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Palis BE, Janczewski LM, Browner AE, Cotler J, Nogueira L, Richardson LC, Benard V, Wilson RJ, Walker N, McCabe RM, Boffa DJ, Nelson H. The National Cancer Database Conforms to the Standardized Framework for Registry and Data Quality. Ann Surg Oncol 2024; 31:5546-5559. [PMID: 38717542 PMCID: PMC11300494 DOI: 10.1245/s10434-024-15393-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/17/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Standardization of procedures for data abstraction by cancer registries is fundamental for cancer surveillance, clinical and policy decision-making, hospital benchmarking, and research efforts. The objective of the current study was to evaluate adherence to the four components (completeness, comparability, timeliness, and validity) defined by Bray and Parkin that determine registries' ability to carry out these activities to the hospital-based National Cancer Database (NCDB). METHODS Tbis study used data from U.S. Cancer Statistics, the official federal cancer statistics and joint effort between the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), which includes data from National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) to evaluate NCDB completeness between 2016 and 2020. The study evaluated comparability of case identification and coding procedures. It used Commission on Cancer (CoC) standards from 2022 to assess timeliness and validity. RESULTS Completeness was demonstrated with a total of 6,828,507 cases identified within the NCDB, representing 73.7% of all cancer cases nationwide. Comparability was followed using standardized and international guidelines on coding and classification procedures. For timeliness, hospital compliance with timely data submission was 92.7%. Validity criteria for re-abstracting, recording, and reliability procedures across hospitals demonstrated 94.2% compliance. Additionally, data validity was shown by a 99.1% compliance with histologic verification standards, a 93.6% assessment of pathologic synoptic reporting, and a 99.1% internal consistency of staff credentials. CONCLUSION The NCDB is characterized by a high level of case completeness and comparability with uniform standards for data collection, and by hospitals with high compliance, timely data submission, and high rates of compliance with validity standards for registry and data quality evaluation.
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Affiliation(s)
| | | | | | | | | | | | - Vicki Benard
- Centers for Disease Control and Prevention, Atlanta, USA
| | - Reda J Wilson
- Centers for Disease Control and Prevention, Atlanta, USA
| | - Nadine Walker
- National Cancer Registrars Association, Alexandria, USA
| | | | | | - Heidi Nelson
- Department of Surgery, Mayo Clinic, Rochester, USA
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Vyas A, Kamat S, Oh J. Rhode Island (RI) Women's Breast Cancer Mammography Use Prior to and After Cancer Diagnosis: Linkage of RI Cancer Registry Data With RI All-Payer Claims Database. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:E65-E73. [PMID: 38271112 DOI: 10.1097/phh.0000000000001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE A limitation of the central cancer registries to examine associations between mammography use and cancer diagnosis is their lack of cancer screening history. To fill this measurement gap, Rhode Island Cancer Registry (RICR) breast cancer (BC) records were linked to Rhode Island-all-payer claims database (RI-APCD) to study Rhode Island (RI) women's regular mammography use and identify its predictors. METHODS From the linked 2011-2019 data, we identified 4 study cohorts: (1) women who ever received mammography by Women's Cancer Screening Program (WCSP) and were diagnosed with BC ("WCSP-BC" cohort: n = 149), (2) women diagnosed with BC outside of WCSP (BC-control cohort: n = 4304), (3) women with a history of mammography use at WCSP but no BC diagnosis (n = 6513), and (4) general RI women with no BC diagnosis (n = 15 121). Logistic regressions were conducted to identify predictors of regular mammography use. RESULTS The linkage for RI-APCD and RICR for our study had a high matching rate of 82%. Mammography use prior to BC diagnosis was not different between the WCSP-BC cohort and the BC-control cohort (58% vs 57%). Women in the BC-control cohort who had mammography in 2 years prior to their cancer diagnosis were more likely of being diagnosed at an early-stage disease. Among BC-control group, women with no anxiety/depression or with no preventive examinations were less likely of regular mammography use. Among women with no BC, a lower proportion of women with a history of screening at WCSP had regular mammography use, compared with the general RI women (38% vs 66%). CONCLUSION RI-APCD data linkage with RICR provides excellent opportunities to examine regular mammography use among RI women and compare their outcomes to the general women population in the state. We identified opportunities for improving their mammography use. A measurement gap in the central cancer registries can be effectively reduced by utilizing statewide claims database.
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Affiliation(s)
- Ami Vyas
- Department of Pharmacy Practice & Clinical Research, The University of Rhode Island, College of Pharmacy, Kingston, Rhode Island (Dr Vyas and Ms Kamat); and Rhode Island Department of Health, Providence, Rhode Island (Ms Oh)
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Luo J, Hendryx M, Dong Y. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and non-small cell lung cancer survival. Br J Cancer 2023; 128:1541-1547. [PMID: 36765176 PMCID: PMC10070339 DOI: 10.1038/s41416-023-02177-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs with demonstrated renal and cardiovascular disease benefit. This study evaluates the role of SGLT2 inhibitors on the survival of non-small cell lung cancer (NSCLC) patients. METHODS We used National Surveillance, Epidemiology and End Results (SEER)-Medicare linked data. Twenty four thousand nine hundred fifteen NSCLC patients newly diagnosed between 2014 and 2017 with pre-exiting diabetes and aged 66 years or older were included and followed to the end of 2019. Information on SGLT2 inhibitors use was extracted from the Medicare Part D file. RESULTS SGLT2 inhibitor use was associated with significantly reduced mortality risk after adjusting for potential confounders (HR = 0.68, 95% CI = 0.60-0.77) with stronger association for longer duration of use (HR = 0.54, 85% CI = 0.44-0.68). Further, we found that SGLT2 inhibitor use was associated with a significant reduced risk of mortality regardless of patients' demographic, tumour characteristics and cancer treatments. CONCLUSION Our large SEER-Medicare linked data study indicates that SGLT2 inhibitors use was associated with improved overall survival of NSCLC patients with pre-existing diabetes. Further studies are needed to confirm our findings and elucidate the possible mechanisms behind the association.
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Affiliation(s)
- Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA.
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Yi Dong
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
- Division of Hematology Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Gaber CE, Shaheen NJ, Edwards JK, Sandler RS, Nichols HB, Sanoff HK, Lund JL. Trimodality Therapy vs Definitive Chemoradiation in Older Adults With Locally Advanced Esophageal Cancer. JNCI Cancer Spectr 2022; 6:pkac069. [PMID: 36205723 PMCID: PMC9623425 DOI: 10.1093/jncics/pkac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The comparative effectiveness of trimodality therapy vs definitive chemoradiation for treating locally advanced esophageal cancer in older adults is uncertain. Existing trials lack generalizability to older adults, a population with heightened frailty. We sought to emulate a hypothetical trial comparing these treatments using real-world data. METHODS A cohort of adults aged 66-79 years diagnosed with locally advanced esophageal cancer between 2004 and 2017 was identified in the Surveillance Epidemiology and End Results-Medicare database. The clone-censor-weight method was leveraged to eliminate time-related biases when comparing outcomes between treatments. Outcomes included overall mortality, esophageal cancer-specific mortality, functional adverse events, and healthy days at home. RESULTS A total of 1240 individuals with adenocarcinomas and 661 with squamous cell carcinomas were identified. For adenocarcinomas, the standardized 5-year risk of mortality was 73.4% for trimodality therapy and 83.8% for definitive chemoradiation (relative risk [RR] = 0.88, 95% confidence interval [CI] = 0.82 to 0.95). Trimodality therapy was associated with mortality risk reduction for squamous cell carcinomas (RR = 0.87, 95% CI = 0.70 to 1.01). The 1-year incidence of functional adverse events was higher in the trimodality group (adenocarcinomas RR = 1.40, 95% CI = 1.22 to 1.65; squamous cell carcinomas RR = 1.21, 95% CI = 1.00 to 1.49). Over 5 years, trimodality therapy was associated with 160 (95% CI = 67 to 229) and 177 (95% CI = 51 to 313) additional home days in individuals with adenocarcinomas and squamous cell carcinomas, respectively. CONCLUSIONS Compared with definitive chemoradiation, trimodality therapy was associated with reduced mortality but increased risk of function-related adverse events. Discussing these tradeoffs may help optimize care plans.
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Affiliation(s)
- Charles E Gaber
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois-Chicago, Chicago, IL, USA
| | - Nicholas J Shaheen
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert S Sandler
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hanna K Sanoff
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Jang JK, Atay SM, Ding L, David EA, Wightman SC, Kim AW, Ye JC. Patterns of Use of Stereotactic Body Radiation Therapy Compared With Surgery for Definitive Treatment of Primary Early-stage Non-small Cell Lung Cancer. Am J Clin Oncol 2022; 45:146-154. [PMID: 35320815 PMCID: PMC8971891 DOI: 10.1097/coc.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE As stereotactic body radiation therapy (SBRT) becomes widely available for early-stage non-small cell lung cancer (NSCLC), there may be concerns in the surgical community that SBRT is being offered for patients with operable tumors, even though surgery is standard of care. We evaluated the trends in SBRT and surgery over time for patients with NSCLC. MATERIALS AND METHODS The National Cancer Database was queried for patients with node-negative NSCLC ≤5 cm from 2004 to 2016. The relationships between definitive local treatment modalities and year were analyzed using a multinomial regression model while controlling for other covariates. RESULTS Among the 202,367 patients who met the inclusion criteria, there was a steady decrease in mean tumor size in all treatment modalities, from 2.44 cm (SD=1.08) to 2.25 cm (SD=1.00) over the study period. In the multinomial model, the probability of receiving lobectomy demonstrated a slight decline from 58% (2004) to 53% (2016). The use of SBRT increased from 1% to 20%, while patients receiving no therapy declined from 27% to 16%. The likelihood of SBRT increased with year of diagnosis (P<0.0001) and decreasing tumor size (P<0.0001), compared with lobectomy. Age, race, income, facility, and Charlson-Deyo score were also associated with treatment modality. CONCLUSIONS The mean tumor size of early-stage NSCLC decreased over the study period for all treatment modalities. SBRT use has increased, mostly among older patients with smaller tumors and Charlson-Deyo scores ≥3. The increase in SBRT contributed to the significant decline in patients who had no therapy.
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Affiliation(s)
- Julie K Jang
- Keck School of Medicine, University of Southern California, Department of Radiation Oncology, Los Angeles, CA
| | - Scott M. Atay
- Keck School of Medicine, University of Southern California, Division of Thoracic Surgery, Los Angeles, CA
| | - Li Ding
- Keck School of Medicine, University of Southern California, Department of Preventive Medicine, Los Angeles, CA
| | - Elizabeth A. David
- Keck School of Medicine, University of Southern California, Division of Thoracic Surgery, Los Angeles, CA
| | - Sean C. Wightman
- Keck School of Medicine, University of Southern California, Division of Thoracic Surgery, Los Angeles, CA
| | - Anthony W. Kim
- Keck School of Medicine, University of Southern California, Division of Thoracic Surgery, Los Angeles, CA
| | - Jason C Ye
- Keck School of Medicine, University of Southern California, Department of Radiation Oncology, Los Angeles, CA
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Multilevel predictors of guideline concordant needle biopsy use for non-metastatic breast cancer. Breast Cancer Res Treat 2021; 190:143-153. [PMID: 34405292 DOI: 10.1007/s10549-021-06352-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Persistent breast cancer disparities, particularly geographic disparities, may be explained by diagnostic practice patterns such as utilization of needle biopsy, a National Quality Forum-endorsed quality metric for breast cancer diagnosis. Our objective was to assess the relationship between patient- and facility-level factors and needle biopsy receipt among women with non-metastatic breast cancer in the United States. METHODS We examined characteristics of women diagnosed with breast cancer between 2004 and 2015 in the National Cancer Database. We assessed the relationship between patient- (e.g., race/ethnicity, stage, age, rurality) and facility-level (e.g., facility type, breast cancer case volume) factors with needle biopsy utilization via a mixed effects logistic regression model controlling for clustering by facility. RESULTS In our cohort of 992,209 patients, 82.96% received needle biopsy. In adjusted models, the odds of needle biopsy receipt were higher for Hispanic (OR 1.04, Confidence Interval 1.01-1.08) and Medicaid patients (OR 1.04, CI 1.02-1.08), and for patients receiving care at Integrated Network Cancer Programs (OR 1.21, CI 1.02-1.43). Odds of needle biopsy receipt were lower for non-metropolitan patients (OR 0.93, CI 0.90-0.96), patients with cancer stage 0 or I (at least OR 0.89, CI 0.86-0.91), patients with comorbidities (OR 0.93, CI 0.91-0.94), and for patients receiving care at Community Cancer Programs (OR 0.84, CI 0.74-0.96). CONCLUSION This study suggests a need to account for sociodemographic factors including rurality as predictors of utilization of evidence-based diagnostic testing, such as needle biopsy. Addressing inequities in breast cancer diagnosis quality may help improve breast cancer outcomes in underserved patients.
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Au D, Lee EK, Popoola TO, Parker WP, Onge JMS, Ellis SD. Factors associated with utilization of neoadjuvant chemotherapy in charlson comorbidity zero non-metastatic muscle-invasive bladder cancer patients. Int Braz J Urol 2021; 47:803-818. [PMID: 33848073 PMCID: PMC8321501 DOI: 10.1590/s1677-5538.ibju.2020.0594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/01/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Guideline-based best practice treatment for muscle invasive bladder cancer (MIBC) involves neoadjuvant chemotherapy followed by radical cystectomy (NACRC). Prior studies have shown that a minority of patients receive NACRC and older age and renal function are drivers of non-receipt of NACRC. This study investigates treatment rates and factors associated with not receiving NACRC in MIBC patients with lower comorbidity status most likely to be candidates for NACRC. MATERIALS AND METHODS Retrospective United States National Cancer Database analysis from 2006 to 2015 of MIBC patients with Charlson comorbidity index (CCI) of zero. Analysis of NACRC treatment trends in higher CCI patients was also performed. RESULTS 15.561 MIBC patients met inclusion criteria. 1.507 (9.7%) received NACRC within 9 months of diagnosis. NACRC increased over time (15.0% in 2015 compared to 3.6% in 2006). Higher NACRC was noted in females, cT3 or cT4 cancer, later year of diagnosis, and academic facility treatment. Lower utilization was noted for blacks and NACRC decreased with increasing age and CCI. Only 16.9% of patients aged 23-62 in the lowest age quartile with muscle invasive bladder cancer and CCI of 0 received NACRC. CONCLUSIONS Although utilization is increasing, receipt of NACRC remains low even in populations most likely to be candidates. Further study should continue to elucidate barriers to utilization of NACRC.
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Affiliation(s)
- Daniel Au
- University of Kansas Health SystemDepartment of UrologyKansas CityKSUnited StatesDepartment of Urology, University of Kansas Health System, Kansas City, KS, United States
| | - Eugene K. Lee
- University of Kansas Health SystemDepartment of UrologyKansas CityKSUnited StatesDepartment of Urology, University of Kansas Health System, Kansas City, KS, United States
| | - Taiye O. Popoola
- Health University of Kansas Health SystemDepartment of PopulationKansas CityKSUnited StatesDepartment of Population, Health University of Kansas Health System, Kansas City, KS, United States
| | - William P. Parker
- University of Kansas Health SystemDepartment of UrologyKansas CityKSUnited StatesDepartment of Urology, University of Kansas Health System, Kansas City, KS, United States
| | - Jarron M. Saint Onge
- Health University of Kansas Health SystemDepartment of PopulationKansas CityKSUnited StatesDepartment of Population, Health University of Kansas Health System, Kansas City, KS, United States
| | - Shellie D. Ellis
- Health University of Kansas Health SystemDepartment of PopulationKansas CityKSUnited StatesDepartment of Population, Health University of Kansas Health System, Kansas City, KS, United States
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Cui X, Song D, Li X. Construction and Validation of Nomograms Predicting Survival in Triple-Negative Breast Cancer Patients of Childbearing Age. Front Oncol 2021; 10:636549. [PMID: 33628740 PMCID: PMC7898905 DOI: 10.3389/fonc.2020.636549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background Triple-negative breast cancer (TNBC) is one of the most aggressive subtypes of breast cancer with poorest clinical outcomes. Patients of childbearing age have a higher probability of TNBC diagnosis, with more demands on maintenance and restoration of physical and psychosocial function. This study aimed to design effective and comprehensive nomograms to predict survival in these patients. Methods We used the SEER database to identify patients with TNBC aged between 18 and 45 and randomly classified these patients into a training (n=2,296) and a validation (n=2,297) cohort. Nomograms for estimating overall survival (OS) and breast cancer-specific survival (BCSS) were generated based on multivariate Cox proportional hazards models and competing-risk models in the training cohort. The performances of the nomograms were quantified in the validation cohort using calibration curves, time-dependent receiver operating characteristic (ROC) curves and Harrell’s concordance index (C-index). Results A total of 4,593 TNBC patients of childbearing age were enrolled. Four prognostic factors for OS and six for BCSS were identified and incorporated to construct nomograms. In the validation cohort, calibration curves showed excellent agreement between nomogram-predicted and actual survival data. The nomograms also achieved relatively high Harrell’s C-indexes and areas under the time-dependent ROC curves for estimating OS and BCSS in both training and validation cohorts. Conclusions Independent prognostic factors were identified, and used to develop nomograms to predict OS and BCSS in childbearing-age patients with TNBC. These models could enable individualized risk estimation and risk-adapted treatment for these patients.
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Affiliation(s)
- Xiang Cui
- Department of Thyroid and Breast Surgery, The First People's Hospital of Shangqiu, Shangqiu, China
| | - Deba Song
- Department of Thyroid and Breast Surgery, The First People's Hospital of Shangqiu, Shangqiu, China
| | - Xiaoxu Li
- Department of Thyroid and Breast Surgery, The First People's Hospital of Shangqiu, Shangqiu, China
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The effect of guideline-concordant care in mitigating insurance status disparities in cervical cancer. Gynecol Oncol 2020; 159:309-316. [DOI: 10.1016/j.ygyno.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022]
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Song C, Yu D, Wang Y, Wang Q, Guo Z, Huang J, Li S, Hu W. Dual Primary Cancer Patients With Lung Cancer as a Second Primary Malignancy: A Population-Based Study. Front Oncol 2020; 10:515606. [PMID: 33194578 PMCID: PMC7649344 DOI: 10.3389/fonc.2020.515606] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 09/01/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Research on patients with lung cancer as a second primary malignancy (LCSPM) remains limited. This study aims to determine the clinical characteristics, prognosis, and temporal relationship of other cancers to lung cancer in these patients. METHODS This study retrospectively analyzed 3465 patients with dual primary cancers from the 5253 patients with LCSPM retrieved from the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2015. RESULTS 2285 eligible patients were further analyzed in this study cohort with 59.3% of 1-year OS, 34.7% of 3-year OS, and 25.2% of 5-year OS. The most common first primary cancer (FPC) in dual primary cancer patients with LCSPM was prostate cancer, followed by female breast cancer and urinary bladder cancer. In the entire study population, the median interval between the two primary malignancies was 21 months (range: 3.5-52 months). Age, sex, FPC location, surgery, stage, and histology of lung cancer were regarded as independent prognostic factors for these patients. The prognosis of patients with urinary bladder cancer as FPC was the worst in the univariate (p = 0.024) and multivariate (p < 0.001) Cox analyses. Lung cancer-directed surgery could significantly improve long-term survival (HR = 0.22, p < 0.001). Additionally, the C-index of the established nomogram with acceptable calibration curves was 0.760 (95% CI: 0.744-0.776) in the training cohort and was 0.759 (95% CI: 0.737-0.781) in the validation cohort, showing an ideal model discrimination ability. The corresponding decision curve analysis (DCA) indicated the nomogram had relatively ideal clinical utility. CONCLUSIONS Cancer patients still have the risk of developing a new primary lung cancer. Close, lifelong follow-up is recommended for all these patients. Early detection for surgical treatment will significantly improve the prognosis of dual primary cancer patients with LCSPM. The nomogram developed to predict 1-, 3-, and 5-year OS rates has relatively good performance.
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Affiliation(s)
- Congkuan Song
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, China
| | - Donghu Yu
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yujin Wang
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, China
| | - Qingwen Wang
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, China
| | - Zixin Guo
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, China
| | - Jingyu Huang
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, China
| | - Sheng Li
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
- Human Genetics Resource Preservation Center of Hubei Province, Wuhan, China
| | - Weidong Hu
- Department of Thoracic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, China
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11
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Corrigan KL, Nogueira L, Yabroff KR, Lin CC, Han X, Chino JP, Coghill AE, Shiels M, Jemal A, Suneja G. The impact of the Patient Protection and Affordable Care Act on insurance coverage and cancer-directed treatment in HIV-infected patients with cancer in the United States. Cancer 2020; 126:559-566. [PMID: 31709523 PMCID: PMC6980281 DOI: 10.1002/cncr.32563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/19/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND To the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act (ACA) on people living with HIV and cancer (PLWHC), who have lower cancer treatment rates and worse cancer outcomes. To investigate this research gap, the authors examined the effects of the ACA on insurance coverage and receipt of cancer treatment among PLWHC in the United States. METHODS HIV-infected individuals aged 18 to 64 years old with cancer diagnosed between 2011 and 2015 were identified in the National Cancer Data Base. Health insurance coverage and cancer treatment receipt were compared before and after implementation of the ACA in non-Medicaid expansion and Medicaid expansion states using difference-in-differences analysis. RESULTS Of the 4794 PLWHC analyzed, approximately 49% resided in nonexpansion states and were more often uninsured (16.7% vs 4.2%), nonwhite (65.2% vs 60.2%), and of low income (36.3% vs 26.9%) compared with those in Medicaid expansion states. After 2014, the percentage of uninsured individuals decreased in expansion states (from 4.9% to 3%; P = .01) and nonexpansion states (from 17.6% to 14.6%; P = .06), possibly due to increased Medicaid coverage in expansion states (from 36.9% to 39.2%) and increased private insurance coverage in nonexpansion states (from 29.5% to 34.7%). There was no significant difference in cancer treatment receipt noted between Medicaid expansion and nonexpansion states. However, the percentage of PLWHC treated at academic facilities increased significantly only in expansion states (from 40.2% to 46.7% [P < .0001]; difference-in-differences analysis: 7.2 percentage points [P = .02]). CONCLUSIONS The implementation of the ACA was associated with improved insurance coverage among PLWHC. Lack of insurance still is common in non-Medicaid expansion states. Patients with minority or low socioeconomic status more often resided in nonexpansion states, thereby highlighting the need for further insurance expansion.
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Affiliation(s)
| | - Leticia Nogueira
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Chun Chieh Lin
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.,Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Junzo P Chino
- Duke University School of Medicine, Durham, North Carolina.,Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina
| | - Anna E Coghill
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Meredith Shiels
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, Maryland
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Gita Suneja
- Duke University School of Medicine, Durham, North Carolina.,Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina.,Department of Radiation Oncology and Global Health, Duke Global Health Institute, Durham, North Carolina
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Liu X, Huang X, Zhao P, Zhang P. Survival benefit of nephron-sparing surgery for patients with pT1b renal cell carcinoma: A population-based study. Oncol Lett 2020; 19:498-504. [PMID: 31897163 DOI: 10.3892/ol.2019.11065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 04/15/2019] [Indexed: 02/05/2023] Open
Abstract
The use of partial nephrectomy (PN) to treat patients with large renal cell carcinoma (RCC) remains controversial, particularly among elderly patients. The present study compared the improvement in cancer-specific survival (CSS) in patients with pT1b RCC who underwent either PN or radical nephrectomy (RN) and investigated the effects of age and sex on CSS. A total of 20,343 patients were identified in the Surveillance, Epidemiology and End Results database. Kaplan-Meier curves and Cox regression analysis were used to compare the CSS of patients who received PN vs. those who received RN. In total, 5,375 (26.42%) and 14,968 (73.58%) patients with pT1b RCC received PN and RN, respectively. Kaplan-Meier and Cox regression analysis indicated that PN resulted in an improved CSS compared with RN (P<0.001). In addition, PN was observed to be beneficial in male (P<0.001) and female patients <75 years of age. However, it was not beneficial for female patients of ≥75 years of age (P=0.197). These preliminary results warrant further investigation in clinical trials.
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Affiliation(s)
- Xiaode Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, School of Medicine University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Xuemei Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, School of Medicine University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Pan Zhao
- Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, School of Medicine University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Peng Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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13
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Tan WS, Trinh QD, Hayn MH, Marchese M, Lipsitz SR, Nabi J, Kilbridge KL, Vale JA, Khoubehi B, Kibel AS, Sun M, Chang SL, Sammon JD. Delayed nephrectomy has comparable long-term overall survival to immediate nephrectomy for cT1a renal cell carcinoma: A population-based analysis. Urol Oncol 2019; 38:74.e13-74.e20. [PMID: 31864937 DOI: 10.1016/j.urolonc.2019.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/06/2019] [Accepted: 11/25/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Early surgical resection remains the recommended treatment option for most small renal mass (≤4 cm). We examined the long-term overall survival (OS) of patients managed with delayed and immediate nephrectomy of cT1a renal cancer. PATIENT AND METHODS We utilized the National Cancer Database (2005-2010) to identify 14,677 patients (immediate nephrectomy: 14,050 patients vs. late nephrectomy: 627 patients) aged <70 years with Charlson Comorbidity Index 0 and cT1aN0M0 renal cell carcinoma. Immediate nephrectomy and late nephrectomy were defined as nephrectomy performed <30 days and >180 days from diagnosis, respectively. Inverse probability of treatment weighting-adjusted Kaplan-Meier curves and Cox proportional hazards regression analyses were used to compare OS of patients in the 2 treatment arms. Influence of patient age and Charlson Comorbidity Index on treatment effect was tested by interactions. Sensitivity analysis was performed to explore the outcome of delaying nephrectomy for >12 months. RESULTS Median patient age was 55 years with a median follow-up of 82.5 months. Inverse probability of treatment weighting-adjusted Kaplan-Meier curves suggest no significant difference between treatment arms (immediate nephrectomy [<30 days] vs. delayed nephrectomy [>180 days]) (Hazard ratio 0.96; 95% confidence interval 0.73-1.26; P = 0.77). This outcome was consistent between all patients regardless of age (P = 0.48). Sensitivity analysis reports no difference in OS even if nephrectomy was delayed by >12 months (P = 0.60). CONCLUSIONS We report that delayed and immediate nephrectomy for cT1a renal cell carcinoma confers comparable long-term OS. These findings suggest that a period of observation of between 6 and 12 months is safe to allow identification of renal masses, which will benefit from surgical resection.
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Affiliation(s)
- Wei Shen Tan
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Surgery & Interventional Science, Department of Urology, University College London, London, United Kingdom; Department of Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA.
| | - Matthew H Hayn
- Division of Urology, Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME
| | - Maya Marchese
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart R Lipsitz
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Junaid Nabi
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kerry L Kilbridge
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Justin A Vale
- Department of Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Bijan Khoubehi
- Department of Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Adam S Kibel
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Maxine Sun
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Steven L Chang
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jesse D Sammon
- Division of Urology, Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME
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14
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Comparison of Outcomes in Patients With Muscle-invasive Bladder Cancer Treated With Radical Cystectomy Versus Bladder Preservation. Am J Clin Oncol 2019; 42:36-41. [PMID: 29912804 DOI: 10.1097/coc.0000000000000471] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Radical cystectomy currently remains the standard of care for muscle-invasive bladder cancer. However, surgery can be associated with considerable morbidity and mortality, including the removal of the bladder. An alternative strategy is to preserve the bladder through concurrent chemoradiation following a maximal transurethral resection of the tumor. National protocols using a bladder-preservation approach have demonstrated disease-specific outcomes comparable to radical cystectomy in selected patients, but these results have not been replicated in previously reported population-based series. Here, we describe an outcomes analysis of patients with muscle-invasive bladder cancer treated with either radical surgery or bladder-preserving chemoradiation (BPCRT) for those patients meeting BPCRT criterion using the National Cancer Database (NCDB). MATERIALS AND METHODS Using the NCDB, patients with American Joint Commission on Cancer clinical T2-3, N0, M0 urothelial carcinoma diagnosed between 2004 and 2013 were included for analysis. Only patients treated with definitive intent with either radical cystectomy or concurrent chemotherapy and radiation after a maximal transurethral tumor resection were included. Propensity-score matching was used. RESULTS Among 8454 eligible patients, 7276 (86%) underwent radical cystectomy, and 1178 (14%) underwent BPCRT. Patients undergoing BPCRT were significantly older (median age, 77 vs. 68 y; P<0.001) and had higher Charlson-Deyo comorbidity scores (P=0.002). Using propensity-matched analysis, 1002 patients remained in each cohort, and there was no significant difference in survival found between the 2 cohorts (median overall survival, 2.7 vs. 3.0 y [P=0.20]; 4-year overall survival, 39.1% and 42.6% [P=0.15], for BPCRT and surgery, respectively). In addition, the hazard ratio (HR) of surgery versus BPCRT decreased over time, with an initial HR of 1.27 favoring BPCRT which decreased by a factor of 0.85 per year. CONCLUSIONS From 2004 to 2013, ∼14% of patients from the NCDB who potentially met bladder-preservation criteria underwent the procedure. Our propensity-matched analysis is the only report of its kind to demonstrate similar survival outcomes with bladder preservation when patients are properly selected. This study is also the first to demonstrate a dynamic HR between radical surgery and BPCRT over time.
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15
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Aksenov LI, Gansler T, Sineshaw HM, Fedewa S, Yabroff KR, Jemal A, Moul J. Prevalence and correlates of non-tissue prostate cancer diagnosis in the United States. J Geriatr Oncol 2019; 11:885-892. [PMID: 31734078 DOI: 10.1016/j.jgo.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/01/2019] [Accepted: 11/07/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Given the potential complications of prostate biopsies, it is sometimes reasonable in selected patients to make a non-tissue diagnosis of prostate cancer. Little is known about prevalence and factors associated with non-tissue prostate cancer diagnoses in the United States. METHODS We identified 40 to 99-year-old prostate cancer patients with prostate specific antigen (PSA) ≥20 ng/ml from the 2010-2015 National Cancer Database. Associations were examined between non-tissue prostate cancer diagnosis and age, race, clinical T (cT) and M (cM) categories, PSA, and Charlson-Deyo Comorbidity Index (CCI) with multivariable analyses. RESULTS Among 62,635 patients, 6.2% had a non-tissue diagnosis. The proportion of patients with non-tissue diagnoses increased with advanced age (from 0.9% in ages 40-49 to 44.0% in ages 90-99) and disease stage (cT and cM) and higher CCI and PSA level. Demographic and clinical characteristics statistically significantly associated (all P < .001) with non-tissue diagnosis in adjusted analyses were older age (OR = 24.24, 90 to 99 vs. 60 to 69 years), and higher cT (OR = 4.83; T4 vs. T1), cM (OR = 5.25, M1C vs. M0), CCI (OR = 2.07; 3+ vs. 0), and PSA levels (OR = 3.19, >97.9 ng/ml vs.20 to 39 ng/ml), as well as hormonal therapy (OR = 0.51, with vs. without). CONCLUSIONS Non-tissue diagnosis of prostate cancer, while rare, is not outside normal clinical practice and is strongly associated with advanced patient age, higher clinical stage, multiple comorbidities, and very high PSA levels.
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Affiliation(s)
- Leonid I Aksenov
- Duke University School of Medicine, Division of Urologic Surgery, Durham, NC, United States of America
| | - Ted Gansler
- Intramural Research, American Cancer Society, Atlanta, GA, United States of America.
| | - Helmneh M Sineshaw
- Intramural Research, American Cancer Society, Atlanta, GA, United States of America
| | - Stacey Fedewa
- Intramural Research, American Cancer Society, Atlanta, GA, United States of America
| | - K Robin Yabroff
- Intramural Research, American Cancer Society, Atlanta, GA, United States of America
| | - Ahmedin Jemal
- Intramural Research, American Cancer Society, Atlanta, GA, United States of America
| | - Judd Moul
- Duke University School of Medicine, Division of Urologic Surgery, Durham, NC, United States of America
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16
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Chapman BC, Edgcomb M, Gleisner A, Vogel JD. Outcomes in rectal cancer patients undergoing laparoscopic or robotic low anterior resection compared to open: a propensity-matched analysis of the NCDB (2010-2015). Surg Endosc 2019; 34:4754-4771. [PMID: 31728754 DOI: 10.1007/s00464-019-07252-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Minimally invasive resection of rectal cancer is controversial due to concerns of the oncologic efficacy and the difficulties of a laparoscopic total mesorectal excision (TME). METHODS Using the National Cancer Database (NCDB), for the period 2010-2015, perioperative outcomes and overall survival (OS) in patients with rectal cancer who underwent laparoscopic or robotic low anterior resection (LLAR or RLAR) were compared to open LAR (OLAR) after propensity score matching. RESULTS 26,047 patients underwent LAR: 4062 (16%) RLAR, 9236 (35%) LLAR, and 12,749 (49%) OLAR. Patient and clinical tumor characteristics were similar between groups after matching. The conversion rates among patients undergoing LLAR and RLAR were 15% and 8%, respectively. In matched OLAR and LLAR patients, longitudinal and circumferential resection margins (CRM) were positive in 5.4% and 3.2% (p < 0.001) and 5.5% and 4.1% (p < 0.001); length of stay was 6 and 5 days, (p < 0.001); readmission was required in 6.5% and 7.0% (p = 0.112); OS at 1, 3, and 5 years were 95.5%, 83.7%, and 72.0% and 95.9%, 86.3%, and 76.4%, respectively (p < 0.001). In matched OLAR and RLAR patients, longitudinal and CRM were positive in 5.4% and 3.2% (p < 0.001) and 5.5% and 3.9% (p < 0.001); length of stay was 6 and 5 days (p < 0.001); readmission was required in 6.1% and 7.9%, (p = 0.010); and OS at 1, 3, and 5 years were 96.2%, 86.5%, and 77.1% and 97.5%, 89.4%, and 79.7%, respectively (p = 0.001). CONCLUSIONS In this national sample of propensity matched patients with rectal cancer who underwent open, laparoscopic, or robotic sphincter-saving rectal resection, only small differences in terms of resection margin status, length of stay, readmission, and overall survival were revealed. With acknowledgement of the limitations introduced by selection bias, our data indicate that each of the evaluated operative techniques results in acceptable outcomes for patients with rectal cancer.
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Affiliation(s)
- Brandon C Chapman
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. .,Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Ave., C313, Aurora, CO, 80045, USA.
| | - Mark Edgcomb
- Department of Surgery, Saint Anthony's Hospital, Lakewood, CO, USA
| | - Ana Gleisner
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jon D Vogel
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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17
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Tan WS, Berg S, Cole AP, Krimphove M, Marchese M, Lipsitz SR, Nabi J, Sammon JD, Choueiri TK, Kibel AS, Sun M, Chang S, Trinh QD. Comparing Long-Term Outcomes Following Radical and Partial Nephrectomy for cT1 Renal Cell Carcinoma in Young and Healthy Individuals. JNCI Cancer Spectr 2019; 3:pkz003. [PMID: 31360891 PMCID: PMC6649692 DOI: 10.1093/jncics/pkz003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/04/2019] [Accepted: 01/28/2019] [Indexed: 01/07/2023] Open
Abstract
Background Despite randomized data demonstrating better overall survival favoring radical nephrectomy, partial nephrectomy continues to be the treatment of choice for low-stage renal cell carcinoma. Methods We utilized the National Cancer Database to identify patients younger than 50 years diagnosed with low-stage renal cell carcinoma (cT1) treated with radical nephrectomy or partial nephrectomy (2004-2007). Inverse probability of treatment weighting adjustment was performed for all preoperative factors to account for confounding factors. Kaplan-Meier curves and Cox proportional hazards regression analyses were used to compare overall survival of patients in the two treatment arms. Sensitivity analysis was performed to explore the interaction of type of surgery and clinical stage on overall survival. Results Among the 3009 patients (median age = 44 years [interquartile range (IQR) = 40-47 years]), 2454 patients (81.6%) were treated with radical nephrectomy and 555 patients (18.4%) with partial nephrectomy. The median follow-up was 108.6 months (IQR = 80.2-124.3 months) during which 297 patients (12.1%) in the radical nephrectomy arm and 58 patients (10.5%) in the partial nephrectomy arm died. Following inverse probability of treatment weighting adjustment, there was no difference in overall survival between patients treated with partial nephrectomy and radical nephrectomy (hazard ratio = 0.83, 95% confidence interval = 0.63 to 1.10, P = .196). There were no statistically significant interactions between type of surgery and clinical stage on treatment outcome. Conclusions There was no difference in long-term overall survival between radical and partial nephrectomy in young and healthy patients. This patient cohort may have sufficient renal reserve over their lifetime, and preserving nephrons by partial nephrectomy may be unnecessary.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Quoc-Dien Trinh
- Correspondence to: Quoc-Dien Trinh, MD, Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, 45 Francis St, ASB II-3, Boston, MA 02115 (e-mail: )
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18
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Foster CC, Sher DJ, Rusthoven CG, Verma V, Spiotto MT, Weichselbaum RR, Koshy M. Overall survival according to immunotherapy and radiation treatment for metastatic non-small-cell lung cancer: a National Cancer Database analysis. Radiat Oncol 2019; 14:18. [PMID: 30691492 PMCID: PMC6348608 DOI: 10.1186/s13014-019-1222-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/16/2019] [Indexed: 12/20/2022] Open
Abstract
Background Preclinical studies suggest enhanced anti-tumor activity with combined radioimmunotherapy. We hypothesized that radiation (RT) + immunotherapy would associate with improved overall survival (OS) compared to immunotherapy or chemotherapy alone for patients with newly diagnosed metastatic non-small-cell lung cancer (NSCLC). Methods The National Cancer Database was queried for patients with stage IV NSCLC receiving chemotherapy or immunotherapy from 2013 to 2014. RT modality was classified as stereotactic radiotherapy (SRT) to intra- and/or extracranial sites or non-SRT external beam RT (EBRT). OS was analyzed using the Kaplan-Meier method and Cox proportional hazards models. Results In total, 44,498 patients were included (13% immunotherapy, 46.8% EBRT, and 4.7% SRT). On multivariate analysis, immunotherapy (hazard ratio [HR]:0.81, 95% confidence interval [CI]:0.78–0.83) and SRT (HR:0.78, 95%CI:0.70–0.78) independently associated with improved OS; however, the interaction term for SRT + immunotherapy was insignificant (p = 0.89). For immunotherapy patients, the median OS for no RT, EBRT, and SRT was 14.5, 10.9, and 18.2 months, respectively (p < 0.0001), and EBRT (HR:1.37, 95%CI:1.29–1.46) and SRT (HR:0.78, 95%CI:0.66–0.93) associated with OS on multivariate analysis. In the SRT subset, median OS for immunotherapy and chemotherapy was 18.2 and 14.3 months, respectively (p = 0.004), with immunotherapy (HR:0.82, 95%CI:0.69–0.98) associating with OS on multivariate analysis. Furthermore, for patients receiving SRT, biologically effective dose (BED) > 60 Gy was independently associated with improved OS (HR:0.79, 95%CI:0.70–0.90, p < 0.0001) on multivariate analysis with a significant interaction between BED and systemic treatment (p = 0.008). Conclusions Treatment with SRT associated with improved OS for patients with metastatic NSCLC irrespective of systemic treatment. The high survival for patients receiving SRT + immunotherapy strongly argues for evaluation in randomized trials.
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Affiliation(s)
- Corey C Foster
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9006, Chicago, IL, 60637, USA.
| | - David J Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Radiation Oncology Building, 2280 Inwood Road, Dallas, TX, 75390-9303, USA
| | - Chad G Rusthoven
- Department of Radiation Oncology at the Anschutz Medical Campus, University of Colorado School of Medicine, 1655 Aurora Court, Suite 1032, Aurora, CO, 80045, USA
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA, 15212, USA
| | - Michael T Spiotto
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9006, Chicago, IL, 60637, USA.,Department of Radiation Oncology, University of Illinois at Chicago, Outpatient Care Center, 1801 West Taylor Street, Chicago, IL, 60612, USA
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9006, Chicago, IL, 60637, USA
| | - Matthew Koshy
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9006, Chicago, IL, 60637, USA.,Department of Radiation Oncology, University of Illinois at Chicago, Outpatient Care Center, 1801 West Taylor Street, Chicago, IL, 60612, USA
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19
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Chapman BC, Goodman K, Hosokawa P, Gleisner A, Cowan ML, Birnbaum E, Vogel JD. Improved survival in rectal cancer patients who are treated with long-course versus short-course neoadjuvant radiotherapy: A propensity-matched analysis of the NCDB. J Surg Oncol 2019; 119:518-531. [DOI: 10.1002/jso.25355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Brandon C. Chapman
- Department of Surgery; University of Colorado School of Medicine; Aurora Colorado
| | - Karyn Goodman
- Division of Radiation Oncology; University of Colorado School of Medicine; Aurora Colorado
| | - Patrick Hosokawa
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS); Aurora Colorado
| | - Ana Gleisner
- Department of Surgery; University of Colorado School of Medicine; Aurora Colorado
| | - Michelle L. Cowan
- Department of Surgery; University of Colorado School of Medicine; Aurora Colorado
| | - Elisa Birnbaum
- Department of Surgery; University of Colorado School of Medicine; Aurora Colorado
| | - Jon D. Vogel
- Department of Surgery; University of Colorado School of Medicine; Aurora Colorado
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20
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Pathologic Complete Response (pCR) and Survival of Women with Inflammatory Breast Cancer (IBC): An Analysis Based on Biologic Subtypes and Demographic Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16010124. [PMID: 30621221 PMCID: PMC6339010 DOI: 10.3390/ijerph16010124] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/03/2018] [Accepted: 12/28/2018] [Indexed: 12/25/2022]
Abstract
In this US-based study of the National Cancer Database (NCDB), we examined 8550 patients diagnosed with non-metastatic, invasive inflammatory breast cancer (IBC) who received surgery from 2004–2013. Patients were grouped into four biologic subtypes (HR+/HER2−, HR+/HER2+, HR−/HER2+, HR−/HER2−). On average, women were 56 years of age at diagnosis and were followed for a median of 3.7 years. The majority were white (80%), had private health insurance (50%), and presented with poorly differentiated tumors (57%). Approximately 46% of the cancers were >5 cm. Most patients underwent mastectomy (94%) and received radiotherapy (71%). Differences by biologic subtypes were observed for grade, lymph node invasion, race, and tumor size (p < 0.0001). Patients experiencing pathologic complete response (pCR, 12%) vs. non-pCR had superior 5-year overall survival (OS) (77% vs. 54%) (p < 0.0001). Survival was poor for triple-negative (TN) tumors (37%) vs. other biologic subtypes (60%) (p < 0.0001). On multivariable analysis, TN-IBC, positive margins, and not receiving either chemotherapy, hormonal therapy or radiotherapy were independently associated with poor 5-year survival (p < 0.0001). In this analysis of IBC, categorized by biologic subtypes, we observed significant differential tumor, patient and treatment characteristics, and OS.
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21
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Wong ML, McMurry TL, Schumacher JR, Hu CY, Stukenborg GJ, Francescatti AB, Greenberg CC, Chang GJ, McKellar DP, Walter LC, Kozower BD. Comorbidity Assessment in the National Cancer Database for Patients With Surgically Resected Breast, Colorectal, or Lung Cancer (AFT-01, -02, -03). J Oncol Pract 2018; 14:e631-e643. [PMID: 30207852 DOI: 10.1200/jop.18.00175] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Accurate comorbidity measurement is critical for cancer research. We evaluated comorbidity assessment in the National Cancer Database (NCDB), which uses a code-based Charlson-Deyo Comorbidity Index (CCI), and compared its prognostic performance with a chart-based CCI and individual comorbidities in a national sample of patients with breast, colorectal, or lung cancer. PATIENTS AND METHODS Through an NCDB Special Study, cancer registrars re-abstracted perioperative comorbidities for 11,243 patients with stage II to III breast cancer, 10,880 with stage I to III colorectal cancer, and 9,640 with stage I to III lung cancer treated with definitive surgical resection in 2006-2007. For each cancer type, we compared the prognostic performance of the NCDB code-based CCI (categorical: 0 or missing data, 1, 2+), Special Study chart-based CCI (continuous), and 18 individual comorbidities in three separate Cox proportional hazards models for postoperative 5-year overall survival. RESULTS Comorbidity was highest among patients with lung cancer (13.2% NCDB CCI 2+) and lowest among patients with breast cancer (2.8% NCDB CCI 2+). Agreement between the NCDB and Special Study CCI was highest for breast cancer (rank correlation, 0.50) and lowest for lung cancer (rank correlation, 0.40). The NCDB CCI underestimated comorbidity for 19.1%, 29.3%, and 36.2% of patients with breast, colorectal, and lung cancer, respectively. Within each cancer type, the prognostic performance of the NCDB CCI, Special Study CCI, and individual comorbidities to predict postoperative 5-year overall survival was similar. CONCLUSION The NCDB underestimated comorbidity in patients with surgically resected breast, colorectal, or lung cancer, partly because the NCDB codes missing data as CCI 0. However, despite underestimation of comorbidity, the NCDB CCI was similar to the more complete measures of comorbidity in the Special Study in predicting overall survival.
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Affiliation(s)
- Melisa L Wong
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Timothy L McMurry
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Jessica R Schumacher
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Chung-Yuan Hu
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - George J Stukenborg
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Amanda B Francescatti
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Caprice C Greenberg
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - George J Chang
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Daniel P McKellar
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Louise C Walter
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Benjamin D Kozower
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
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22
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Preker AS, Adeyi OO, Lapetra MG, Simon DC, Keuffel E. Health Care Expenditures Associated With Pollution: Exploratory Methods and Findings. Ann Glob Health 2018; 82:711-721. [PMID: 28283121 DOI: 10.1016/j.aogh.2016.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The research done for this paper is part of the background analysis undertaken to support the work of the Global Commission on Pollution, Health and Development, an initiative of The Lancet, the Global Alliance on Health and Pollution, and the Icahn School of Medicine at Mount Sinai. The paper expands on areas where the current literature has gaps in knowledge related to the health care cost of pollution. OBJECTIVES This study aims to generate an initial estimate of total tangible health care expenditure attributable to man-made pollution affecting air, soil and water. METHODS We use two methodologies to establish an upper and lower bounds for pollution related health expenditure. Key data points in both models include (a) burden-of-disease (BoD) at the national level in different countries attributable to pollution; and (b) the total cost of health care at the national level in different countries using standard national health accounts expenditure data. FINDINGS Depending on which determinist model we apply, annual expenditures range from US$630 billion (upper bound) to US$240 billion (lower bound) or approximately three to nine percent of global spending on health care in 2013 (the reference year for the analysis). Although only 14 percent of global total for pollution related health care spending is in lower- and middle-income countries (LMICs) in our primary (lower bound) model, the relative share of spending for pollution related illness is substantial, especially in very low-income countries. Cancer, chronic respiratory and cardio/cerebrovascular illnesses account for the largest health care spending items linked to pollution even in LMICs. CONCLUSIONS These conditions have historically received less attention by national governments, international public health organizations and development/financial agencies than infectious disease and maternal/child health sectors. Other studies posit that intangible costs associated with environmental pollution include lower productivity and reduced income - components which our models do not attempt to capture. The financial and health impacts are substantial even when we exclude intangible costs, yet it is likely that in many LMICs poor households simply forgo medical treatment and lose household income as a result of man-made environmental degradation. RECOMMENDATIONS When evaluating the value of public health or environmental programs which prevent or limit pollution-related illness, policy makers should consider the health benefits, the tangible cost offsets (estimated in our models) and the opportunity costs.
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Affiliation(s)
- Alexander S Preker
- Columbia University, NYU, and Ichan School of Medicine at Mt. Sinai, New York, NY; Health Investment & Financing, New York, NY.
| | - Olusoji O Adeyi
- Health, Nutrition and Population Global Practice of the World Bank, Washington, DC; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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23
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Brachytherapy Boost Utilization and Survival in Unfavorable-risk Prostate Cancer. Eur Urol 2017; 72:738-744. [DOI: 10.1016/j.eururo.2017.06.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 06/08/2017] [Indexed: 11/17/2022]
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24
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Yamano T, Yamauchi S, Kimura K, Babaya A, Hamanaka M, Kobayashi M, Fukumoto M, Tsukamoto K, Noda M, Tomita N, Sugihara K, Takemasa I, Hakamada K, Kameyama H, Takii Y, Hase K, Kotake K, Watanabe T, Takahashi K, Kanemitsu Y, Itabashi M, Yano H, Yasuno M, Hasegawa H, Hashiguchi Y, Masaki T, Watanabe M, Maeda K, Komori K, Sakai Y, Ohue M, Akagi Y. Influence of age and comorbidity on prognosis and application of adjuvant chemotherapy in elderly Japanese patients with colorectal cancer: A retrospective multicentre study. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.05.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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25
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Lv JW, Zhou GQ, Chen YP, Tang LL, Mao YP, Chen L, Li WF, Lin AH, Ma J, Sun Y. Refining the Role of Lymph Node Biopsy in Survival for Patients with Nasopharyngeal Carcinoma: Population-Based Study from the Surveillance Epidemiology and End-Results Registry. Ann Surg Oncol 2017; 24:2580-2587. [DOI: 10.1245/s10434-017-5966-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Indexed: 01/18/2023]
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26
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Abstract
BACKGROUND A significant proportion of patients never receive curative-intent surgery for resectable gastric cancer (GC). The primary aims of this study were to identify disparities and targetable risk factors associated with failure to operate in the context of national trends in surgical rates for resectable GC. METHODS The National Cancer Database was used to identify patients with resectable GC (adenocarcinoma, clinical stage IA-IIIC, 2004-2013). Multivariate modeling was used to identify predictors of resection and to analyze the impact of surgery on overall survival (OS). RESULTS Of 46,970 patients with resectable GC, 18,085 (39%) did not receive an appropriate operation. Among unresected patients, 69% had no comorbidities. Failure to resect was associated with reduced median OS (44.4 versus 11.8 mo, hazard ratio [HR]: 2.09, P < 0.001). In the multivariate analysis, the most critical factors affecting OS were resection (HR: 2.09) and stage (reference IA; HR range: 1.16-3.50, stage IB-IIIC). Variables independently associated with no surgery included insurance other than private or Medicare (odds ratio [OR]: 1.60/1.54), nonacademic/nonresearch hospital (OR: 1.16), non-Asian race (OR: 1.72), male (OR: 1.19), older age (OR: 1.04), Charlson-Deyo score >1 (OR: 1.17), residing in areas with median income <$48,000 (OR: 1.23), small urban populations <20,000 (OR: 1.41), and stage (reference IA; OR range: 1.36-3.79, stage IB-IIIC, P < 0.001). CONCLUSIONS Over one-third of patients with resectable GC fail to receive surgery. Suitable insurance coverage and treatment facility are the most salient (and only modifiable) risk factors for omitting surgery. To mitigate national disparities in surgical care, policymakers should consider improving insurance coverage in underserved areas and regionalization of gastric cancer care.
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