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RVD With Weekly Bortezomib Has a Favorable Toxicity and Effectiveness Profile in a Large Cohort of US Veterans With Multiple Myeloma
Background
Lenalidomide, bortezomib, and dexamethasone (RVD) is standard triplet induction for fit newly-diagnosed myeloma (NDMM) patients, with response rate (RR)>90%. A 21-day cycle with bortezomib given days 1, 4, 8, and 11 (2x/w) is standard. However, up to 80% of patients develop neuropathy. Weekly bortezomib dosing (1x/w), subcutaneous route, and 28- to 35-day cycle length may optimize tolerance. We present an effectiveness and toxicity analysis of Veterans who received RVD with 1x/w and 2x/w bortezomib for NDMM.
Methods
The VA Corporate Data Warehouse identified 1499 Veterans with NDMM given RVD ≤42 days of treatment start. 840 Veterans were grouped for initial analysis based on criteria: 1) lenalidomide and ≥ 3 bortezomib doses during cycle 1; 2) ≥6 mean days between bortezomib treatments=1x/w); and 3) number of lenalidomide days informed cycle length (21d, 28d, or 35d; default 7-day rest). Investigators reviewed algorithm results to finalize group assignments. Endpoints included depth of response, time to next treatment (TTNT), overall survival (OS), and neuropathy. Neuropathy was defined as use of neuropathy medications and neuropathy ICD-10 codes.
Results
Our algorithm correctly assigned 82% of 840 cycle 1 RVD schedules. The largest groups were 21d 1x/w (n=291), 21d 2x/w (n=193), 28d 1x/w (n=188), and 28d 2x/w (n=82). Median age was 68.3; 53% were non-Hispanic White. Demographics and ISS stage of groups were similar. 30% underwent autologous transplant. Tolerability. Median number of bortezomib doses ranged from 22.5-25.5 (p=0.57). Neuropathy favored 1x/w, 17.7 vs 30.2% (p=0.0001) and was highest (34.7%) in 21d 2x/w. Effectiveness. Response was assessable for 28% of patients. RR (72%, p=0.68) and median TTNT (19.3 months, p=0.20) were similar, including 1x/w vs 2x/w comparison (p=0.79). 21d regimens optimized TTNT (21.4 vs 13.9 months, p=0.045) and trended to better OS (73 vs 65 months, p=0.06).
Conclusions
1x/w RVD preserved effectiveness compared to “standard” RVD in a large Veteran cohort. 1x/w reduced neuropathy incidence. 28d regimens demonstrated inferior longer-term outcomes. Certain endpoints, such as RR and neuropathy, appear underestimated due to data source limitations. 21d 1x/w RVD optimizes effectiveness, tolerability, and administration and should be considered for broader utilization in Veterans with NDMM.
Background
Lenalidomide, bortezomib, and dexamethasone (RVD) is standard triplet induction for fit newly-diagnosed myeloma (NDMM) patients, with response rate (RR)>90%. A 21-day cycle with bortezomib given days 1, 4, 8, and 11 (2x/w) is standard. However, up to 80% of patients develop neuropathy. Weekly bortezomib dosing (1x/w), subcutaneous route, and 28- to 35-day cycle length may optimize tolerance. We present an effectiveness and toxicity analysis of Veterans who received RVD with 1x/w and 2x/w bortezomib for NDMM.
Methods
The VA Corporate Data Warehouse identified 1499 Veterans with NDMM given RVD ≤42 days of treatment start. 840 Veterans were grouped for initial analysis based on criteria: 1) lenalidomide and ≥ 3 bortezomib doses during cycle 1; 2) ≥6 mean days between bortezomib treatments=1x/w); and 3) number of lenalidomide days informed cycle length (21d, 28d, or 35d; default 7-day rest). Investigators reviewed algorithm results to finalize group assignments. Endpoints included depth of response, time to next treatment (TTNT), overall survival (OS), and neuropathy. Neuropathy was defined as use of neuropathy medications and neuropathy ICD-10 codes.
Results
Our algorithm correctly assigned 82% of 840 cycle 1 RVD schedules. The largest groups were 21d 1x/w (n=291), 21d 2x/w (n=193), 28d 1x/w (n=188), and 28d 2x/w (n=82). Median age was 68.3; 53% were non-Hispanic White. Demographics and ISS stage of groups were similar. 30% underwent autologous transplant. Tolerability. Median number of bortezomib doses ranged from 22.5-25.5 (p=0.57). Neuropathy favored 1x/w, 17.7 vs 30.2% (p=0.0001) and was highest (34.7%) in 21d 2x/w. Effectiveness. Response was assessable for 28% of patients. RR (72%, p=0.68) and median TTNT (19.3 months, p=0.20) were similar, including 1x/w vs 2x/w comparison (p=0.79). 21d regimens optimized TTNT (21.4 vs 13.9 months, p=0.045) and trended to better OS (73 vs 65 months, p=0.06).
Conclusions
1x/w RVD preserved effectiveness compared to “standard” RVD in a large Veteran cohort. 1x/w reduced neuropathy incidence. 28d regimens demonstrated inferior longer-term outcomes. Certain endpoints, such as RR and neuropathy, appear underestimated due to data source limitations. 21d 1x/w RVD optimizes effectiveness, tolerability, and administration and should be considered for broader utilization in Veterans with NDMM.
Background
Lenalidomide, bortezomib, and dexamethasone (RVD) is standard triplet induction for fit newly-diagnosed myeloma (NDMM) patients, with response rate (RR)>90%. A 21-day cycle with bortezomib given days 1, 4, 8, and 11 (2x/w) is standard. However, up to 80% of patients develop neuropathy. Weekly bortezomib dosing (1x/w), subcutaneous route, and 28- to 35-day cycle length may optimize tolerance. We present an effectiveness and toxicity analysis of Veterans who received RVD with 1x/w and 2x/w bortezomib for NDMM.
Methods
The VA Corporate Data Warehouse identified 1499 Veterans with NDMM given RVD ≤42 days of treatment start. 840 Veterans were grouped for initial analysis based on criteria: 1) lenalidomide and ≥ 3 bortezomib doses during cycle 1; 2) ≥6 mean days between bortezomib treatments=1x/w); and 3) number of lenalidomide days informed cycle length (21d, 28d, or 35d; default 7-day rest). Investigators reviewed algorithm results to finalize group assignments. Endpoints included depth of response, time to next treatment (TTNT), overall survival (OS), and neuropathy. Neuropathy was defined as use of neuropathy medications and neuropathy ICD-10 codes.
Results
Our algorithm correctly assigned 82% of 840 cycle 1 RVD schedules. The largest groups were 21d 1x/w (n=291), 21d 2x/w (n=193), 28d 1x/w (n=188), and 28d 2x/w (n=82). Median age was 68.3; 53% were non-Hispanic White. Demographics and ISS stage of groups were similar. 30% underwent autologous transplant. Tolerability. Median number of bortezomib doses ranged from 22.5-25.5 (p=0.57). Neuropathy favored 1x/w, 17.7 vs 30.2% (p=0.0001) and was highest (34.7%) in 21d 2x/w. Effectiveness. Response was assessable for 28% of patients. RR (72%, p=0.68) and median TTNT (19.3 months, p=0.20) were similar, including 1x/w vs 2x/w comparison (p=0.79). 21d regimens optimized TTNT (21.4 vs 13.9 months, p=0.045) and trended to better OS (73 vs 65 months, p=0.06).
Conclusions
1x/w RVD preserved effectiveness compared to “standard” RVD in a large Veteran cohort. 1x/w reduced neuropathy incidence. 28d regimens demonstrated inferior longer-term outcomes. Certain endpoints, such as RR and neuropathy, appear underestimated due to data source limitations. 21d 1x/w RVD optimizes effectiveness, tolerability, and administration and should be considered for broader utilization in Veterans with NDMM.
Agent Orange and Myelodysplastic Syndrome: A Single VAMC Experience
Background
Agent Orange (AO) exposure may be linked to development of myeloid malignancies, including myelodysplastic syndrome (MDS). This is not yet definitive, though, and, unlike several other malignancies, MDS is not yet a service-connected diagnosis for AO. Although recent studies have not revealed AO associated specific mutations in MDS, other clinical and pathological potential differences have not been well described. In addition, determination of AO exposure is often not reported. Purpose: To assess for differences between AO versus non-AO exposed veterans with MDS.
Methods
All veterans diagnosed with MDS at the Cleveland VAMC from 2012-2023 were identified. Prior AO exposure was determined by Military Exposure tab in the EMR (CPRS) and confirmed with direct patient contact. Data collected included age and IPSS-R score at diagnosis; ring sideroblast percentage; mutations (on NGS); progression to AML and overall survival (OS).
Results
129 veterans were identified, 48 of whom had AO exposure. The mean age was 70.7 years in the AO group and 73.3 in the non-AO group (p=0.098); average IPSS-R score was 3.14 in AO and 2.75 in non-AO group (p= 0.32). In the AO group 4/48 (8.3%) progressed to AML vs 10/81 (12.3%) in the non-AO group; median OS was 39 months in AO vs 33 months in non-AO group (p=0.93). The most common mutations seen were TP53, SF3B1, SRSF2, DNMT, ASXL1, and U2AF1, with no differences between the 2 groups. 50% of those in the AO group had 2 or more genetic mutations vs. 61% for the non-AO group. Average variant allele frequency (VAF) was 40.2% in the AO group vs. 44% in the non-AO group. The average ring sideroblasts seen was 6% for the AO group compared to 5.7% for the non-AO group, p = 0.89.
Conclusions
This small retrospective study did not reveal statistically significant differences between AO vs non-AO exposed veterans with MDS, in terms of age at diagnosis, IPSS-R score, RS %, mutations (type, number or VAF load), progression to AML or OS. There were trends for AO exposed veterans presenting at a younger age and having a lower rate of progression to AML.
Background
Agent Orange (AO) exposure may be linked to development of myeloid malignancies, including myelodysplastic syndrome (MDS). This is not yet definitive, though, and, unlike several other malignancies, MDS is not yet a service-connected diagnosis for AO. Although recent studies have not revealed AO associated specific mutations in MDS, other clinical and pathological potential differences have not been well described. In addition, determination of AO exposure is often not reported. Purpose: To assess for differences between AO versus non-AO exposed veterans with MDS.
Methods
All veterans diagnosed with MDS at the Cleveland VAMC from 2012-2023 were identified. Prior AO exposure was determined by Military Exposure tab in the EMR (CPRS) and confirmed with direct patient contact. Data collected included age and IPSS-R score at diagnosis; ring sideroblast percentage; mutations (on NGS); progression to AML and overall survival (OS).
Results
129 veterans were identified, 48 of whom had AO exposure. The mean age was 70.7 years in the AO group and 73.3 in the non-AO group (p=0.098); average IPSS-R score was 3.14 in AO and 2.75 in non-AO group (p= 0.32). In the AO group 4/48 (8.3%) progressed to AML vs 10/81 (12.3%) in the non-AO group; median OS was 39 months in AO vs 33 months in non-AO group (p=0.93). The most common mutations seen were TP53, SF3B1, SRSF2, DNMT, ASXL1, and U2AF1, with no differences between the 2 groups. 50% of those in the AO group had 2 or more genetic mutations vs. 61% for the non-AO group. Average variant allele frequency (VAF) was 40.2% in the AO group vs. 44% in the non-AO group. The average ring sideroblasts seen was 6% for the AO group compared to 5.7% for the non-AO group, p = 0.89.
Conclusions
This small retrospective study did not reveal statistically significant differences between AO vs non-AO exposed veterans with MDS, in terms of age at diagnosis, IPSS-R score, RS %, mutations (type, number or VAF load), progression to AML or OS. There were trends for AO exposed veterans presenting at a younger age and having a lower rate of progression to AML.
Background
Agent Orange (AO) exposure may be linked to development of myeloid malignancies, including myelodysplastic syndrome (MDS). This is not yet definitive, though, and, unlike several other malignancies, MDS is not yet a service-connected diagnosis for AO. Although recent studies have not revealed AO associated specific mutations in MDS, other clinical and pathological potential differences have not been well described. In addition, determination of AO exposure is often not reported. Purpose: To assess for differences between AO versus non-AO exposed veterans with MDS.
Methods
All veterans diagnosed with MDS at the Cleveland VAMC from 2012-2023 were identified. Prior AO exposure was determined by Military Exposure tab in the EMR (CPRS) and confirmed with direct patient contact. Data collected included age and IPSS-R score at diagnosis; ring sideroblast percentage; mutations (on NGS); progression to AML and overall survival (OS).
Results
129 veterans were identified, 48 of whom had AO exposure. The mean age was 70.7 years in the AO group and 73.3 in the non-AO group (p=0.098); average IPSS-R score was 3.14 in AO and 2.75 in non-AO group (p= 0.32). In the AO group 4/48 (8.3%) progressed to AML vs 10/81 (12.3%) in the non-AO group; median OS was 39 months in AO vs 33 months in non-AO group (p=0.93). The most common mutations seen were TP53, SF3B1, SRSF2, DNMT, ASXL1, and U2AF1, with no differences between the 2 groups. 50% of those in the AO group had 2 or more genetic mutations vs. 61% for the non-AO group. Average variant allele frequency (VAF) was 40.2% in the AO group vs. 44% in the non-AO group. The average ring sideroblasts seen was 6% for the AO group compared to 5.7% for the non-AO group, p = 0.89.
Conclusions
This small retrospective study did not reveal statistically significant differences between AO vs non-AO exposed veterans with MDS, in terms of age at diagnosis, IPSS-R score, RS %, mutations (type, number or VAF load), progression to AML or OS. There were trends for AO exposed veterans presenting at a younger age and having a lower rate of progression to AML.
Treatment Patterns and Outcomes of Older (Age ≥ 80) Veterans With Newly Diagnosed Diffuse Large B-Cell Lymphoma (DLBCL)
Background
Over one-third of newly diagnosed Diffuse Large B-Cell Lymphoma (DLBCL) cases are in people age ≥75. Although a potentially curable malignancy, older adults have a comparatively lower survival rate. This may be due to multiple factors including suboptimal management. In one study, up to 23% of patients age ≥80 did not receive any therapy for DLBCL. This age-related survival disparity is potentially magnified in patients who reside in rural areas. As there is no standard of care for this population, we speculate that there is wide variation in treatment practices which may influence outcomes. The purpose of this study is to describe treatment patterns and outcomes in in veterans age ≥80 with DLBCL by area of residence.
Methods
We conducted a retrospective study of veterans age ≥80 newly diagnosed with Stage II-IV DLBCL between 2006-2023 using the Veterans Affairs (VA) Cancer Registry System (VACRS). Patient, disease, and treatment variables were extracted from the VA Corporate Data Warehouse (CDW) and via chart review. Variables were compared amongst Veterans residing at urban vs. rural addresses.
Results
We evaluated a total of 181 Veterans. Most veterans resided in an urban area (60.2%). At least 18.8% of veterans failed to start lymphoma-directed therapy, but only 6.6% of veterans were not explicitly offered treatment per documentation. In total, 68.5% of veterans were offered a curative treatment regimen by their provider; curative treatment was more likely to be offered to urban patients (68.8% vs 61.5%, p=0.86). Pre-phase steroids and geriatric assessments prior to treatment were severely underutilized (2.8% and 0.6%). More urban veterans started treatment (75.2% vs 65.4%, p=0.38) and 40.9% started an anthracyclinecontaining regimen. Only 27.6% of veterans completed 6 total cycles of treatment. Only 37.6% of veterans achieved a complete response at end of treatment, although response was not reported in 46.4% of patients.
Conclusions
Most elderly veterans with DLBCL are being offered and started on a curative treatment regimen; however, most do not complete a full course of treatment. Although not statistically significant, more urban veterans were offered a curative regimen and received treatment. Wider adoption of pre-phase steroids and geriatric assessments could improve response outcomes.
Background
Over one-third of newly diagnosed Diffuse Large B-Cell Lymphoma (DLBCL) cases are in people age ≥75. Although a potentially curable malignancy, older adults have a comparatively lower survival rate. This may be due to multiple factors including suboptimal management. In one study, up to 23% of patients age ≥80 did not receive any therapy for DLBCL. This age-related survival disparity is potentially magnified in patients who reside in rural areas. As there is no standard of care for this population, we speculate that there is wide variation in treatment practices which may influence outcomes. The purpose of this study is to describe treatment patterns and outcomes in in veterans age ≥80 with DLBCL by area of residence.
Methods
We conducted a retrospective study of veterans age ≥80 newly diagnosed with Stage II-IV DLBCL between 2006-2023 using the Veterans Affairs (VA) Cancer Registry System (VACRS). Patient, disease, and treatment variables were extracted from the VA Corporate Data Warehouse (CDW) and via chart review. Variables were compared amongst Veterans residing at urban vs. rural addresses.
Results
We evaluated a total of 181 Veterans. Most veterans resided in an urban area (60.2%). At least 18.8% of veterans failed to start lymphoma-directed therapy, but only 6.6% of veterans were not explicitly offered treatment per documentation. In total, 68.5% of veterans were offered a curative treatment regimen by their provider; curative treatment was more likely to be offered to urban patients (68.8% vs 61.5%, p=0.86). Pre-phase steroids and geriatric assessments prior to treatment were severely underutilized (2.8% and 0.6%). More urban veterans started treatment (75.2% vs 65.4%, p=0.38) and 40.9% started an anthracyclinecontaining regimen. Only 27.6% of veterans completed 6 total cycles of treatment. Only 37.6% of veterans achieved a complete response at end of treatment, although response was not reported in 46.4% of patients.
Conclusions
Most elderly veterans with DLBCL are being offered and started on a curative treatment regimen; however, most do not complete a full course of treatment. Although not statistically significant, more urban veterans were offered a curative regimen and received treatment. Wider adoption of pre-phase steroids and geriatric assessments could improve response outcomes.
Background
Over one-third of newly diagnosed Diffuse Large B-Cell Lymphoma (DLBCL) cases are in people age ≥75. Although a potentially curable malignancy, older adults have a comparatively lower survival rate. This may be due to multiple factors including suboptimal management. In one study, up to 23% of patients age ≥80 did not receive any therapy for DLBCL. This age-related survival disparity is potentially magnified in patients who reside in rural areas. As there is no standard of care for this population, we speculate that there is wide variation in treatment practices which may influence outcomes. The purpose of this study is to describe treatment patterns and outcomes in in veterans age ≥80 with DLBCL by area of residence.
Methods
We conducted a retrospective study of veterans age ≥80 newly diagnosed with Stage II-IV DLBCL between 2006-2023 using the Veterans Affairs (VA) Cancer Registry System (VACRS). Patient, disease, and treatment variables were extracted from the VA Corporate Data Warehouse (CDW) and via chart review. Variables were compared amongst Veterans residing at urban vs. rural addresses.
Results
We evaluated a total of 181 Veterans. Most veterans resided in an urban area (60.2%). At least 18.8% of veterans failed to start lymphoma-directed therapy, but only 6.6% of veterans were not explicitly offered treatment per documentation. In total, 68.5% of veterans were offered a curative treatment regimen by their provider; curative treatment was more likely to be offered to urban patients (68.8% vs 61.5%, p=0.86). Pre-phase steroids and geriatric assessments prior to treatment were severely underutilized (2.8% and 0.6%). More urban veterans started treatment (75.2% vs 65.4%, p=0.38) and 40.9% started an anthracyclinecontaining regimen. Only 27.6% of veterans completed 6 total cycles of treatment. Only 37.6% of veterans achieved a complete response at end of treatment, although response was not reported in 46.4% of patients.
Conclusions
Most elderly veterans with DLBCL are being offered and started on a curative treatment regimen; however, most do not complete a full course of treatment. Although not statistically significant, more urban veterans were offered a curative regimen and received treatment. Wider adoption of pre-phase steroids and geriatric assessments could improve response outcomes.
Investigating Differences in Melanoma Mortality Based on Demographic Information from 1999-2022 Using CDC Wonder
Background
Melanoma is a malignant type of skin cancer and is the fifth most common type of cancer in the United States. The purpose of this study is to determine how demographic information such as race and gender may influence mortality rates in melanoma patients. To date, no previous studies have analyzed epidemiological trends in melanoma mortality using the CDC Wonder database. However, previous literature has suggested that non-Hispanic Whites have the highest mortality rate.
Methods
CDC Wonder is a database that contains mortality and demographic information for various pathologies. Melanoma cases were specified using the ICD-10 code C43. Patients over the age of 35 were considered for this study. Mortality rates were generated based on gender, race, and a combination of both variables. Data analysis involved finding the rates and 95% confidence intervals for the crude and age-adjusted mortality rate (AAMR) per 100,000. Joinpoint regression analysis was also used.
Results
Several differences in the age-adjusted mortality rate were observed. In every year from 1999 to 2022, the non-Hispanic White group (NH White) had the highest mortality rate, whereas all other races had similar rates. Meanwhile, when stratifying by both race and gender, it appears that NH White males have the highest rate in mortality. In 2022, the mortality rate for NH White males was 8.8 per 100,000, whereas the second highest rate belonged to the NH White female group (4 per 100,000). All other racial and gender combinations had similar mortality rates. The trends in mortality rates did not fluctuate much from the years 1999-2022. No significant deviation in mortality trends were seen after the start of the COVID-19 pandemic.
Conclusions
This data corroborates with the results from previous studies. It also indicates that certain demographics that may be at greater risk for mortality, and that the mortality rates have remained relatively stable. The mortality rate for melanoma may vary by race and gender. More specifically, NH White males may be susceptible to higher mortality rates compared to other demographic groups. Future research on cancer staging and treatment modality received could help explain these differences.
Background
Melanoma is a malignant type of skin cancer and is the fifth most common type of cancer in the United States. The purpose of this study is to determine how demographic information such as race and gender may influence mortality rates in melanoma patients. To date, no previous studies have analyzed epidemiological trends in melanoma mortality using the CDC Wonder database. However, previous literature has suggested that non-Hispanic Whites have the highest mortality rate.
Methods
CDC Wonder is a database that contains mortality and demographic information for various pathologies. Melanoma cases were specified using the ICD-10 code C43. Patients over the age of 35 were considered for this study. Mortality rates were generated based on gender, race, and a combination of both variables. Data analysis involved finding the rates and 95% confidence intervals for the crude and age-adjusted mortality rate (AAMR) per 100,000. Joinpoint regression analysis was also used.
Results
Several differences in the age-adjusted mortality rate were observed. In every year from 1999 to 2022, the non-Hispanic White group (NH White) had the highest mortality rate, whereas all other races had similar rates. Meanwhile, when stratifying by both race and gender, it appears that NH White males have the highest rate in mortality. In 2022, the mortality rate for NH White males was 8.8 per 100,000, whereas the second highest rate belonged to the NH White female group (4 per 100,000). All other racial and gender combinations had similar mortality rates. The trends in mortality rates did not fluctuate much from the years 1999-2022. No significant deviation in mortality trends were seen after the start of the COVID-19 pandemic.
Conclusions
This data corroborates with the results from previous studies. It also indicates that certain demographics that may be at greater risk for mortality, and that the mortality rates have remained relatively stable. The mortality rate for melanoma may vary by race and gender. More specifically, NH White males may be susceptible to higher mortality rates compared to other demographic groups. Future research on cancer staging and treatment modality received could help explain these differences.
Background
Melanoma is a malignant type of skin cancer and is the fifth most common type of cancer in the United States. The purpose of this study is to determine how demographic information such as race and gender may influence mortality rates in melanoma patients. To date, no previous studies have analyzed epidemiological trends in melanoma mortality using the CDC Wonder database. However, previous literature has suggested that non-Hispanic Whites have the highest mortality rate.
Methods
CDC Wonder is a database that contains mortality and demographic information for various pathologies. Melanoma cases were specified using the ICD-10 code C43. Patients over the age of 35 were considered for this study. Mortality rates were generated based on gender, race, and a combination of both variables. Data analysis involved finding the rates and 95% confidence intervals for the crude and age-adjusted mortality rate (AAMR) per 100,000. Joinpoint regression analysis was also used.
Results
Several differences in the age-adjusted mortality rate were observed. In every year from 1999 to 2022, the non-Hispanic White group (NH White) had the highest mortality rate, whereas all other races had similar rates. Meanwhile, when stratifying by both race and gender, it appears that NH White males have the highest rate in mortality. In 2022, the mortality rate for NH White males was 8.8 per 100,000, whereas the second highest rate belonged to the NH White female group (4 per 100,000). All other racial and gender combinations had similar mortality rates. The trends in mortality rates did not fluctuate much from the years 1999-2022. No significant deviation in mortality trends were seen after the start of the COVID-19 pandemic.
Conclusions
This data corroborates with the results from previous studies. It also indicates that certain demographics that may be at greater risk for mortality, and that the mortality rates have remained relatively stable. The mortality rate for melanoma may vary by race and gender. More specifically, NH White males may be susceptible to higher mortality rates compared to other demographic groups. Future research on cancer staging and treatment modality received could help explain these differences.
Recent Incidence and Survival Trends in Pancreatic Cancer at Young Age (<50 Years)
Background
Pancreatic cancer stands as a prominent contributor to cancer-related mortality in the United States. In this abstract, we reviewed the SEER database to uncover the latest trends in pancreatic cancer among individuals diagnosed under the age of 50.
Methods
Information was obtained from the SEER database November 2023 which covers 22 national cancer registries. Only patients with age < 50 years were included. Age adjusted incidence and 5-year relative survival were compared between different ethnic groups.
Results
We identified 124691 patients with pancreatic cancer diagnosed between 2017-2021, among them 6477 were with age less than 50 years at the time of diagnosis. 3074 were male and 3403 were male. Age adjusted incidence rate was 1.2/100,000 in females and 1.4/100,000 in males. Overall, Average Annual Percent Change (AAPC) of 2.6% (95% CI: 1.9 – 4.3) was noticed between 2017-2021 when compared to previously reported rates. AAPC among different ethnic groups were Hispanics, any race: 5.3% (CI: 4-7.5), Non-Hispanic American Indian/Alaska Native: 1.1 (CI: -2.7-5.1), Non-Hispanic Asian/Pacific Islander: 1.9 (CI: 1.1-2.9), Non-Hispanic Black: 1.0 (CI: 0.3-1.7), and Non-Hispanic White: 1.6 (CI: 1.1-2.1). Stage 4 was the most common stage. Overall, the 5-year relative survival from 2014- 2020 was 37.4% (CI: 36.1-38.7). 5-year relative survival among ethnic groups from 2014-2020 were: Hispanics, any race: 40.3% (CI: 37.6-43.0), Non-Hispanic American Indian/Alaska Native: 21.4 (CI: 8.5-38.2), Non-Hispanic Asian/Pacific Islander: 40.2 (CI: 35.7-44.7), Non-Hispanic Black: 33.1 (CI: 29.9-36.3), and Non-Hispanic White: 36.6 (CI: 34.8-38.4).
Conclusions
Our analysis reveals a rise in the ageadjusted incidence of pancreatic cancer among younger demographics. Particularly noteworthy is the sharp increase observed over the past five years among Hispanics when compared to other ethnic populations. This rise is observed in both males and females. Further studies need to be done to study the risk factors associated with this increase in trend of pancreatic cancer at young age specifically in Hispanic population.
Background
Pancreatic cancer stands as a prominent contributor to cancer-related mortality in the United States. In this abstract, we reviewed the SEER database to uncover the latest trends in pancreatic cancer among individuals diagnosed under the age of 50.
Methods
Information was obtained from the SEER database November 2023 which covers 22 national cancer registries. Only patients with age < 50 years were included. Age adjusted incidence and 5-year relative survival were compared between different ethnic groups.
Results
We identified 124691 patients with pancreatic cancer diagnosed between 2017-2021, among them 6477 were with age less than 50 years at the time of diagnosis. 3074 were male and 3403 were male. Age adjusted incidence rate was 1.2/100,000 in females and 1.4/100,000 in males. Overall, Average Annual Percent Change (AAPC) of 2.6% (95% CI: 1.9 – 4.3) was noticed between 2017-2021 when compared to previously reported rates. AAPC among different ethnic groups were Hispanics, any race: 5.3% (CI: 4-7.5), Non-Hispanic American Indian/Alaska Native: 1.1 (CI: -2.7-5.1), Non-Hispanic Asian/Pacific Islander: 1.9 (CI: 1.1-2.9), Non-Hispanic Black: 1.0 (CI: 0.3-1.7), and Non-Hispanic White: 1.6 (CI: 1.1-2.1). Stage 4 was the most common stage. Overall, the 5-year relative survival from 2014- 2020 was 37.4% (CI: 36.1-38.7). 5-year relative survival among ethnic groups from 2014-2020 were: Hispanics, any race: 40.3% (CI: 37.6-43.0), Non-Hispanic American Indian/Alaska Native: 21.4 (CI: 8.5-38.2), Non-Hispanic Asian/Pacific Islander: 40.2 (CI: 35.7-44.7), Non-Hispanic Black: 33.1 (CI: 29.9-36.3), and Non-Hispanic White: 36.6 (CI: 34.8-38.4).
Conclusions
Our analysis reveals a rise in the ageadjusted incidence of pancreatic cancer among younger demographics. Particularly noteworthy is the sharp increase observed over the past five years among Hispanics when compared to other ethnic populations. This rise is observed in both males and females. Further studies need to be done to study the risk factors associated with this increase in trend of pancreatic cancer at young age specifically in Hispanic population.
Background
Pancreatic cancer stands as a prominent contributor to cancer-related mortality in the United States. In this abstract, we reviewed the SEER database to uncover the latest trends in pancreatic cancer among individuals diagnosed under the age of 50.
Methods
Information was obtained from the SEER database November 2023 which covers 22 national cancer registries. Only patients with age < 50 years were included. Age adjusted incidence and 5-year relative survival were compared between different ethnic groups.
Results
We identified 124691 patients with pancreatic cancer diagnosed between 2017-2021, among them 6477 were with age less than 50 years at the time of diagnosis. 3074 were male and 3403 were male. Age adjusted incidence rate was 1.2/100,000 in females and 1.4/100,000 in males. Overall, Average Annual Percent Change (AAPC) of 2.6% (95% CI: 1.9 – 4.3) was noticed between 2017-2021 when compared to previously reported rates. AAPC among different ethnic groups were Hispanics, any race: 5.3% (CI: 4-7.5), Non-Hispanic American Indian/Alaska Native: 1.1 (CI: -2.7-5.1), Non-Hispanic Asian/Pacific Islander: 1.9 (CI: 1.1-2.9), Non-Hispanic Black: 1.0 (CI: 0.3-1.7), and Non-Hispanic White: 1.6 (CI: 1.1-2.1). Stage 4 was the most common stage. Overall, the 5-year relative survival from 2014- 2020 was 37.4% (CI: 36.1-38.7). 5-year relative survival among ethnic groups from 2014-2020 were: Hispanics, any race: 40.3% (CI: 37.6-43.0), Non-Hispanic American Indian/Alaska Native: 21.4 (CI: 8.5-38.2), Non-Hispanic Asian/Pacific Islander: 40.2 (CI: 35.7-44.7), Non-Hispanic Black: 33.1 (CI: 29.9-36.3), and Non-Hispanic White: 36.6 (CI: 34.8-38.4).
Conclusions
Our analysis reveals a rise in the ageadjusted incidence of pancreatic cancer among younger demographics. Particularly noteworthy is the sharp increase observed over the past five years among Hispanics when compared to other ethnic populations. This rise is observed in both males and females. Further studies need to be done to study the risk factors associated with this increase in trend of pancreatic cancer at young age specifically in Hispanic population.
Laterality in Renal Cancer: Effect on Survival in Veteran Population
Background
Kidney and renal pelvis cancers (KC) represent 4% of new cancer cases in the US. Although it is a common cancer, there is no data to compare the effect of laterality on survival in veteran population. In this abstract, we attempt to bridge this gap and compare the effect of laterality on survival.
Methods
We obtained data from Albany VA (VAMC) for patients diagnosed with KC between 2010-2020. Data were analyzed for age, stage at diagnosis, histopathological type, laterality of tumor, and 6,12 and 60-months survival after the diagnosis and performed a comparison of overall survival of left versus rightsided cancer by calculating odds ratio using logistic regression, significance level was established at p< 0.05.
Results
We reviewed 130 patients diagnosed with KC at VAMC. 62 had right-sided, 62 had left-sided, and 6 had bilateral cancer. Clear cell (40.8%) was predominant type. Other less common histopathological types include Papillary RCC, mixed, papillary urothelial and transitional types. 58 patients had stage 1 (28 right versus 30 left), 8 had stage 2 (5 versus 3), 29 had stage 3 (13 versus 16), 16 with stage 4 (12 versus 4), and 14 had stage 0 (papillary-urothelial). 59.2% patients underwent surgical treatment after diagnosis (R=35, L=39). At 6-months, 60 patients (96.8%) with left-sided and 53 (85.5%) with right-sided cancer survived. The odds of surviving 6-months were 12% higher (95% CI: 1.014, 1.236; p=0.03) in left versus right-sided cancer. For 1-year survival, the results were similar. 111 patients completed a 5-year follow-up and there was no evidence to support a difference in survival between cohorts at 5-years: OR (95% CI: 0.88, 1.47; p=0.32).
Conclusions
In this study, we discovered that leftsided cancer showed better survival at 6-months and 1-year compared to right-sided cancer, but 5-year survival rates appeared similar irrespective of laterality of cancer. Both subgroups had similar distribution for baseline characteristics with majority of patients being males, older than 60 years, with stage 1 disease. Further studies in larger populations with wider distribution of baseline characteristics are needed to establish clear role of laterality as a prognostic factor.
Background
Kidney and renal pelvis cancers (KC) represent 4% of new cancer cases in the US. Although it is a common cancer, there is no data to compare the effect of laterality on survival in veteran population. In this abstract, we attempt to bridge this gap and compare the effect of laterality on survival.
Methods
We obtained data from Albany VA (VAMC) for patients diagnosed with KC between 2010-2020. Data were analyzed for age, stage at diagnosis, histopathological type, laterality of tumor, and 6,12 and 60-months survival after the diagnosis and performed a comparison of overall survival of left versus rightsided cancer by calculating odds ratio using logistic regression, significance level was established at p< 0.05.
Results
We reviewed 130 patients diagnosed with KC at VAMC. 62 had right-sided, 62 had left-sided, and 6 had bilateral cancer. Clear cell (40.8%) was predominant type. Other less common histopathological types include Papillary RCC, mixed, papillary urothelial and transitional types. 58 patients had stage 1 (28 right versus 30 left), 8 had stage 2 (5 versus 3), 29 had stage 3 (13 versus 16), 16 with stage 4 (12 versus 4), and 14 had stage 0 (papillary-urothelial). 59.2% patients underwent surgical treatment after diagnosis (R=35, L=39). At 6-months, 60 patients (96.8%) with left-sided and 53 (85.5%) with right-sided cancer survived. The odds of surviving 6-months were 12% higher (95% CI: 1.014, 1.236; p=0.03) in left versus right-sided cancer. For 1-year survival, the results were similar. 111 patients completed a 5-year follow-up and there was no evidence to support a difference in survival between cohorts at 5-years: OR (95% CI: 0.88, 1.47; p=0.32).
Conclusions
In this study, we discovered that leftsided cancer showed better survival at 6-months and 1-year compared to right-sided cancer, but 5-year survival rates appeared similar irrespective of laterality of cancer. Both subgroups had similar distribution for baseline characteristics with majority of patients being males, older than 60 years, with stage 1 disease. Further studies in larger populations with wider distribution of baseline characteristics are needed to establish clear role of laterality as a prognostic factor.
Background
Kidney and renal pelvis cancers (KC) represent 4% of new cancer cases in the US. Although it is a common cancer, there is no data to compare the effect of laterality on survival in veteran population. In this abstract, we attempt to bridge this gap and compare the effect of laterality on survival.
Methods
We obtained data from Albany VA (VAMC) for patients diagnosed with KC between 2010-2020. Data were analyzed for age, stage at diagnosis, histopathological type, laterality of tumor, and 6,12 and 60-months survival after the diagnosis and performed a comparison of overall survival of left versus rightsided cancer by calculating odds ratio using logistic regression, significance level was established at p< 0.05.
Results
We reviewed 130 patients diagnosed with KC at VAMC. 62 had right-sided, 62 had left-sided, and 6 had bilateral cancer. Clear cell (40.8%) was predominant type. Other less common histopathological types include Papillary RCC, mixed, papillary urothelial and transitional types. 58 patients had stage 1 (28 right versus 30 left), 8 had stage 2 (5 versus 3), 29 had stage 3 (13 versus 16), 16 with stage 4 (12 versus 4), and 14 had stage 0 (papillary-urothelial). 59.2% patients underwent surgical treatment after diagnosis (R=35, L=39). At 6-months, 60 patients (96.8%) with left-sided and 53 (85.5%) with right-sided cancer survived. The odds of surviving 6-months were 12% higher (95% CI: 1.014, 1.236; p=0.03) in left versus right-sided cancer. For 1-year survival, the results were similar. 111 patients completed a 5-year follow-up and there was no evidence to support a difference in survival between cohorts at 5-years: OR (95% CI: 0.88, 1.47; p=0.32).
Conclusions
In this study, we discovered that leftsided cancer showed better survival at 6-months and 1-year compared to right-sided cancer, but 5-year survival rates appeared similar irrespective of laterality of cancer. Both subgroups had similar distribution for baseline characteristics with majority of patients being males, older than 60 years, with stage 1 disease. Further studies in larger populations with wider distribution of baseline characteristics are needed to establish clear role of laterality as a prognostic factor.
Surgical Management of SDH-Deficient Gastrointestinal Stromal Tumors (GIST): A National Cancer Database Review
Background
To evaluate factors predicting surgical resection of SDH-deficient GIST and outcomes of adjuvant therapies. SDH-deficient GIST are very rare, comprising 5-7.5% of all GIST and most frequently occurring in the stomach or small bowel. Veterans who were exposed to burn pit toxins have an increased risk of developing these tumors. While most patients undergo surgery, there is limited information available regarding prognosis and survivability
Methods
The National Cancer Database was used to identify patients diagnosed with SDH-deficient GIST from 2004 to 2019 using histology code 8936 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05.
Results
721 patients with SDH-deficient GIST were queried, with 606 (84.05%) receiving surgical resection. Surgical patients experienced longer overall survival than non-surgical patients (116.3 months vs. 48.05 months, p< 0.001), with 248 (40.9%) patients undergoing a lobectomy and 29 (4.79%) patients undergoing a wedge/segmental resection. Patients who received wedge/segmental resection survived for 109.5 months while those who received a lobectomy survived for 108.6 months. Both surgeries showed a greater survival than other types of resections (p< 0.001). Of the initial sample, 42 (6.93%) patients received adjuvant chemotherapy, 3 (0.50%) patients received adjuvant radiation, and 3 (0.50%) patients received both. None of these adjuvants impacted overall survival. Stage I-II disease and well to moderately differentiated disease predicted an increased likelihood of receiving surgery (p< 0.001), while liver metastases predicted a decreased likelihood of receiving surgery (p< 0.001). Income status, race, insurance, facility type, and age were not significant predicting factors of receiving surgery.
Conclusions
Surgical resection of SDH-deficient GIST is associated with improved overall survival. Adjuvant therapies do not significantly improve survival over surgery alone. Patients with lower stage and grade of disease are more likely to receive surgery, while other social, economic, and demographic factors do not significantly affect the likelihood of receiving surgery. Surgical resection of SDH-deficient GIST is significantly associated with improved overall survival without the need for adjuvant therapies.
Background
To evaluate factors predicting surgical resection of SDH-deficient GIST and outcomes of adjuvant therapies. SDH-deficient GIST are very rare, comprising 5-7.5% of all GIST and most frequently occurring in the stomach or small bowel. Veterans who were exposed to burn pit toxins have an increased risk of developing these tumors. While most patients undergo surgery, there is limited information available regarding prognosis and survivability
Methods
The National Cancer Database was used to identify patients diagnosed with SDH-deficient GIST from 2004 to 2019 using histology code 8936 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05.
Results
721 patients with SDH-deficient GIST were queried, with 606 (84.05%) receiving surgical resection. Surgical patients experienced longer overall survival than non-surgical patients (116.3 months vs. 48.05 months, p< 0.001), with 248 (40.9%) patients undergoing a lobectomy and 29 (4.79%) patients undergoing a wedge/segmental resection. Patients who received wedge/segmental resection survived for 109.5 months while those who received a lobectomy survived for 108.6 months. Both surgeries showed a greater survival than other types of resections (p< 0.001). Of the initial sample, 42 (6.93%) patients received adjuvant chemotherapy, 3 (0.50%) patients received adjuvant radiation, and 3 (0.50%) patients received both. None of these adjuvants impacted overall survival. Stage I-II disease and well to moderately differentiated disease predicted an increased likelihood of receiving surgery (p< 0.001), while liver metastases predicted a decreased likelihood of receiving surgery (p< 0.001). Income status, race, insurance, facility type, and age were not significant predicting factors of receiving surgery.
Conclusions
Surgical resection of SDH-deficient GIST is associated with improved overall survival. Adjuvant therapies do not significantly improve survival over surgery alone. Patients with lower stage and grade of disease are more likely to receive surgery, while other social, economic, and demographic factors do not significantly affect the likelihood of receiving surgery. Surgical resection of SDH-deficient GIST is significantly associated with improved overall survival without the need for adjuvant therapies.
Background
To evaluate factors predicting surgical resection of SDH-deficient GIST and outcomes of adjuvant therapies. SDH-deficient GIST are very rare, comprising 5-7.5% of all GIST and most frequently occurring in the stomach or small bowel. Veterans who were exposed to burn pit toxins have an increased risk of developing these tumors. While most patients undergo surgery, there is limited information available regarding prognosis and survivability
Methods
The National Cancer Database was used to identify patients diagnosed with SDH-deficient GIST from 2004 to 2019 using histology code 8936 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05.
Results
721 patients with SDH-deficient GIST were queried, with 606 (84.05%) receiving surgical resection. Surgical patients experienced longer overall survival than non-surgical patients (116.3 months vs. 48.05 months, p< 0.001), with 248 (40.9%) patients undergoing a lobectomy and 29 (4.79%) patients undergoing a wedge/segmental resection. Patients who received wedge/segmental resection survived for 109.5 months while those who received a lobectomy survived for 108.6 months. Both surgeries showed a greater survival than other types of resections (p< 0.001). Of the initial sample, 42 (6.93%) patients received adjuvant chemotherapy, 3 (0.50%) patients received adjuvant radiation, and 3 (0.50%) patients received both. None of these adjuvants impacted overall survival. Stage I-II disease and well to moderately differentiated disease predicted an increased likelihood of receiving surgery (p< 0.001), while liver metastases predicted a decreased likelihood of receiving surgery (p< 0.001). Income status, race, insurance, facility type, and age were not significant predicting factors of receiving surgery.
Conclusions
Surgical resection of SDH-deficient GIST is associated with improved overall survival. Adjuvant therapies do not significantly improve survival over surgery alone. Patients with lower stage and grade of disease are more likely to receive surgery, while other social, economic, and demographic factors do not significantly affect the likelihood of receiving surgery. Surgical resection of SDH-deficient GIST is significantly associated with improved overall survival without the need for adjuvant therapies.
Factors Affecting Academic Center Access in Merkel Cell Carcinoma: An NCDB Analysis
Background
To identify socio-demographic factors affecting academic center access in Merkel cell carcinoma (MCC) patients. MCC is a leading cause of skin cancer death, disproportionately affecting males over 65. Treatment at academic cancer centers has been shown to improve survival in MCC, but there is limited literature on factors affecting accessibility. The National Cancer Database (NCDB) was analyzed to determine variables impacting treatment at academic versus non-academic facility types in MCC.
Methods
A retrospective cohort analysis using the NCDB from 2004 to 2021 included 21,866 patients with histologically confirmed MCC. Socio-demographic factors collected include sex, age, race, Hispanic status, population density, education level, income level, and distance to the treatment facility. Multivariate analysis of factors on academic center facility type was performed via binary logistic regression. Kaplan-Meier curves were used to estimate overall survival. A significance level of 0.05 was used.
Results
The majority of MCC patients were male (63.9%) and treated at a non-academic center (56.7%) with an average age of 74.4 (SD=10.8). Overall survival was significantly better at academic versus non-academic centers (97.1 months vs 80.1 months, P< 0.05). Those who were treated at a non-academic center were older (OR=1.004; CI, 1.001-1.007). Native Americans were 2.06 times as likely to be treated at a non-academic center relative to White patients (95% CI, 1.00-4.24). Patients with median household incomes in the top first or second quartile were 0.62 and 0.86 times as likely to receive treatment at a non-academic center compared to those in the bottom quartile (95% CI, 0.55-0.69 and CI, 0.77- 0.95, respectively). Those who were treated at an academic center lived in an urban area but traveled further for care (P< 0.05; 64.9 miles vs 20.7 miles, respectively).
Conclusions
Treatment at academic centers significantly improves survival in MCC patients. The results show that Native American, low-income, and older patients are undertreated at academic facilities, highlighting inequalities in access to care. Addressing these disparities is crucial for improving overall outcomes in MCC.
Background
To identify socio-demographic factors affecting academic center access in Merkel cell carcinoma (MCC) patients. MCC is a leading cause of skin cancer death, disproportionately affecting males over 65. Treatment at academic cancer centers has been shown to improve survival in MCC, but there is limited literature on factors affecting accessibility. The National Cancer Database (NCDB) was analyzed to determine variables impacting treatment at academic versus non-academic facility types in MCC.
Methods
A retrospective cohort analysis using the NCDB from 2004 to 2021 included 21,866 patients with histologically confirmed MCC. Socio-demographic factors collected include sex, age, race, Hispanic status, population density, education level, income level, and distance to the treatment facility. Multivariate analysis of factors on academic center facility type was performed via binary logistic regression. Kaplan-Meier curves were used to estimate overall survival. A significance level of 0.05 was used.
Results
The majority of MCC patients were male (63.9%) and treated at a non-academic center (56.7%) with an average age of 74.4 (SD=10.8). Overall survival was significantly better at academic versus non-academic centers (97.1 months vs 80.1 months, P< 0.05). Those who were treated at a non-academic center were older (OR=1.004; CI, 1.001-1.007). Native Americans were 2.06 times as likely to be treated at a non-academic center relative to White patients (95% CI, 1.00-4.24). Patients with median household incomes in the top first or second quartile were 0.62 and 0.86 times as likely to receive treatment at a non-academic center compared to those in the bottom quartile (95% CI, 0.55-0.69 and CI, 0.77- 0.95, respectively). Those who were treated at an academic center lived in an urban area but traveled further for care (P< 0.05; 64.9 miles vs 20.7 miles, respectively).
Conclusions
Treatment at academic centers significantly improves survival in MCC patients. The results show that Native American, low-income, and older patients are undertreated at academic facilities, highlighting inequalities in access to care. Addressing these disparities is crucial for improving overall outcomes in MCC.
Background
To identify socio-demographic factors affecting academic center access in Merkel cell carcinoma (MCC) patients. MCC is a leading cause of skin cancer death, disproportionately affecting males over 65. Treatment at academic cancer centers has been shown to improve survival in MCC, but there is limited literature on factors affecting accessibility. The National Cancer Database (NCDB) was analyzed to determine variables impacting treatment at academic versus non-academic facility types in MCC.
Methods
A retrospective cohort analysis using the NCDB from 2004 to 2021 included 21,866 patients with histologically confirmed MCC. Socio-demographic factors collected include sex, age, race, Hispanic status, population density, education level, income level, and distance to the treatment facility. Multivariate analysis of factors on academic center facility type was performed via binary logistic regression. Kaplan-Meier curves were used to estimate overall survival. A significance level of 0.05 was used.
Results
The majority of MCC patients were male (63.9%) and treated at a non-academic center (56.7%) with an average age of 74.4 (SD=10.8). Overall survival was significantly better at academic versus non-academic centers (97.1 months vs 80.1 months, P< 0.05). Those who were treated at a non-academic center were older (OR=1.004; CI, 1.001-1.007). Native Americans were 2.06 times as likely to be treated at a non-academic center relative to White patients (95% CI, 1.00-4.24). Patients with median household incomes in the top first or second quartile were 0.62 and 0.86 times as likely to receive treatment at a non-academic center compared to those in the bottom quartile (95% CI, 0.55-0.69 and CI, 0.77- 0.95, respectively). Those who were treated at an academic center lived in an urban area but traveled further for care (P< 0.05; 64.9 miles vs 20.7 miles, respectively).
Conclusions
Treatment at academic centers significantly improves survival in MCC patients. The results show that Native American, low-income, and older patients are undertreated at academic facilities, highlighting inequalities in access to care. Addressing these disparities is crucial for improving overall outcomes in MCC.
Impact of Facility Type on Survival Outcomes in Pancreatic Neuroendocrine Carcinoma: An Analysis of the National Cancer Database
Background
This study aims to evaluate the impact of treatment facility type on the long-term survival rates of patients with pancreatic neuroendocrine tumors, as well as the demographic and treatment differences between these groups. Pancreatic neuroendocrine tumors are a rare form of pancreatic cancer with a highly variable survival rate. While existing cancer research indicates that patients treated at academic facilities generally experience improved survival outcomes compared to low income patients, there is little research on this topic in the context of pancreatic neuroendocrine tumors.
Methods
The National Cancer Database (NCDB) was used to identify patients diagnosed with pancreatic neuroendocrine carcinoma from 2004 to 2019 using the histology code 8246 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, and Chi-Square tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05.
Results
In this analysis of 13,987 patients, 6,957 (49.7%) were treated at academic facilities, while 7,012 (50.3%) were treated at non-academic facilities. Patients treated at academic facilities experienced a significantly increased mean survival rate of 100.5 months following diagnosis compared to the 75.6 month mean survival rate of patients treated at non-academic facilities (p< 0.05). Additionally, patients treated at academic facilities were more likely to be black, have private insurance, undergo surgery, and live in a metropolitan area with a population larger than 1 million (p< 0.05). Conversely, patients treated at non-academic facilities experienced a worse 30-day and 90-day mortality, had a higher average Charlson-Deyo Comorbidity Index, and lived closer to their treatment facility (p< 0.05). Patients’ income did not differ significantly.
Conclusions
This study showed that patients with pancreatic neuroendocrine carcinomas treated at academic facilities experienced a significantly improved overall survival rate compared to low income patients. This disparity may be attributed to differences in rates of surgical intervention or insurance status, among other factors. These observations are based on correlational data, and they underscore the necessity for further investigation to establish causality.
Background
This study aims to evaluate the impact of treatment facility type on the long-term survival rates of patients with pancreatic neuroendocrine tumors, as well as the demographic and treatment differences between these groups. Pancreatic neuroendocrine tumors are a rare form of pancreatic cancer with a highly variable survival rate. While existing cancer research indicates that patients treated at academic facilities generally experience improved survival outcomes compared to low income patients, there is little research on this topic in the context of pancreatic neuroendocrine tumors.
Methods
The National Cancer Database (NCDB) was used to identify patients diagnosed with pancreatic neuroendocrine carcinoma from 2004 to 2019 using the histology code 8246 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, and Chi-Square tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05.
Results
In this analysis of 13,987 patients, 6,957 (49.7%) were treated at academic facilities, while 7,012 (50.3%) were treated at non-academic facilities. Patients treated at academic facilities experienced a significantly increased mean survival rate of 100.5 months following diagnosis compared to the 75.6 month mean survival rate of patients treated at non-academic facilities (p< 0.05). Additionally, patients treated at academic facilities were more likely to be black, have private insurance, undergo surgery, and live in a metropolitan area with a population larger than 1 million (p< 0.05). Conversely, patients treated at non-academic facilities experienced a worse 30-day and 90-day mortality, had a higher average Charlson-Deyo Comorbidity Index, and lived closer to their treatment facility (p< 0.05). Patients’ income did not differ significantly.
Conclusions
This study showed that patients with pancreatic neuroendocrine carcinomas treated at academic facilities experienced a significantly improved overall survival rate compared to low income patients. This disparity may be attributed to differences in rates of surgical intervention or insurance status, among other factors. These observations are based on correlational data, and they underscore the necessity for further investigation to establish causality.
Background
This study aims to evaluate the impact of treatment facility type on the long-term survival rates of patients with pancreatic neuroendocrine tumors, as well as the demographic and treatment differences between these groups. Pancreatic neuroendocrine tumors are a rare form of pancreatic cancer with a highly variable survival rate. While existing cancer research indicates that patients treated at academic facilities generally experience improved survival outcomes compared to low income patients, there is little research on this topic in the context of pancreatic neuroendocrine tumors.
Methods
The National Cancer Database (NCDB) was used to identify patients diagnosed with pancreatic neuroendocrine carcinoma from 2004 to 2019 using the histology code 8246 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, and Chi-Square tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05.
Results
In this analysis of 13,987 patients, 6,957 (49.7%) were treated at academic facilities, while 7,012 (50.3%) were treated at non-academic facilities. Patients treated at academic facilities experienced a significantly increased mean survival rate of 100.5 months following diagnosis compared to the 75.6 month mean survival rate of patients treated at non-academic facilities (p< 0.05). Additionally, patients treated at academic facilities were more likely to be black, have private insurance, undergo surgery, and live in a metropolitan area with a population larger than 1 million (p< 0.05). Conversely, patients treated at non-academic facilities experienced a worse 30-day and 90-day mortality, had a higher average Charlson-Deyo Comorbidity Index, and lived closer to their treatment facility (p< 0.05). Patients’ income did not differ significantly.
Conclusions
This study showed that patients with pancreatic neuroendocrine carcinomas treated at academic facilities experienced a significantly improved overall survival rate compared to low income patients. This disparity may be attributed to differences in rates of surgical intervention or insurance status, among other factors. These observations are based on correlational data, and they underscore the necessity for further investigation to establish causality.
An NCDB Analysis of Factors Associated With the Receipt of Surgery in Myxoid/Round Cell Liposarcoma
Background
Myxoid/round cell liposarcoma (MRCLS) is a rare soft tissue sarcoma originating from adipocytes and most commonly occurs in patients aged 20 to 40. Though slow-growing, MRCLS has a high propensity to metastasize. Complete surgical resection is central in the treatment of MRCLS. However, no significant study has analyzed the factors that predict the utilization of surgical therapy in MRCLS patients. This study also aims to characterize the effect of different treatment modalities on overall survival of these patients.
Methods
The National Cancer Database (NCDB) was used to identify patients diagnosed with MRCLS from 2004 to 2019 using the histology code 8852 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Multilevel Logistic Regression were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05.
Results
5365 patients with MRCLS were queried. 4811 (89.8%) patients received surgery. Surgical patients experienced greater overall survival compared to nonsurgical patients (159.17 vs 93.72 months, p < 0.001). Wedge/segmental resection (1551 patients, 32.2%) and lobectomy resection (2724 patients, 56.6%) were associated with improved survival over other surgery types (OS =161.0 months, p < 0.001). Private insurance status and care at an academic facility were associated with an increased likelihood of receiving surgery (p< 0.001). Metastasis was associated with a decreased likelihood of receiving surgery (p< 0.001). On nominal regression, grades I-II, stages 1-3, and histologically well to moderately differentiated disease were associated with a greater likelihood of receiving surgery. Adjuvant therapy did not appear to impact survival.
Conclusions
This study reaffirms that tumor resection is associated with increased overall survival in MRCLS patients. Specifically, wedge/segmental and lobectomy surgery types are associated with improved outcomes. It appears that care at an academic facility, private insurance status, lower stage and grade of disease, and well-differentiated histology are correlated to an increased likelihood of receiving surgical treatment. Metastasis is associated with a decreased chance of receiving surgery. This research serves as the start to a better understanding of the factors involved in the receipt of tumor resection, as it is the mainstay of MRCLS treatment.
Background
Myxoid/round cell liposarcoma (MRCLS) is a rare soft tissue sarcoma originating from adipocytes and most commonly occurs in patients aged 20 to 40. Though slow-growing, MRCLS has a high propensity to metastasize. Complete surgical resection is central in the treatment of MRCLS. However, no significant study has analyzed the factors that predict the utilization of surgical therapy in MRCLS patients. This study also aims to characterize the effect of different treatment modalities on overall survival of these patients.
Methods
The National Cancer Database (NCDB) was used to identify patients diagnosed with MRCLS from 2004 to 2019 using the histology code 8852 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Multilevel Logistic Regression were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05.
Results
5365 patients with MRCLS were queried. 4811 (89.8%) patients received surgery. Surgical patients experienced greater overall survival compared to nonsurgical patients (159.17 vs 93.72 months, p < 0.001). Wedge/segmental resection (1551 patients, 32.2%) and lobectomy resection (2724 patients, 56.6%) were associated with improved survival over other surgery types (OS =161.0 months, p < 0.001). Private insurance status and care at an academic facility were associated with an increased likelihood of receiving surgery (p< 0.001). Metastasis was associated with a decreased likelihood of receiving surgery (p< 0.001). On nominal regression, grades I-II, stages 1-3, and histologically well to moderately differentiated disease were associated with a greater likelihood of receiving surgery. Adjuvant therapy did not appear to impact survival.
Conclusions
This study reaffirms that tumor resection is associated with increased overall survival in MRCLS patients. Specifically, wedge/segmental and lobectomy surgery types are associated with improved outcomes. It appears that care at an academic facility, private insurance status, lower stage and grade of disease, and well-differentiated histology are correlated to an increased likelihood of receiving surgical treatment. Metastasis is associated with a decreased chance of receiving surgery. This research serves as the start to a better understanding of the factors involved in the receipt of tumor resection, as it is the mainstay of MRCLS treatment.
Background
Myxoid/round cell liposarcoma (MRCLS) is a rare soft tissue sarcoma originating from adipocytes and most commonly occurs in patients aged 20 to 40. Though slow-growing, MRCLS has a high propensity to metastasize. Complete surgical resection is central in the treatment of MRCLS. However, no significant study has analyzed the factors that predict the utilization of surgical therapy in MRCLS patients. This study also aims to characterize the effect of different treatment modalities on overall survival of these patients.
Methods
The National Cancer Database (NCDB) was used to identify patients diagnosed with MRCLS from 2004 to 2019 using the histology code 8852 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Multilevel Logistic Regression were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05.
Results
5365 patients with MRCLS were queried. 4811 (89.8%) patients received surgery. Surgical patients experienced greater overall survival compared to nonsurgical patients (159.17 vs 93.72 months, p < 0.001). Wedge/segmental resection (1551 patients, 32.2%) and lobectomy resection (2724 patients, 56.6%) were associated with improved survival over other surgery types (OS =161.0 months, p < 0.001). Private insurance status and care at an academic facility were associated with an increased likelihood of receiving surgery (p< 0.001). Metastasis was associated with a decreased likelihood of receiving surgery (p< 0.001). On nominal regression, grades I-II, stages 1-3, and histologically well to moderately differentiated disease were associated with a greater likelihood of receiving surgery. Adjuvant therapy did not appear to impact survival.
Conclusions
This study reaffirms that tumor resection is associated with increased overall survival in MRCLS patients. Specifically, wedge/segmental and lobectomy surgery types are associated with improved outcomes. It appears that care at an academic facility, private insurance status, lower stage and grade of disease, and well-differentiated histology are correlated to an increased likelihood of receiving surgical treatment. Metastasis is associated with a decreased chance of receiving surgery. This research serves as the start to a better understanding of the factors involved in the receipt of tumor resection, as it is the mainstay of MRCLS treatment.