Clinical Features and Outcomes of Plasmacytoma in the United States: Analysis Using the National Cancer Data Base

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3249-3249 ◽  
Author(s):  
Gaurav Goyal ◽  
Wilson I Gonsalves ◽  
Ronald S. Go ◽  
Shaji Kumar
Keyword(s):  
United States ◽  
Overall Survival ◽  
Research Funding ◽  
Median Overall Survival ◽  
Clinical Presentation ◽  
The United States ◽  
National Cancer Data Base ◽  
Extramedullary Plasmacytoma ◽  
Anatomical Distribution ◽  
Cancer Data

Abstract Introduction Plasmacytomas comprise approximately 3% of all plasma cell malignancies. There is a paucity of large studies assessing clinical features and outcomes of this relatively uncommon disease. Our objective was to describe the patterns of clinical presentation and survival of plasmacytomas using the National Cancer Data Base (NCDB). Methods This is a retrospective study of patients with histologically confirmed diagnosis of plasmacytoma from 2000-2011 using International Classification of Diseases for Oncology version 3 (ICD-0-3) code: 9930. Patients who had bone marrow involvement were excluded from the analysis. Plasmacytomas were grouped into two broad categories: extramedullary plasmacytoma (P-EM) and bone plasmacytoma (P-bone) based on their anatomical locations. Overall survival was analyzed using Kaplan-Meier estimates. Results A total of 6,939 patients were included in the study (median age 64 years; range 18-90 years). Approximately 62% of these patients were males and 46% patients were ≥ 70 years. Racial/ethnic distribution of the disease was as follows: 76% Whites, 13% Blacks, 7% Hispanics, and 4% others. The anatomical distribution and survival of patients is depicted in the Table. P-EM comprised 30% of the patients, with remaining 70% presenting as P-bone. Among P-EM, most common sites of presentation were upper aero-digestive tract (41%) and connective/soft tissue (20%). After a median follow up of 65 months, the overall survival of P-EM was significantly better than P-bone (113 vs. 78 months; Figure). Based on outcomes, we can categorize the P-EM patients into 3 groups: good (median overall survival > 120 months: upper aero-digestive tract, lymph nodes, endocrine and digestive system), intermediate (median overall survival 90-120 months: nervous system, eye/orbit, pulmonary), and poor (median overall survival <90 months: connective/soft tissue, cardiac/mediastinum, genitourinary, and hepatobiliary system). Males had better overall survival than females in P-bone (84 vs. 67 months; p<0.0001), but had no significant survival difference in P-EM (109 vs. 116 months; p=0.7). In the P-EM group, median overall survival was worst for Blacks (98 months vs. Whites- 108 months, Hispanics- not reached, others-145 months). Conversely, for P-bone, Blacks had a better overall survival than Whites (Blacks- 99 months, Whites- 72 months, Hispanics- 156, others-84 months). Patients who were treated at an academic center had better overall survival than patients treated at other/community centers both in case of P-EM (130 vs. 108 months) and P-bone (107 vs. 69 months). Conclusions This is the largest registry-based study on plasmacytoma in the United States. Plasmacytomas have varied clinical presentation, along with significantly different survival based on sites of presentation, race, sex, and treatment facility. Our study results point toward important differences in disease biology based on location and may aid in assessing prognosis for planning treatment. Table. Anatomical distribution and median overall survival of plasmacytomas. Table Overall survival based on location (P-EM: extramedullary plasmacytoma; P-bone: bone plasmacytoma) Table. Overall survival based on location (P-EM: extramedullary plasmacytoma; P-bone: bone plasmacytoma) Figure Figure. Disclosures Kumar: Noxxon Pharma: Consultancy, Research Funding; Kesios: Consultancy; Skyline: Honoraria, Membership on an entity's Board of Directors or advisory committees; Onyx: Consultancy, Research Funding; BMS: Consultancy; Array BioPharma: Consultancy, Research Funding; Sanofi: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Millennium: Consultancy, Research Funding; Glycomimetics: Consultancy; AbbVie: Research Funding; Janssen: Consultancy, Research Funding.

scholarly journals Clinical Features and Outcomes of Isolated Myeloid Sarcoma in the United States: Analysis Using a National Dataset

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1618-1618
Author(s):  
Gaurav Goyal ◽  
Adam C Bartley ◽  
Aref Al-Kali ◽  
William J Hogan ◽  
Mark Litzow ◽  
...  
Keyword(s):  
United States ◽  
Overall Survival ◽  
Research Funding ◽  
Median Overall Survival ◽  
Case Series ◽  
The United States ◽  
Myeloid Sarcoma ◽  
Anatomical Distribution ◽  
Mediastinal Disease ◽  
Significant Difference

Abstract Introduction Isolated myeloid sarcoma is a rare form (<1%) of acute myeloid leukemia presenting as extramedullary tumor. Contemporary clinical data are mostly limited to institutional case series. Using the National Cancer Database, the largest public cancer registry covering >70% of all newly diagnosed cancers in the United States, we determined the patterns of anatomical presentation and clinical outcome of myeloid sarcoma. Methods We identified patients with a histologically confirmed diagnosis of isolated myeloid sarcoma from 2004-2013 using International Classification of Diseases for Oncology version 3 (ICD-O-3) code: 9930. To allow at least 1 year of follow-up, only patients diagnosed from 2004-2012 were included in the survival analysis using Kaplan-Meier estimates. Results A total of 746 patients were included in the study. The median age of patients was 59 years (range, 41 to 73) and 56% were males. The anatomical distribution and median overall survival of patients are depicted in the Table. The top 3 most common sites of presentation were connective/soft tissues (31.3%), skin/breast (12.3%), and digestive system (10.3%). Compared to other races, Blacks were more likely to have presentation in bones/joints (11.8% vs 6.3% in others), lymph nodes/spleen (22.1% vs. 9%), and less likely in skin/breast (4.4% vs. 13.8%). Asians were more likely to present with cardiopulmonary/mediastinal disease as compared to other races (13.6% vs. 4.2%). According to outcomes, we can categorize the patients into 3 groups: good (median overall survival >30 months: reproductive and digestive systems), intermediate (median overall survival 15-30 months: head/neck and kidney/bladder/retroperitoneum/adrenal), and poor (median overall survival <15 months: nervous system, connective/soft tissue, and bones/joints). There was no significant difference in overall survival between males and females (P =0.06). Among the races, Blacks had the worst overall survival (P =0.02; Figure). Conclusions This is the largest registry-based study on isolated myeloid sarcoma in the United States. Isolated myeloid sarcoma has a diverse anatomic clinical presentation and the overall survival varied significantly according to sites of presentation and racial subgroups. The results of our study may aid the prognostication of patients for treatment decision making and in the understanding of the biological differences by anatomic sites of presentation. Table Anatomical distribution and median overall survival of isolated myeloid sarcoma Table. Anatomical distribution and median overall survival of isolated myeloid sarcoma Figure Overall survival by sex and race in isolated myeloid sarcoma Figure. Overall survival by sex and race in isolated myeloid sarcoma Disclosures Al-Kali: Onconova Therapeutics, Inc.: Research Funding; Celgene: Research Funding.

Outcome of Myelodysplastic Syndromes Over Time in the United States: A National Cancer Data Base Study From 2004-2013

2019 ◽  
Vol 94 (8) ◽  
pp. 1467-1474 ◽  
Author(s):  
Aref Al-Kali ◽  
Darci Zblewski ◽  
James M. Foran ◽  
Mrinal S. Patnaik ◽  
Beth R. Larrabee ◽  
...  
Keyword(s):  
United States ◽  
Data Base ◽  
Myelodysplastic Syndromes ◽  
The United States ◽  
National Cancer Data Base ◽  
Cancer Data ◽  
Base Study ◽  
Over Time

Variation in the Use of Splenectomy for Splenic Lymphomas: Analysis of the National Cancer Data Base

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3584-3584
Author(s):  
Jaleh Fallah ◽  
Adam J Olszewski
Keyword(s):  
Data Base ◽  
Research Funding ◽  
Academic Research ◽  
The United States ◽  
National Cancer Data Base ◽  
Diagnostic Tools ◽  
Community Centers ◽  
Integrated Network ◽  
Cancer Data ◽  
Geographical Regions

Introduction: Splenectomy has been a historically important diagnostic and therapeutic modality for splenic lymphomas, but with the advent of sensitive diagnostic tools and efficacious immunochemotherapy, its role has diminished. Our objective was to describe trends in the use of splenectomy for management of splenic lymphomas, and to determine the association of practice setting with choice of surgical treatment. Methods: Using the National Cancer Data Base (NCDB), a nationwide registry capturing >80% of lymphomas in the United States, we selected non-Hodgkin lymphoma cases diagnosed in 2004-2013, with spleen recorded as the primary site. We identified the use of splenectomy and chemotherapy as part of the initial treatment. Splenectomy was assumed to be diagnostic when it was coincident with lymphoma diagnosis (0 days from diagnosis to surgery). Treatment facilities were designated by the NCDB as community, comprehensive community, academic/research, or integrated network cancer programs, depending on case volume and available services. We studied factors associated with the use of splenectomy in a multilevel mixed-effects logistic model (with random intercepts for each geographic region and each facility within it), reporting odds ratios (OR) and intraclass correlation (ICC) with 95% confidence intervals (CI). Linearized trends from log-binomial regression were expressed as average annual percent change (APC) in the proportion of patients (pts) undergoing splenectomy. Results: Among 6,504 of pts with splenic lymphomas, 48% were classified as splenic marginal zone (SMZL), 28% as diffuse large B-cell (DLBCL), 4% as mantle cell (MCL), 5% as follicular (FL), 4% as T-cell lymphoma (TCL, 52% being hepatosplenic γd-TCL), and 11% were other or unspecified histologies. Overall, 58% of pts underwent any splenectomy, and 33% a diagnostic splenectomy, but these proportions significantly varied by histology (χ2P<.0001, Table). After a diagnostic splenectomy, 31% of DLBCL and 47% of MCL pts did not receive chemotherapy. Between 2004 and 2013, the proportion undergoing splenectomy significantly decreased for most histologies (Figure). This trend was most pronounced in SMZL (APC, -7.7%; Table), and MCL (APC, -8.4%), and it was paralleled by a significant increase in the use of chemotherapy for management of SMZL and TCL. Mortality at 30 days after splenectomy was 4% overall, varying from <2% in SMZL/MCL/FL, 6% in DLBCL, to 10% in TCL (χ2P<.0001). The proportion of pts undergoing splenectomy differed significantly according to type of treating hospital only in SMZL, where it was 39% for pts treated in "community", 52% in "comprehensive community", 50% in "academic/research", and 44% in "integrated network" centers (χ2P=.0004). In contrast, facility type was not associated with splenectomy use in DLBCL (P=.47), MCL (P=.55), FL (P=.75), or TCL (P=.15). The proportion of splenectomies performed for diagnosis was significantly lower in academic (51%) than in community (62%), comprehensive community (59%), or integrated network centers (60%, χ2P<.0001) In a multivariable model in treated SMZL pts, those who had advanced-stage lymphoma or B symptoms, and those who were older, male, without comorbidities, with Medicaid, or with no insurance were significantly less likely to undergo splenectomy. There was evidence of significant clustering of treatment selection in each hospital (ICC, 24%; CI, 17-32%), but not in geographical regions (ICC, 2%; CI, 0.2-9.5%). Compared with academic/research centers, splenectomy was performed less frequently in smaller community centers (adjusted OR, 0.59; CI, 0.38-0.93, P=.022), but not in larger comprehensive community centers (OR, 0.97; CI, 0.72-1.32, P=.86). Conclusions: Although the use of splenectomy for management of splenic lymphomas has declined, nearly half of pts with splenic DLBCL, FL, or TCL still undergo surgery for diagnosis, highlighting the ongoing need for reliable, non-invasive diagnostic modalities. A substantial proportion of pts with DLBCL and MCL do not receive chemotherapy after surgery. Further research should elucidate the reasons for it, and associated outcomes in those groups. In SMZL, the use of splenectomy is facility-dependent after adjusting for patient- and lymphoma-related characteristics, with lower rate of splenectomy in smaller community centers, possibly reflecting availability of surgical expertise. Disclosures Olszewski: TG Therapeutics: Research Funding; Genentech: Research Funding; Bristol-Myers Squibb: Consultancy.

Impact of adjuvant therapies on treatment outcomes for patients with resected gallbladder cancer and changes in treatment patterns in the United States over the past decade: An analysis from the National Cancer Data Base.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 391-391
Author(s):  
Timur Mitin ◽  
C. Kristian Enestvedt ◽  
Ahmedin Jemal ◽  
Helmneh M. Sineshaw
Keyword(s):  
Overall Survival ◽  
Gallbladder Cancer ◽  
Data Base ◽  
Adjuvant Treatment ◽  
Locally Advanced ◽  
The United States ◽  
National Cancer Data Base ◽  
Cancer Data ◽  
Adjuvant Therapies ◽  
The Past

391 Background: There are no randomized data to guide clinicians treating patients with gallbladder cancer (GBC). Several retrospective studies reported the survival benefits of adjuvant radiotherapy (RT) and chemoradiation (CRT). The aims of this study were to examine whether these publications have impacted the utilization of adjuvant therapies and whether their survival benefits were evident in contemporary cohort of patients. Methods: Using the National Cancer Data Base, we identified 5,029 patients diagnosed with T1-3N0-1 GBC and treated with surgical resection from 2005 to 2013. We described trends in receipt of adjuvant treatments for three time periods (2005-2007, 2008-2010, 2011-2013) and calculated 3-year overall survival (OS) probabilities for 2,989 patients treated in 2005-2010. Results: The percentage of patients who received no adjuvant treatment was unchanged from 2005 to 2013. Adjuvant RT decreased from 4.3% to 1.7% (p < 0.01), adjuvant chemotherapy increased from 8% to 14% (p < 0.01), and adjuvant CRT remained stable at 16% (p = 0.98). Even for locally advanced disease (T3N0 and T1-3N1) or in the setting of positive resection margins, over 50% of patients in US did not receive adjuvant treatments. Adjuvant treatments were associated with improved 3-year overall survival in patients with resected GBC, as listed in Table. Adjuvant CRT was associated with improved survival in all stages, except T1N0, and in patients with negative and positive margins. Conclusions: Over the past decade there was no increase in the utilization of adjuvant therapies in the US for patients with resected GBC. Adjuvant therapy is associated with significantly improved 3-yr OS. In the absence of randomized data, this analysis should form the basis for clinical recommendations and national guidelines should be amended to support adjuvant treatment.[Table: see text]

scholarly journals The National Cancer Data Base 10-year survey of breast carcinoma treatment at hospitals in the United States

Cancer ◽  
1998 ◽  
Vol 83 (6) ◽  
pp. 1262-1273 ◽  
Author(s):  
Kirby I. Bland ◽  
Herman R. Menck ◽  
Carol E. H. Scott-Conner ◽  
Monica Morrow ◽  
David J. Winchester ◽  
...  
Keyword(s):  
United States ◽  
Breast Carcinoma ◽  
Data Base ◽  
The United States ◽  
National Cancer Data Base ◽  
Cancer Data

scholarly journals RTHP-06. IMPACT OF THE AMERICAN TAX PAYER RELIEF ACT ON STEREOTACTIC RADIOSURGERY UTILIZATION IN THE UNITED STATES

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi211-vi211
Author(s):  
Shearwood McClelland III ◽  
Catherine Degnin ◽  
Yiyi Chen ◽  
Gordon Watson ◽  
Jerry Jaboin
Keyword(s):  
United States ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
The United States ◽  
National Cancer Data Base ◽  
Federal Law ◽  
Cancer Data ◽  
Whole Brain Radiation ◽  
The Us

Abstract INTRODUCTION For brain metastases, single-fraction stereotactic radiosurgery (SRS) spares appropriately chosen patients from the invasiveness of operative intervention and the permanent cognitive morbidity of whole brain radiation. SRS is delivered predominantly via two modalities: Gamma Knife, and linear accelerator (LINAC). The implementation of the American Tax Payer Relief Act (ATRA) in 2013 represented the first time limitations specifically targeting SRS reimbursement were introduced into federal law. The subsequent impact of the ATRA on SRS utilization in the United States (US) has yet to be examined. METHODS The National Cancer Data Base (NCDB) from 2010–2016 identified brain metastases patients from non-small cell lung cancer (NSCLC) throughout the US having undergone SRS. Utilization between GKRS and LINAC was assessed before (2010–2012) versus after (2013–2016) ATRA implementation. Utilization was adjusted for several variables, including patient demographics and healthcare system characteristics. RESULTS From 2012 to 2013, there was a substantial decrease of LINAC SRS in favor of GKRS overall (37% to 28%) and individually in both academic and non-academic centers. Over the three-year span immediately preceding ATRA implementation, 65.8% received GKRS and the remaining 34.2% receiving LINAC. In the four years immediately following ATRA implementation 68.0% received GKRS compared with 32% receiving LINAC; these differences were not statistically significant. CONCLUSIONS ATRA implementation in 2013 caused an initial spike in Gamma Knife SRS utilization, followed by a steady decline, similar to rates prior to implementation. These findings are indicative that the ATRA provision mandating Medicare reduction of outpatient payment rates for Gamma Knife to be equivalent with those of LINAC SRS had a significant short-term impact on the radiosurgical treatment of metastatic brain disease throughout the US. Such findings should serve as a reminder of the importance and impact of public policy on treatment modality utilization by physicians and hospitals.

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