US Surveillance, Epidemiology, And End Results Research Articles

Subsite-specific metastatic organotropism and risk in gastric cancer: A population-based cohort study of the US SEER database and a Chinese single-institutional registry.

Studies exploring whether metastatic organotropism and risk in gastric cancer (GC) differ by primary anatomical site are scarce. This study included 15,260 and 1623 patients diagnosed with GC from the Surveillance, Epidemiology, and End Results (SEER) registry database and the Nanfang Hospital in China, respectively. Patients were stratified according to primary site of GC, and the incidence of metastasis to different organs was used to determine the metastatic organotropism for each GC subsite. Finally, the metastatic organotropism and risk were compared among the different subsite groups. Liver metastasis was the most common metastasis site in cardia GC, whereas other-site metastases were more common in the body, antrum, overlapping lesions, and unspecified GCs. Liver and other-site metastases were also frequently observed in the fundus, pylorus, lesser curvature, and greater curvature GCs. Patients with GC with definite primary tumor sites in the SEER and validation Nanfang hospital cohorts were compared by grouping as proximal and distal GCs for further analysis. In the SEER cohort, the top three metastatic sites of proximal GC were liver (21.4%), distant lymph node (LN) (14.6%), and other-site (mainly peritoneum, 11.9%), whereas those of distal GC were other-site (mainly peritoneum, 19.5%), liver (11.8%), and distant LN (9.5%). The incidence of metastasis to the liver, distant LN, lung, and brain was significantly higher in patients with proximal GC than in those with distal GC in both the SEER and Nanfang cohorts (p < 0.05). However, metastasis to other-site/peritoneum was significantly lower in patients with proximal GC compared to those with distal GC in the Nanfang Hospital and SEER cohorts, respectively (p < 0.05). Liver and distant LN are the preferred metastatic sites for proximal GC, whereas peritoneal metastasis is more common in distal GC. Proximal GC has a higher risk of lymphatic and hematogenous metastases, and a lower risk of transcoelomic metastasis than distal GC. Our findings highlight the need to stratify GC by its primary subsite to aid in planning and decision-making related to metastatic management in clinical practice.

Differences in racial and sex at birth representativeness between randomized controlled trial (RCT) and real-world evidence (RWE) or Surveillance, Epidemiology, and End Results (SEER) datasets in advanced non-small cell lung cancer (aNSCLC).

e18654 Background: Historically, racial and ethnic minorities, women, and older patients have been underrepresented in RCTs. Hence, therapeutics are approved based on data not representative of the broader population, leaving important gaps in knowledge of safety and effectiveness. RWE may help address these gaps and inform regulatory, clinical, payer, and manufacturer decision-making. Racial, sex at birth, and age distributions were compared between RWE studies and a corresponding RCT in the aNSCLC setting. Additionally, RCT data were compared to SEER aNSCLC data. Methods: Demographics of adults with aNSCLC in the KEYNOTE-407 RCT were compared with those of adults in two physician-abstracted medical chart review US RWE studies conducted in 2019 or 2020 or with the most recently available US SEER data (2017-2019). Statistical comparisons were performed using t-tests or chi square tests. Results: We identified 10,089 patients (RCT: n = 559, 5.5%; RWE: n = 783, 7.8%; SEER: n = 8,747, 86.7%) (Table). Significant differences in racial distribution were observed between the RCT and RWE study populations, with Black/African American patients comprising 1.3% of RCT patients and 24.0% of the RWE study population. Non-Hispanic Black patients made up 12.8% of SEER patients. The proportion of female patients was lower in the RCT (18.6%) compared with RWE (40.5%) and SEER (36.7%) data. Age at 1L initiation was significantly lower for RCT patients vs. age at metastatic diagnosis in SEER (mean: 64.7 vs. 70.0 years). However, no statistically significant difference in age at 1L initiation was observed between RCT and RWE data (64.9 vs. 64.7 years). Conclusions: In aNSCLC, significant differences in sex at birth and race were observed between RCT and RWE study populations. Additionally, significant differences in sex at birth and age were observed between RCT and SEER data. Given that regulatory, therapeutic development, clinical, payer, and decision-making is largely driven by data from RCTs, future research can leverage RWE to improve representativeness and generalizability. [Table: see text]

Clinicopathological characteristics and cancer-specific prognosis of primary pulmonary lymphoepithelioma-like carcinoma: a population study of the US SEER database and a Chinese hospital.

Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) is a rare histological type of non-small cell lung cancer (NSCLC), which accounts for less than 1% of NSCLC. Currently, there is no well-recognized treatment guideline for PPLELC. We identified PPLELC patients from the Surveillance, Epidemiology, and End Results (SEER) dataset between 2000 and 2015 (n = 72) as well as from our medical center between 2014 and 2020 (n = 16). All diagnoses were confirmed by pathological testing, and the clinicopathological characteristics of patients were retrieved and summarized. Survival analyses were conducted using the Kaplan-Meier analysis and log-rank tests. Multivariate survival analysis was performed with the Cox regression hazards model. The median age at diagnosis of the PPLELC cohort was 64 years, ranging from 15 to 86 years. The percentages of patients with TNM stages I, II, III, and IV were 52.3%, 10.2%, 20.5%, and 17.0%, respectively. Among the 88 cases, lesion resection was performed in 69 cases (78.4%), 16 cases (18.1%) received beam radiation, and 40 cases (45.5%) underwent chemotherapy. In the SEER dataset of lung cancer, the percentage of PPLELC in the Asian race (0.528‰) was almost 10 times higher than that in the white (0.065‰) and black (0.056‰) races. Patients with TNM stage III-IV exhibited a worse prognosis than those with TNM stage I-II (p = 0.008), with a 5-year cancer-specific survival (CSS) rate of 81.8% for TNM stage I-II and 56.2% for TNM stage III-IV. Specifically, the N stage and M stage were the leading prognostic factors, not the T stage and tumor size. Moreover, patients who underwent surgery had significantly better outcomes than those who did not (p = 0.014). Additional multivariate analysis indicated that the TNM stage was an independent prognosis factor for CSS (HR, 3.31; 95% CI, 1.08-10.14). PPLELC is a rare tumor with Asian susceptibility. Although the prognosis of PPLELC is better than that of other subtypes of NSCLC, it remains unsatisfactory for advanced-stage disease. The current treatment options for PPLELC include surgical resection, chemotherapy, radiotherapy, and immune therapy. Among these options, patients with surgical resection have better survival rates in this study. However, large-scale clinical research trials will be necessary to develop effective treatment guidelines for PPLELC.

Trends in the cause of death among patients with bladder cancer in the US SEER population, 1992-2018.

Bladder cancer (BC) survival has shown no significant improvement. This study investigated the trends in the common causes of death among patients with BC to improve the management and survival of BC. The Surveillance, Epidemiology, and End Results (SEER) (1992-2018) database was utilized to get the data of BC patients. We presented the proportion of six common causes of death in BC patients. We calculated the annual incidence of death due to the six most common causes and analyzed temporal trends in mortality rates using joinpoint regression. The competitive risk model was utilized to analyze the risk factors for death of BC and other causes. 198037 BC patients were enrolled. BC was the most common cause of death (30.62%), followed by other cancers (22.22%), circulatory diseases (20.28%), non-disease causes (11.58%), other non-cancer diseases (8.29%), and respiratory diseases (7.01%). However, the proportion of cases dying from BC gradually decreased from 44.87% in 1992-1996 to 26.74% in 2012-2018. The proportion of deaths due to BC decreased gradually with survival time from diagnosis. Age-standardized temporal trends present an initial increase in BC-specific and other-cause mortality rates. Advanced stage and older age were the most influential risk factors for BC-specific and other-cause death, respectively. Although BC was still the leading cause of death, other causes, especially other cancers and circulatory diseases, gradually became more critical. The management of other comorbid conditions will be a crucial part of the treatment for BC patients, especially for those with prolonged survival and NMIBC tumors.

Abstract P1-01-05: Influence of age and tumor size on lymph node positivity in breast cancer: A retrospective population study on the US SEER database

Abstract Background: Lymph node positivity (LNP) is among the most important prognostic factors in breast cancer. Counterintuitively, a negative association of LNP with age has been shown in different cancers. The goal of this study is to determine the influence of age and tumor size on lymph node positivity in breast cancer in a large real-world population setting. Methods: Patients aged 0-85 years with primary invasive breast cancer who underwent primary surgery and lymph node dissection between 2010 and 2018 were selected using the U.S. Surveillance, Epidemiology, and End Results (SEER) database. Patients with systemic therapy before surgery or patients not receiving surgery for the breast tumor and/or lymph nodes were excluded. We used a multivariate logistic regression model to determine the association of age with regional LNP. We corrected for grade, tumor size, ER-, PR- and HER2-positivity and race. Based on previous studies and exploratory analysis on the current database, we used a piecewise effect of age with cutoff at 70y, and an interaction term between age and tumor size. We also introduced a piecewise linear effect for tumor size, with cut-off at 50mm. Results: (see table) 177,866 patients were included. The multivariate model suggests that LNP strongly decreases with age in patients with breast cancer ≤ 70y. This effect is stronger for smaller tumor sizes. The effects in patients &amp;gt;70 years are less clear, and may be more biased by delay in diagnosis or selection bias as older patients with small tumors are less likely to undergo surgery (of both breast tumor and lymph nodes).Concerning impact of tumor size, our analysis shows that LNP strongly increases with tumor size in tumors ≤ 50 mm as expected, but that this association is not present anymore in tumors &amp;gt; 50 mm. Conclusion: We found a clear negative association of LNP with age in patients ≤ 70 years, when corrected for grade, tumor size, ER-, PR- and HER2-positivity and race. This points to differences in biological mechanisms of lymph node invasion in young versus older persons that are counterintuitive and poorly understood. We also found that LNP strongly increases with tumor size in tumors ≤ 50 mm, but not in larger tumors. The impact of age on tumor biology, micro-environment and the lymphatic system may each play a role. However, these areas are understudied and further research is needed to understand the mechanism behind the current results. Impact of age on Lymph node positivity (LNP), according to tumor sizeAge expressed per 10-year increaseTumor sizeOdds Ratio (95% CI)≤70y15mm0.852 (0.841;0.863)25mm0.871 (0.860;0.881)40mm0.900 (0.885;0.914)&amp;gt;70y15mm0.980 (0.939;1.023)25mm1.002 (0.960;1.046)40mm1.035 (0.990;1.082)Impact of tumor size on Lymph node positivity (LNP), according to ageTumor size expressed by 1 cm increaseAgeOdds Ratio (95% CI)≤50mm50y2.041 (2.016;2.066)60y2.086 (2.063;2.109)70y2.132 (2.105;2.159)80y2.179 (2.143;2.215)&amp;gt;50mm50y0.957 (0.945;0.970)60y0.978 (0.967;0.990)70y1.000 (0.987;1.013)80y1.022 (1.005;1.039)OR: odds ratio, CI: confidence interval OR&amp;gt;(&amp;lt;)1: increased (decreased) risk with increasing level (ordinal variables)/for first category (binary variables) Citation Format: Michael Pinchuk, Annouschka Laenen, Sigrid Hatse, Kevin Punie, Patrick Neven, Ines Nevelsteen, Hans Wildiers. Influence of age and tumor size on lymph node positivity in breast cancer: A retrospective population study on the US SEER database [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-01-05.

Risk of developing second malignant neoplasms in patients with neuroblastoma: a population study of the US SEER database

BackgroundNeuroblastoma is a common extracranial malignant tumor in children. Its main treatment modality is a combination of chemotherapy, radiotherapy, and surgery. Given the advances in chemotherapy regimens and the widespread use of bone marrow transplantation over the decades, there has been improvement in treatment efficacy, which has led to prolonged patient survival. Accordingly, long-term complications have become a growing concern among physicians and patients. This study aimed to analyze the survival rate of patients with neuroblastoma and the risk factors for developing second malignant neoplasms (SMNs).MethodsThe SEER 18 Regs (1973–2015) and SEER 9 Regs (1973–2015) data of the surveillance, epidemiology, and end results (SEER) database of the US National Cancer Institute were adopted for survival and SMN analysis.ResultsThe 5-, 10-, and 20-year overall survival rates of patients with neuroblastoma were 67%, 65%, and 62%, respectively. Among 38 patients with neuroblastoma who presented with SMNs, those with abdomen as the primary site accounted for the majority (63.2%), followed by those with thorax (26.3%) and other sites (10.5%). SMNs occurred more commonly in non-specific neuroblastoma (incidence: 0.87%) than ganglioneuroblastoma (incidence: 0.3%). Compared with the general population, the risk of SMN is significantly higher (SIR = 4.36). The risk of developing SMNs was significantly higher in the digestive system (SIR = 7.29), bones and joints (SIR = 12.91), urinary system (SIR = 23.48), brain and other nervous systems (SIR = 5.70), and endocrine system (SIR = 5.84). Multivariate analysis revealed that the year of diagnosis (OR = 2.138, 95% CI = 1.634–2.797, p < 0.001) was the only independent risk factor for developing SMNs.ConclusionThis study identifies the risk factor for developing SMNs in patients with neuroblastoma, which could facilitate individualized screening for high-risk patients, to allow early diagnosis and treatment of SMNs.

The prognostic performance of the log odds of positive lymph nodes in patients with esophageal squamous cell carcinoma: A population study of the US SEER database and a Chinese single‐institution cohort

BackgroundThe purpose of this study was to assess the prognostic performance of the log odds of positive lymph nodes (LODDS) value compared with the pathological N stage and lymph node ratio (LNR) in patients with esophageal squamous cell carcinoma (ESCC).MethodIn total 1144 patients diagnosed with ESCC from the Surveillance, Epidemiology, and End Results (SEER) database and 930 patients from our validation cohort were eligible. Kaplan–Meier plotter and multivariate Cox proportional hazards models were conducted to investigate the prognostic value of the N stage, LNR stage, and LODDS stage. The homogeneity, discriminatory ability, and monotonicity of these variables were evaluated using the linear trend χ 2 test, likelihood ratio χ 2 test, Akaike information criterion (AIC), and consistency index (C‐index) to determine the potential superiorities.ResultsThe prognostic LODDS cutoff values were determined to be −1.49 and −0.55 (p < 0.001). Univariate analyses showed significant association among the N, LNR, and LODDS stages and overall survival of the patients (all p < 0.001). Multivariate analyses confirmed that the LODDS stage remained an independent prognostic indicator in both the SEER database and our validation cohort. Subgroup analyses identified the ability of LODDS stage to distinguish heterogeneous patients within various groups in both independent databases. Furthermore, the model with the highest C‐index and smallest AIC value was the one incorporating the LODDS stage among the three investigated nodal classifications of both cohorts.ConclusionThe novel LODDS stage demonstrated better prognostic performance than the traditional N or LNR stages in ESCC patients. It can serve as an auxiliary factor to improve prognostic performance and can be applied to evaluate the lymph node status to increase the precision of staging and evaluation of survival.

The Prognostic Performance of Log Odds of Positive Lymph Nodes in Patients with Esophageal Squamous Cell Carcinoma: A Population Study of the US SEER Database and a Chinese Single-Institution Cohort

Background: The purpose of this study was to assess the prognostic performance of log odds of positive lymph nodes (LODDS) compared with pN stage and lymph node ratio (LNR), in patients with esophageal squamous cell carcinoma (ESCC). Method: A total of 1,144 patients diagnosed with ESCC from the Surveillance, Epidemiology and End Results (SEER) database and 930 patients from our validation cohort were eligible. Kaplan-Meier plot and multivariate Cox proportional hazards models were conducted to investigate the prognostic value of pN, LNR and LODDS classifications. The homogeneity, discriminatory ability, and monotonicity of these variables were evaluated using the linear trend χ2 test, likelihood ratio χ2 test, Akaike information criterion (AIC) and consistency index (C-index) to determine the potential superiorities. Results: The prognostic cut-off values were determined as -1.49, and -0.55 (P< 0.001). Univariate analyses showed that pN, LNR and LODDS stages significantly influenced the overall survival (OS) of patients (all P < 0.001). Multivariate analyses confirmed that LODDS was an independent prognostic indicator in both the SEER database and our validation cohort. Subgroup analyses identified the LODDS as an important prognostic factor over the ability of distinguish heterogeneous patients within various groups in both two independent databases. Furthermore, the model incorporated LODDS had the highest C-index and the smallest AIC value among the three investigated nodal classifications of both cohorts. Conclusion: The novel LODDS classification showed a better prognostic performance than the traditional N or LNR classifications in patients with ESCC. It can serve as the auxiliary prognostic factor out of the better performance and apply to the evaluation of the lymph node status devoting for precise staging and better survival. Funding Statement: This work was supported by National Natural Science Foundation of China, Clinical Trial Project of Tianjin Medical University, Bethune Charitable Foundation-Excelsior Surgical Fund, and Science and Technology Project of Tianjin Municipal Health Commission. Declaration of Interests: No potential conflicts of interest are disclosed. Ethics Approval Statement: This study obtained approval from the Ethical Committee and institutional review board of Tianjin Medical University Cancer Institute and Hospital.

The Impact of Radiotherapy on the Incidence of Secondary Malignancies: A Pan-Cancer Study in the US SEER Cancer Registries.

The population of cancer patients with second primary malignancies (SPMs) is rapidly growing. The relationship between radiotherapy and SPMs for some types of tumors is unknown or debated. In this study, we identify 24 types of first primary malignancies (FPMs) between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. Patients in the radiotherapy group were matched to those in the no radiotherapy group with a matching ratio of 1:1. After propensity-score matching (PSM), additional competing risk regression analyses were performed to calculate the efficacy of radiotherapy to SPMs in the PSM-adjusted population. In addition, the Fine and Gray model was utilized in the primary cohorts, and stratified analyses were performed based on surgery. This study includes a total of 2,831,789 eligible patients with tumors diagnosed from 2004 to 2015 in the SEER 18 database, amongst whom 100,194 (3.5%) patients developed SPMs. We observe higher risks of SPMs associated with radiotherapy in several types of tumors in the PSM-adjusted populations (small bowel adenocarcinoma, small cell lung carcinoma, prostate adenocarcinoma, urinary bladder transitional cell carcinoma, invasive ductal breast carcinoma, invasive lobular breast carcinoma, and Hodgkin lymphoma). The results in the PSM-adjusted populations were consistent with outcomes in the multivariable competing risk models. Meanwhile, in subgroup analyses stratified by surgery, some other types of tumor (except for those with positive results in the PSM-adjusted cohorts) with radiotherapy were also associated with a higher prevalence of SPMs in the subgroups of surgical treatment (pancreatic adenocarcinoma, rectal adenocarcinoma, lung adenocarcinoma and follicular thyroid carcinoma in the surgery subgroups). The impact of radiotherapy on the incidence of secondary malignancies is distinct in different types of cancer. These findings merit further investigation and may ultimately impact treatment decision-making for tumor management.

Impact of Primary Tumor Size on Prognosis in Patients With Metastatic Renal Cell Carcinoma Receiving Cytoreductive Nephrectomy: A Population Study of a Chinese Center and the US SEER Database.

Background:The relationship between the size of the primary tumor and the prognosis of patients with metastatic renal cell carcinoma (mRCC) is unclear. In this study, we aimed to investigate the significance of the size of the primary tumor in mRCC.Methods:We retrospectively reviewed the data of patients with mRCC who underwent cytoreductive nephrectomy (CN) from 2006 to 2013 in a Chinese center (n = 96) and those in the Surveillance, Epidemiology, and End Results (SEER) database (from 2004 to 2015, n = 4403). Tumors less than 4 cm in size were defined as small. Prognostic factors were analyzed using univariate and multivariate Cox proportional hazards regression analyses.Results:Patients with small tumors had a longer overall survival than other patients, both in the Chinese cohort (median, 30.0 vs 24.0 months, P = 0.026) and the SEER cohort (median, 43.0 vs 23.0 months, P < 0.001). After adjusting for other significant prognostic factors, small tumor size was still an independent protective factor in the Chinese cohort (adjusted hazard ratio [HR], 0.793; 95% confidence interval [CI]: 0.587–0.998, P = 0.043). In the SEER cohort, multivariate analysis showed that small tumor size was also an independent protective factor (HR, 0.880; 95% CI: 0.654–0.987, P = 0.008). In addition, as a continuous variable, a 1 cm elevation in tumor size translated into a 3.8% higher risk of death (HR, 1.038; 95% CI, 1.029–1.046; P < 0.001).Conclusion:Patients with small tumors may have a favorable prognosis after CN for mRCC. Although CN is not a standard protocol in mRCC, small tumor size may be a candidate when we are deciding to perform CN because of the potential benefit for OS.

Thermal Ablation Versus Wedge Resection for Stage I Non-small Cell Lung Cancer Based on the Eighth Edition of the TNM Classification: A Population Study of the US SEER Database.

BackgroundThe incidence rates of early-stage non-small cell lung cancer (NSCLC) are now increasing, and therapies such as thermal ablation have shown potential therapeutic promise. This study aimed to determine the influence of different surgical methods on overall survival (OS) and cancer-specific survival (CSS) in patients with stage I NSCLC.MethodsPatients diagnosed with stage I NSCLC who had received thermal ablation or wedge resection between 2004 and 2014 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed according to the surgical method. Kaplan–Meier curves and a Cox proportional hazard model were used to evaluate OS and CSS.ResultsIn all, 4,372 patients with stage I NSCLC were included. Before PSM, the respective 3- and 5-year OS rates were 68.9 and 52.7% in the wedge resection group and 68.5 and 47.8% in the thermal ablation group (p < 0.0001); the corresponding CSS rates were 79.1 and 69.4% and 62.6 and 46.0% (p < 0.0001). After PSM, survival analysis showed that wedge resection had better OS (44.5% vs. 30.1%, p = 0.033) and CSS (63.5% vs. 46%, p = 0.038) than thermal ablation. After PSM, Cox regression showed that treatment was not associated with OS or CSS. For patients aged >75 years, thermal ablation showed similar OS and CSS as wedge resection (OS: 30.6% vs. 41.7%, p = 0.470; CSS: 46.4% vs. 64.1%, p = 0.100). After PSM, thermal ablation still had OS (30.6% vs. 41.0%, p = 0.470) and CSS (46.4% vs. 59.8%, p = 0.100) comparable to wedge resection.ConclusionFor patients with stage I NSCLC who are unfit for lobectomy, thermal ablation could be a potential therapeutic option, especially for those >75 years old.

Clinical Outcomes of N3 Breast Cancer: A Real-World Study of a Single Institution and the US Surveillance, Epidemiology, and End Results (SEER) Database.

BackgroundAlthough stage IIIC (any TN3M0) breast cancer is known to have a dismal prognosis, the clinical outcome of current standard management and the prognostic differences between N3a, N3b and N3c remain to be further investigated.Material and MethodsData from our center on pathologic N3 (pN3) (n=284) breast cancer and the US Surveillance, Epidemiology, and End Results (SEER) database on clinical N3 (cN3) (n=15,291) and M1 (n=23,623) breast cancer between January 2004 and December 2015 were systematically analyzed for clinicopathological characteristics and survival outcomes.ResultsIn our institution, patients with pN3c had the worst survival, with 5-year OS and DFS rates of 52.4% and 41.5%, respectively. Patients with pN3b had a relatively good prognosis, with a 5-year OS rate of 75.3% vs 63.9% for the pN3a group (p=0.045). For DFS, the 5-year survival rate was 63.1% in the pN3b group compared with 40.3% in the pN3a group (p=0.030). In the US SEER database, patients with cN3c had the worst survival in the cN3 group, but the prognosis of cN3c was much better than that of M1. Similarly, patients with cN3b had a better prognosis compared with patients in other groups, with a 5-year OS rate of 68.9% vs 61.9% for the cN3a group (p<0.001) and a 5-year BCSS rate of 73.4% vs 67.1% for the cN3a group (p<0.001).ConclusionBreast cancer patients with N3c had the worst clinical outcomes, while the prognosis of N3b patients was better than that of N3a patients.

Mortality from heart disease following radiotherapy in esophageal carcinoma: a retrospective cohort study in US SEER cancer registry.

BackgroundRecently, multiple studies have focused on cardiac toxicity induced by radiation, particularly in patients with breast carcinoma. However, in most circumstances, the radiation intensity is much higher for the heart in patients with esophageal carcinoma. This study aimed to investigate whether cardiac toxicity is related to radiation and distinguish the types of patients who are more susceptible to cardiac death.MethodsWe analyzed 8,210 esophageal cancer survivors who were involved in the US Surveillance Epidemiology and End Results (SEER) cancer program. Descriptive statistics were used to demonstrate the disease characteristics in radiation therapy (RT) and non-RT groups. Cox hazard proportional regression and Kaplan-Meier method were applied to determine independent risk factors of cardiac death.ResultsThe most important risk factors determining heart death were age (HR, 14.297; 95% CI: 9.174–22.283) and radiation (HR, 1.952; 95% CI: 1.684–2.263). The radiotherapy performed in the middle (HR, 1.872; 95% CI: 1.464–2.395) and lower thoracic segment of the esophagus (HR, 1.539; 95% CI: 1.464–1.772) was associated with an increased risk of cardiogenic death, which occurred since the first year after diagnosis. Compared with RT in postoperative group (HR, 0.48; 95% CI, 0.37–0.62), patients in preoperative group had a significantly increased survival rate.ConclusionsCardiogenic death is closely related to RT in esophageal cancer patients. Age, radiation sequence and tumor sites are key factors influencing the cardiac death risk induced by radiotherapy. Early detection and prevention are necessary for the high-risk population.

Risk of Alzheimer's Disease in Cancer Patients: Analysis of Mortality Data from the US SEER Population-Based Registries.

Previous studies have reported an inverse association between cancer and Alzheimer’s disease (AD), which are leading causes of human morbidity and mortality. We analyzed the SEER (Surveillance, Epidemiology, and End Results) data to estimate the risk of AD death in (i) cancer patients relative to reference populations stratified on demographic and clinical variables, and (ii) female breast cancer (BC) patients treated with chemotherapy or radiotherapy, relative to those with no/unknown treatment status. Our results demonstrate the impact of race, cancer type, age and time since cancer diagnosis on the risk of AD death in cancer patients. While the risk of AD death was decreased in white patients diagnosed with various cancers at 45 or more years of age, it was increased in black patients diagnosed with cancers before 45 years of age (likely due to early onset AD). Chemotherapy decreased the risk of AD death in white women diagnosed with BC at the age of 65 or more, however radiotherapy displayed a more complex pattern with early decrease and late increase in the risk of AD death during a prolonged time interval after the treatment. Our data point to links between molecular mechanisms involved in cancer and AD, and to the potential applicability of some anti-cancer treatments against AD.

The Impact of Radiotherapy on the Incidence of Secondary Malignancies: A Pan-Cancer Study in the US SEER Cancer Registries

Background: The population of cancer patients with second primary malignancies (SPMs) is rapidly growing. The relationship between radiotherapy and SPMs for some types of tumors is unknown or debated. Methods: We identified 24 types of first primary malignancies (FPMs) between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. Patients in the radiotherapy group were matched to those in the no radiotherapy group with a matching ratio of 1:1. After propensity-score matching (PSM), additional competing risk regression analyses was performed to calculate the efficacy of radiotherapy to SPMs in the PSM-adjusted population. In addition, the Fine & Gray model was utilized in the primary cohorts and stratified analyses were performed based on surgery. Results: This study included a total of 2,831,789 eligible patients with tumors diagnosed from 2004 to 2015 in the SEER 18 database, amongst whom 100,194 (3.5%) patients developed SPMs. We have observed higher risks of SPMs associated with radiotherapy in several types of tumors in the PSM-adjusted populations. Basically, the results in the PSM-adjusted populations were consistent with outcomes in the multivariable competing risk models. Meanwhile, in subgroup analyses stratified by surgery, some other types of tumor (except for those with positive results in the PSM-adjusted cohorts) with radiotherapy were also associated with higher prevalence of SPMs in the subgroups of surgical treatment. Conclusions: We present a comprehensive and newest pan-cancer study illustrating the effect of radiotherapy on the incidence of SPMs. The findings merits further investigation and may ultimately impact treatment decision-making for tumor management. Funding: None. Competing Interest Declaration: The authors declare that they have no competing interests. Ethics: This study is in accordance with the Declaration of Helsinki and has been approved by the Institutional Review Board at the West China Hospital.

Trends in cause of death among patients with multiple myeloma in Puerto Rico and the United States SEER population, 1987-2013.

Multiple myeloma (MM) survival has improved due to recent developments in MM treatment. As a result, other co-morbid conditions may be of increasing importance to MM patients' long-term survival. This study examines trends in common causes of death among patients with MM in Puerto Rico, and in the US Surveillance, Epidemiology, and End Results (SEER) population. We analyzed the primary cause of death among incident MM cases recorded in the Puerto Rico Central Cancer Registry (n = 3,018) and the US SEER Program (n = 67,733) between 1987 and 2013. We calculated the cumulative incidence of death due to the eight most common causes and analyzed temporal trends in mortality rates using joinpoint regression. Analyses of SEER were also stratified by Hispanic ethnicity. MM accounted for approximately 72% of all reported deaths among persons diagnosed with MM in Puerto Rico and in SEER. In both populations, the proportion of patients who died from MM decreased with increasing time since diagnosis. Age-standardized temporal trends showed a decreased MM-specific mortality rate among US SEER (annual percent change [APC] = -5.0) and Puerto Rican (APC = -1.8) patients during the study period, and particularly after 2003 in non-Hispanic SEER patients. Temporal decline in non-MM causes of death was also observed among US SEER (APC = -2.1) and Puerto Rican (APC = -0.1) populations. MM-specific mortality decreased, yet remained the predominant cause of death for individuals diagnosed with MM over a 26-year period. The most pronounced decreases in MM-specific death occurred after 2003, which suggests a possible influence of more recently developed MM therapies.

Cancer risk in microscopic colitis: a retrospective cohort study

BackgroundThe long-term natural history of microscopic colitis (MC) (collagenous colitis (CC), lymphocytic colitis (LC)), traditionally considered relapsing but non-progressive diseases, is poorly defined. Whether persistent histologic inflammation in such diseases is associated with an increased risk of colorectal neoplasia (CRN) or extracolonic cancers has not been robustly established.MethodsThis retrospective cohort included diagnosed with MC at a referral center. Rates of CRN and extracolonic cancer were compared to patients undergoing screening colonoscopy (n = 306) and to the United States population using data from the Surveillance, Epidemiology, and End-Results (SEER) program. Standardized incidence ratios (SIR) and 95% confidence intervals were calculated and multivariable regression models used to identify the effect of MC diagnosis and severity on cancer risk.ResultsOur study included 221 patients with microscopic colitis (112 CC, 109 LC) among whom 77% were women. Compared to the colonoscopy control population, MC was associated with similar odds of tubular adenoma (Odds ratio (OR) 1.07, 95% CI 0.69–1.66) or villous adenoma (OR 1.26, 95% CI 0.17–9.42). Compared to patients with a single episode of MC, those with 2 or more episodes had similar risk of colon cancer (OR 0.83, 95% CI 0.20–3.39) or tubular adenoma (OR 1.49 95% CI 0.83–2.67). We also identified no statistical increase in the rates of cancer in the MC population compared to US-SEER data.ConclusionMicroscopic colitis was not associated with increased risk of CRN and extracolonic cancers when compared to controls undergoing colonoscopy or the US SEER population.

The pathological types of pancreatic carcinoma: an analysis based on US SEER database

Objective To study the component ratios of pancreatic carcinoma, and prognosis of patients with the different pathological types. Methods The data of 92 011 pancreatic carcinoma patients who were diagnosed by the definite pathological method from 2004 to 2014 were extracted from the US SEER database. The life table was used to calculate the 1-, 3- and 5-year survival rates. The Kaplan-Meier was used to construct the survival curves of the patients. The Cox univariate analysis was applied to evaluate the HR of the different pathological types, and the χ2 test and independent sample t-test were used to evaluate the baseline data. Results The overall 5-year survival of 92 011 pancreatic carcinoma patients was 7.6%. The median survival time was 8.8 months and the component ratios of the pancreatic ductal adenocarcinoma (PDAC), pancreatic epithelium cancer bedside the PDAC, neuroendocrine tumors, undifferentiated carcinoma, mesenchymal carcinoma and rare cancer unclassified were 85.78%, 6.40%, 6.67%, 0.97%, 0.10% and 0.08%, respectively. The differences were statistically significant between the baseline data such as age, gender, race and position (P<0.05). The overall 5-year survivals of the PDAC, pancreatic epithelium cancer beside the PDAC, neuroendocrine tumors, undifferentiated carcinoma, mesenchymal carcinoma and rare cancer unclassified were 4.2%, 13.4%, 49.2%, 5.0%, 29.2% and 24.5%, respectively, and the median survival times were 5 months, 7 months, 58 months, 2 months, 26 months and 7 months respectively. The distant metastasis rate of neuroendocrine carcinoma was the lowest (35.0%). The undifferentiated carcinoma was the most prone to distant metastases (65.2%). Basically, half of the other types of pancreatic cancer had metastasis at the time of diagnosis. In pancreatic epithelium cancer beside the PDAC, the high to low 5-year survival rates were solid pseudopapillary carcinoma (87.3%), cystadenocarcinoma (36.8%), intraductal papillary mucinous neoplasm (36.5%), acinar cell carcinoma (20.0%), and pancreatic adenocarcinoma mixed with other subtypes (19.7%). The incidence of the other types of pancreatic carcinoma was less than 8%, such as mucinous carcinoma, squamous cell carcinoma, adenosquamous carcinoma and signet ring cell carcinoma. In neuroendocrine tumor, the 5-year survival rate of insulinoma (77.1%) was higher than those of neuroendocrine tumor (malignant) (NET, 62.0%) and neuroendocrine carcinoma (NEC, 46.5%). Conclusion The prognosis of pancreatic carcinoma was poor, and the pathological types had a significant impact on the prognosis of the patients. Key words: Pancreatic carcinoma; Prognosis; Pathological types; Surveillance, epidemiology, and end results (SEER)

Recent Trends in Survival of Patients With Pancreatic Cancer in Germany and the United States.

Survival improvement for pancreatic cancer has not been observed in the last 4 decades. We report the most up-to-date population-based relative survival (RS) estimates and recent trends in Germany and the United States. Data for patients diagnosed in 1997 to 2010 and followed up to 2010 were drawn from 12 population-based German cancer registries and the US SEER (Surveillance, Epidemiology and End Results) 13 registries database. Using period analysis, 5-year RS for 2007 to 2010 was derived. Model-based period analysis was used to assess 5-year RS time trends, 2002-2010. In total 28,977 (Germany) and 34,793 (United States) patients aged 15 to 74 years were analyzed. Five-year RS was 10.7% and 10.3% in Germany and the United States, respectively, and strongly decreased with age and tumor spread. Prognosis slightly improved from the period 2002-2004 to 2008-2010 (overall age-adjusted RS: +2.5% units in Germany and +3.4% units in the United States); improvement was particularly strong for regional stage and head and body subsites in Germany and for localized and regional stages and tail subsite in the United States. Although pancreatic cancer survival continues to be poor for advanced-stage patients, our study disclosed encouraging indications of first improvements in 5-year RS after decades of stagnation.

Physician referral patterns among men with advanced prostate cancer.

211 Background: Among men diagnosed with localized prostate cancer (PC), the type of specialist visited has been shown to influence the type of treatment regimen prescribed. There is limited data on referral patterns among men diagnosed with advanced PC. The objective of this study was to characterize referral patterns across physician types who treat men with stage IV nonmetastatic (M0) and metastatic (M1) PC. Methods: Using the linked US SEER (Surveillance, Epidemiology, and End Results) and Medicare database, we identified men aged 66 or older who were diagnosed with incident stage IV M0 or M1 PC between 2000 and 2007. We evaluated patterns of the first and second type of physicians visited after diagnosis of PC for men with visits to the following physician types: urologist, medical oncologist (medonc), radiation oncologist (radonc), or primary care physician (PCP). Results were stratified by M0 and M1 disease. Results: We identified 9,826 men with stage IV PC (median age=77 years). Of these 9,826 men, 8,736 (89%) visited at least two physician types (93% among men with M0 and 87% among men with M1). Across the physician types of interest, 94% of men initially visited a urologist (52%) or PCP (42%). Among men who visited a urologist first, most were referred to a PCP, while smaller percentages were referred to a medonc or radonc (Table). Among men who saw a PCP first, most were referred to a urologist next; smaller proportions were referred to a medonc or radonc. Men with M1 PC had more referrals to medonc and fewer referrals to radonc than men with M0 PC. Conclusions: In this analysis of nearly 10,000 men aged 66 or older with stage IV PC in the US, most men initially visited a urologist or PCP regardless of whether or not they had distant metastasis. Based on the patterns observed, the most frequent referral pattern occurred between urologists and PCPs. More referrals to a medonc were evident if the men had M1 disease. [Table: see text]