Surveillance Program Research Articles

Comparative Trends in the Distribution of Prostate Cancer Stage at Diagnosis in the Department of Defense Cancer Registry and the Surveillance, Epidemiology, and End Results Data, 2004-2014.

It has been demonstrated that there was an increase in later-stage prostate cancer (PCa) at diagnosis after the U.S. Preventive Services Task Force recommended against prostate-specific antigen screening for prostate cancer. However, the cancer characteristics at diagnosis within the equal-access Military Health System (MHS) during the period have not been described. In this study, we compared PCa stage at diagnosis and its trends between the military health care system and the general public and further compared the trends in tumor stage by race. This study was based on nonidentifiable data from the U.S. Department of Defense's Central Cancer Registry (CCR) and the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. Patients diagnosed between 2004 and 2014 were included. The distributions of PCa stage at diagnosis over time were compared between the 2 populations. Comparisons were further conducted for White and Black patients, respectively. Among the 11,895 patients in the CCR and 544,142 patients in SEER, the majority of patients were diagnosed with stage I or II prostate cancer. However, the CCR had a larger proportion of early-stage tumors (stages I and II combined) with 84.3% vs. 80.0% of SEER patients. The proportion of late-stage tumors (stages III and IV combined) increased over time from 2008 for both populations and the proportion of early-stage tumors decreased for the general population. In terms of temporal distributions by race, the trends were the same between White and Black groups in the general population. In the MHS, the trends in the White patients were similar to those in the general population, but in the Black patients, the percentages of stages I and II at diagnosis continued to increase and those of stages III and IV decreased, differing from those in the general population. The MHS consistently diagnosed PCa at an earlier stage than the U.S. general population across all time periods evaluated in this study. Although similar trends were observed for White patients between both populations, the proportion of stages I and II at diagnosis increased from 2012 among Black patients in the MHS, which stands in sharp contrast to trends in the U.S. general population. Although the differences between the two populations may be associated with various factors, differences in accessibility to care and thus the use of prostate-specific antigen testing might play an important role.

Machine learning approach as an early warning system to prevent foodborne Salmonella outbreaks in northwestern Italy

Salmonellosis, one of the most common foodborne infections in Europe, is monitored by food safety surveillance programmes, resulting in the generation of extensive databases. By leveraging tree-based machine learning (ML) algorithms, we exploited data from food safety audits to predict spatiotemporal patterns of salmonellosis in northwestern Italy. Data on human cases confirmed in 2015–2018 (n = 1969) and food surveillance data collected in 2014–2018 were used to develop ML algorithms. We integrated the monthly municipal human incidence with 27 potential predictors, including the observed prevalence of Salmonella in food. We applied the tree regression, random forest and gradient boosting algorithms considering different scenarios and evaluated their predictivity in terms of the mean absolute percentage error (MAPE) and R2. Using a similar dataset from the year 2019, spatiotemporal predictions and their relative sensitivities and specificities were obtained. Random forest and gradient boosting (R2 = 0.55, MAPE = 7.5%) outperformed the tree regression algorithm (R2 = 0.42, MAPE = 8.8%). Salmonella prevalence in food; spatial features; and monitoring efforts in ready-to-eat milk, fruits and vegetables, and pig meat products contributed the most to the models’ predictivity, reducing the variance by 90.5%. Conversely, the number of positive samples obtained for specific food matrices minimally influenced the predictions (2.9%). Spatiotemporal predictions for 2019 showed sensitivity and specificity levels of 46.5% (due to the lack of some infection hotspots) and 78.5%, respectively. This study demonstrates the added value of integrating data from human and veterinary health services to develop predictive models of human salmonellosis occurrence, providing early warnings useful for mitigating foodborne disease impacts on public health.

Impact of the oral contraceptive pill on the rate of ovarian cancer incidence in different races of women.

10521 Background: The rate of ovarian cancer incidence has drastically decreased over the years, though it is the fifth most leading cause of cancer death in women. Oral contraceptive pills (OCP) are a major cause for the decline due to decreasing the number of ovulations in a woman’s lifetime. In fact, women who have ever used OCPs have a 30-50% lower risk of ovarian cancer incidence compared to women who have never used OCP. This study compares the use of OCP in different races of women and its effect on the decline in incidence of ovarian cancer. Methods: The average rate of incidence per 100,000 cases per year for ovarian cancer in White, Asian and Black females was obtained from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics 2001–2019 Public Use Research Database. The National Center for Health Statistics, National Survey of Family Growth was used to find ever use of OCP among sexually experienced women ages 15–49 in the United States for 2002 and 2015-2019. Results: White women, in the year 2002 and 2019 had a rate of ever OCP use of 87% and 87.5% respectively. During that same time period, they had the most drastic decrease in ovarian cancer incidence of 43%, compared to Black and Asian female population. In 2002, the incidence rate of ovarian cancer for White women was 14.6 per 100,000. 17 years later, in 2019, it dropped to 10.2 per 100,000. Black women had the second highest ever use of OCP and the second highest rate of change for ovarian cancer incidence. In 2002, 79.1% of Black women had ever used OCPs compared to 73% in 2019. In 17 years, the incidence rate per 100,00 decreased 39% for Black women. Incidence rate per 100,000 in 2002 was 10.4 and incidence rate in 2019 was 7.5 per 100,000. Asian women comparatively had the lowest ever use of OCP and the lowest rate of change for ovarian cancer incidence. Data was not available for 2002, but in 2019, Asian women’s ever use of OCP was 65.6%. Incidence of ovarian cancer for Asian women decreased by 21% between the years 2002 to 2019. Rate per 100,000 was 10.8 in 2002 and decreased to 8.9 per 100,000 in 2019. Conclusions: The oral contraceptive pill was made available in the year 1960. Since then, it has been a large factor as to why ovarian cancer incidence has declined. Healthcare disparities and cultural differences play a part in the rate of OCP use across different races of women. This, in turn, leads to varying levels of ovarian cancer incidence decline with White women having the highest rate, followed by Black, then Asian women. Ovarian cancer has a high mortality due to inadequate screening techniques and late diagnosis which is perpetuated by cultural barriers to receiving care. A decreased risk of ovarian cancer should be considered as a benefit when prescribing OCPs and a protective factor among all studied races.

Representativeness of race, ethnicity and social determinants of health in patients with advanced non-small cell lung cancer via linkage of real-world electronic health records, administrative claims, and consumer financial data.

e13559 Background: Social determinants of health (SDOH) are both drivers of health disparities and barriers to clinical research participation, particularly among historically underserved or marginalized populations. Using real-world data (RWD), diversity plans in cancer clinical trials frequently aim to reduce disparities and improve representation. Our aim was to describe the representativeness of patients with advanced non-small cell lung cancer (aNSCLC) with respect to race, ethnicity and person-level SDOH in a curated electronic health record (EHR) database. Methods: This was a retrospective cohort study of individuals diagnosed with aNSCLC between 2016–2022 in a US-based oncology EHR database (ConcertAI). Information on person-level SDOH was derived from linkage of curated EHR data to administrative claims and consumer financial data. These data were also compared to a sample of patients diagnosed with first primary NSCLC from the Surveillance, Epidemiology, and End Results (SEER) Program and American Community Survey (ACS), where possible. The Kaplan-Meier product limit estimator was used to compare time from advanced diagnosis to treatment initiation. Results: From an overall sample of 17,772 patients with aNSCLC, a total of 10,390 patients had 1 or more SDOH characteristics of interest documented. Compared with patients without linked SDOH data, a higher proportion of patients with linked person-level SDOH data were non-Hispanic (NH) White patients (79% vs 71%) and lower proportions were NH Black (10% vs 13%), NH Asian/Pacific Islander (2% vs 4%) and Hispanic patients (2% vs 4%). Patients with linked SDOH were also more likely to have aNSCLC progressed from an earlier stage and received biomarker testing for targetable alterations. Overall, 54% of patients were married, 38% completed a bachelor’s degree or higher, 14% worked in a blue-collar occupation, and 61% had an individual income of ≤$35,000. All 4 of these SDOH characteristics differed significantly by race/ethnicity. Differences in time-to-treatment initiation were statistically significant by marital status (median of 50 [married] vs 55 [not married] days; P=0.02) and individual income (median of 50 [>$60,000] vs 55 [≤$30,000] days; P=0.04). Patients with aNSCLC in these data differed from patients in SEER and ACS estimates with respect to greater representation of patients who are NH White, have lower levels of education, and lower individual income. Conclusions: This analysis demonstrated the feasibility of measuring person-level SDOH using EHR from patients with aNSCLC treated at oncology clinics across the US. RWD with linked SDOH characteristics should be used cautiously to address the representativeness gap in evidence from oncology trials given their potential inherent selection biases.

Trends in survival in solid malignancies with synchronous brain metastases: A population-based study.

e23299 Background: Brain metastasis in solid malignancies at diagnosis has a poor prognosis. Improvements in the treatment of solid malignancies and advancements in neuroimaging techniques have led to increased incidence of brain metastases. In our study, we examined survival outcomes in patients diagnosed with brain metastasis at the time of diagnosis of primary malignancy at four different sites in the year groups 2010 to 2014 and 2015 to 2020. Methods: Surveillance, Epidemiology, and End Results (SEER) Program 17 registry (November 2022 submission) database was analyzed for four primary sites of cancer based on their high propensity to develop brain metastases- lung and/or bronchus, breast, kidney and/or renal pelvis, and melanoma. Patients diagnosed with malignancy during autopsy or via death certificate and patients with incomplete survival data were excluded. R 4.3.1 software was used for all the analyses. Kaplan-Meier method was used for 2-year survival rate and overall survival analyses. Cox regression analysis was used for hazard ratios (HR). Results: A total of 29,056 and 37,437 cases were identified across the four cancer groups during the period 2010-2014 (Group 1) and 2015-2020 (Group 2), respectively. Lung and/or bronchus tumors comprised the majority of the cases (n = 58,324). 14,811 patients in Group 1 and 18,703 patients in Group 2 received chemotherapy. 8,741 patients in Group 1 and 12,533 patients in Group 2 received radiotherapy. In all the cancers combined, the median survival time in Group 1 was 4 months, and in Group 2 was 5 months. Patients in Group 2 had significantly better survival outcomes than Group 1 (HR:0.81, 95% CI:0.78-0.83, p < 0.001). Table 1 outlines the 2-year survival rates with overall survival p-value. Conclusions: Modest improvement in survival was found in patients diagnosed with synchronous brain metastases during 2015-2020 compared to patients diagnosed in 2010-2014. This slight improvement could be attributed to the improved systemic therapies for cancer, like immunotherapy, as well as advanced local therapy options for brain metastases, although the data for immunotherapy use is unavailable in the SEER database. Overall, the prognosis of synchronous brain metastases remains poor in both groups. Further studies and brain metastases inclusive clinical trials are warranted to improve outcomes in this population. [Table: see text]

Racial/ethnic distribution of participants in NRG oncology clinical trials: 2014-2023.

e13706 Background: External validity and applicability of clinical research relies upon characteristics of trial participants matching those of the respective disease groups in the general population. Understanding the racial/ethnic distribution of patients enrolled in recent US-based, federally sponsored Phase II and III clinical trials could inform strategies to further align characteristics of trial participants with those of disease group populations. As such, we report the racial/ethnic distribution of participants in NRG Oncology studies during 2014-2023 and compare the distribution to that from the Surveillance, Epidemiology, and End Results (SEER) program data during 2014-2020 (most recent data available). Methods: Proportions of self-reported race/ethnicity were summarized for the 33,370 trial participants enrolled since Mar 1, 2014 (NRG Oncology inception) to therapeutic, symptoms management, and other interventional trials. SEER proportions were used to benchmark NRG trials for representativeness of disease burden in the population. Results: Among NRG trial participants, 71.5% were non-Hispanic (NH) White, 9.7% NH Black, 4.9% Hispanic, and 7.8% N-H Asian (Table). Examining distributions within selected cancer sites relative to cancer proportional incidence in 2014-2020 SEER data, NRG accrual to prostate, lung, cervix, and breast cancer trials is commensurate with observed disease burden for NH Blacks and modestly lower for Asians. For other sites shown, representation was 2 to 5 percentage points lower than SEER frequencies for Blacks and Asians. For all sites, accrual of individuals of Hispanic background was lower than that reported in SEER. As the NRG trials do not reflect sampling across stages and other features of a given cancer in the population, further analysis to be presented will consist of more detailed breakdowns of trial participant disease-specific cancer stage and tumor subtype and comparison to relevant observations from the 2014-2020 SEER database. Conclusions: This high-level comparison of the racial/ethnic distribution of NRG trial participants provides supportive information for population representative enrollment in several cancer sites, but also identifies opportunities to improve enrollment diversity to represent more closely the respective affected population. Areas of success identified merit further investigation to understand if there are best practices which may be applied more broadly towards expanding access to federally funded clinical trials. [Table: see text]

Exploration and prognostic analysis of two types of high-risk ovarian cancers: clear cell vs. serous carcinoma: a population-based study

BackgroundOvarian clear cell carcinoma (OCCC) is a rare pathological histotype in ovarian cancer, while the survival rate of advanced OCCC (Stage III-IV) is substantially lower than that of the advanced serous ovarian cancer (OSC), which is the most common histotype. The goal of this study was to identify high-risk OCCC by comparing OSC and OCCC, with investigating potential risk and prognosis markers.MethodsPatients diagnosed with ovarian cancer from 2009 to 2018 were identified from the Surveillance, Epidemiology, and End Results (SEER) Program. Logistic and Cox regression models were used to identify risk and prognostic factors in high-risk OCCC patients. Cancer-specific survival (CSS) and overall survival (OS) were assessed using Kaplan-Meier curves. Furthermore, Cox analysis was employed to build a nomogram model. The performance evaluation results were displayed using the C-index, calibration plots, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Immunohistochemically approach was used to identify the expression of the novel target (GPC3).ResultsIn the Cox analysis for advanced OCCC, age (45–65 years), tumor numbers (total number of in situ/malignant tumors for patient), T3-stage, bilateral tumors, and liver metastases could be defined as prognostic variables. Nomogram showed good predictive power and clinical practicality. Compared with OSC, liver metastases had a stronger impact on the prognosis of patients with OCCC. T3-stage, positive distant lymph nodes metastases, and lung metastases were risk factors for developing liver metastases. Chemotherapy was an independent prognostic factor for patient with advanced OCCC, but had no effect on CSS in patients with liver metastases (p = 0.0656), while surgery was significantly related with better CSS in these patients (p < 0.0001) (p = 0.0041). GPC3 expression was detected in all tissue sections, and GPC3 staining was predominantly found in the cytoplasm and membranes.ConclusionAdvanced OCCC and OCCC with liver metastases are two types of high-risk OCCC. The constructed nomogram exhibited a satisfactory survival prediction for patients with advanced OCCC. GPC3 immunohistochemistry is expected to accumulate preclinical evidence to support the inclusion of GPC3 in OCCC targeted therapy.

Time to treatment initiation of lung cancer and contributing factors from 2015-2020 utilizing Surveillance, Epidemiology and End Results program database.

1540 Background: Time from diagnosis of cancer to definitive therapy, or time to treatment initiation (TTI), has significant impact on prognosis. Kohorana et al performed an observational study in 2019 that found that TTI has increased in the United States with an absolute increased risk of mortality ranging from 1.2-3.2% per week in early-stage breast, lung, renal and pancreatic cancers. This study aims at identifying contributing factors and trends that can assist in shortening TTI of lung cancer. Methods: This is a retrospective cohort study conducted by review of Surveillance, Epidemiology and End Results Program database. Participants included 212,607 adults ages 18 and older diagnosed with lung cancer during 2015-2020. Variables contributing to TTI were studied like age, sex, race, marital status, geographic location, household income, stage and grade. TTI was measured as less than 30 days and greater than 30 days. ANOVA analysis was performed with SPSS and BlueSky Statistics, with p-value of &lt;0.05 as significant. Results: TTI was 1.30 months in males and 1.31 months in females (p=0.038). In patients less than 65 years, TTI was 1.14 months, while those greater than 65 had a delay of 1.38 months (p&lt;0.001). White patients had TTI of 1.26 months versus non-white patients, 1.44 months (p&lt;0.001). Married patients had TTI of 1.24 months versus 1.44 months in widowed patients (P&lt;0.001). Income less than $35,000 had less TTI (1.22 months) than income greater than $75,000 (1.33 months) (p&lt;0.001), but the population earning &lt;$35,000 was smaller (n=3,082) compared to &gt;$75,000 (n=209,525), therefore not representative of the total population. Metropolitan had longer TTI than nonmetropolitan at 1.34 months versus 1.24 months, p&lt;0.001. Grade IV had shorter TTI at 0.94 months with grades I and II having TTI of 1.42 and 1.46 months, respectively (p&lt;0.001). Localized cancers had the longest TTI at 1.71 months versus distant at 1.01 months (p&lt;0.001). More aggressive cancers had shorter TTI such as grade IV + distant at 0.76 months versus grade I + localized at 1.42 months. Association between grade and stage and impact on TTI was significant at p&lt;0.001. Conclusions: This study revealed significant factors influencing the duration from cancer diagnosis to treatment among adult patients greater than 18 years old diagnosed with lung cancers. Shorter TTI intervals were observed for females, younger individuals (&lt;65 years-old), white patients, married and those with higher tumor grades and distant cancer. Addressing these disparities requires targeted interventions that consider socioeconomic status, geographic location and cancer characteristics to ensure equitable access to timely and high-quality cancer care. Further investigation is warranted to fully understand the impact of factors such as household income and regional variations on treatment delays.

Patterns and trends in incidence, survival, and treatment among patients with early-onset lung cancer in the U.S.: A population-based study.

e22517 Background: Lung cancer is the second leading cause of cancer-related deaths among young adults. An in-depth investigation into the demographic distribution and temporal trends in early-onset lung cancer (EOLC) incidence and survival, as well as treatment patterns, could help monitor the cancer burden, identify high-risk populations, and develop effective screening and prevention strategies. Methods: This serial cross-sectional study used data from the U.S. Cancer Statistics (USCS) and the Surveillance, Epidemiology, and End Results (SEER) program. EOLC refers to lung cancer diagnosed in individuals aged 20-49 years. USCS database (2001-2019) was used for demographic description and incidence estimation. SEER-17 registries database (2000-2019) was used for survival estimation and treatment patterns examination. Age-adjusted incidence rate per 100,000 population and cancer-specific survival were reported. Changes in rates were assessed with average annual percentage change (AAPC) using Joinpoint regression. Results: There were 4,086,435 lung cancer cases recorded between 2001 and 2019 in the U.S. (USCS: 53.3% male; median age of 70 years). EOLC accounted for 4.1% (169,132) of all lung cancer cases and was more common among females, non-Whites, with higher adenocarcinoma and advanced-stage diagnoses. During this period, the incidence of EOLC decreased from 9.0 to 4.5 per 100,000 population (APC, -4.2; P &lt; 0.001). EOLC incidence continued to decrease across all demographic groups, except for young people aged 20-29. The rate of decline was faster among men than women, blacks than whites, squamous carcinoma than adenocarcinoma, and distant disease than localized disease. The historical higher incidence among young men vs. young women and among blacks vs. whites have been reversed in recent years. A consistent increase in survival rates of EOLC across all demographic groups from 2001 to 2017 (SEER-17) was observed. Despite the increases were more pronounced among men than women and among black individuals than white individuals, gender and racial disparities persisted. EOLC patients received more intensive treatment than late-onset patients. Still, 12.1% of EOLC cases were not treated, and this was most common among black individuals and those with distant disease. Treatment patterns for EOLC have not undergone significant changes in recent decades. Of note, the proportion of untreated patients has not decreased during the study period. Conclusions: EOLC was an uncommon type of disease with distinctive clinical features in the U.S. Substantial decreases in incidence and improves in survival were observed, whereas major treatment pattern remained relatively stable.

Cancer burden in South Asians in the United States: Epidemiologic report using Surveillance, Epidemiology, and End Results (SEER) program.

10574 Background: Studying racial-ethnic disparities in cancer risk can help in identifying underlying factors and developing targeted screening and education strategies. South Asian Americans (SAA), Asian Indians and Pakistanis, are a fast-growing ethnic group in the US, but there is limited research on their cancer risks. This study examines cancer prevalence patterns in the SAA population compared to Whites in the US. Methods: We analyzed cancer prevalence in 5,120,423 patients diagnosed with 23 different types of cancer between 2000 and 2018, using data from 18 SEER cancer registries. We compared cancer prevalence between SAA and Whites and examined factors such as cancer types, demographics, socioeconomic status, and urban vs. rural residency. Χ2 test was used to determine statistical significance (p&lt;0.001). Results: Our analysis revealed higher prevalence of breast (19.0% vs. 14.6%) and thyroid (5.9% vs. 2.8%) cancers among SAAs compared to Whites, but lower rates of lung (6.5% vs. 12.0%), colorectal (5.9% vs. 7.4%), and melanoma (0.8% vs. 5.4%) cancers; p&lt;0.001. Demographically, a significantly larger proportion of younger individuals (22.3% vs. 10.0%, ages 00-44) were found in the SAA cohort. The SAA survivor cohort also had a significantly higher percentage of females (50.8% vs. 48.6%) and married individuals than their White counterparts (69.3% vs 55.3%). Lastly, there were significant state-based variances in cancer prevalence. In California, SAAs had a lower cancer prevalence (23%) compared to Whites (38.5%), while in New Jersey, SAAs had a higher cancer prevalence (36.7%) than Whites (12.3%). Conclusions: Our analysis shows a disparity, highlighting the need for culturally attuned healthcare policies to enhance cancer education and screening among diverse groups. The higher prevalence of breast cancer in SAAs suggest possible effective screening, while lower rates of colorectal and lung cancers point to potential awareness gaps or cultural barriers. Addressing these, alongside researching genetic, environmental, and lifestyle influences—particularly given the younger SAA cancer population—is prudent. A focused approach, emphasizing targeted public health initiatives and further research, is necessary to enhance cancer outcomes and ensure health equity.

State mandatory paid medical leave policies and cancer stage at diagnosis in US adults.

11008 Background: Since 2012, several states implemented mandatory paid medical leave policies. Mandatory paid medical leave may alleviate time and financial burdens, enabling patients to undergo screening and/or timely diagnostic workup for new cancer-related symptoms. These policies have been associated with increased cancer screening. We investigated whether state mandatory paid medical leave policies were associated with stage at cancer diagnosis. Methods: Adults ages 18-64 years diagnosed with cancer from 2010-2019 were identified from the Surveillance, Epidemiology, and End Results program. Differences-in-differences (DID) analyses using the updated method of accounting for heterogeneity in policy enactment compared proportions of stage I and IV cancer diagnoses from pre- to post-policy implementation in states with vs. without paid medical leave policies. Analyses adjusted for age, sex, race, ethnicity, rurality, cancer site, county-level income, and time-varying state Medicaid eligibility levels. Since some cities enacted city-wide policies prior to state-wide implementation, cases from affected states between the time of city and state policy enactment were excluded. Sensitivity analyses were conducted excluding counties with cities that enacted paid leave policies. The plausibility of the parallel trends assumption was assessed by comparing stage at diagnosis between state groups in the pre-policy period and was satisfied for all reported results. Results: A total of 1,052,307 adults with cancer were identified. 39.8% and 19.7% of patients were diagnosed with stage I and IV cancers, respectively. In adjusted DID analyses, there was a 1.34 percentage point (PP) increase in stage I diagnoses and a 2.05 PP decrease in stage IV diagnoses associated with mandatory paid medical leave policy implementation (Table). Results were similar in sensitivity analyses. In subgroup analyses, policy-associated stage shifts were seen in males, Hodgkin lymphoma, and liver and lung cancers, with less clear patterns for cervix and pancreas cancers. Conclusions: State mandatory paid medical leave was associated with increased early-stage cancer diagnoses and decreased late-stage diagnoses. Paid leave policies may promote earlier detection of non-screenable cancers by enabling employees to promptly seek care for new cancer-related symptoms. Policies that improve opportunities to seek medical care may facilitate earlier cancer detection and ultimately contribute to better patient outcomes. [Table: see text]

Value of a confirmatory re‐biopsy as part of a modern risk stratified cancer surveillance programme for early prostate cancer

Value of a confirmatory re‐biopsy as part of a modern risk stratified cancer surveillance programme for early prostate cancer

ITS 15 - Adoption of a Delphi technique to achieve consensus for a national infection surveillance program in Australian long term care facilities

ITS 15 - Adoption of a Delphi technique to achieve consensus for a national infection surveillance program in Australian long term care facilities

ITS 101 - Results: of a 2-year Surgical Site Infection (SSI) Surveillance Program for Caesarean Sections (C-sections) at a Community Hospital

ITS 101 - Results: of a 2-year Surgical Site Infection (SSI) Surveillance Program for Caesarean Sections (C-sections) at a Community Hospital

Prevalence of obesity and its impact on outcome in children diagnosed with cancer in Canada: A population-based study.

10517 Background: Childhood obesity can result in a variety of adverse health outcomes. Objectives were to describe the prevalence of obesity and determine the association between baseline obesity with event-free survival (EFS) and overall survival (OS) in children diagnosed with cancer in Canada. Methods: We conducted a retrospective cohort study using the Cancer in Young People in Canada database, a population-based surveillance program collecting data from all cancer patients &lt; 15 years old before 2015 and &lt; 19 years old after 2015. This study included all children with newly diagnosed cancer aged 2 to 18 years across Canada from 2001 to 2020. Obesity was defined as age and sex-adjusted body mass index ≥ 95th percentile. EFS was defined as the time from diagnosis to first event (relapse, progression, secondary malignancies, or death). Univariate and multivariable Cox proportional hazards models compared EFS and OS between patients with and without obesity. The prevalence of obesity was compared annually from diagnosis. All analyses were stratified by cancer categories. Results: A total of 11,291 patients were included (37.1% leukemias, 14.5% lymphomas, 21.8% central nervous system (CNS) tumors, 26.6% non-CNS solid tumors; median age: 7.6 years [interquartile range (IQR): 4.2-12.5] and median follow-up time: 4.7 years [IQR: 2.6-5.1]). At diagnosis, 10.5% were obese and the prevalence of obesity was significantly higher at 1 year (15.7%, p &lt; 0.001) and 2 years (20.1%, p &lt; 0.001) after diagnosis. The prevalence of obesity was higher in the leukemia and lymphoma cohort compared to other cancer categories (11.4% vs. 9.5%, p = 0.001). In multivariable models controlling for age at diagnosis, sex, ethnicity, income quintile, treatment era and cancer categories, obesity at diagnosis remained significantly associated with inferior EFS [adjusted HR (aHR) 1.16, 95% CI 1.02–1.32] and OS [aHR 1.29, 95% CI 1.11–1.49]. In children with acute lymphoblastic leukemia (ALL) (n = 3458, 82.5% of all leukemias), after adjusting for high-risk features such as age, white blood cell count and CNS status, obesity at diagnosis remained associated with inferior EFS [aHR 1.55, 95% CI 1.17–2.04] and OS [aHR 1.75, 95% CI 1.23–2.49]. In patients with CNS tumors, obesity at diagnosis was also associated with inferior EFS [aHR 1.38, 95% CI 1.09–1.76] and OS [aHR 1.47, 95% CI 1.13–1.91]. Obesity at diagnosis did not confer adverse outcomes in other cancer categories. Conclusions: In this population-based study of children with cancer, the prevalence of obesity was 11% at diagnosis and continued to increase in the following 2 years. Obesity at cancer diagnosis was independently associated with inferior survival across the entire cohort, especially in children with ALL and CNS tumors. Further studies are needed to better characterize the relationship between obesity and survival in children with cancer to inform future trial design.

Prognostic value analysis and survival model construction of different treatment methods for advanced intestinal type gastric adenocarcinoma

BackgroundIntestinal-type gastric adenocarcinoma, representing 95 % of gastric malignancies, originates from the malignant transformation of gastric gland cells. Despite its prevalence, existing methods for prognosis evaluation of this cancer subtype are inadequate. This study aims to enhance patient-specific prognosis evaluation by analyzing the clinicopathological characteristics and prognostic risk factors of intestinal-type gastric adenocarcinoma patients using data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI). MethodsWe extracted clinical data for patients diagnosed with intestinal-type gastric adenocarcinoma between 2010 and 2015 from the SEER database, selecting 257 cases based on predefined inclusion and exclusion criteria. Independent risk factors for overall survival (OS) and cancer-specific survival (CSS) were identified using a Cox regression model. A nomogram model for predicting OS or CSS was developed from the Cox risk regression analysis and validated through the consistency index (C-index), ROC curve, and calibration curve. ResultsAge, primary tumor resection, chemotherapy, lymph node metastasis, and tumor size were identified as independent prognostic factors for OS and CSS (P < 0.05). The nomogram model, constructed from these indicators, demonstrated superior predictive consistency for OS and CSS compared to the AJCC-TNM staging system. ROC curve analysis confirmed the model's higher accuracy, and calibration curve analysis indicated good agreement between the nomogram's predictions and actual observed outcomes. ConclusionThe nomogram model derived from SEER database analyses accurately predicts OS and CSS for patients with intestinal-type gastric adenocarcinoma. This model promises to facilitate more tailored treatments in clinical practice.

Risk of second primary thyroid cancer in cancer survivors

A risk factor for thyroid cancer (TC) may be a history of former cancer and cancer therapy. The precise risk of a second primary thyroid carcinoma has not yet been revealed. In this study, we evaluated standardized incidence ratios (SIRs) of second primary thyroid cancer (SPTC) with consideration of different conditions and further analyzed the clinicopathological characteristics and survival of these patients. The cohort was selected from the US Surveillance, Epidemiology, and End Results (SEER) Program between 1975 and 2019. The standardized incidence ratios, morbidity risk, clinicopathological features, and survival of second primary thyroid carcinoma were analyzed. Propensity score matching (PSM) was used to balance covariates. Kaplan–Meier method was performed to assess the survival outcomes. Overall, 7066 patients with SPTC and 83,113 patients with primary TC were identified. The SIR of TC in tumor patients was 1.51/10,000, statistically higher than the natural population (0.94/10,000, P < 0.05). The most significant tumors contributing to the increased SIRs of SPTC were acute lymphocytic leukemia (3.49/10,000), Hodgkin’s lymphoma-nodal (3.29/10,000), salivary gland cancer (3.23/10,000), and kidney and renal pelvis cancer (3.05/10,000). The incidence of TC increased significantly in tumor patients who received radiotherapy/chemotherapy before age 35. The age at diagnosis of the SPTC was much older than the primary TC (64.01 vs. 49.55 years, p < 0.001). The SPTC had a higher percentage of histological grades 3/4 (23.14% vs. 15.19%, p < 0.001). Survival analyses demonstrated a worse prognosis for the SPTC group compared to the primary TC group. But after PSM, the survival outcomes of the two groups tended to be equivalent (P = 0.584). The SIRs of TC are higher in tumor patients. The most significant factors contributing to the increased risk of SPTC were some specific former tumors and acceptance of radiotherapy/ chemotherapy before age 35. There was no significant difference in survival between SPTC and primary TC.

Different sampling strategies for optimal detection of the overall genetic diversity of methicillin-resistant Staphylococcus aureus.

Surveillance schemes for methicillin-resistant Staphylococcus aureus (MRSA) are widely established at the national and international levels. Due to the simple standardization of the protocol, mainly isolates from bloodstream infections are used. However, the limitations of this simple surveillance system are well described. We conducted a comprehensive analysis of MRSA isolates in a large Slovenian region over 5 years to identify the optimal sample group for assessing the overall MRSA diversity. At the same time, this study provides to date non-available molecular characterization of Slovenian MRSA isolates. A total of 306 MRSA isolates from various sources were sequenced and phenotypically tested for resistance. The isolates exhibited significant molecular diversity, encompassing 30 multi locus sequence type (MLST) sequence types (STs), 39 ST-SCCmec genetic lineages, 49 spa types, and 29 antibiotic resistance profiles. Furthermore, the isolate pool comprised 57 resistance genes, representing 22 resistance mechanisms, and 96 virulence genes. While bloodstream isolates, commonly used in surveillance, provided insights into frequently detected clones, they overlooked majority of clones and important virulence and resistance genes. Blood culture isolates detected 21.3% spa types, 24.1% resistance phenotypes, and 28.2% MLST-SCCmec profiles. In contrast, strains from soft tissues demonstrated superior genomic diversity capture, with 65.3% spa types, 58.6% resistance phenotypes, and 71.8% MLST-SCCmec profiles. These strains also encompassed 100.0% of virulence and 82.5% of resistance genes, making them better candidates for inclusion in surveillance programs. This study highlights the limitations of relying solely on bloodstream isolates in MRSA surveillance and suggests incorporating strains from soft tissues to obtain a more comprehensive understanding of the epidemiology of MRSA.IMPORTANCEIn this study, we investigated the diversity of methicillin-resistant Staphylococcus aureus (MRSA), a bacterium that can cause infections that are difficult to treat due to its resistance to antimicrobial agents. Currently, surveillance programs for MRSA mainly rely on isolates from bloodstream infections, employing a standardized protocol. However, this study highlights the limitations of this approach and introduces a more comprehensive method. The main goal was to determine which group of samples is best suited to understand the overall diversity of MRSA and to provide, for the first time, molecular characterization of Slovenian MRSA isolates. Our results suggest that including MRSA strains from soft tissue infections rather than just blood infections provides a more accurate and comprehensive view of bacterial diversity and characteristics. This insight is valuable for improving the effectiveness of surveillance programs and for developing strategies to better manage MRSA infections.

Imaging for Early Detection of Pancreatic Ductal Adenocarcinoma: Updates and Challenges in the Implementation of Screening and Surveillance Programs.

Pancreatic ductal adenocarcinoma (PDA) is one of the most aggressive cancers. It has a poor 5-year survival rate of 12%, partly because most cases are diagnosed at advanced stages, precluding curative surgical resection. Early-stage PDA has significantly better prognoses due to increased potential for curative interventions, making early detection of PDA critically important to improved patient outcomes. We examine current and evolving early detection concepts, screening strategies, diagnostic yields among high-risk individuals, controversies, and limitations of standard-of-care imaging.

Seroprevalence of leptospirosis in a Mexican military population working with animals

AbstractBackgroundLeptospirosis is a zoonotic disease and a challenge to global public health. There is an occupational risk, particularly in populations with direct contact with animals and in high‐humidity environments, which favors the survival of leptospires. This study aimed to determine the seroprevalence of leptospirosis in military personnel working in close contact with animals in México and to describe the available preventive measures and protection levels.MethodsA cross‐sectional study was conducted from March to October 2015. Information regarding protective factors in daily activities was gathered through a self‐evaluation questionnaire. The serum samples of participants were analyzed through enzyme‐linked immunoassay (ELISA) and microscopic agglutination test.ResultsSerums were obtained from 65 active military personnel, 56 males (86.2%) and 9 females (13.8%). Out of the total, 54 (83.1%) tested positive for infection by leptospirosis, 49 were males (87.5%) and 5 were females (55.6%). The highest seroprevalence age group was in the ≥45 years group (15, 23.07%), where all tested positive. Regarding military ranks, 100% of the highest hierarchy turned out positive: Officers (4 out of 4) and Chiefs (14 out of 14); and troops resulted in a seroprevalence of 76.5%. Protection equipment available during daily chores included: Overall, 64.6% had gloves and 53.8% had boots; the reported frequency for the use of gloves was 35.3% (46/65) if worn during more than half of the workday, yet 29.2% (19/65) reported never wearing them.ConclusionsThis study makes the petition to implement protocols of continuous training regarding labor risks and having an epidemiologic surveillance program for exposed personnel indispensable to improve the health and sanitary conditions of military personnel who work in direct contact with animals.