Survival, Epidemiology, And End Results Research Articles

Incidence and survival characteristics of pediatric ganglioglioma from 2004 to 2018, with focus on infratentorial sites.

Ganglioglioma (GG) is a slow-growing glioneuronal neoplasm, most frequently seen in the supratentorial location in older children and associated with epilepsy syndromes. GG is rare in the infratentorial location, hence we embarked upon analyzing the National Cancer Institute's (NCI) Survival, Epidemiology, and End Results (SEER) database to better evaluate GG outcomes by location in comparison to the broader pediatric low-grade glioma (pLGG) population. Pediatric patients diagnosed with GG and pLGG from 2004 to 2018 were included in the study. Their demographic, clinical, and survival characteristics were analyzed using SEER*Stat. This study describes the largest cohort of pediatric GG, including 852 cases from year 2004 to 2018, with focus on infratentorial sites. Patients with brainstem GG or those with subtotally resected disease were identified as having higher risk of death. Our analysis highlights brainstem GG as a high-risk, poor-prognostic subgroup and elaborates on the incidence and survival characteristic of this lesser-known subgroup.

Assessing Epidemiological Differences in Myelofibrosis: A Comparative Study of a Single-Center Cohort and the SEER National Database

Background Myelofibrosis (MF) is a rare class of BCR-ABL negative myeloproliferative neoplasms characterized by clonal proliferation of hematopoietic stem cells and progressive fibrosis of the bone marrow. This study attempts to elucidate epidemiological discrepancies in survival outcomes between MF patients at a single tertiary care center from an underserved population in the Bronx (which ranks last in health outcomes amongst 62 New York state counties) versus the Survival, Epidemiology, and End Results (SEER) national cancer registry by analyzing different population parameters. Methods Our retrospectively constructed single center database included 96 patients with biopsy confirmed primary or secondary MF who were age ≥20 diagnosed after 2000. 75 remained for analysis after excluding subjects without known race or date of diagnosis. The SEER [SEER research plus data, 17 registries, Nov 2022 Sub (2000-2020)] dataset comprised of 5254 patients with microscopically confirmed primary MF (ICD code: 9661.3) diagnosed between 2000 and 2015, had age of diagnosis ≥20, and whose deaths were attributable to MF diagnosis. Both cohorts were independently analyzed via log-rank testing and/or cox proportional hazards (cox-PH) regression with death as event outcome. Results Mean age of our single-center cohort was 65.87 years. Males [37 (49.3%)] and females [38 (50.7%)] were approximately evenly distributed. Races included non-hispanic white (NHW) [26 (34.7%)], NH black (NHB) [20 (26.7%)], NH asian and pacific islanders (NH-API) [6 (8.0%)], and hispanics of all races [23 (30.7%)]. Primary [40 (53.3%)] and secondary [35 (46.7%)] MF were approximately even. Log rank testing detected significance in race (p=.05) but not sex (p=.2) or type (p=.7). Significant univariate cox-PH findings include increased mortality within the NHB group [hazard ratio (HR) 2.69, p=.04] and increased mortality with age (HR 1.07, p=.005) (Table 1). Low event size precluded multivariate analysis. In the SEER cohort, age was grouped into 4 categories: ≤44 years old [214 (4.1%)], 45-64 [1,590 (30.3%)], 65-84 [3,051 (58.1%)], and ≥85 [399 (7.6%)]. There were more females [3,159 (60.1%)] than males [2,095 (39.9%)]. NHW [3,995 (76.0%)] comprised the overwhelming majority of races reported, followed by NHB [441 (8.4%)], hispanic [420 (8.0%)], and NH-API [398 (7.6%)]. Median household income (MHI) data (inflation adjusted to 2021) was divided into <$70,000 and ≥$70,000 (table 2). Univariate cox-PH noted improved survival in NH-APIs (HR .75, p<.001) and MHI ≥$70K (HR .92, p=.05). However this significance disappeared upon adjustment for age and race. In multivariate cox-PH, age demonstrated significance for each category (45-64 HR 2.20; 65-84 HR 4.45; ≥85 HR 6.59, p < .001). Female patients had better survival compared to males (HR .73, p<.001) (Table 2). Conclusion In this comparison study of MF cohorts from an underserved tertiary center and SEER, we found differences in demographic features and their impact on disease mortality. NHW patients constitute the overwhelming majority of subjects in the SEER dataset while the tertiary cohort has nearly equal distribution of NHW, NHB, and hispanic patients. NHB patients from the single-center cohort tended to do worse while SEER showed no differential survival based on race. Possible explanations for this include differences in racial distribution, healthcare accessibility, and other socioeconomic factors. Median income in the Bronx is 36% lower than the national average and the poverty rate is 2.3x higher. Unexpectedly, no significant association was found between MHI and survival in SEER when adjusted for age and race. Also notable is that improved survival in NH-APIs per SEER data disappeared upon adjustment for age, which may suggest that the NH-API group tends to be younger at diagnosis given that age serves as a negative prognostic marker. Further research is warranted. Regarding sex, SEER data suggests that female patients have a decreased mortality risk compared to males which is consistent with literature. Caution in interpretation is necessary given the low tertiary center sample size and the inherent limitations of the SEER dataset.

Comparison of demographics, disease characteristics, and outcomes between African American patients and White patients with myelodysplastic syndrome: A population-based study.

7051 Background: Myelodysplastic syndrome (MDS) consists of a heterogeneous group of clonal myeloid neoplasms, classified as a malignancy since 2001. Previous studies have described inferior outcomes for African Americans (AA) versus Whites (W) in several solid tumors and hematological malignancies, including AML. We performed an analysis of the Survival, Epidemiology, and End Results (SEER) cancer registry to analyze baseline characteristics and various outcomes. Methods: Using SEER (18 Registries, 2000-2018, Nov 2020 submission), we included 37,564 patients (pts) with microscopically confirmed MDS, age > = 20, diagnosed between 2000-2013 based on ICO-O3 codes. MDS sub-types were grouped into low, intermediate, and high-risk disease. We compared baseline characteristics, mortality rates per attributed cause of death (COD) and overall survival (OS). Multivariate Cox regression and Propensity Score analyses were conducted to reduce effect of confounding due to imbalance in baseline covariates. Results: We included 34,543 W (92%) and 3021 AA (8%) pts; There were more males (58%) among W vs AA (49%). At diagnosis the median age was 71 and 76 in AA and W subjects, respectively. Low and high risk MDS comprised 22.8% and 14.5% of cases among AA and 21.5% and 16.3% among W pts, respectively. 66.8% of AA were living in large metropolitan areas vs 60.2% for W pts. mOS was 33 months for AA and 26 months for W; HR for OS comparing W vs AA using a univariate Cox PH model was: 0. 79 (0.76- 0.82), p < 0.001. In a multivariate Cox-PH model, HR for OS after adjusting for sex, age at diagnosis, histology, urban-rural continuum, income group was: 0.90 (95%CI 0.86-0.94), p < 0.001. HRs after stratified cox PH model and propensity score matching model for age, sex, histology and income group were 0.92 (0.88-0.96), p < 0.001 and 0.93(0.88-0.98), p = 0.01 respectively. Analysis by histology shows statistically significant association between race and OS for refractory anemia and MDS-unclassifiable while not significant for refractory anemia with ringed sideroblasts, refractory anemia with excess blasts and MDS with del(5q). Incidence rate ratio for AA vs W for death attributed to the two most frequent CODs were: MDS/Leukemia: 0.74 (0.69-0.81, p < 0.001); CVD: 1.07 (0.94-1.21, ns). Conclusions: In this large study of MDS cases reported to the SEER registry, we observed differences in age, sex, disease subtype, socio-economic factors, mortality rate per attributed COD, survival outcomes between AA and W. The finding of AA having better OS outcomes than W pts is unexpected and needs to be further investigated, specifically the contribution of the less well-defined low-grade risk forms of MDS. Although caution in the interpretation is necessary due to multiple limitations inherent to the SEER dataset, this data does raise intriguing questions for future study.

Sarcomatoid Urothelial Carcinoma: A Population-Based Study of Clinicopathologic Characteristics and Survival Outcomes.

Sarcomatoid urothelial carcinoma (SUC) is a rare and aggressive variant of bladder cancer with limited data regarding epidemiology and survival. In this study, we explored clinicopathologic factors and oncologic outcomes of patients with SUC derived from Survival, Epidemiology and End Results (SEER) database, in comparison to conventional UC (CUC). SEER database was searched for patients with invasive (≥T1) SUC or CUC using the topography codes C67.0 to C67.9 for bladder cancer and the morphologic codes 8120/8122 for CUC/SUC respectively. Demographic/clinicopathologic/treatment/survival data were extracted. Disease-specific survival (DSS) was estimated with the Kaplan-Meier method. Chi-squared tests were used for comparative analysis and Cox proportional hazards model for identifying clinical covariates associated with DSS. A total of 569 patients with SUC and 37,740 with CUC were identified. Overall, there was a male predominant population in both cohorts, although a higher proportion of women were noted in the SUC cohort (32 vs. 25%). Patients with SUC had significantly higher incidence of non-bladder confined disease (T3/4, 37% vs. 22%) and nodal invasion (18% vs. 12%) in comparison to those with CUC (all P < .05). Median DSS was 16 months (95% CI: 12.4-19.6) in the SUC vs. 82 months (95% CI; 75.9-88.1) in the CUC cohort. Presence of SUC histology was independently associated with shorter DSS in the multivariate analysis, when adjusted for other significant clinicopathologic factors. SUC was associated with advanced stage and shorter DSS compared to CUC. Further studies are needed to better understand biological underpinnings behind its aggressive behavior and the role of novel systemic treatments.

Early mortality in metastatic cancer: A SEER population data analysis.

e18789 Background: Overall survival from cancer has continuously improved over the last thirty years. This is due, in part, to advances in systemic treatment of some cancers resulting in clinically significant increases in long-term survival. Despite these improvements in long-term survival, many patients die quickly after a diagnosis of metastatic cancer, possibly being denied the opportunity to benefit from these recent advances in cancer treatment. To identify the scope and predictors of early mortality in de novo metastatic cancer, we analyzed population-based data, focusing on patients with early mortality. Methods: Using the Survival, Epidemiology and End Results (SEER) Database we analyzed adult patients who presented with de-novo metastatic solid malignancies diagnosed between 2008-2016. We defined early mortality as 1- and 2-month mortality. Factors associated with early mortality were analyzed including primary site of cancer and demographics. Correlations between categorical variables were analyzed with chi squared tests and survival data was derived from life tables using STATA I/C 12.1. Results: Of 519,553 patients identified, 273,976 (53%) were males, 411,041 (79%) were white, 213,325 (41%) had lung cancer, 65,679 (13%) colorectal cancer and 49,139 (10%) pancreatic cancer. One - and two - month cancer specific mortality was 12.4% and 22.5% respectively for the entire cohort. Mortality from cancer in the first two months after diagnosis decreased only marginally between 2008 and 2016 (23.4% and 21.6 %, respectively). Cancers with the highest 2-month cancer specific mortality rates were liver (39.5%), pancreatic (36.3%), lung (26.8%), gastroesophageal (23.7%), and urothelial (21.2%). Cancers with the lowest 2-month mortality rate were breast (10.4%) and prostate cancer (5%). Patients who presented with liver metastases had a clinically significant higher 2- month cancer specific mortality rate (29% vs. 18% p &lt; 0.001), brain metastases were associated with a milder increase in 2-month cancer specific mortality (25%vs 21% p &lt; 0.001) and bone metastases were not associated with a clinically significant difference in 2-month cancer specific mortality (22% vs 21%, p = 0.047). Other factors associated with early mortality included increasing age, low income, and living in a rural area. Conclusions: Over 21% of newly diagnosed metastatic cancer patients die within 2 months of their diagnosis, with little improvement over the last decade, rendering this an urgent unmet need in cancer care. Further research is urgently required to better identify the causative and treatable factors of early mortality in cancer patients.

Long-Term Survival of Patients with Metastatic Non-Small-Cell Lung Cancer over Five Decades.

Objective Novel therapeutics and supportive care improved outcomes for metastatic non-small-cell lung cancer (mNSCLC) patients. Major advances over the past five decades include the introduction of combination chemotherapy, small molecules targeting mutant proteins, especially EGFR, and more recently immunotherapy. We aim to document real-world long-term survival over the past five decades. Methods Survival statistics were extracted from the Survival, Epidemiology, and End Results (SEER) database for mNSCLC patients during 1973–2015. Two- and five-year survival (2yS and 5yS) were analyzed using Kaplan–Meier and proportional hazard models. Results The study population consisted of 280,655mNSCLC patients diagnosed during 1973–2015. Longer survival was seen in younger, female, married, Asian/Pacific Islander race, adenocarcinoma, lower grade, more recent diagnosis, higher income, and chemotherapy-treated patients. 2yS increased during the study period from 2.6% to 12.9%, and 5yS increased from 0.7% to 3.2%. 2yS of patients <50 years of age rose from 2.1% to 22.8%, and their 5yS rose from 0.7% to 6.2%. 2yS of adenocarcinoma patients improved from 2.7% to 16.2%, and their improved 5yS from 1.1% to 3.9%. Conclusions Between 1973 and 2015, there was a dramatic improvement in long-term survival, with an approximately five-fold increase in both 2yS and 5yS. Nonetheless, absolute numbers of long-term survivors remained low, with less than 4% living 5 years. This provides a baseline to compare long-term outcomes seen in the current generation of clinical trials.

15639 Balloon cell melanoma: A National Cancer Institute database analysis of patient characteristics and survival

Introduction: Balloon cell melanoma (BCM) is a very rare subtype of malignant melanoma, characterized histologically by large, round foamy cells. To our knowledge, no prior National Cancer Institute (NCI) Survival, Epidemiology, and End Results (SEER) database analysis has focused specifically on this type of melanoma. We aimed to analyze patient characteristics and survival of BCM.

18840 Melanomas arising in giant pigmented nevi: A National Cancer Institute database analysis of patient characteristics and survival

Introduction: Malignant melanomas may arise in giant pigmented nevi. To the best of our knowledge, no previous study using the National Cancer Institute (NCI) Survival, Epidemiology, and End Results (SEER) database has focused on this type of melanoma. Our objective was to analyze patient characteristics and survival.

Epidemiology and survival of liposarcoma and its subtypes: A dual database analysis

Liposarcoma (LPS) is a one of the most commonly diagnosed soft tissue sarcomas. Little is known about the epidemiology and prognosis of each subtype. We present an analysis of epidemiology and survival of the subtypes of LPS using a national database. We queried the Survival Epidemiology, and End Results (SEER) and the Canadian Institute for Clinical Evaluative Sciences (ICES) databases for data on 7 types of LPS. Pearson's chi square was used to determine associations between variables and subtypes. Kaplan-Meier and Cox Regression analyses were performed for two tests: one using SEER data and the other using variables common to both SEER and ICES. The well-differentiated subtype was the most common subtype identified. Metastatic disease was associated with decreased survival across all subtypes and age >35 was associated with decreased survival in well-differentiated and myxoid subtypes. Tumor grade was associated with decreased survival in the well-differentiated, myxoid, mixed, and round cell subtypes. In the secondary analysis, age >35 was associated with decreased survival in the myxoid subtype. The prognosis of liposarcoma differs greatly by subtype. Clinicians should account for patient factors at the time of diagnosis to best navigate treatment of their patients.

Early mortality in metastatic lung cancer: A SEER population data analysis.

9103 Background: Millions of dollars invested in improving outcomes for metastatic lung cancer patients are essentially aimed at extending long term survival, with significant benefits being achieved over the last decade. However, little is known about lung cancer patients who die rapidly after diagnosis, potentially being deprived of these advances. We analyzed population-based data to describe real-world outcomes in metastatic lung cancer patients focusing on patients with early mortality. Methods: Using the Survival, Epidemiology and End Results (SEER) Database we analyzed adult metastatic lung cancers diagnosed between 1994-2014. This period was divided into 3 equal time periods: 1994-2000 (TP1), 2001-2007 (TP2) and 2008-2014 (TP3). Early mortality was defined as death within 2 months of diagnosis. Correlations between categorical variables were analyzed with chi squared tests and survival was analyzed using the Kaplan-Meier method. Results: Of 276,527 patients diagnosed with metastatic lung cancer, median age was 67 (range 20-105) and 154,465 (56%) were males. Thirty eight percent (103,830) of all patients died within 2 months of diagnosis. Of these early deaths, 96,344 (92.8%) were due to lung cancer. While the 2-year survival almost doubled from TP1 compared to TP3 (6% vs 11%, p &lt; 0.001), the percentage of patients who died within 2 months only marginally improved (39.7% vs. 36.2% in TP1 vs TP3, respectively). For patients surviving at least 2 months, 2-year survival increased from 10% to 18% in TP1 vs TP3 (p &lt; 0.001). Factors associated with early mortality include age &gt; 65 (45% vs 31%), unmarried status (42% vs 34%), male sex (39% vs 36%), liver metastases (47% vs 32%) and large cell carcinoma vs adenocarcinoma (44% vs 36%) (all p &lt; 0.001). Conclusions: While there has been a steady improvement in the long-term overall survival of patients with metastatic lung cancer, over one third of patients still die within 2 months of diagnosis. This has only marginally improved in the last 20 years. Research is urgently needed to identify causative and treatable factors.

Survival in sinonasal and middle ear malignancies: a population-based study using the SEER 1973\u20132015 database

BackgroundThe sinuses, nasal cavity, and middle ear represent a rarer location of head and neck malignancy than more common sites such as the larynx and oral cavity. Population-based studies are a useful tool to study the demographic and treatment factors affecting survival in these malignancies.MethodsPopulation-based database search of the Survival, Epidemiology, and End Results (SEER) database from 1973 to 2015 for malignancies involving the nasal cavity, paranasal sinuses, and middle ear. Data were analyzed for demographics, treatment type, stage, primary site and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival.ResultsA total of 13,992 cases of sinonasal or middle ear malignancy were identified and analyzed. The majority of patients were between ages 50 and 80 at the time of diagnosis. Overall 5-, 10-, and 20-year survival was 45.7%, 32.2%, and 16.4%, respectively. Lymph node metastasis was reported in 4.4% of patients, while distant metastasis was present in 1.5% of cases. On univariate analysis surgical vs. nonsurgical treatment, sex, race, age at diagnosis, T stage, N stage, M stage, AJCC overall stage, primary site, tumor grade, and histopathologic subtype significantly affected survival. On multivariate analysis age, race, sex, primary site, overall AJCC stage, surgical vs. nonsurgical treatment, and T, N, and M stage remained significant predictors of overall survival.ConclusionsMalignancies of the nasal cavity, paranasal sinuses, and middle ear account for a minority of overall head and neck cancers. The overall 5-, 10-, and 20-year survival for these malignancies is relatively low. Higher T, N, M, and overall stage and higher tumor grade is associated with lower survival. Patients treated with surgery as part of the treatment regimen had higher overall survival. Demographics and primary site also significantly affect survival. Certain histopathologic subtypes were associated with poorer survival.

Survival in elderly glioblastoma patients treated with bevacizumab-based regimens in the United States.

The efficacy of bevacizumab (BEV) in elderly patients with glioblastoma remains unclear. We evaluated the effect of BEV on survival in this patient population using the Survival, Epidemiology, and End Results (SEER)-Medicare database. This retrospective, cohort study analyzed SEER-Medicare data for patients (aged ≥66 years) diagnosed with glioblastoma from 2006 to 2011. Two cohorts were constructed: one comprised patients who had received BEV (BEV cohort); the other comprised patients who had received any anticancer treatment other than BEV (NBEV cohort). The primary analysis used a multivariate Cox proportional hazards model to compare overall survival in the BEV and NBEV cohorts with initiation of BEV as a time-dependent variable, adjusting for potential confounders (age, gender, Charlson comorbidity index, region, race, radiotherapy after initial surgery, and diagnosis of coronary artery disease). Sensitivity analyses were conducted using landmark survival, propensity score modeling, and the impact of poor Karnofsky Performance Status. We identified 2603 patients (BEV, n = 597; NBEV, n = 2006). In the BEV cohort, most patients were Caucasian males and were younger with fewer comorbidities and more initial resections. In the primary analysis, the BEV cohort showed a lower risk of death compared with the NBEV cohort (hazard ratio, 0.80; 95% confidence interval, 0.72-0.89; P < .01). The survival benefit of BEV appeared independent of the number of temozolomide cycles or frontline treatment with radiotherapy and temozolomide. BEV exposure was associated with a lower risk of death, providing evidence that there might be a potential benefit of BEV in elderly patients with glioblastoma.

Do Prostate Cancer Patients With Markedly Elevated PSA Benefit From Radiation Therapy?: A Population-based Study.

Patients with clinically localized prostate cancer but markedly elevated prostate-specific antigen (PSA) are often treated with systemic agents alone. We hypothesized that they would benefit from radiation therapy. We utilized the Survival, Epidemiology and End Results (SEER) Database for patients diagnosed with nonmetastatic prostate cancer from 2004 to 2008. Patients treated surgically or with brachytherapy were excluded. Survival was analyzed using the Kaplan-Meier method and Cox proportional hazard models. Propensity score was used to adjust for the nonrandomized assignment of local therapies. A total of 75,539 nonmetastatic prostate cancer patients were identified who received either radiotherapy or no local treatment. Median age was 70 years. Median follow-up of alive subjects was 60 months, with an interquartile range of 47 to 77 months. Estimated 4-year overall survival of entire population was 88%. Significant prognostic variables for overall survival on multivariate analysis included age, grade, PSA level, T stage, and use of radiation therapy. Use of radiation therapy was the most powerful predictor of both cause-specific and overall survival (HR=0.41 and 0.46, respectively, P<0.001). The benefit conferred by local treatment was seen even in subjects with PSA≥75 ng/mL. Four-year cancer-specific survival was 93.8% in those receiving radiation treatments versus 76.5% in those who did not receive any local treatment. Survival was significantly improved by radiotherapy for localized prostate cancer. Extremely high PSA levels (≥25 ng/mL) should not be considered a contraindication to local treatment.

Palliative Radiation Therapy in Extensive Stage Small Cell Lung Cancer (ES-SCLC): A Survival, Epidemiology and End Results (SEER) Analysis

Palliative Radiation Therapy in Extensive Stage Small Cell Lung Cancer (ES-SCLC): A Survival, Epidemiology and End Results (SEER) Analysis

Short and long-term survival in metastatic pancreatic adenocarcinoma, 1993-2013.

232 Background: Over the previous two decades several new agents have been approved for the treatment of metastatic pancreatic cancer (mPDAC). Their efficacy was demonstrated amongst highly selected patients that participate in randomized phase III trials, hence it is not clear to what extent these advances are reflected within the broader mPDAC population. We performed a population-based survival analysis of newly diagnosed patients who presented with mPDAC. Methods: Survival statistics were extracted from the Survival, Epidemiology and End Results (SEER) Database for patients diagnosed with mPDAC between 1993-2013. Demographic variables collected included age, gender, race, and marital status. Tumor characteristics collected included location and grade. Survival was analyzed using the Kaplan-Meier method and proportional hazard models as appropriate. Exclusion criteria included diagnosis at autopsy, unknown histology and pancreatic neuroendocrine tumors. Results: The study population consisted of 57,263 patients diagnosed with mPDAC from 1993-2013, 52% male, median age 69 years (range 15-104). Prognosis correlated with age, gender, race, marital status, tumor location, grade and year of diagnosis. Median overall survival (OS) stayed stable at 2 months between 1993 and 2013. Improvements in OS were seen for all patients, but especially for younger patients ( &lt; 50 years of age) and more recent year of diagnosis group (2009-2013). The percentage of patients who died within two months of initial diagnosis decreased between 1993 and 2013 (from 63.5% to 50.6%, p &lt; 0.0001). The subgroup of patients achieving longer-term survival has increased, with 12-month survival improving from 4.9 % to 12.7% (p &lt; 0.0001) between 1993 and 2013. Conclusions: There has been a continuous but modest improvement in OS of patients diagnosed with mPDAC between 1993 and 2013. The percentage of patients living beyond one year has significantly increased over time; however the percentage of patients dying within 2 months has only slightly decreased.

Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient.

Multidisciplinary care (MDC) in managing breast cancer is resource-intensive and growing in prevalence anecdotally, although care patterns are poorly characterized. We sought to determine MDC patterns and effects on care in the United States Medicare patient. Patients diagnosed with non-metastatic invasive breast cancer from 1992-2009 were reviewed using the Survival, Epidemiology, and End Results (SEER)-Medicare linked dataset. MDC was defined as a post-diagnosis, preoperative visit with a surgical, medical, and radiation oncologist. Same-day MDC (MDCSD) was the MDC subset having all three visits on one date. Among 88,865 patients, MDC was utilized in 2.9%, with 14.1% of these having MDCSD. MDC use did not vary by stage, but MDC patients were more likely to be younger, black, receive lumpectomy, have fewer nodes examined, and receive radiotherapy. MDCSD patients were more likely than non-MDC patients to be black, receive mastectomy, and receive radiotherapy. MDC and MDCSD use increased over time and varied by geographic region, with rural patients less likely to receive MDC (OR 0.54 [95% CI 0.45-0.65]) and MDCSD (OR 0.32 [95% CI 0.19-0.54]). Radiotherapy after breast conserving surgery, used in 86.2 % of non-MDC patients, was administered to 90.2 % of MDC (p < 0.001) and 92.6 % of MDC(SD) (p = 0.096) patients. Post-mastectomy radiotherapy was administered in 52.0 % of non-MDC patients, 63.8 % of MDC (p = 0.050), and 89.1 % of MDC(SD) (p = 0.011) patients after propensity score adjustment. While increasing, few Medicare patients undergo MDC and MDCSD is rare. MDC may improve quality and MDCSD should be considered for patient convenience. While not yet widespread, efforts should integrate MDC and MDCSD across the U.S.

Abstract P1-07-25: Patterns of multidisciplinary care in the management of nonmetastatic invasive breast cancer in the United States Medicare patient

Abstract Background: Multidisciplinary care (MDC) in managing localized breast cancer is a resource-intensive treatment strategy that is anecdotally growing in prevalence, but is poorly characterized and thus cannot yet be defined as "standard care." We sought to determine the patterns of MDC care in the United States Medicare patient and assess if survival advantages exist for this paradigm. Methods: Using the Survival, Epidemiology, and End Results (SEER)-Medicare linked dataset, we evaluated patients with non-metastatic breast cancer from 1992 to 2009. MDC was defined as a preoperative visit after breast cancer diagnosis with a surgeon, medical oncologist and radiation oncologist. Two separate analyses were performed: The first evaluated all MDC patients, and the second characterized the subset of patients who saw all three specialties on the same day. We tested for associations between MDC and clinical/demographic variables using logistic regression and evaluated outcomes using propensity score matching. Results: A total of 87,984 invasive nonmetastatic breast cancer patients were included. MDC was utilized in 2.8% of patients, while 13% of these saw all three oncologic specialists on the same date. MDC use did not vary significantly according to AJCC stage. Patients receiving MDC overall were significantly more likely to be younger (continuous variable; OR [95% CI] = 0.99 [0.98-0.99]), black race (1.75 [1.50-2.05]), receive lumpectomy (1.15 [1.03-1.28], have fewer nodes examined (0.98 [0.98-0.99], and receive radiation therapy (1.37 [1.25-1.51]. MDC patients receiving care all on the same date were significantly more likely than non-MDC patients to have lobular histology (OR [95% CI] = 1.48 [1.06-2.06]), black race (3.09 [2.19-4.35], receive mastectomy (1.75 [1.34-2.30]) and receive radiation therapy (1.98 [1.52-2.60]). The use of MDC overall and on the same date increased over time (p &amp;lt; 0.001) and varied widely according to geographic region. There was a 20.8 odds increase in the use of same-date MDC in the Midwest compared to the South (p &amp;lt; 0.001). Patients in rural settings were less likely to receive MDC overall: OR [95% CI] = 0.57 [0.48-0.68] and on the same date (0.27 [0.16-0.48]). Survival data suggest improved outcomes for women undergoing MDC (Table 1). There were 117 breast cancer deaths in the MDC overall group but only 15 such events in the smaller MDC same-day subgroup (limiting its power). Table 1. Propensity score matched outcomes according to MDC. MDC Overall* MDC on Same Date (n = 2,491) (n = 330) HR[95% CI]pHR[95% CI]pAdjusted Overall Survival0.940.80-1.090.4000.360.18-0.720.004Adjusted Breast Cancer Specific Mortality0.750.58-0.960.0240.420.15-1.180.102* Includes MDC patients on same and different dates. Conclusions: The vast majority of Medicare patients having breast cancer did not undergo MDC during the period of study. MDC rates have increased over time, with widely varied MDC utilization across regions. Employing same-day MDC should be considered for patient convenience and may improve outcomes. While not yet widespread, efforts should be made to integrate MDC as standard care across the United States. Citation Format: Churilla TM, Egleston BL, Murphy CT, Sigurdson ER, Hayes SB, Goldstein LJ, Bleicher RJ. Patterns of multidisciplinary care in the management of nonmetastatic invasive breast cancer in the United States Medicare patient. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-25.

Incidence and benefits of surgical therapy for third primary lung cancers.

e18512 Background: Continued surveillance of lung cancer patients after curative surgery allows for the diagnosis of new disease. However, there is a relative paucity of data in regards to the development of third primary lung cancers. The goals of this study were to examine the incidence of third primary cancers and the results of surgical therapy. Methods: Surgically resected Stage 1 second primary lung cancers with complete data were identified in The Survival Epidemiology and End Results (SEER) database between 2004 and 2010. Among these 238 cases, those which developed a third primary lung cancer 6 or more months after the diagnosis of the second primary were analyzed. Statistical methods were performed using Kaplan-Meier and multivariate analysis. A p value < 0.05 was considered statistically considered significant. Results: Twenty-four patients (10.1%) experienced a third primary lung cancer; sixteen cases (66.7%) were diagnosed in stage I. Twelve patients (50% of cases) underwent cancer surgery. N...

Presentation and outcomes among patients with isolated myeloid sarcoma: a Surveillance, Epidemiology, and End Results database analysis

Isolated myeloid sarcoma (MS) is a rare extramedullary presentation of acute myeloid leukemia (AML). Little is known about MS outcomes due to its rarity. A population-based analysis of MS using the Survival, Epidemiology, and End Results (SEER) database was performed. We identified 345 patients, aged 15 or older, diagnosed with isolated MS between 1973 and 2010. Overall survival (OS) was calculated and compared between MS and non-MS AML using the log-rank test. Survival was also evaluated based upon the primary site of disease presentation. The 3-year survival rate for MS (0.319; 95% confidence interval [CI]: 0.267–0.371) was greater than for non-MS AML (0.172; 95% CI: 0.168–0.175). There was variation in survival based on the site of involvement. The survival rates for isolated MS involving the pelvis/genitourinary organs, eyes/gonads and gastrointestinal mucosa appeared to be slightly improved when compared to primary sites of soft tissues, lymphatic/hematopoietic tissues or nervous system.

Malignant peripheral nerve sheath tumors (MPNST): a SEER analysis of incidence across the age spectrum and therapeutic interventions in the pediatric population.

Malignant peripheral nerve sheath tumors (MPNST) are very rare in the general population and challenging to treat. A paucity of data exists regarding the incidence of MPNST across all age groups and treatment outcomes in the pediatric population. We aimed to characterize both using the Survival, Epidemiology, and End Results (SEER) database. The SEER-18 database with information on the United States population from 1973 to 2009 was queried for cases of MPNST. For incidence data, 1,182 cases were found among the general population. Of those, 165 cases were in individuals aged 0-19. After exclusions, 139 cases from the SEER-18 database met study criteria for outcomes analysis. For each patient, variables including gender, age, race, stage (localized, regional, or distant), surgical treatment, and radiotherapy were obtained. The overall incidence of MPNST was 1.46 per million person-years, with increased incidence among the elderly. In the pediatric population, the incidence was 0.56 per million person-years, and was higher among post-pubertal children aged 10-19. Median overall survival in the pediatric population was 30 months, with only localized disease and treatment with surgery being positive prognostic factors on multivariate analysis. MPNST is a rare disease and, among children, is most frequent seen in adolescents. Surgery is crucial as first-line treatment for MPNST, especially if the tumor is localized at diagnosis. In patients with non-localized MPNST, the disease remains extremely difficult to manage, and both surgery and radiotherapy are interventions that should be considered.