specific incidence of malignances as first cancers in the Surveillance Epidemiology and End-Results Program (SEER) population. Methods and Materials : We analyzed the likelihood of SNBM development for 1884 patients with clinical Stage I or II breast cancer treated with gross excision and ≥60 Gy (median 63) to the breast between 1970 and 1987. Fifty-seven percent received supraclavicular/axillary radiation (median dose 45 Gy, range 20–60) and 28% received systemic therapy. The median age at diagnosis was 52 years. The median clinical tumor size was 2 cm. Patients were considered at risk of an SNBM until the development of the first of distant metastases or contralateral breast cancer or death or, if alive and disease-free, until the last follow-up visit. The expected numbers of cancers were obtained from the SEER database, using the age-specific incidence for white women within 5-year age groups and 5-year calendar intervals. The median time at risk for an SNBM was 10.9 years (range 0.2–27.9). Results : By 8 years of follow-up, 432 patients (23%) had developed distant metastases, 295 patients (16%) a local/regional recurrence, and 159 (8%) a contralateral primary. Of the 1884 patients in our cohort, 147 (8%) developed an SNBM compared with the 127.7 expected from SEER. This corresponds to an absolute excess of 1% of the study population and a relative increase of 15% greater than that expected from SEER ( p = 0.05). Within the first 5 years, the observed and expected rates of SNBMs were identical (47 vs. 46.9). After 5 years, 24% more SNBMs were observed than expected (100 vs. 80.8, p = 0.02). Among patients <50 years old at breast cancer diagnosis, 43% more observed SNBMs occurred than expected (40 vs. 28, p = 0.02). For patients ≥50 years, 7% more SNBMs were observed than expected (107 vs. 99.7, p = 0.25). Lung SNBMs were observed in 33 women, 52% more than the 21.67 predicted by SEER ( p = 0.01). Most of the lung SNBMs occurred >5 years after treatment ( n = 23) and in women who were >50 years at the time of their breast cancer diagnosis ( n = 27). The observed incidence of ovarian cancer was significantly greater than expected among patients <50 years (7 vs. 1.96, p = 0.004) but was not different than expected for patients ≥50 years (5 vs. 5.3, p = 0.61). Among the 7 sarcomas, 3 developed in the radiation field. Conclusions : SNBMs occur in a substantial minority (8%) of patients treated with conservative surgery and radiotherapy. However, the absolute excess risk compared with the general population is very small (1%). This excess risk is only evident after 5 years. In particular, a slightly increased incidence of lung SNBMs and a somewhat larger increase in ovarian cancer among younger patients was found. Our data suggest that preventive strategies to reduce the incidence of certain cancers (e.g., smoking cessation and prophylactic oophorectomy) and/or continued monitoring for SNBMs to increase the likelihood of early detection and treatment may be prudent in this population.