Time Period Of Diagnosis Research Articles

Abstract IA010: Neighborhood socioeconomic status and outcomes of patients with endometrial cancer

Abstract Cancer disparities manifest a particularly intricate interplay between incompletely understood genomic risks, biologic susceptibility, and access to quality care. Disparate access to quality cancer care is often a reflection of a complex relationship between social, historical, and environmental factors that influence a patient’s surroundings, however large observational studies rarely quantify these contextual elements beyond individual or area-level income and education. The well-established racial and socioeconomic inequities in uterine cancer outcomes remain one of the widest amongst all cancer types, with an approximate 20% difference in 5-year survival between Black and White patients, which remains unchanged over the past 15 years. Racial disparities persist even when controlling for more advanced stage at presentation, the occurrence of more aggressive tumor subtypes and quality of treatment. When controlling for age, time period of diagnosis, region of the country, urban or rural setting, treating facility type, socioeconomic status, education, insurance, comorbidity index, pathologic stage, histology, lymphadenectomy and adjuvant treatment, African American patients still have lower overall survival than White patients (HR 1.21, 95% CI 1.16-1.26). There continues to be a concerted call for further explanation of the socioeconomic factors that contribute to these racial disparities. To date, few epidemiologic studies of uterine cancer have utilized markers that are more representative of the complex interplay of various social and environmental factors that influence health outcomes. Some studies have examined area level poverty and uterine cancer treatment and outcomes, finding that living in more vulnerable neighborhoods was associated with poor survival, delays in care, and inadequate treatment. However, these studies do not take into account the interplay of neighborhood poverty and how race, or experience of racism, may affect this relationship. Given the complex and insidious nature of racism in the United States, we have further explored how neighborhood poverty may affect uterine cancer outcomes taking into account the race of patients studied. Preliminary data from New York state suggests that neighborhood socioeconomic vulnerability is associated with worse treatment and survival for patients with uterine cancer, and this was best seen in White patients living outside of major metropolitan areas. The greatest Black/White survival disparities are seen in the wealthiest neighborhoods in New York City. Black women with advanced stage endometrial cancer living in affluent areas have no significant survival advantage over those living in vulnerable neighborhoods. Citation Format: Charlotte Gamble. Neighborhood socioeconomic status and outcomes of patients with endometrial cancer [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr IA010.

Prognostic factors of gallbladder cancer (GBC) in patients diagnosed over a period of 20 years: A Canadian province experience.

437 Background: GBC is an uncommon but often fatal gastrointestinal cancer. The poor prognosis of GBC may in part be due to lack of effective screening tools and a delay in diagnosis that leads to presentation in the latter stages of the disease. The current study aims to determine outcomes of patients with GBC in relation to contextual, demographic and clinical factors in a Canadian province over a span of 20 years. Methods: In this population-based retrospective cohort study patients with GBC diagnosed in Saskatchewan, Canada from 2000-2019 were evaluated. Cox proportional multivariate regression analyses was performed to determine factor correlated with inferior outcomes. Results: 331 patients with median age of 74 yrs and M:F of 1:2 were identified. 92% had a pathological diagnosis of GBC & 80% had adenocarcinoma. 49% were diagnosed >year 2010. 217 (66%) of those diagnosed with GBC were rural residents. 149 (45%) patients were referred to a cancer center. In patients with documented stage, 64% had stage IV disease & >90% were symptomatic with a median time from the onset of symptoms to the diagnosis of 7 months. Rural residents have a significantly high rate of smoking history whereas urban residents have significantly high rates of pathological diagnosis, low serum albumin and elevated platelet count. Median overall survival (OS) of patients with stage I-III GBC was 20 months (95% CI:10.9-29.1) vs. 4.0 months (3.0-5.0) with stage IV GBC (<0.001). No significant differences were noted in OS in relation to residence and time-period of diagnosis. Patients who were not referred for a cancer center had a median OS of 3 months (1.98-4.0) vs. 13 months (9.9-16.1), p<0.001. Median disease-free survival (DFS) of patients with stage I-III GBC was 20 months (95%CI: 10-30.1) with 5-year DFS of 36%. Patients with stage I-III GBC who received adjuvant chemotherapy had 5-yr DFS of 43% vs. 33% without adjuvant chemotherapy (p=0.73). 5-year DFS of urban patients was 25% vs. 42% of rural patients (p=0.016). On multivariate analysis for patients with Stage I-III GBC, stage III disease, HR (hazard ratio), 2.63 (1.09-6.34) and urban residence, HR, 2.20 (1.1-4.39) were correlated with inferior DFS whereas for all patients, stage IV disease, HR, 3.02 (1.85-4.94); no referral to cancer center, HR, 2.64 (1.51-4.62); lack of surgery, HR, 1.63 (1.03-2.57); neutrophil:lymphocyte of >3.2, HR, 1.57 (1.05-2.36); and age ≥70, HR, 1.51 (1.04-2.19) were correlated with inferior OS. Conclusions: In a real-world setting, most patients with GBC are diagnosed with late-stage disease and were not referred to cancer center. For early-stage GBC, urban residence and stage III disease were correlated with inferior outcome, whereas for all stage GBC, stage IV disease, old age, lack of surgery, lack of referral to cancer center, and high neutrophil to lymphocyte ratio were correlated with inferior survival.

Causes of death in primary plasma cell leukemia differ from multiple myeloma: A STROBE-compliant descriptive study based on SEER database.

The primary plasma cell leukemia (pPCL) is a rare but aggressive variant of multiple myeloma (MM). Few studies have focused on the differences in the causes of death between pPCL and MM. This study aimed to compare and evaluate the causes of death of patients with pPCL and MM.The data were collected from the Surveillance Epidemiology, and End Results (SEER) database. The demographic characteristics, survival, and causes of death in pPCL and MM patients were evaluated and compared. The competing risk regression model was performed to predict the cause of death.Between 1975 and 2009, the overall mortality rate was 96.13% and 88.71% for pPCL and MM, and the median survival was 9 and 26 months, respectively. In pPCL, leukemia caused 45.05% of the deaths, followed by myeloma (38.83%). In MM, myeloma was the leading cause of death, accounting for 74.89% of the deaths. Older age at diagnosis was a risk factor for dying of leukemia in pPCL patients (HR = 1.49, 95% CI: 1.16–1.91), while older age at death was associated with reduced risk (HR = 0.67, 95% CI: 0.52–0.86). Although the survival of pPCL patients increased with time periods of diagnosis since 1975 to 2009, the risk of dying of leukemia increased with the periods. For MM, most of the demographic characteristics were found to have independently predicting influence on the cause of death.Patients with pPCL and MM had distinct causes of death. Leukemia was the leading and the most serious cause of death in pPCL patients. The demographic factors could not predict the causes of death in pPCL. More large-scale and multi-center studies are needed to evaluate the effect of novel agents in pPCL patients, especially for patients who have progressed to leukemia.

PD13-09 TRENDS IN SURVIVAL FOR MEN WITH DE NOVO METASTATIC PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022PD13-09 TRENDS IN SURVIVAL FOR MEN WITH DE NOVO METASTATIC PROSTATE CANCER Nina Wyatt, and Christopher Filson Nina WyattNina Wyatt More articles by this author , and Christopher FilsonChristopher Filson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002545.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The USPSTF recommended against routine prostate cancer screening in 2008 (men >75 years) and 2011 (all men). After 2010, novel therapies were approved for men with metastatic prostate cancer, such as abiraterone. We examined the characteristics and survival of the men presenting with metastatic prostate cancer before and after those time periods. We hypothesized that men diagnosed more recently would have improved survival compared to men diagnosed long ago. METHODS: Using SEER cancer registry data, we identified men newly diagnosed with metastatic prostate cancer diagnosis from 2004–2018. Our outcome of interest was prostate cancer specific survival. Primary exposure was time period of diagnosis (2004–2008; 2009–2012; 2013–2016; 2017–2018). We evaluated factors including age, race/ethnicity, registry, and PSA level. We performed survival analysis to generate Kaplan-Meier curves for men eligible for at least 3 years follow up (diagnosed 2004–2016) (Figure). Multivariable Cox proportional hazard model provided adjusted estimates for cancer specific survival. RESULTS: Among 840,852 prostate cancer patients, 47,343 (5.6%) had metastatic disease. This proportion increased from 4.2% in 2004–2008 to 8.1% in 2017–2018 (p <0.001). Over time, a greater proportion of men with metastatic prostate cancer were Asian/Hispanic (16.0% in 2004–2008 to 17.7% in 2017–2018, p <0.001). Survival after 1 year was most common for men diagnosed in 2017–2018 (81.3% vs 67.9% alive in 2004–2008, p <0.001). Median cancer-specific survival was longest for men diagnosed from 2013–2016 (36 vs 31 months for 2004–2008, p <0.001). After adjusting for other factors, men diagnosed in 2013–2016 had 15% improved survival compared to those diagnosed earlier (vs 2004-2008; adjusted HR 0.85, 95% CI 0.82–0.88). CONCLUSIONS: Men presenting with metastatic prostate cancer in more recent years are living longer. More work will need to evaluate the relative contribution to this finding from therapeutic successes with novel systemic therapies, stage migration with adoption of PET scans, and the impact of earlier cancer detection with screening. Source of Funding: ACS MRSG 18-1-CPHPS © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e254 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nina Wyatt More articles by this author Christopher Filson More articles by this author Expand All Advertisement PDF DownloadLoading ...

Women with short survival after diagnosis of metastatic breast cancer: a population-based registry study

PurposeDespite therapeutic advances, overall survival of metastatic breast cancer (MBC) at the population level has seen little improvement over the past decades. Aggressive tumor biology or delay in access to cancer care might be contributing factors. With this retrospective population-based study we aimed to quantify and characterize patients with very short survival time following MBC diagnosis.MethodsWomen diagnosed with MBC between Jan 1st, 2005 and Dec 31st, 2016 were identified using the population-based Stockholm–Gotland breast cancer registry. Data regarding demographic and clinicopathological characteristics, survival, and treatment were extracted retrospectively from the registry and from patient charts. Patients who died within 90 days following diagnosis of MBC were identified and their characteristics were compared with all other patients diagnosed with MBC during the same period.ResultsBetween 2005 and 2016, 3124 patients were diagnosed with MBC, of whom 498 (16.2%) died within 90 days of diagnosis. Nearly half (N = 233) did not receive any antitumoral treatment. Patients with short survival were older (p < 0.001), had higher primary tumor grade (p < 0.001), higher clinical stage at primary diagnosis (p = 0.002), and more often estrogen receptor (ER)-negative breast cancer (p < 0.001). Visceral metastases were more frequent (p < 0.001) and patients with short survival received adjuvant chemotherapy (p < 0.001) to a lesser extent compared to patients with a better prognosis. In multivariable analysis older age, time period of diagnosis, metastasis site, adjuvant chemotherapy, and primary tumor grade were independent predictors for short survival, whereas ER status was not.ConclusionNearly one out of six patients with MBC survive less than 3 months after diagnosis. Our findings demonstrate a different spectrum of MBC at population level and can potentially inform on individualized follow-up strategies and treatment algorithms.

OA10 Survival analysis of 496 patients with systemic lupus erythematosus with up to 40 years follow-up shows improved survival in patients diagnosed in more recent time-periods

Abstract Background/Aims Patients with systemic lupus erythematosus (SLE) have increased mortality compared to age- and sex-matched controls. Lupus nephritis (LN) is a severe manifestation of SLE and an important cause of death. Our objective was to carry out a retrospective survival analysis to investigate factors that could influence risk of mortality and LN in a large multi-ethnic cohort of patients with SLE. Methods By careful review of medical records, we identified 496 patients with SLE for whom we had complete information regarding period of observation and occurrence of death and nephritis. Patients were stratified into groups according to sex, ethnicity (Caucasian, African/Caribbean, South Asian, East Asian, Other), age at start of follow-up (above and below median) and time-period of diagnosis (1978-89, 1990-99, 2000-5, 2006-11). Kaplan-Meier analysis was used to investigate differences between the groups in survival and LN. Results Overall, there were 454 women and 42 men. 91 patients died and 165 developed LN. Mean follow-up was 15.8 ± 8.75 years with a maximum of 40 years. Median age at start of follow-up was 28.0 ± 12.13 years. Results are shown in Table 1 There were no differences between men and women in mortality or LN. Caucasian patients were significantly less likely to develop LN (P &amp;lt; 0.0001) than other groups but there was no mortality difference between ethnic groups. Patients diagnosed below age 28 were more likely to develop LN (P &amp;lt; 0.0001) but less likely to die (P = 0.0039) than those diagnosed above age 28. Patients diagnosed between 2006 and 2011 were significantly less likely to die than those diagnosed between 1978 and1989 by Cox proportional hazards analysis of survival curves. (P = 0.019) Conclusion In this long-term survival analysis of 496 patients, non-Caucasian patients and those diagnosed below the age of 28 years were more likely to develop LN. The latter group were less likely to die than those diagnosed at older ages. Survival curves for groups of patients diagnosed in successive time periods suggested improved survival over time. Disclosure W. Luo: None. F. Farinha: None. D.A. Isenberg: None. A. Rahman: None.

Survival analysis of mortality and development of lupus nephritis in patients with systemic lupus erythematosus up to 40 years of follow-up.

Patients with SLE have increased mortality compared with age- and sex-matched controls. LN is a severe manifestation of SLE and an important cause of death. We carried out a retrospective survival analysis to investigate factors that could influence the risk of mortality and LN in a large multi-ethnic cohort of patients with SLE. By careful review of medical records, we identified 496 patients with SLE for whom we had complete information regarding the period of observation and occurrence of death and nephritis. Patients were stratified into groups according to sex, ethnicity, age at start of follow-up and time period of diagnosis. Kaplan-Meier analysis was used to investigate differences between the groups. Of the 496 patients in the study, 91 (18.3%) died, 165 (33.3%) developed LN and 33 (6.7%) developed end-stage renal failure. There was no difference between men and women in either mortality or development of LN. Caucasian patients were significantly less likely to develop LN than other ethnic groups (P < 0.0001) but not less likely to die. Patients diagnosed before the median age of 28 years were significantly more likely to develop LN (P < 0.0001) but significantly less likely to die (P = 0.0039) during the period of observation. There has been a significant improvement in survival in patients diagnosed between 1978 and 1989 and those diagnosed between 2006 and 2011 (P = 0.019). In our cohort, non-Caucasian ethnicity and younger age at diagnosis are associated with the risk of developing LN. There is evidence of improvement in survival of patients with SLE over time.

Regional differences in treatment and outcome for myeloma patients in Sweden: A population based Swedish myeloma register study.

We wanted to evaluate if health care for multiple myeloma (MM) patients is equal in different regions of Sweden. To study differences in survival for MM depending on health care region and early use of modern treatment. Data from the Swedish Myeloma Register from patients diagnosed between 2008 and 2017 was used. Cohorts were defined by the six healthcare regions (labeled A-F) in Sweden and modern initial treatment was defined as including certain drug combinations. To adjust for time to treatment bias, survival analyses were performed also for patients alive 6months after diagnosis. In all treated MM patients (n=5326), we observed a superior overall survival (OS) for region A compared to all other regions (p<.01 for all respectively). After adjusting for time to treatment there was also a superior survival in the region with highest use of modern initial treatment (region A) compared to the regions defined in the study as having intermediate and low use (p<.01 for both). In patients receiving autologous stem cell transplantation (ASCT) a superior survival was observed for region A compared to all regions besides region B. Similar results were seen when adjusting for a time to treatment bias. In patients not receiving ASCT, 75years or older and adjusted for time to treatment bias, a difference was noted only between region A and E (log rank p=.04, HR 1.2, CI 1.00-1.44, p=.06). In multivariate analyses including age, international staging system stage and time period of diagnosis, differences in survival remained for patients receiving ASCT between region A versus C, D, E and F (p=.01, p<.01, p<.01, p=.03). We observed a superior survival in region A for patients receiving ASCT. Explanations may be higher usage of modern initial treatment or regional residual confounding. For patients not receiving ASCT, 75years or older, differences in survival could be adjusted for.

Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic

Mortality among patients hospitalized for COVID‐19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID‐19, we compared 28‐day mortality between early 2020 (March 1, 2020–June 19, 2020) and late 2020 (June 20, 2020–December 31, 2020). Multivariable logistic regression was used to assess comorbidity‐adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p < .001). Crude 28‐day mortality decreased between the early and late periods (112/571 [19.6%] vs. 55/402 [13.7%]) and remained lower in the late period even after adjusting for baseline comorbidities (aOR 0.67, 95% CI 0.46–0.98, p = .016). Between the early and late periods, the use of corticosteroids (≥6 mg dexamethasone/day) and remdesivir increased (62/571 [10.9%] vs. 243/402 [61.5%], p < .001 and 50/571 [8.8%] vs. 213/402 [52.2%], p < .001, respectively), and the use of hydroxychloroquine and IL‐6/IL‐6 receptor inhibitor decreased (329/571 [60.0%] vs. 4/492 [1.0%], p < .001 and 73/571 [12.8%] vs. 5/402 [1.2%], p < .001, respectively). Mortality among SOTR hospitalized for COVID‐19 declined between early and late 2020, consistent with trends reported in the general population. The mechanism(s) underlying improved survival require further study.

468. Delayed Mortality Among Solid Organ Transplant Recipients Hospitalized for Covid-19: An International Multicenter Study

Abstract Background Studies of solid organ transplant recipients (SOTr) hospitalized for Covid-19 have focused on short-term outcomes with approximately 30 days of follow-up time. Intermediate-term mortality and associated risk factors for intermediate-term death have not previously been reported. Methods Using data from a multi-center registry, we assessed mortality by 90 days among SOTr hospitalized for Covid-19 between 3/1/2020 and 12/31/2020. Multivariable Cox-proportional hazard models were used to compare risk factors for mortality by 28 and 90 days. Covariates were selected a priori based on known predictors of death in SOTr hospitalized for Covid-19. All patients were followed for 90 days or were censored at the time of death or last clinical contact, if this occurred prior to day 90 after diagnosis. Results Among SOTr hospitalized for Covid-19, 198/979 (20%) died within 90 days of diagnosis and 37/198 (19%) of deaths occurred between days 29 and 90. Risk factors for mortality by day 90 days included age &amp;gt;65 years (1.8, 95% CI 1.3-2.4, P&amp;lt; 0.001), lung transplant (compared to non-lung) (1.6, 95% CI 1.1-2.4, P=0.02), chronic lung disease (2.2, 95% CI 1.5-3.4, P=0.002) and heart failure (1.9, 95% CI 1.2-2.9), which were similar to risk factors reported for 28-day mortality (Table 1). Diagnosis during the second half of 2020 (6/20-12/31/20) was associated with lower mortality by 28 days (aHR 0.7, 95% CI 0.5-1.0, P=0.03) compared to diagnosis during the early half of 2020 (3/1-6/19/20); however, mortality by 90 days was similar in the late and early time periods (aHR 0.9, 95% CI 0.7-1.2, P=0.54). Obesity and mTOR inhibitor use were also associated with death by 28 but not 90 days. Kaplan-Meier survival curves by time period of diagnosis are shown in Figure 1. Table 1. Multivariable Cox-Proportional Hazard Model for Mortality at 28 and 90-days Among Solid Organ Transplant Recipients Hospitalized for Covid-19 (N=979) Figure 1. Survival among SOT recipients hospitalized for Covid-19 by diagnosis time period Vertical tick marks represent censored cases. Early 2020 refers to cases diagnosed between March 1 and June 19, 2020 and late 2020 refers to cases diagnosed between June 20 and December 31, 2020. Conclusion Approximately 20% of deaths among SOTr hospitalized for Covid-19 occurred between days 29 and 90. Future investigations are required to discern the mechanism(s) for the improvement in early, but not late, mortality among SOTr with Covid-19 during the course of the pandemic. Disclosures Madeleine R. Heldman, MD, Cigna Lifesource (Other Financial or Material Support, Speaking honoraria)Thermo Fisher Scientific (Other Financial or Material Support, Speaking honoraria) Olivia S. Kates, MD, Merk (Scientific Research Study Investigator) Ajit P. Limaye, MD, astellas (Scientific Research Study Investigator)CTI (Scientific Research Study Investigator)GSK (Consultant)Johnson&amp;Johnson (Other Financial or Material Support, Adjudication Committee)merck (Consultant, Grant/Research Support, Scientific Research Study Investigator)moderna (Scientific Research Study Investigator)Novartis (Other Financial or Material Support, DMC member)Novo Nordisk (Consultant)

P-184: Regional differences in treatment and outcome for myeloma patients in Sweden: a population based Swedish Myeloma Register study

<h3>Background</h3> The objective of this study was to investigate if there are differences in survival for Multiple myeloma (MM) patients in Sweden depending on health care region and early use of modern therapies <h3>Method</h3> Cohorts (labelled A-F) were defined by the six healthcare regions in Sweden. Modern initial therapies were defined as bortezomib in combination with melphalan, cyclophosphamide or thalidomide or as therapy including lenalidomide, pomalidomide, carfilzomib or daratumumab. Only therapies started within a year from diagnosis were considered. Data from patients with MM in the Swedish Myeloma Register diagnosed during 2008-2017 was used. Overall, 5326 patients with MM were analyzed after 250 patients who did not receive any treatment were excluded. A one year follow up report was required to evaluate treatment. To adjust for time to treatment bias, separate analyses were performed for patients alive 6 months after diagnosis. <h3>Results</h3> In all treated MM patients, we observed a significant superior overall survival (OS) for region A compared to all other regions (p<0.01 for all respectively). After adjusting for time to treatment bias there was also a superior survival for patients with high use of modern initial therapy compared to intermediate and low use (p<0.01 for both). Initial modern therapy appeared to increase in regions over time. Age adjusted incidence for region A, B, C, D, E and F was 6.3, 6.1, 6.0, 5.9, 6.4 and 7.3 per 100 000, respectively. Coverage of one-year follow up was less frequent in region A (82.6 %) compared to other regions (95.2-99.2%). In patients treated with autologous stem cell transplantation (ASCT) a significantly superior survival was observed for region A compared to all regions besides region B. When adjusting for time to treatment bias, results were similar. In patients not treated with ASCT, 75 years or older, a superior survival was observed for region A when compared to region B, E and F (log rank p=0.02, p=0.04, p=0.02). After adjusting for time to treatment bias, a difference was noted only between region A and E (log rank p=0.04, HR 1.2, CI 1.00-1.44, p=0.06). In patients not receiving ASCT younger than 75 years of age we saw no differences in OS. When adjusting for age, ISS stage and time period of diagnosis, a difference remained in survival for patients treated with ASCT when comparing region A vs C, D, E and F (p=0.01, p<0.01, p<0.01, p=0.03). In patients not treated with ASCT, 75 years or older, no differences remained between the regions in multivariate analysis. <h3>Conclusion</h3> In conclusion we observed a superior survival in region A for patients treated with ASCT. Possible explanations may be higher usage of modern initial therapy, different number in cycles of pretreatment or regional residual confounding. In patients not receiving ASCT younger than 75 years of age no difference in survival was observed. For patients not receiving ASCT, 75 years or older the small differences in survival could be adjusted for.

Demographic and clinical characteristics of a population-based pediatric cohort of type 1 and type 2 diabetes in Western Australia (1999-2019).

To determine demographic and clinical characteristics of youth diagnosed with type 1 (T1D) or type 2 (T2D) diabetes aged ≤15 years from 1999 to 2019 in Western Australia, and examine time to first diagnosis of diabetes complications. A retrospective cohort study was conducted of patients identified from the population-based, prospective Western Australian Children's Diabetes Database and longitudinal data extracted for available demographic and clinical variables. Patients were followed from diagnosis to transition to adult services, death, or December 31, 2019. Cox proportional hazards regression models were used to analyse time to first diagnosis of hypertension, high cholesterol or microalbuminuria, after adjusting for sex, age at diagnosis, time period of diagnosis, hemoglobin A1c , and body max index Z-score. 2438 eligible patients were identified (2209 [91%] T1D: 229 [9%] T2D). The mean age at diagnosis was lower in patients with T1D (8.5 [±4.0] vs. 12.7 [±2.0] years). A higher proportion of patients with T2D were female (58% vs. 47%) and of Aboriginal ethnicity (59% vs. 2%). The median HbA1c (interquartile range) at diagnosis was lower 8.9% [6.7, 11.5] (74 mmol/mol [50, 102]) versus 11.6% [10.1, 13.3] (103 mmol/mol [87, 122]) and mean body max index Z-score higher (2.05 [±0.66] vs. 0.37 [±0.95]), in patients with T2D compared to T1D. Patients with T2D had a higher risk of hypertension, high cholesterol, and microalbuminuria (aHR 3.39 [95%CI:2.04, 5.63], 2.69 [95%CI:1.21, 5.98], and 19.79 [95%CI:10.99, 35.64] respectively).

Epidemiological Characteristics and Survival Analysis of Patients With Nasopharyngeal Cancer in Western Greece.

PurposeThe purpose of this study is to assess the overall survival (OS) of patients with nasopharyngeal cancer and the factors affecting the survival rates.MethodsA retrospective cohort study was performed, including 77 patients with nasopharyngeal cancer diagnosed and treated in the Otorhinolaryngology Clinic of the University Hospital of Patras during 1990-2017. The prognostic impact of age, gender, occupation, smoking/alcohol, and TNM staging were evaluated using Kaplan-Meier analysis.ResultsDuring the last 28 years, nasopharyngeal cancer (NPC) was higher in men (80.5% of patients) than women (19.5%) (mean age 56-years). Most patients were smokers (64.9%, mean 70 pack-years) and 35 (45.5%) of them were alcohol users. Postoperative staging indicated 39% stage-III, 26% stage-IV, and 26% stage-I. Histologically, 70.1% of the volumes were WHO-III, 20.8% WHO-II, and 5.2% WHO-I. Also, 98.7% of patients received radiotherapy, 85.7% chemotherapy, and 20.8% surgery. More than half were farmers (26%), self-employed (16.9%), and workers (14.3). During the follow-up (mean 66 months), 38 (49.5%) patients died, 88.9% from disease-related causes. The 5-year survival was 58.8%, 74.5% for non-smokers, and 49.1% for smokers, and 10-year survival was 43.6%, 63.4%, and 31.6%, respectively (p=0.016). Moreover, significant statistical differences were observed in age (p=0.054), time period of diagnosis and treatment (p=0.002), cause of death (p=0.033), and metastatic disease (p=0.023).ConclusionsAge, stage in disease detection, tumor characteristics, treatment, and tobacco abuse are important factors that affect the OS of patients with NPC during the three last decades.

Abstract PS8-06: Survival outcomes after chemotherapy in invasive lobular carcinoma compared to estrogen receptor positive invasive ductal carcinoma

Abstract Introduction Invasive lobular breast cancer (ILC) accounts for 10-15% of all invasive breast carcinomas and has distinct clinical and biological characteristics compared with the more common invasive ductal carcinoma (IDC). They are generally ER-positive (ER+) with the exception of a small number of pleomorphic cases and there is some evidence that the 10-year survival rate of women with ILC is lower than that for ER+ IDC. Furthermore, studies have shown that ILC may be less sensitive to chemotherapy than IDC, with lower rates of complete pathological response after neoadjuvant chemotherapy, but it is not clear what effects this has on long term survival. The aim of this study was to investigate whether ER+ ILC patients who received chemotherapy (neoadjuvant or adjuvant) had similar outcomes to ER+ IDC patients who received chemotherapy. Methods Patients were diagnosed at Guy’s &amp; St Thomas’ NHS Foundation Trust between 1971 and 2016 and were eligible for inclusion into the study if they were female, had been diagnosed with either IDC or ILC, if their tumours were ER+, and if they received chemotherapy. They were followed up from date of primary diagnosis until 30th June 2019 and were assumed to be alive in the absence of a reported death date. Patients with estrogen receptor negative (ER-) tumours were excluded, due to well-known chemosensitivity in these breast cancer subtypes. Data used was requested from the Guy’s &amp; St Thomas’ Breast Cancer Database. Results Of 5526 patients diagnosed with ILC or IDC between 1971 and 2016, 3945 were ER+ with 3436 IDC and 509 ILC. ER+ IDC and ILC had similar survival for the first 10 years after diagnosis after which outcomes began to diverge with worse outcomes in ILC. The 10-year and 15-year survival of 59.3% and 47.5% respectively were seen in IDC, and 58.6% and 44.6% in ILC. 1327 ER+ patients who received chemotherapy were selected for analysis, of which 161 (12.1%) were ILC and 1166 (87.9%) were IDC. 159 (12.0%) of patients received neo-adjuvant chemotherapy, while 1168 (88.0%) received adjuvant chemotherapy. In chemotherapy patients, 10-year survival was 53.1% in ILC and 54.0% in IDC, and by 15 years this was 35.1% and 44.7% respectively. In ER+ chemotherapy patients, there was no evidence of a crude association between histological subtype and survival (HR: 1.19, 95% CI: 0.97, 1.47) using Cox regression. However, the multivariate Cox regression model estimated a significantly worse outcome in ILC compared to IDC (HR: 1.28, 95% CI: 1.02, 1.60), adjusted for chemotherapy (neo-adjuvant or adjuvant), stage (I-IV), grade, HER2 status, time period of diagnosis, and surgery type (mastectomy or excision). When stratified by chemotherapy, this association was only observed in patients that received adjuvant treatment. Conclusion This study suggests that ER+ ILC patients who received adjuvant chemotherapy may have a worse outcome than ER+ IDC when adjusted for stage and grade. This is a potentially important finding but needs to be studied in a larger population treated with modern chemotherapy regimens. Other studies have shown that the outcome for ILC is better in the first 5 years after diagnosis compared to ER+ IDC but worsens after 10 years, as it does in this study. Thus, having long follow up is essential in order to be able to detect any differences in survival between ILC and ER+ IDC. Nonetheless, this study has displayed a significant difference in survival between ER+ ILC and ER+ IDC receiving adjuvant chemotherapy, and thus recommendations for adjuvant chemotherapy may need to be considered separately for the two subtypes. Furthermore, it would be beneficial to develop a tool that could help in identifying cases of ILC that would most benefit from chemotherapy. Citation Format: Jasmine Timbres, Charlotte Moss, Anca Mera, Anna Haire, Cheryl Gillett, Mieke Van Hemelrijck, Elinor Sawyer. Survival outcomes after chemotherapy in invasive lobular carcinoma compared to estrogen receptor positive invasive ductal carcinoma [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-06.

Outcome Among Adolescents and Young Adults with Mature B-Cell Non Hodgkin Lymphoma at Pediatric Versus Adult Centers: A Population-Based Study Using the IMPACT Cohort

Background: Disparities in survival between adolescents and young adults (AYA) treated for acute lymphoblastic leukemia in pediatric versus adult centers are well documented. Whether similar disparities exist among AYA with mature B-cell non-Hodgkin lymphoma (B-NHL) is unknown, despite substantial differences between pediatric and adult treatment protocols. We compared outcomes among AYA with B-NHL by locus of care (LOC; pediatric versus adult) using a population-based clinical AYA database. We also assessed whether socioeconomic status or geographic area impacted outcome in this population. Methods: The IMPACT cohort comprises all Ontario, Canada AYA aged 15-21 years diagnosed with one of six common cancers (including NHL) between 1992-2012. Detailed demographic, disease (histology, stage), treatment, and outcome data were collected through chart abstraction and validated by content experts. Postal code at diagnosis allowed determination of neighbourhood income quintile and rural residence. Linkage to population-based health administrative data identified additional events (second cancers, relapse, death). Event-free (EFS) and overall survival (OS) were determined using Kaplan-Meier methods. The impact of LOC on EFS and OS was determined using multivariable Cox proportional hazard models, adjusted for demographics and disease-related variables. Results: Among 176 AYA with B-NHL, 62 (35.2%) received therapy at a pediatric center. Pediatric center AYA were more likely to have Burkitt lymphoma (BL) than diffuse large B-cell lymphoma (DLBCL) as compared to adult center AYA [26/62 (41.9%) vs. 21/114 (18.4%); p&amp;lt;0.001], and more likely to have advanced stage (i.e. Stage III/IV) disease [38/62 (61.3%) vs. 46/114 (40.4%); p=0.006]. The 5-year EFS and OS (with standard errors) for the whole cohort were 72.2%±3.4% and 76.1%±3.2%. Both EFS and OS were superior among pediatric center patients (EFS 82.2%±4.9% vs. 66.7%±4.4%; p=0.02), (OS 85.5%±4.5% vs. 71.1%±4.3%; p=0.03). When stratified by histology (BL vs. DLBCL), the EFS and OS were similar. However, the superior outcome of pediatric center AYA retained statistical significance only among those with DLBCL (Table 1). Adjusted for histology (BL vs. DLBCL), stage, and time period of diagnosis, adult center AYA had inferior EFS [hazard ratio (HR) 2.4, 95% confidence interval (95CI) 1.1-4.9, p=0.02] and OS (HR 2.5, CI 1.1-5.7, p=0.03). Neither neighbourhood income quintile nor rural residence was associated with EFS or OS. Conclusions: In this population-based cohort, AYA with B-NHL treated at pediatric centers experienced substantially superior EFS and OS compared to those treated at adult centers, even accounting for disease characteristics. In subgroup analyses, this difference retained statistical significance among patients with DLBCL but not among patients with BL, though the latter analyses were limited by small sample sizes. Future analyses will analyze whether patterns of treatment failure and late effects vary by locus of care. Further confirmatory studies are warranted, as are studies to determine the relative contribution of pediatric protocols versus other components of care. Our results nonetheless suggest that similar to AYA with acute lymphoblastic leukemia, AYA with B-NHL may benefit from being treated in pediatric centers with pediatric protocols. Disclosures Baxter: Servier: Membership on an entity's Board of Directors or advisory committees.

Characteristics of male triple negative breast cancer: A population-based study.

Male triple negative breast cancer (TNBC), which lacks expression of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), is a very rare entity, comprising only a very small percentage of all male breast cancer cases. Management strategies are typically based off research conducted in female TNBC patients; however, there is still much that remains unknown in the male cohort, such as risk factors for developing these malignancies, the optimal treatment approach, and both short-term and long-term outcome data. In this retrospective cohort study, we aimed to address these concerns by assessing both the characteristics of male patients who develop TNBC as well as their outcomes. We harnessed data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program and identified 66 male patients diagnosed with TNBC between 2010 and 2016. Patients were stratified by several variables including age, insurance status, time period of diagnosis, histology, nodal status, tumor grade, tumor stage at diagnosis, and treatment strategy employed for the assessment of overall survival (OS) differences. Our analysis demonstrated that stage remains the most important prognostic factor for OS, with higher stage corresponding to worse OS. A significant OS benefit was also identified in men undergoing a total mastectomy, compared to partial mastectomy or no surgery at all. We also identified that male patients are more likely to present with more advanced disease stages compared to their female counterparts and, therefore, have worse outcomes on average. This may be due to various factors, including the rarity of male TNBC cases and less clear screening guidelines for male breast cancer in general. Trends toward poorer OS with higher tumor grade, higher tumor T stage, advanced age, earlier time period of diagnosis, and ductal histology were also identified, but did not achieve statistical significance. The remaining variables did not appear to influence outcomes in a meaningful manner. In summary, our study suggests, similar to population studies of women with TNBC, that tumor stage is a major prognostic factor of OS in men with TNBC. The data also suggest that the surgical treatment strategy employed is also likely of significance, with improved OS being seen with total mastectomies over partial mastectomies. Other variables such as tumor grade and T stage also likely play a role, but did not achieve statistical significance owing to the small population size. Owing to the rarity of cases, further studies of male TNBC are needed to better understand this rare entity and guide future management strategies.

Real-life outcomes of unselected acute promyelocytic leukemia patients: a single-center 14-year experience.

After the inclusion of all-trans retinoic acid (ATRA) into the treatment of Acute Promyelocytic leukemia (APL), a notable improvement concerning the survival rates of patients with APL has been observed. However, the population-based studies demonstrated that there was no marked improvement in the survival of patients after the 2000s. We aim to describe the clinical response and prognosis of adult patients diagnosed with APL and examine the change in these outcomes by the time period of diagnosis. We retrospectively reviewed thirty-six unselected APL patients who were diagnosed between September 2003 and February 2016. The probability of survival at two years was 58%, while disease-free survival (DFS) was 87%. The overall early death (ED) rate was 33% and remain stable over time [42% in 2003-2009 vs. 24% in 2010-2016 (p=.20)]. In addition, the 2-year overall survival (OS) rates were 47% in 2003-2009 and 70% in 2010-2016 (p=.29), and no differences were noted. Univariate analyses showed possible predictors of poor OS were defined as leukocytosis (≥10x109/L), high Sanz score, hemorrhage, infection, disseminated intravascular coagulopathy (DIC) at presentation and microgranular morphologic subtype. This study shows that long-term survival remains low in APL patients, particularly related to a high ED rate. Initiatives to reduce ED are exceedingly substantial for improving the survival in APL.

P060 THE TREND OF DIAGNOSTIC COMPETENCY OF CROHN’S DISEASE IN THAI POPULATION FOR THE PAST TWO DECADES

Abstract Background Crohn’s disease (CD) is an uncommon disease in Thai population, leading to delay in diagnosis due to lacking of familiarity, which may increase disease complications. One of the most problematic issues is to differentiate CD from intestinal tuberculosis (ITB), and many scoring systems have been introduced since 2006. However, competency of diagnosis of CD in the latter period is still unknown in Thailand. Our aim is to compare this competency in the period of 2000–2006, 2007–2012, and 2013–2018. Methods Retrospective study collecting all patients, whom diagnosed with CD in two tertiary referral centers in Bangkok, was performed. We focused the competency of diagnosis of each period by using the following variables; duration of presenting symptoms, number of colonoscopy before diagnosis, receiving anti-TB medication before diagnosis, and having first surgery before and at diagnosis. Comparison in each parameter was done by statistical analysis. Results A total of 190 CD patients were identified. Characteristics of patients were shown in Table 1. The patients were classified into 3 groups by using time period of diagnosis, which included 27, 62, and 101 patients in the 2000–2006, 2007–2012, and 2013–2018 period groups, respectively. Mean age was 38.6, 46, and 47.7 respectively. Nearly 50% were male, and 80% had inflammatory phenotypes in all groups. The median duration of presenting symptoms was 15.8, 10.1, and 11.7 months in the 2000–2006, 2007–2012, and 2013–2018 period groups, respectively (p=0.67). The percentage of patients receiving anti-TB medication before diagnosis was 19.2%, 9.8%, and 10.2%, in each group respectively (p=0.31). The number of colonoscopy for 1, 2, and &amp;gt;2 times before diagnosis were 56.5%, 30.4%, and 13.1%; 55.7%, 24.6%, and 19.7%; and 41.7%, 38.5%, and 19.8% in each group, respectively (p=0.32). The percentage of patients undergoing first surgery before or at diagnosis were 33.3%, 21.0%, and 26.8%, respectively (p=0.80). Conclusion Competency in diagnosis of CD in Thailand has not changed in the past 2 decades. It is necessary to find effective methods helping physicians differentiate CD from other conditions to avoid the diagnosis delay, which may improve treatment outcomes.

Changes in clinical features of multiple system atrophy in Japan

IntroductionMultiple system atrophy (MSA) is an adult-onset progressive neurodegenerative disease that causes parkinsonism, cerebellar ataxia, and/or autonomic failure. MSA is categorized as MSA with predominant cerebellar ataxia (MSA-C) or MSA with predominant parkinsonism (MSA-P) according to the cardinal symptom at diagnosis. MSA-C has been reported to be the predominant presentation in Japan to date. However, major epidemiological studies regarding MSA in Japan were carried out before 2006; thus, the recent advancement of various imaging studies remains unclear. This study aimed to investigate the clinical characteristics of the recent MSA patients in Japan. MethodsIn this retrospective study, we divided 80 probable MSA patients into group A and group B and examined them to reveal whether the clinical features of MSA were different depending on the time periods of diagnosis (1989–2003 and 2004–2018, respectively). ResultsThe age at onset was significantly higher in MSA-P patients than in MSA-C patients (p = 0.0039) and was also higher in group B than in group A (p = 0.013). Although MSA-C was the predominant type in both groups, MSA-P was significantly more frequent in group B than in group A (p = 0.039). Although not statistically significant, the early heart/mediastinum ratio in [123I]-meta-iodo benzylguanidine (MIBG) myocardial scintigraphy tended to be lower in patients with MSA-P than in those with MSA-C. ConclusionThe proportion of MSA-P was likely larger than previously recorded due to the aging population in Japan and the improvement of differential diagnosis between PD and MSA-P.

Trends of incidence and survival in patients with gastroenteropancreatic signet ring cell carcinoma: an analysis from the Surveillance, Epidemiology, and End Results program.

The epidemiology and clinical outcome of gastroenteropancreatic signet ring cell carcinoma (SRC) were not well illustrated. We aimed to explore the long-term epidemiology and predictors affect the overall survival (OS) of patients with SRC in gastrointestinal tract and pancreas. Annual age-adjusted incidence, OS and survival trend of patients with gastroenteropancreatic SRC were evaluated in the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2014. Multivariate Cox hazards regression model were used to identify predictive factors of the entity disease. Of the 24,613 patients in the cohort, 54.0% (13,295) were male gender. The age-adjusted incidence of SRC from January 2000 to December 2014 was decreased slightly. This trend appeared across all stages, grades and all the tumor locations, excerpt for esophagus and appendix. In regard to the incidence of SRC in gastrointestinal tract and pancreas, the stomach carried a higher incidence than other sites. Different primary site, stage and grade, and age of clinical diagnosis as well as time period of diagnosis were all found to have the significant median OS by multivariable analysis. Five years' OS of gastroenteropancreatic SRC was improving gradually between 2000-2014. In subgroups stratified by tumor stages and grades, the most pronounced improvement of survival over the same interval was observed in the early-stage and well differentiation SRC. SRC in a heterogeneous US population tended to carry the poor prognosis with a high proportion of distant metastasis. The poor prognosis of SRC was mainly caused by high tumor stages and poor differentiation at diagnosis.