Impact of Commission on Cancer Accreditation on Cancer Survival: A Surveillance, Epidemiology, and End Results (SEER) Database Analysis

INTRODUCTION

To analyze the cancer burden in the United States, researchers are relying on the Surveillance, Epidemiology, and End Results (SEER) Program. Our objective was to analyze differences in cancer outcome between Commission on Cancer (CoC)-accredited and non-accredited facilities.

METHODS

The SEER database was queried for diagnosis years 2018 and 2019. Only analytic cases were included. Observed survival was calculated using the Kaplan-Meier method for all cancer sites, stratified by accreditation status. Univariate analyses were performed to quantify differences in survival between cancer cases in CoC-accredited and non-CoC-accredited facilities. Cancers of interest were chosen based on statistical significance (p < 0.01) and clinical significance (> 25% difference in end survival). Multivariate analyses were conducted on cancers of interest.

RESULTS

Overall, there were 602,185 cases from CoC-accredited facilities and 198,492 from non-CoC-accredited facilities. 5 of 59 solid organ cancers showed statistically and clinically significant reductions in survival in non-accredited facilities (lung and bronchus: 27.9%; liver: 41.1%; esophagus: 30.4%; pancreas: 32.7%; intrahepatic bile duct: 39.4%). Multivariate analysis on these 5 cancers was performed. CoC accreditation was a statistically significant variable decreasing the hazard in all 5 cancers (hazard ratio 0.86-0.91; all p-values <0.005). All these cancers demand resource-intensive treatment.

CONCLUSION

Accreditation has a significant impact on survival in 5/59 solid organ cancers. Although accredited facilities may be better apt to handle these cancer cases, the survival in most cancers is not significantly affected by accreditation. However, examining longer-term endpoints elucidate further nuances. Herein, CoC accreditation was found to be an independent variable impacting 2-year survival for a minority of cancers.

Massive pancreatic serous cystadenomas raise important questions regarding surgical management of incidental pancreatic cystic lesions: a report of two cases

Background

The widespread use of cross-sectional imaging and ultrasound has led to an increase in the diagnosis of pancreatic cystic neoplasms. These lesions have an estimated prevalence of 2.4% of which approximately 10–16% are serous cystadenoma (SCA). SCA is the most common benign pancreatic lesion; the vast majority are asymptomatic and associated with low risk for malignant transformation. Despite improved insight into the natural history of these tumors, recommendations for their management remain contentious. We present two cases of giant SCA that call attention to shortcomings of the current guidelines for management of benign cystic pancreatic lesions.

Case Description

In both cases, patients presented for surgical evaluation late in the disease course despite multiple medical consultations with generalist and specialty providers. Although both lesions were resected, their late presentation may have increased risk for complication and post-operative morbidity.

Conclusions

These cases highlight possible discrepancies between medical and surgical perspectives in the field and support future investigation into more aggressive surgical management of SCA.

Giant pedunculated hepatocellular adenoma masquerading as a subdiaphragmatic mass: Diagnostic challenges of a rare tumor

Giant pedunculated hepatocellular adenomas are extremely rare tumors and often detected incidentally on cross-sectional imaging studies. We report the case of a 34-year-old woman who underwent cross-sectional imaging for staging evaluation of a uterine tumor. A large left subdiaphragmatic mass, without clear connection to the liver, was seen prompting diagnostic laparoscopy; during which a large pedunculated mass attached to the left lobe of the liver was found and resected. This case report highlights the challenges and pitfalls in the imaging diagnosis of pedunculated hepatocellular adenomas, such as difficulty in characterizing the mass or inability to identify the vascular attachment to the liver. Image-guided biopsy and diagnostic laparoscopy are valuable tools to establish diagnosis; most of these lesions are amenable to laparoscopic resection.

Primary liposarcoma of the diaphragm: a rare intra-abdominal mass

Primary malignant tumors of the diaphragm are rare, and primary liposarcoma of the diaphragm is extremely rare. The role of imaging is description of the anatomic relationships of the tumor as well as a suggestion of histologic diagnosis based on the presence of fatty and/or nonfatty components.

Is laparoscopic repeat hepatectomy feasible? A tri-institutional analysis

BACKGROUND

A laparoscopic approach has not been advocated for repeat hepatectomy on a large scale. This report analyzes the experience of 3 institutions pioneering laparoscopic repeat liver resection (LRLR). The aim of this study was to evaluate the feasibility, safety, oncologic integrity, and outcomes of LRLR.

STUDY DESIGN

All patients undergoing LRLR were identified. Since 1997, 76 LRLRs have been attempted. Operative indications were metastasis (n = 63), hepatocellular carcinoma (n = 3), and benign tumors (n = 10). All patients had 1 or more earlier liver resections (28 open, 44 laparoscopic), including 16 major resections (en bloc removal of 3 or more Couinaud segments).

RESULTS

Eight conversions (11%) to open resections (n = 7) or radiofrequency ablation (n = 1) were required due to technical difficulties or hemorrhage. LRLRs included 49 wedge or segmental resections and 19 major hepatectomies. Median blood loss and operative time were 300 mL and 180 minutes. Patients with previous open liver resection (group B) experienced more intraoperative blood loss and transfusion requirements than those with earlier laparoscopic resections (group A) (p = 0.02; p = 0.01, respectively). R0 resection was achieved in 58 of 64 (91%) patients with malignant tumor. The incidence of postoperative complications and duration of hospital stay were not statistically different between the 2 groups. Bile leakages developed in 5 (6.6%) patients, including 1 requiring reoperation. There was no perioperative death. Median tumor size was 25 mm (range 5 to 125 mm) and the median number of tumors was 2 (range 1 to 7). Median follow-up was 23.5 months (range 0 to 86 months). There was no port-site metastasis. The 3- and 5-year actuarial survivals for patients with colorectal metastases were 83% and 55%, respectively.

CONCLUSIONS

Laparoscopic repeat hepatic resections can be performed safely and with good results, particularly in patients with earlier laparoscopic resections.

Cyclopamine increases the cytotoxic effects of paclitaxel and radiation but not cisplatin and gemcitabine in Hedgehog expressing pancreatic cancer cells

INTRODUCTION

The hedgehog signaling pathway (Hh) is frequently over expressed in pancreatic adenocarcinomas. We studied the potential cytotoxic interactions between cyclopamine, a Hh pathway inhibitor and paclitaxel, cisplatin, gemcitabine and ionizing radiation (IR).

METHODS

In vitro clonogenic survival analysis was performed with cyclopamine alone or cyclopamine in combination with paclitaxel, gemcitabine, cisplatin and IR in Hh expressing human pancreatic tumor cells and Hh non-expressing colon cancer cells. Relative cytotoxicity was assessed in combination treatment compared with exposure to single agents. Assays of apoptosis (annexin V) were performed in the presence of cyclopamine, chemotherapeutic agents, and IR.

RESULTS

We report that cyclopamine increased the cytotoxic effects of paclitaxel and IR in Hh expressing pancreatic carcinoma cells. These effects were not observed in Hh non-expressing cells. Cyclopamine did not significantly increase killing by cisplatin or gemcitabine in Hh expressing pancreatic cancer cells.

CONCLUSIONS

These data suggest strategies to combine Hh inhibitors with radiotherapy and chemotherapeutic agents, specifically paclitaxel and related compounds in the treatment of pancreatic cancer.

Breast cancer in women with HIV/AIDS: report of five cases with a review of the literature

BACKGROUND

The association of human immunodeficiency virus (HIV) infection with breast carcinoma is unclear. With improved survival of HIV-infected patients due to better understanding and treatment of the disease, there is likely to be an increase in incidence of breast cancer in women with HIV infection.

METHODS

The medical records of 305 patients with breast cancer seen between January 1995 and December 2000 at Harlem Hospital Center, New York, where approximately 1,000 HIV-infected patients are treated yearly, were reviewed with attention to age, breast cancer stage at presentation, and patient survival.

RESULTS

Breast cancer in the five HIV-infected patients has same median age distribution, disease stage, and pathologic characteristics as in the 300 HIV-indeterminate patients. Four of the five (80%) HIV-infected women compared to 79% in the HIV-indeterminate patients presented with early breast cancer (Stages I and II). Five-year survival in the HIV-infected patients is 80%, which is similar to the observed 70% 5-year crude survival rate in the indeterminate group.

CONCLUSIONS

Our results do not support the recent reports suggesting that HIV infection is associated with poorly differentiated, aggressive disease with poor survival outcome. It remains unclear if breast carcinoma is directly linked to HIV infection.