Surveillance, Epidemiology, And End Results Program Research Articles

Histology-specific standardized incidence ratio improves the estimation of second primary lung cancer risk

BackgroundLung cancer (LC) survivors are at increased risk for developing a second primary cancer (SPC) compared to the general population. While this risk is particularly high for smoking-related SPCs, the published standardized incidence ratio (SIR) for lung cancer after lung cancer is unexpectedly low in countries that follow international multiple primary (IARC/IACR MP) rules when compared to the USA, where distinct rules are employed. IARC/IACR rules rely on histology-dependent documentation of SPC with the same location as the first cancer and only classify an SPC when tumors present different histology. Thus, SIR might be underestimated in cancer registries using these rules. This study aims to assess whether using histology-specific reference rates for calculating SIR improves risk estimates for second primary lung cancer (SPLC) in LC survivors.MethodsWe (i) use the distribution of histologic subtypes of LC in population-based cancer registry data of 11 regional cancer registries from Germany to present evidence that the conventional SIR metric underestimates the actual risk for SPLC in LC survivors in registries that use IARC/IACR MP rules, (ii) present updated risk estimates for SPLC in Germany using a novel method to calculate histological subtype-specific SIRs, and (iii) validate this new method using US SEER (Surveillance, Epidemiology, and End Results Program) data, where different MP rules are applied.ResultsThe adjusted relative risk for lung cancer survivors in Germany to develop an SPLC was 2.98 (95% CI 2.53–3.49) for females and 1.15 (95% CI 1.03–1.27) for males using the novel histology-specific SIR. When using IARC/IACR MP rules, the conventional SIR underestimates the actual risk for SPLC in LC survivors by approximately 30% for both sexes.ConclusionsOur proposed histology-specific method makes the SIR metric more robust against MP rules and, thus, more suitable for cross-country comparisons.

Abstract PO4-17-11: Normalized Breast Cancer Survival Outcomes in U.S. Tumor Registries

Abstract Background The largest U.S. tumor registries, NCDB (National Cancer Database) and SEER (Surveillance, Epidemiology, and End Results Program), are vital sources of epidemiological data and are frequently utilized in research. Although the NCDB includes the majority of patients diagnosed with breast cancer, it is a hospital-based registry. In contrast, SEER is a population-based registry, but includes less than half of all breast cancer patients diagnosed each year. While the US Cancer Statistics Public Use Database (USCS) captures nearly all breast cancers, treatment and survival data are not included. As such, we sought to normalize the NCDB and SEER populations to mirror the USCS population and examine survival outcomes after normalization. Methods All patients diagnosed with stage I-IV breast cancer (2010-2018) were selected from the NCDB and SEER. Frequencies of patients by select characteristics were exported from the USCS. Rates from the USCS were then used to normalize the NCDB and SEER cohorts, using patient weighted frequencies for age, sex, race/ethnicity, tumor biomarkers [estrogen receptor (ER), HER2], and extent of disease (local, regional, distant; anatomic staging data not available in USCS). Of note, the USCS does not have individual patient-level data (only summary data for select variables), and thus, weighted frequencies were used for normalization. The weighted frequencies were calculated based on the total number of patients in the USCS database divided by the total number of patients in the NCDB or SEER separately for each variable (age, sex, race/ethnicity, etc). Weighted and unweighted data were summarized with N (%). Unweighted patient and disease characteristics (crude data) were compared using Chi-square tests. Overall survival (OS) was estimated using the Kaplan-Meier method before and after normalization. Results The USCS cohort included 2,473,739 patients; the NCDB included 1,441,556 and SEER 504,938. The median followup was 54.9 months for NCDB and 57 months for SEER. There were minimal differences between the cohorts based on age (age < 50y: USCS 18.1%, NCDB 19.3%, SEER 18.9%) or sex (female: USCS 99.1%, NCDB 99.1%, SEER 99.3%). However, there were notable differences in the racial/ethnic composition; non-Hispanic White: USCS 75%, NCDB 78.2%, SEER 68.2%; non-Hispanic Black: USCS 11.4%, NCDB 11.4%, SEER 9.9%; Hispanic: USCS 8.3%, NCDB 5.9%, SEER 11.7%; p< 0.001 for USCS vs NCDB and USCS vs SEER). There were minimal differences in tumor biomarkers (ER+: USCS 82.9%, NCDB 83%, SEER 84.9%; HER2+: USCS 14.5%, NCDB 14.1%, SEER 13.8%), but significant differences in extent of disease (local: USCS 66.1%, NCDB 80.2%, SEER 68.4%; distant: USCS 6%, NCDB 3.9%, SEER 3.9%; p< 0.001 for USCS vs NCDB and USCS vs SEER). For the variables that were similar without weighting (age, sex, tumor biomarkers), OS was also similar after weighting (Table). After normalizing the NCDB based on race, 8-year OS remained comparable (crude 77.2% vs weighted 77.3%); similar findings were noted after normalizing SEER (crude 75.8% vs weighted 75.3%). After normalizing the NCDB based on extent of disease, 8-year OS was notably worse (crude 77.2% vs weighted 74.2%); similar findings were noted for SEER (crude 75.8% vs weighted 74.4%). Conclusions While national tumor registries afford researchers the opportunity to study large breast cancer cohorts, they do not always fully represent the entire breast cancer population. This limitation should be considered when working with these data sets. Table. Citation Format: Tori Chanenchuk, Kerri-Anne Crowell, Samantha Thomas, Rachel Greenup, Jennifer Plichta. Normalized Breast Cancer Survival Outcomes in U.S. Tumor Registries [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-17-11.

Squamous Cell Carcinoma of the Colon: Evaluation of Treatment Modalities and Survival

BackgroundSquamous cell carcinoma of the colon (CSCC) is a rare subtype of colon cancer. This study aimed to evaluate treatment strategies and overall survival. MethodsUtilizing the Surveillance, Epidemiology and End Results Program (SEER) database from 2008-2019, patients 18 years of age with CSCC colon where identified. Treatment strategies and overall survival was summarized using Kaplan Meier analysis and the log-rank test. Adjusted cox proportion hazard ratios were calculated to evaluate the effect of confounding variables. ResultsAfter exclusions, 153 patients met inclusion criteria. The most common treatment modalities included surgery alone (52.1%), surgery and adjuvant chemotherapy (12.9%), and no treatment (26.4%). Kaplan Meier analysis revealed patients undergoing surgery and adjuvant chemotherapy had significant improvements in overall survival (log-rank p=0.002). Cox regression analysis revealed tumor grade (HR: 2.12 95% CI: 1.17-3.86) and receipt of chemotherapy (HR: 2.66 95% CI: 1.23-5.76) as the only factors associated with improvements in OS. ConclusionsPatients undergoing surgery in combination with chemotherapy had the best overall survival when compared to those that underwent surgery alone. Tumor grade and receipt of chemotherapy were independent associated with overall survival.

Bone Sarcoma Survival in the US Military Health System: Comparison With the SEER Program.

Access to care is associated with cancer survival. The US Military Health System (MHS) provides universal health care to all beneficiaries. However, it is unknown whether survival among patients with bone sarcoma in a health system providing universal care is better than that in the general population. The aim of the study was to compare survival of patients with bone sarcoma in the US MHS with that of the US general population. The MHS data were obtained from the Department of Defense Automated Central Tumor Registry (ACTUR). The US general population data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. Adult patients were defined as those aged 25 years or older with a histologically confirmed musculoskeletal bone sarcoma diagnosed from January 1, 1987, to December 31, 2013. Kaplan-Meier survival curves and multivariable Cox proportional hazards models were used to compare the overall survival of the two populations. The final analysis included 2,273 bone sarcoma cases from ACTUR and 9,092 bone sarcoma cases from SEER. ACTUR patients had significant lower 5-year all-cause death (hazard ratio = 0.72; 95% CI, 0.66 to 0.78) after adjustment for the potential confounders. ACTUR patients with bone sarcoma also exhibited significantly lower risk of all-cause death during the entire follow-up period than the SEER patients (hazard ratio = 0.75; 95% CI, 0.6 to 0.81). MHS beneficiaries with bone sarcoma may have longer survival than SEER patients. Our findings support the role of universal access to high-quality care in improving bone sarcoma outcomes.

Increased risk of multiple metastases and worse overall survival of metastatic pancreatic body and tail cancer: a retrospective cohort study.

Pancreatic cancer (PC) is a lethal disease, especially metastatic PC. And it can be divided into two types: head pancreatic cancer (H-PC) and body and tail pancreatic cancer (BT-PC). Prior studies have proved that they have different overall survival (OS) and should be regarded as two different categories of PC. At present, there remains a gap in the field regarding OS across different primary tumor locations and metastatic sites, as well as the metastatic patterns associated with various primary tumor locations in patients with metastatic PC. Thus, our study aims to address this gap by analyzing data from a large population sourced from the Surveillance, Epidemiology, and End Results (SEER) database. The different prognosis of different primary tumor locations and metastatic sites may indicate that different primary locations and metastatic sites may require different therapy and follow-up strategy. It is hoped that these findings will lay the groundwork for future guideline updates and related research. Patients with pathologically confirmed stage IV metastatic PC from the National Cancer Institute's SEER program between 2010 and 2015 were included, excluding patients with various tumors, without specifying age, specific sites of metastasis, or OS. Data including age, race, gender, tumor size, T stage, N stage, grade, sites, number of metastatic sites, surgery, radiotherapy, chemotherapy and years of diagnoses were collected from the SEER database. OS was defined as the period from initial diagnosis to the date of death. Specific metastatic sites for the different primary locations of tumor were compared. Survival was analyzed by Cox regression analyses. Overall, 14,406 patients with metastatic PC were included in this research (7,104 of H-PC and 7,302 of BT-PC). Gender proportion, tumor size, T stage, N stage, number of metastatic sites surgery of the primary lesions and radiotherapy were different between BT-PC and H-PC. The proportion of only 1 metastatic site was 68.3% in H-PC compared with 58.3% in the BT-PC. The BT-PC was an independent risk factor for liver metastases compared with the H-PC [odds ratio (OR) =1.510; 95% confidence interval (CI): 1.320-1.727]. No matter for those with multiple metastases, or for those with solitary liver or lung metastases, patients with metastatic H-PC showed better OS (P<0.001, P=0.001, P=0.04, respectively). In patients with solitary liver metastases, worse OS was observed in the BT-PC than the H-PC [hazard ratio (HR) =1.109; 95% CI: 1.046-1.175]. The metastatic BT-PC had worse OS and increased risk to suffer from liver and multiple metastases. Moreover, in patients with solitary metastases, those with liver metastases presented poorest survival.

Estimation of the tumor size at cure threshold among adult patients with adrenocortical carcinoma: A populational-based study

BackgroundThe prognostic significance of tumor size with adrenocortical carcinoma (ACC) patients has not yet been thoroughly evaluated. Our objective was to investigate the influence of tumor size on prognostic value in adult ACC patients. MethodsThe Surveillance, Epidemiology and End Results Program (SEER) was employed to identify adult ACC patients who had been diagnosed from 2004 to 2015. The “X-Tile” program determined the optimal cutoff value of tumor size. Cancer-specific survival (CSS) and overall survive (OS) were estimated. The survival outcomes and risk factors were analyzed by the Kaplan-Meier methods and the multivariable cox regression respectively. ResultsA total 426 adult ACC patients were included. Univariable and multivariable cox analysis revealed age, larger tumor size and metastasis as consistent predictors of lower CSS and OS. The optimal cutoff value of tumor size was identified as 8.5 cm using X-tile software, and Kaplan-Meier method showed dramatic prognostic difference between patients with larger tumors (＞8.5 cm) and smaller tumors (≤8.5 cm) (log-rank test, P < 0.001). Subgroup analyses revealed no statistical significance and a consistent proportionate effect of tumor size on CSS and OS across all eight pre-specified subgroups. Interestingly, an additional subgroup analysis showed that ACC patients could not benefit from chemotherapy in terms of CSS and OS. ConclusionThe study suggests that tumor size is a crucial prognostic factor in ACC patients and a cutoff value 8.5 cm might indicate a poor outcome. Given the limitations of the available data, it is challenging to conclusively determine the benefit of chemotherapy in adult ACC patients across different tumor size ranges.

A SEER program study of survival trends in Merkel cell carcinoma of the eyelid: 2000–2019

ABSTRACT Purpose Merkel cell carcinoma of the eyelid (MCCE) is a rare yet aggressive neuroendocrine tumour associated with significant morbidity and mortality. This study aimed to investigate survival trends and demographic factors related to MCCE, 2000–2019, using the Surveillance, Epidemiology, and End Results (SEER) Program. Methods Cases were analysed by demographic parameters, disease properties, and survival. Statistical analyses were performed via a dedicated computerized software package. Results A total 349 cases of MCCE were identified, accounting for 2% of all MCC cases in the United States during that time. Of note, the incidence of MCCE remained stable over the study period (p = .35). Female patients accounted for 56% of the cases, and males for 44%. White patients accounted for 90.8% of the the cases, and Black patients for 2.9%. MCCE incidence increased with age, with the majority of patients age 85+ (p < .05). Incidence was greatest in metropolitan areas and among those with median incomes >$75,000/year. Income correlated with likelihood of MCCE diagnosis (p < .05). Analysis of 5-year survival data showed 20% of the patients died due to MCCE within 5 years of diagnosis. Of these, the majority died within one year of diagnosis. Conclusions Consistent with previous reports, most patients were white, female, and age 85+.Incidence correlated with metropolitan environments and median income. While most patients did not die from MCCE, majority of recorded deaths occurred within one year of diagnosis.

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&gt;0.05) annually from 2005 to 2011 and 3.33% (95% CI 1.79 to 4.27, p&lt;0.05) annually from 2011 to 2014 and the incidence rate decreased by 0.06% (95% CI -1.44 to 0.5, p&gt;0.05) annually from 2014 to 2019. Melanoma specific mortality rate increased annually by 2.03 % (95% CI 0.78 to 3.94, P &lt;0.05) from 2005 to 2013 and decreased by 5.49% annually (95% CI -8.65 to -3.65, P &lt;0.05) from 2013 to 2019. Cardiovascular disease specific mortality rate increased by 7.08% annually (95% CI 4.66 to 9.64, P &lt;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.

Risk of chronic liver disease and cirrhosis mortality among patients with digestive system cancers: a registry-based analysis.

Non-cancer deaths are now becoming a great threat to the health of cancer survivors. There are no comprehensive and systematic reports on chronic liver disease and cirrhosis mortality (CLDCM) among patients with digestive system cancers (DSCs). This research aimed to quantitatively assess the risks and patterns of CLDCM among patients with DSCs. From the surveillance, epidemiology and end results (SEER) program, we extracted the data of patients diagnosed with DSCs between 2000 and 2017. Trends in incidence-based mortality rate (IBMR) were calculated using Joinpoint software. The standardized mortality ratio (SMR) was obtained based on the reference of the general United States population. The cumulative incidence function curves were constructed by all causes of death. Independent indicators were identified using the multivariate Fine and Gray competing risk model. We included 906,292 eligible patients from the SEER program, of which 3068 (0.34%) died from chronic liver disease and cirrhosis (CLDC). The IBMR of CLDC continued to increase during the study period [average annual percent change (APC): 6.7%; 95% confidence interval (CI) 5.1-8.2] and the SMR was significantly increased (SMR: 3.19; 95% CI 3.08-3.30). The cumulative mortality of CLDC was the lowest in all causes of death. Furthermore, the age at diagnosis, race, gender, marital status, year of diagnosis, SEER stage, surgery, chemotherapy and radiotherapy were identified as independent indicators. Better screening, diagnostic and management approaches need to be implemented as a preferred method to protect the liver among patients with DSCs.

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.

Estimating Breast Cancer Overdiagnosis After Screening Mammography Among Older Women in the United States.

Overdiagnosis is increasingly recognized as a harm of breast cancer screening, particularly for older women. To estimate overdiagnosis associated with breast cancer screening among older women by age. Retrospective cohort study comparing the cumulative incidence of breast cancer among older women who continued screening in the next interval with those who did not. Analyses used competing risk models, stratified by age. Fee-for-service Medicare claims, linked to the SEER (Surveillance, Epidemiology, and End Results) program. Women 70 years and older who had been recently screened. Breast cancer diagnoses and breast cancer death for up to 15 years of follow-up. This study included 54 635 women. Among women aged 70 to 74 years, the adjusted cumulative incidence of breast cancer was 6.1 cases (95% CI, 5.7 to 6.4) per 100 screened women versus 4.2 cases (CI, 3.5 to 5.0) per 100 unscreened women. An estimated 31% of breast cancer among screened women were potentially overdiagnosed. For women aged 75 to 84 years, cumulative incidence was 4.9 (CI, 4.6 to 5.2) per 100 screened women versus 2.6 (CI, 2.2 to 3.0) per 100 unscreened women, with 47% of cases potentially overdiagnosed. For women aged 85 and older, the cumulative incidence was 2.8 (CI, 2.3 to 3.4) among screened women versus 1.3 (CI, 0.9 to 1.9) among those not, with up to 54% overdiagnosis. We did not see statistically significant reductions in breast cancer-specific death associated with screening. This study was designed to estimate overdiagnosis, limiting our ability to draw conclusions on all benefits and harms of screening. Unmeasured differences in risk for breast cancer and differential competing mortality between screened and unscreened women may confound results. Results were sensitive to model specifications and definition of a screening mammogram. Continued breast cancer screening was associated with greater incidence of breast cancer, suggesting overdiagnosis may be common among older women who are diagnosed with breast cancer after screening. Whether harms of overdiagnosis are balanced by benefits and for whom remains an important question. National Cancer Institute.

Non-Hodgkin Lymphoma - Nodal and Extranodal: 20-Year Comparative Mortality, Survival & Biologic Behavior Analysis by Age, Sex, Race, Stage, Cell Morphology/Histology, Cohort Entry Time-Period and Disease Duration: A Systematic Review of 384,651 Total NHL Cases Including 261,144 Nodal and 123,507 Extranodal Cases for Diagnosis Years 1975-2016: (SEER*Stat 8.3.6).

-To update trends in incidence and prevalence in the United States of non-Hodgkin lymphoma, examine, compare and contrast short and long-term patterns of survival and mortality, and consider the outcome impacts of anatomic location of NHL nodal and extranodal subdivisions, utilizing selected ICD-O-3 histologic oncotypes stratified by age, sex, race/ethnicity, stage, cell behavioral morphology and histologic typology, cohort entry time-period and disease duration, employing the statistical database of the National Cancer Institute SEER*Stat 8.3.6 program for diagnosis years 1975-2016.4 Methods.- A retrospective, population-based cohort study using nationally representative data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program to evaluate 384,651 NHL cases for diagnosis years 1975-2016 comparing multiple variables of age, sex, race, stage, cell behavioral morphology, cohort entry time-period, disease duration and histologic oncotype. Relative survival statistics were analyzed in two cohorts: 1975-1995 and 1996-2016. Survival statistics were derived from SEER*Stat Database: Incidence - SEER 9 Regs Research Data, November 2018 Submission (1975-2016) <Katrina/Rita Population Adjustment> released April 2019, based on the November 2018 submission. - Incidence rates, relative frequency distributions, survival and mortality by age, sex, stage and cell behavioral morphology, of adult nodal (N) and extranodal (EN) NHL in 2 entrant time-periods as recorded in the SEER Program of the National Cancer Institute for diagnosis years 1975-2016 (SEER Stat 8.3.6) are summarized. Shifts in trends over time are identified, and the findings are correlated with prognosis, including short and long-term observed (actual), expected and relative survival, median observed and relative survival, mortality rates and excess death rates per 1000 people. - Trends in SEER incidence, prevalence, survival and mortality by age, sex, race, stage, cell behavioral morphology, cohort entry time-period, relative frequency and percent distribution, were examined to provide a current epidemiologic and medical-actuarial risk assessment framework for nodal (N) and extranodal (EN) non-Hodgkin's lymphoma in the 1975-2016 timeframe.

Comparison of incident breast cancer cases in the largest national US tumor registries.

6512 Background: National tumor registries, such as the NCDB (National Cancer Database) and SEER (Surveillance, Epidemiology, and End Results Program), have been used to explore numerous research questions related to trends in disease incidence, treatment patterns, and outcomes. However, some have criticized that they may not fully represent the general population. As such, we sought to compare the incident breast cancer cases in the NCDB and SEER to a national population cancer registry. Methods: All patients diagnosed with malignant or in situ breast cancer 2010-2019 were selected from the NCDB (Fall 2022 release) and SEER-22 (November 2021 release) and compared to breast cancer patient counts from the US Cancer Statistics Public Use Database (USCS, 2021 submission). Patient frequencies were summarized by age, sex, race/ethnicity, and year of diagnosis. Percent case coverage was estimated as the number of patients in the NCDB or SEER divided by the number of patients in the USCS. Chi-square tests were used to compare patient counts across data sources. Results: In total, the USCS database reported 3,047,509 patients diagnosed with breast cancer between 2010-2019, of which, 77.5% (N=2,362,477) were included in the NCDB and 46.0% (N=1,403,272) in SEER. Over time, case coverage steadily improved for the NCDB (72.8% in 2010 to 81.5% in 2019), while only a minor increase was observed in SEER (46.0% in 2010 to 46.6% in 2019). When compared to the USCS, case ascertainment was notably lower for individuals age ≥50 in both the NCDB and SEER (both p&lt;0.001). The overwhelming majority of patients were captured by the NCDB (age &lt;50: 81.7%; age ≥50: 76.6%) while SEER identified approximately half (age &lt;50: 49.4%; age ≥50: 45.3%). Case ascertainment also varied significantly by patient sex across registries (both p&lt;0.001). For male breast cancers, 84.1% were captured in the NCDB, only 77.5% of female patients were included. In contrast, case coverage in SEER was better for females than males (46.1% vs 43.5%). Notably, registries varied significantly by race/ethnicity (both p&lt;0.001). Case coverage in the NCDB was highest for non-Hispanic White (78.2%), non-Hispanic Black (77.7%), and non-Hispanic Asian or Pacific Islander (72.5%) patients, and it was lowest for Hispanic (56.4%) and non-Hispanic American Indian/Alaska Native (41.1%). In SEER, case coverage was highest for non-Hispanic Asian or Pacific Islander (78.1%) and Hispanic (69.6%) patients, and it was considerably lower for all other subgroups (non-Hispanic Black 44.8%, non-Hispanic White 42.4%, and non-Hispanic American Indian/Alaska Native 36.6%). Conclusions: National US tumor registries provide data for a large sampling of breast cancer patients, and case coverage has improved over time. However, significant differences in case coverage were observed based on age, sex, and race/ethnicity, suggesting that analyses using these data sets should be interpreted with caution.

Older adults (OA) in clinical trials: Where are they? Representation of OA in clinical trials conducted at the national cancer institute (NCI) clinical center.

e18517 Background: Clinical trials are a significant source of evidence for diagnostic and management strategies in cancer patients. Diversity, equity, and inclusion are necessary to provide access to clinical trials and improve care. Despite the increase of OA in the United States (US), OA are still under-represented in clinical trials, with a lack of information on clinical outcomes and safety. The NCI provides oncologic care on research studies conducted at the Clinical Center (CC), the research hospital of the National Institutes of Health (NIH) where third-party payers are neither notified nor invoiced for treatments received. Participants come from all over the US and are primarily referred by their primary oncologists. We sought to evaluate the participation of OA in clinical trials at the NCI-CC. Methods: In this retrospective analysis, OA were defined as participants aged ≥65 years. The demographic data of OA enrolled from 2005 to 2019 were retrieved from the Biomedical Translational Research Information System (BTRIS), the NIH clinical research data repository. Data on the incidence of new cancer diagnoses in the US population for the same period (2005-2019) were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. We compared the proportions of OA enrolled in NCI-CC clinical trials with the corresponding data from SEER program. We further stratified the OA into four age subcategories: from 65 to 69, from 70 to 74, from 75 to 79, and older than 80 years of age. No inferential statistical analyses were performed. Results: A total of 37,326 participants were enrolled from 2005 to 2019 on NCI-CC clinical trials. The number of OA = 7,934 (21.3%). According to the SEER program, 11,017,070 people were diagnosed with cancer from 2005 to 2019, and 5,971,607 (54.2%) were OA. Notably, the proportions of OA enrolled in NCI-CC was lower than the SEER data in all the subcategories. Patients ≥75 years accounted for the most under-represented (Table). Conclusions: OA are under-represented in clinical trials conducted at the NCI-CC from 2005 to 2019, emphasizing the need to “geriatricize” clinical trials. Adaptations of trial design such as expansion of eligibility criteria, utilization of geriatric assessment tools, and inclusion of OA-specific enrollment targets may reduce barriers to enrollment. Outreach initiatives to the oncology community to reinforce the need for increased referral of OA along with incorporation of telehealth for trial screening and assessments could also be considered to expand enrollment and increase the evidence base to guide treatment of OA with cancer. [Table: see text]

Could improving mental health disorders help increase cancer survival?

The Article by Thomas Kuczmarski and colleagues 1 Kuczmarski TM Tramontano AC Mozessohn L et al. Mental health disorders and survival among older patients with diffuse large B-cell lymphoma in the USA: a population-based study. Lancet Haematol. 2023; (published online June 1.)https://doi.org/10.1016/S2352-3026(23)00094-7 Google Scholar in The Lancet Haematology is the first in several decades to carefully consider the association between common pre-existing mental health disorders and survival outcomes in patients with diffuse large B-cell lymphoma. Previous studies have explored the possibility of a relationship using smaller cohorts of patients with Hodgkin lymphoma, acute myeloid leukaemia, or less common blood cancers, but by comparison this new study of patients with diffuse large B-cell lymphoma is substantially larger. Using data from the US Surveillance, Epidemiology and End Results Program (SEER) linked to Medicare claims data for those aged 67 years or older, the researchers assembled a cohort of 13 244 patients. The authors focused on anxiety and depression—the two most common mental health diagnoses—finding that one in six patients had been diagnosed with either disorder in the 2 years before their B-cell lymphoma diagnosis. Moreover, the presence of either or both disorders was associated with a subsequent decreased overall survival and 5-year lymphoma-specific survival. The authors consider delayed cancer treatments and barriers to adherence as likely explanations for these disparities, and recommend clinicians undertake comprehensive psychosocial assessments at diagnosis to identify patients at risk and develop psychological interventions to improve their subsequent survival. Mental health disorders and survival among older patients with diffuse large B-cell lymphoma in the USA: a population-based studyPre-existing depression, anxiety, or both disorders present within 24 months before DLBCL diagnosis, worsens prognosis for patients with DLBCL. Our data underscore the need for universal and systematic mental health screening for this population, as mental health disorders are manageable, and improvements in this prevalent comorbidity might affect lymphoma-specific survival and overall survival. Full-Text PDF

Long-term outcomes in a population-based cohort of 2,967 uveal melanoma patients clinically tested with the 15-gene expression profile: A collaborative study with the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program Registries.

e21574 Background: Metastatic risk prediction in uveal melanoma is commonly performed using a commercially available 15-gene expression profile (15-GEP) test. A recent collaborative effort with the NCI’s SEER program registries allowed for serial linkage of UM patients captured by SEER registries with clinical 15-GEP test results. The objective of this study was to confirm the 15-GEP test’s performance in clinically tested uveal melanoma patients with long-term outcomes at the population level. Methods: Following established operating procedures, SEER registries linked UM cases diagnosed from 2010–2019 to 15-GEP test results provided by Castle Biosciences using a trusted third-party (honest broker). The patients were clinically tested as recommended by guidelines (testing was performed either on fine needle aspiration biopsy tissue or formalin-fixed, paraffin-embedded tissue from enucleations). De-identified data were provided to NCI and Castle Biosciences scientists for this study. Kaplan-Meier analysis with log-rank test was used to evaluate the available endpoints of melanoma-specific survival (MSS) and overall survival (OS). Multivariable analysis was performed with Cox proportional hazards modeling. Results: A total of 2,967 UM patients ≥ 18 years of age with localized disease (excluding Stage IV) and 15-GEP test result were included in this study (Class 1, 1904; Class 2, 1063). The cohort was 51.7% male, with a median age of 63 years. Median follow-up time was 2.2 years. Patients with a low-risk (Class 1) vs. high-risk (Class 2) result had significantly higher 7-year survival outcomes (OS, 78.9 vs. 31.8%, p &lt; 0.001; MSS, 90.4 vs. 41.6%, p &lt; 0.001, respectively). Patients with a Class 2 result were over six times more likely to experience a UM-related death than those with a Class 1 result (31.8 [338/1063] vs. 5.0% [96/1904]; p &lt; 0.001). Multivariable analysis showed that the 15-GEP was the strongest independent predictor of MSS when compared with clinicopathologic features (tumor diameter or thickness) and age, with a Class 2 hazard ratio of 6.2 (95% CI, 3.9–9.7; p &lt; 0.001). Notably, there was no association between GEP class call distribution and socioeconomic status as measured by the Yost index (p = 0.79). Conclusions: In this analysis, the 15-GEP accurately stratified risk of death from UM in a clinically tested, population-based cohort of patients, confirming previous studies. Socioeconomic status did not impact the likelihood of getting a high-risk result, suggesting equitable access to care for patients who receive 15-GEP testing. Ongoing analyses of SEER-linked UM data will include patients who received a PRAME test result, allowing for assessment of this adjunctive biomarker in combination with the 15-GEP result.

Abstract P4-03-13: AN EVALUATION OF BREAST CANCER RECURRENCE DATA REPORTED TO THE NCI SEER PROGRAM

Abstract Background: There are currently 18.1 million cancer survivors in the U.S. and the number is expected to increase to 22.5 million in the next ten years. The increasing number of survivors also means that the population at risk for cancer recurrence will increase. Recurrence significantly impacts patients’ health outcomes because there are limited treatment options. Currently, there are limited population level recurrence data in cancer registries world-wide. Most recurrence estimates have been derived from randomized clinical trials (RCTs) where the patient population only represents 4% of all cancer patients. Since 2018 the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program has been collecting abstract-based recurrence information. Our goal is to use the SEER recurrence data sources to develop a high-quality population-based recurrence database to disseminate to the public for future research. Measuring recurrence from population-based cohorts can enhance our understanding of what clinical, demographic, and geographic factors impact the risk of recurrence and can inform researchers on developing prevention strategies. Methods: In November 2021 we obtained a dataset that included recurrence information such as type of first recurrence (defined by the Standard for Oncology Registry Entry manual) and date of first recurrence. To evaluate the burden of breast cancer recurrence in the U.S. SEER population, we described the cohort of women diagnosed with breast cancer from 2010 to 2019. We then evaluated the patients with information on the status of recurrence including those that never experience recurrence and those that were never disease free (NDF). We measured frequencies of recurrence by multiple clinical variables such as age at diagnosis, race, stage at diagnosis, and tumor subtype. We followed patients from their date of diagnosis to the event defined by first recurrence, second primary, death, or last contact. We used the Kaplan-Meier method to estimate DFS. Results: The analytic dataset included 412,920 female breast cancer cases diagnosed between 2010 and 2019. Most women diagnosed with breast cancer were between 40 and 64 years old (53%, n=218,760), were White (78%, n= 320,555), were diagnosed with localized tumors (52%, n=213,824), were HER2 negative (HER2-) hormone receptor positive (HR+) (56%, n=230,874), and received treatment (95%, n=390,959). During the observation period, 67% (n = 278,098) of women did not have a recurrence, 3% (n=10,922) had a recurrence, and 16% (n=66,319) were NDF. After excluding patients with NDF status, we observed that the age group with the highest frequency of recurrence was 20-39 (9%). For reference, 4% of women in the 40 to 64 age group has a recurrence event during the observation period. Black women had higher recurrence (6%) compared to white women (3%). Triple negative breast cancers had the highest recurrence (9%) out of all subtypes. When we measured DFS, we observed significant differences by race, independent of tumor subtype. For example, in patients with HER2+/HR+ tumors, the percentage of patients at 120 months who did not experience a DFS event were 73.6% (95% CI, 72.3% to 74.9%) in white women and 67.5% (95% CI, 63.9% to 70.8%) in black women. Discussion &amp; Conclusion: We are reporting population-based recurrence estimates for breast cancer obtained through the SEER program. This is the largest breast recurrence database in North America. The size of the database allowed precise estimation of recurrence stratified by demographics, subtype, and extent of disease. We observe trends consistent with previous reports and have identified some novel findings that warrant further study. Our long-term goal is to assess how DFS estimates derived from a population-based cohort compares to previously published estimates which are largely derived from RCTs. Citation Format: Esmeralda Ramirez-Pena, Serban Negoita. AN EVALUATION OF BREAST CANCER RECURRENCE DATA REPORTED TO THE NCI SEER PROGRAM [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-13.

The Clinical Characteristics and Prognostic Factors of Primary Extramammary Paget's Disease Treated with Surgery in Anogenital Regions: A Large Population Study from the SEER Database and Our Centre.

Extramammary Paget's disease (EMPD) is a rare malignant cutaneous tumour that is commonly located in anogenital regions. The diagnosis of the disease is always delayed, and treatment is usually troublesome. This study aims to summarise the clinicopathological characteristics and the risk factors of prognosis for EMPD in anogenital regions, potentially providing evidence for the diagnosis and treatment of anogenital EMPD. 688 patients were sourced from the Surveillance, Epidemiology and End Results (SEER) program between 1992 and 2021. In total, 176 participants from our centre from between 2011 and 2021 were included to investigate the characteristics and prognosis for EMPD in anogenital regions. From the SEER program data, patient age of 65 years or older, metastasis of lymph nodes, Spanish-Hispanic-Latino race, diameter exceeding 10cm and lesions located anally were revealed as independent risk factors for shorter cancer-specific survival (CSS). However, the data from our centre highlighted that metastasis of lymph nodes and tumours extending through the epidermis are independent risk factors of shortened progression-free survival (PFS) and CSS of anogenital EMPD. This synthesised study revealed that some characteristics are regarded as risk factors for poor clinical prognosis, which have potential value in formulating more normative and effective strategies for patients with EMPD in anogenital regions.

An Analysis of Conditional Survival Rates for Ewing Sarcoma Patients

Using data from the Surveillance, Epidemiology, and End Results (SEER) Program based at the National Cancer Institute in the US, conditional survival rates are reported for 1,988 Ewing Sarcoma patients diagnosed during the period 2000-2015. These patients represent the experience of 26.5% of the US population. Specifically, 5-year conditional relative survival rates are calculated for these patients for the first eight years subsequent to diagnosis of their cancer by Extent of Disease (EOD) (Localized, Regional, and Distant as coded by the SEER Program), gender, and age (<18, 18 - 34, and 35+). Findings include showing how the conditional survival rate patterns improve over time and that there are differences by gender, age, and EOD.

EPID-13. CHARACTERIZATION OF PEDIATRIC RADIATION-INDUCED MENINGIOMA: A SEER ANALYSIS

Abstract OBJECTIVE Radiation-induced meningiomas (RIM) are the most common secondary neoplasm arising from radiation therapy. RIM have not been characterized in pediatric populations on a national scale despite displaying shorter latency and higher malignancy rates in institutional studies. The objective of this study was to characterize pediatric RIM and compare latency and malignancy rates to those of adult RIM using the National Cancer Institute’s Surveillance, Epidemiology and End Results Program (SEER) database. METHODS From the SEER Research Plus Nov 2020 (1975-2018) dataset, 56161 patients treated with EBRT for ocular/orbital tumors, brain/nervous system tumors, and leukemia were identified. 185 patients meeting criteria for RIM were selected: cranial/spinal EBRT (presumed from diagnostic indication), histologically distinct precedent tumor treated with EBRT, and a minimum 5-year latency from EBRT to meningioma diagnosis. This sub-population was divided into 2 groups – pediatric (ages 0-19, n = 10) and adult (ages &amp;gt; 20, n = 175) RIM – and latency, recurrence rate and multiplicity were compared for each group. The number of tumors classified as malignant (as opposed to benign or borderline malignant) was also compared between groups. Additionally, demographic data were compared for each group. RESULTS Of the pediatric RIM patients, 70% were male, 70% were Caucasian, and 10% were African American. No pediatric RIM patients experienced a recurrence or presented with multiple RIMs. The pediatric group showed lower latency (11.00 ± 1.94 years, p &amp;lt; 0.001) and a higher malignancy rate (30%, p = 0.002) than the adult group (latency of 23.38 ± 8.69 years; malignancy rate 5.1%). CONCLUSION These data represent the first characterization of pediatric RIM from a national database and support prior findings of shorter latency and higher malignancy rates in pediatric vs adult RIM, as well as lay the groundwork for future nationwide monitoring of this rare yet highly significant complication.