Patterns of care and treatment outcomes of patients with stage I esophageal cancer: A National Cancer Database analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4035-4035
Author(s):  
Amy Catherine Moreno ◽  
Ning Zhang ◽  
Steven H. Lin ◽  
Sharon Hermes Giordano
Keyword(s):  
Esophageal Cancer ◽  
Clinical Stage ◽  
Local Therapy ◽  
The United States ◽  
Stage I ◽  
Patterns Of Care ◽  
Median Income ◽  
Comorbidity Score ◽  
Cancer Data ◽  
Definitive Therapy

4035 Background: The aim of this study was to examine current patterns of care and associated outcomes for patients with stage I esophageal cancer (EC) treated in the United States. Methods: The National Cancer Data Base (NCDB) was queried for patients diagnosed with clinical stage T1-2N0 EC from 2004-2012. Patients were categorized into four treatment groups: observation without definitive therapy (Obs), chemoradiotherapy (CRT), local excision (LE), and esophagectomy (Eso). Patient, tumor, and treatment parameters were compared between groups. Kaplan-Meier 5-year overall survival (OS) estimates, postoperative 30- and 90-day mortality comparisons, and multivariate Cox proportional hazards modeling are reported. Results: A total of 5,460 patients met the criteria. Of these, 21% were observed, 14% underwent CRT, 23% LE, and 42% Eso. Median age and follow up were 67 years and 28 months, respectively. Eso was the primary treatment for patients of age ≤ 80 while 48% of patients age > 80 were observed. Age, race, comorbidity score, tumor location within the esophagus, type of medical insurance, median income, type of facility (academic vs. non-academic), and distance from treating facility were significant factors for predicting receipt of local therapy over observation. Postoperative 30-day mortality between the LE and Eso groups was 0.5% and 2.9%, respectively ( P< .001), which increased to 1.4% and 5.5% at 90 days ( P< .001). Five-year OS was 21% for Obs, 26% CRT, 64% LE, and 63% Eso ( P < .001). Multivariate analyses demonstrated improved OS with any form of local definitive therapy: CRT ( HR: 0.54, 95% CI [0.48 - 0.61], P< .001), LE ( HR: 0.24, [0.20 - 0.27], P< .001), Eso (HR: 0.31, [0.28 - 0.35], P< .001). Age, comorbidity score, facility type, distance, median income quartile, and insurance status were also independently associated with OS. Conclusions: Management of stage I EC is influenced by several demographic and socioeconomic factors. Clinical observation yields suboptimal outcomes compared to any local therapy, and a surgical approach should be considered over CRT whenever feasible.

Impact of gender on treatment and survival of patients with esophageal cancer in the United States.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 173-173
Author(s):  
Camille Baumrucker ◽  
Dido Franceschi ◽  
Alan S Livingstone ◽  
Francis Igor Macedo
Keyword(s):  
Esophageal Cancer ◽  
The United States ◽  
Small Sample ◽  
Stage I ◽  
Disease Stage ◽  
Cancer Data ◽  
Female Patients ◽  
White Males ◽  
Chi Square Analysis ◽  
The Impact

173 Background: Esophageal cancer (EC) is historically a male-predominant disease. Current available evidence on the impact of gender on clinical presentation and survival outcomes of EC is limited by small sample size or single institutional series. Methods: Patients with EC (stage I-III) were identified in the National Cancer Data Base (NCDB, 2004-2016). Clinicopathologic and treatment characteristics of male and female patients were compared using Chi-square analysis. Overall survival (OS) was estimated using Kaplan-Meier method and Cox proportional hazards regression. Results: Of 62,893 patients included, male gender was predominant (77.7% vs 22.3%). Adenocarcinoma was the most common subtype (66.7%); however, squamous cell carcinoma was more predominant in females (57.1% vs. 26.5%, p<0.001). Females were significantly older (68.5 vs. 66.1 years; p<0.001) and more likely African American (AA) (14% vs. 8.1%; p<0.001). Females were more likely to present with local disease (stage I, 19.6% vs. 18.2%; p<0.001), while males presented more likely with locoregional disease (LRD, stage II/III, 80.4% vs 81.8%, p<0.001). Females had worse OS compared to males (18.1 vs. 19.7 mo; p=0.001; cI: 23.5 vs. 31.9mo, p<0.001; cII/III: 17.2 vs 18.3mo, p=0.473). White females had worse OS than white males (18.6 vs. 20.4mo, p<0.001), while AA females had better OS (13.5 vs. 12.6mo, p=0.001). Among patients with LRD, females less frequently received chemotherapy (CT, 75.4% vs. 82.9%, p<0.001), radiation therapy (RT, 78.9% vs. 82.6%, p<0.001), and esophagectomy (28% vs. 40.5%, p<0.001). Females who underwent esophagectomy had improved OS over males (40.3 vs. 32.7mo; p<0.001). More specifically, white females who underwent esophagectomy had improved OS over white males (47.6 vs 38mo, p<0.001); however, AA males and females who underwent esophagectomy had similar OS (33.8 vs 32.6mo, p=0.452). Female gender, advanced age, AA race, high comorbidity score and clinical stage, and lack of access to CT, RT, and esophagectomy were independent predictors of mortality (Table). Conclusions: Females with EC seem to have less access to CT, RT and esophagectomy, which is associated with worse OS compared to males. Healthcare policies should be implemented to increase access to standard of care treatment for female patients with EC. [Table: see text]

Room for improvement? The adoption of multimodal esophageal cancer care in the United States.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 78-78
Author(s):  
R. P. Merkow ◽  
K. Y. Bilimoria ◽  
M. McCarter ◽  
A. Stewart ◽  
W. B. Chow ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Surgical Resection ◽  
Tumor Size ◽  
Locally Advanced ◽  
The United States ◽  
Stage I ◽  
Stage Ii ◽  
Cancer Data ◽  
Factors Associated

78 Background: Consensus guidelines recommend neoadjuvant chemo- or chemoradiation therapy as the preferred treatment for locally advanced esophageal adenocarcinoma; however, it is unknown if this recommendation has been widely adopted in the U.S. Our objective was to examine esophageal cancer multimodal therapy and identify factors associated with the use of neoadjuvant therapy. Methods: From the National Cancer Data Base, patients with middle third, lower third and GE junction (GEJ) adenocarcinomas were identified. Patients who were clinical stage I-III and underwent surgical resection were included. Separate logistic regression models were developed to identify predictors of neoadjuvant therapy utilization and outcomes. Results: From 1998 to 2007, 8,051 patients underwent surgical resection for esophageal cancer: 16.3% stage I, 45.0% stage II and 38.7% stage III. For stage II/III tumors, neoadjuvant use increased (49.0% to 77.8%, p<0.001). After adjustment, factors associated with underuse of neoadjuvant therapy in stage II/III patients were older age, Black or Hispanic ethnicity, more severe comorbidities, tumor location (GEJ and middle vs. lower third), tumor size ≥ 2cm, stage II (vs. III) and geographic region. Stage II/III patients not receiving neoadjuvant had an over two fold increased risk of positive lymph nodes (OR 2.14. 95% CI 1.79 – 2.55, p<0.001). In addition, the positive surgical margin rate increased almost three fold (OR 2.80 95% CI 2.17-3.62, p<0.001) but 30-day postoperative mortality risk was not significantly affected (OR 1.50 95% CI 0.94-2.39; p=0.090). For stage I patients, neoadjuvant therapy decreased over time (38.0% to 11.4%, p<0.001). The overuse of neoadjuvant therapy was associated with higher tumor grade, larger tumor size, and low surgical case volume (all p<0.05). Conclusions: The adoption of neoadjuvant therapy has increased in the past decade; however, opportunity exists to improve guideline treatment for locally advanced esophageal cancer. Registry-based feedback to individual hospitals, such as benchmark comparison tools, could help institutions provide care in concordance with national guidelines. No significant financial relationships to disclose.

PD5-04 UNITED STATES TRENDS IN PATTERNS OF CARE IN CLINICAL STAGE I TESTICULAR CANCER: RESULTS FROM THE NATIONAL CANCER DATA BASE (1998-2011)

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Claudio Jeldres ◽  
Craig R. Nichols ◽  
Khanh Pham ◽  
Sia Daneshmand ◽  
Christian Kollmannsberger ◽  
...  
Keyword(s):  
United States ◽  
Testicular Cancer ◽  
Data Base ◽  
Clinical Stage ◽  
National Cancer Data Base ◽  
Stage I ◽  
Patterns Of Care ◽  
Cancer Data

United States trends in patterns of care in clinical stage I testicular cancer: Results from the National Cancer Database (1998-2011).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 369-369 ◽  
Author(s):  
Claudio Jeldres ◽  
Craig R. Nichols ◽  
Khanh Pham ◽  
Siamak Daneshmand ◽  
Christian K. Kollmannsberger ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Testicular Cancer ◽  
Active Surveillance ◽  
Treatment Modality ◽  
Clinical Stage ◽  
Stage I ◽  
Patterns Of Care ◽  
Management Options ◽  
Cancer Data ◽  
The Us

369 Background: There has been significant evolution in worldwide guidelines for management of clinical stage I (CS1) testicular cancer where active surveillance (AS) strategies are now considered a first choice, especially for patients with lower recurrence risk after orchiectomy. Conversely, local therapies for CS1 such as primary retroperitoneal lymphadenectomy (RPLND) in non-seminoma and regional radiation in seminoma are phasing out of recommendations. In the US, there have been no comprehensive efforts to measure uptake of guideline recommendations and modern patterns of care for early-stage testicular cancer. Methods: Access to the testicular cancer data set within the National Cancer Data Base (NCDB) was granted to Virginia Mason Medical Center (A SWOG affiliated cancer research program) for this retrospective cohort study. We identified all patients with CS1 testicular cancer between 1998 and 2011. Management options after orchiectomy such as adjuvant radiotherapy, adjuvant chemotherapy, RPLND, or AS were analyzed using cross tabulation and trend analysis. Results: Within the NCDB, of 75,902 patients with testicular cancer, 31,208 and 13,301 were diagnosed with CS1 seminoma and non-seminoma, respectively. For CS1 seminoma, AS use increased from 25.2% in 1998 to 55.8% in 2011. Similarly adjuvant chemotherapy use also increased (1.9 % to 16.7%). Conversely, use of adjuvant radiation decreased from 72.9% to 27.5%. For CS1 non-seminoma, AS remained the main treatment modality ranging between 58.8% and 66.2%. The use of adjuvant chemotherapy increased (28.3% in 2011) and the rate of primary RPLND constantly decreased down to 12.9% that same year. Interestingly, 50.3% of patients with CS1 non-seminoma and negative lympho-vascular invasion status had chemotherapy rather than AS. Trends analyses were statistically significant for all treatment modalities (p<0.05). Conclusions: Active surveillance as a management strategy has increased and is currently the most common treatment modality used for both CS1 seminoma and non-seminoma in the US. Regional therapies in CSI seminoma and non-seminoma are decreasing but persist even in patients with a low risk of recurrence.

Survival impact of neoadjuvant therapy in resected pancreatic cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 367-367
Author(s):  
Katelin Anne Mirkin ◽  
Christopher S Hollenbeak ◽  
Joyce Wong
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Median Survival ◽  
Clinical Stage ◽  
Stage I ◽  
Median Income ◽  
Stage Disease ◽  
Surgery First ◽  
The Impact

367 Background: Pancreatic cancer carries a dismal prognosis, with surgical resection and adjuvant therapy offering the only hope for long-term survival. In recent years, neoadjuvant therapy (NAT) has been employed to optimize outcomes. This study evaluates the impact of NAT on survival in patients with resected stage I-III pancreatic cancer. Methods: The National Cancer Data Base (2003-2011) was analyzed for patients with clinical stage I-III resected carcinoma of the pancreas who underwent NAT or surgery first +/- adjuvant therapy. Univariate statistics were used to compare characteristics between groups. Analysis of variance and Kaplan Meier analyses were used to compare median survival for each clinical stage of disease. Multivariate analyses were performed using a Cox proportional hazards model. Results: 16,122 patients who underwent NAT and 16,869 patients who underwent surgery-first were included. Patients who underwent NAT tended to be younger, covered by private insurance, have a higher median income, greater comorbidities, higher clinical stage disease, and undergo a whipple. Additionally, NAT patients had a greater number of positive regional lymph nodes (9 vs. 6, respectively), although a similar number of nodes retrieved, and higher pathological stage disease. In patients with clinical stage I disease, adjuvant therapy was associated with improved median survival than NAT and surgery-alone (24.8, 18.5, 17.9 months, p < 0.0001, respectively). However, in stage II, adjuvant and NAT offered similar median survival, which was improved over surgery-alone (20.5, 20.1, and 12.4 months, p < 0.0001, respectively). In stage III, NAT had improved median survival than the other groups (19.6, 14.2, 8.6 months, p < 0.0001, respectively). In the multivariate survival analysis, patients who received NAT had a 22% lower hazard of mortality up to 5 years as compared to adjuvant therapy (p < 0.0001). Conclusions: Neoadjuvant therapy in advanced stage pancreatic cancer confers a survival benefit and may allow more patients to undergo surgery; NAT appears to offer similar survival as adjuvant therapy in early stage pancreatic cancer.

Esophagectomy versus definitive chemoradiotherapy as initial treatment for clinical stage I esophageal cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Li-Xiang Mei ◽  
Jun-Xian Mo ◽  
Yong Chen ◽  
Lei Dai ◽  
Yong-Yong Wang ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Initial Treatment ◽  
Tumor Recurrence ◽  
Clinical Stage ◽  
Stage I ◽  
Current Evidence ◽  
Cochrane Library ◽  
Definitive Chemoradiotherapy ◽  
Randomized Controlled ◽  
Significant Difference

Abstract Background Esophagectomy and definitive chemoradiotherapy are commonly used in the treatment of stage I esophageal cancer (EC). The present study aims to compare the efficacy and safety of esophagectomy and definitive chemoradiotherapy as the initial treatment for clinical stage I EC. Methods This study was registered with the International Prospective Register of Systematic Reviews (CRD42020197203). Relevant studies were identified through PubMed, Web of Science, EMBASE, and Cochrane Library from database inception to June 30, 2020. Hazard ratio (HR) with 95% confidence intervals (CI) was employed to compare overall survival (OS) and progression-free survival (PFS). Odds ratio (OR) with 95% CI was employed to compare treatment-related death, complications, and tumor recurrence. Results A total of 13 non-randomized controlled studies involving 3,346 patients were included. Compared with definitive chemoradiotherapy, esophagectomy showed an improved OS (HR 0.69, 95% CI 0.55–0.86; P &lt; 0.001), PFS (HR 0.47, 95% CI 0.33–0.67; P &lt; 0.001), and a lower risk of tumor recurrence (OR 0.43, 95% CI 0.30–0.61; P &lt; 0.001). There was no significant difference in the incidence of complications (OR 1.11, 95% CI 0.75–1.65; P = 0.60) and treatment-related death (OR 1.15, 95% CI 0.31–4.30; P = 0.84) between the two treatments. Conclusions Current evidence shows esophagectomy has superior survival benefits as the initial treatment for clinical stage I EC. It is still the preferred choice for patients with clinical stage I EC. However, future high-quality randomized controlled trials are needed to validate this conclusion.

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