Post-orchiectomy adjuvant therapy versus surveillance for stage IS testicular cancer.

406 Background: To assess contemporary treatment patterns and survival for stage IS testicular cancer. Methods: Using the National Cancer Data Base, we identified 1,362 patients with AJCC stage IS testicular cancer (seminoma or non-seminoma) treated between 2004-2012 with either adjuvant therapy (AT) or initial surveillance. AT was defined as the receipt of chemotherapy, radiotherapy (RT), or retroperitoneal lymph node dissection (RPLND) as part of first line treatment after orchiectomy. Annual percent change (APC) in the use of AT was calculated and multivariable logistic regression analysis was performed to identify predictors of receiving AT. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves and Cox regression analyses were used to compare overall survival (OS) between AT and initial surveillance groups. All analyses were stratified according to histologic type. Results: Overall, there were 581 (43%) and 781 (57%) men with seminoma and non-seminoma, respectively. Among men with seminoma, 61% received AT (RT = 45%, chemo = 16%) while 39% received initial surveillance. The use of AT decreased over the study period (APC = -2.7; 95%CI: -4.4, 1.1; P = 0.001). Predictors of receiving AT included low income (OR = 1.63; 95%CI: 1.03, 2.56; P = 0.04), while year of diagnosis (OR = 0.89; 95%CI: 0.83, 0.96; P = 0.003) predicted the opposite. The 5-year IPTW-adjusted rates of OS were 99% and 97% in the AT and initial surveillance groups, respectively (HR = 0.36; 95%CI: 0.12, 1.14; P = 0.08). Among men with non-seminoma, 47% received AT (chemo = 38%, RPLND = 9%) while 53% received initial surveillance. The use of AT remained stable over the study period (APC = +0.8; 95%CI: -0.7, +2.2; P = 0.29). Predictors of receiving AT included stage ≥ pT2 (OR = 1.78; 95%CI: 1.06, 3.00; P = 0.03), and lymphovascular invasion (OR = 2.68; 95%CI: 1.88, 3.83; P < 0.001). The 5-year IPTW-adjusted rates of OS were 97% and 95% in the AT and initial surveillance groups, respectively (HR = 0.66; 95%CI: 0.27, 1.61; P = 0.36). Conclusions: Trends in the use of AT for stage IS testicular cancer differed according to histologic type. Nonetheless, we report 5-year OS rates of ≥ 95% for seminoma and non-seminoma without any significant benefit with the use of AT.

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Incomplete non-small-cell lung cancer (NSCLC) resections in the National Cancer Data Base (NCDB): Predictors, prognosis and value of adjuvant therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.15_suppl.7527 ◽

2015 ◽

Vol 33 (15_suppl) ◽

pp. 7527-7527

Author(s):

Raymond U Osarogiagbon ◽

Chun Chieh Lin ◽

Matthew Smeltzer ◽

Ahmedin Jemal

Keyword(s):

Lung Cancer ◽

Adjuvant Therapy ◽

Small Cell Lung Cancer ◽

Data Base ◽

Cell Lung Cancer ◽

National Cancer Data Base ◽

Small Cell ◽

Small Cell Lung ◽

Cancer Data

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Management and outcomes of clinical stage II a/b seminoma: Results from the National Cancer Database.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.378 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 378-378

Author(s):

Jonathan J. Paly ◽

Phillip John Gray ◽

Chun Chieh Lin ◽

Helmneh Sineshaw ◽

Ahmedin Jemal ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Clinical Stage ◽

National Cancer Data Base ◽

Treatment Center ◽

Adjuvant Radiation ◽

Testicular Seminoma ◽

Cancer Data ◽

Factors Associated ◽

Significant Difference

378 Background: Testicular seminoma is the most common solid tumor seen in patients aged 15-35 and disease specific survival approaches 100% in controlled studies, even for those with node-positive disease. We sought to describe modern practice patterns as well as survival outcomes and factors associated with receipt of adjuvant therapy for patients presenting with initial clinical stage (CS) IIA/B disease. Methods: Data on patients diagnosed with CS IIA/B testicular seminoma from 1998-2011 were extracted from the National Cancer Data Base. Demographic, clinical, treatment, payer characteristics were evaluated using multivariate logistic regression to identify factors associated with receipt of chemotherapy or adjuvant radiation therapy (ART) within 6 months of orchiectomy. Five-year Kaplan-Meier overall survival (OS) by CS and treatment was calculated. Results: In total, 2,185 patients with CS II A/B were included. Management included orchiectomy alone (11.35%), adjuvant chemotherapy (27.46%), or ART (52.72%). In multivariate analysis, receipt of orchiectomy plus ART rather than adjuvant chemotherapy was more likely with CS IIA status (OR 2.4, p < 0.01), treatment outside of teaching or NCI network institution (OR 1.9-2.8, p < 0.02), or tumor size ≥4cm (OR 1.6, p < 0.01). Receipt of ART was less likely in Hispanic patients (OR 0.6, p=0.03) or in those diagnosed from 2006-2011 (OR 0.5, p < 0.01). Five-year OS for all patients was 97.2% for orchiectomy + ART, and 93.9% for orchiectomy + chemotherapy (log-rank p = 0.01). For CS IIA patients, 5-year OS was 98.3% for orchiectomy + ART versus 93.6% for orchiectomy + chemotherapy (log-rank p < 0.01). Differences in OS for CS IIB treated with chemotherapy or ART were not statistically significant. Conclusions: Consistent with national guideline recommendations, our analysis suggest that compared to chemotherapy, ART is associated with a survival advantage for CS IIA patients. Chemotherapy or ART showed no significant difference in effectiveness in patients with CS IIB. Disease bulk, race, treatment center type, and time period are associated with choice of adjuvant therapy. Longer follow-up and validation of these results is needed to account for late effects of treatment.

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Effect of adding immunotherapy (IT) to treatment regimen of mantle cell lymphoma (MCL): Analysis of the National Cancer Data Base (NCDB).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e19022 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e19022-e19022

Author(s):

Alaa Altahan ◽

Eric Vick ◽

Upama Giri ◽

Eric Wiedower ◽

Michael Gary Martin

Keyword(s):

Cox Regression ◽

Statistical Significance ◽

Clinical Stage ◽

Single Agent ◽

National Cancer Data Base ◽

Cox Regression Analysis ◽

Cancer Data ◽

Treatment Regimens ◽

Significant Difference ◽

A Prospective Study

e19022 Background: There has been some improvement in overall survival (OS) for patients with MCL over the past years [Gordon 2014]. However, side effects of treatment remain a major concern. With introduction of novel therapies like IT, it is imperative to optimize treatment regimens to improve survival while minimizing toxicity. Methods: MCL patients (pts) who were diagnosed in 2013 or later with information available about chemotherapy (CT) and IT and did not receive transplant were extracted from NCDB. Pts were assigned to age categories and were sorted into six groups based on different combinations of CT (none, single agent (SA), and multi-agent (MA)) with or without IT. Cox regression analysis was used to perform multivariate analysis that included age category, sex, race, clinical stage, Charlson/Deyo score, CT, radiation, and IT for each group. Multivariate p values (p) were used to analyze statistical significance. Kaplan Meier method was utilized to analyze OS. T-test was used to compare means (t-p). Results: 1438 total pts were identified with a mean age of 70 (range 24-90); 71% male; 93% white, 4% black, 3% others; 42% with stage III/IV disease. 667 pts did not receive CT or IT, and 40 received IT alone and both of these groups were excluded from further analysis. 52 pts received SA- (without) IT, 206 received SA+(with) IT and 260 pts received MA-IT and 213 MA+IT. Mean age was 72 and 66 for SA and MA groups, respectively (t-p<0.01). Mean OS for SA+IT was 27 months (m) vs SA-IT 16 m (p < 0.01). MA+IT v MA-IT showed no difference in mean OS (25 vs 26 m, respectively, p =0.49). Although there was a significant difference in OS between SA and MA groups without IT (16 vs 25 months, p < 0.01). SA + IT group showed comparable mean OS time to MA + IT (27 vs 26 m, p =0.145). Conclusions: For MCL pts, MA has superior OS to SA group. However, adding IT significantly improves OS for SA group and makes it comparable to MA. Adding IT to MA did not provide significant difference in OS. These results highlight the possibility of achieving same OS with less toxic regimens. Hence further evaluation in a prospective study to optimize treatment while reducing toxicity is warranted.

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Using the National Cancer Data Base (NCDB) and Oncotype DX data to predict adjuvant therapy effect on overall survival (OS) of N0 & N1 breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.e12529 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. e12529-e12529

Author(s):

Amila Orucevic ◽

Heidel Robert ◽

John Lawrence Bell

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Adjuvant Therapy ◽

Data Base ◽

Cancer Patients ◽

National Cancer Data Base ◽

Oncotype Dx ◽

Breast Cancer Patients ◽

Cancer Data ◽

Therapy Effect

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The impact of the chemoradiation to surgery interval on pathological complete response: Short and long-term overall survival in esophageal cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.2 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 2-2

Author(s):

Basem Azab ◽

Omar Picado ◽

Caroline Ripat ◽

Francisco Igor Macedo ◽

Alan S Livingstone ◽

...

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Cox Regression ◽

Pathological Complete Response ◽

Complete Response ◽

Continuous Variable ◽

National Cancer Data Base ◽

Categorical Variables ◽

Cancer Data ◽

The Impact

2 Background: The association of the interval between neoadjuvant chemo-radiation and surgery (CRT-S), and cancer outcomes in patients with esophageal cancer is not clear. We aimed to determine the relationship between CRT-S interval and pathological complete response rate (pCR), short and long overall survival (OS). Methods: Patients listed on the National Cancer Data Base from 2004 to 2013 were studied. We included patients with CRT followed by surgery in 15-90 days. All patients had reported pT, pN cancer stages and survival status. CRT-S interval was studied as continuous (weeks) and categorical variables (quintiles). Results: A total of 5181 patients were included; 81% were adenocarcinomas, 84% were males and mean age was 62 years. They were divided into CRT-S interval quintiles (15 to 37, 38 to 45, 46 to 53, 54 to 64 and 65 to 90 days) (n = 1016, 1063, 1081, 1083 and 938 patients), respectively. There was a significant increase of pCR rate across the CRT-S quintiles (18%, 21%, 24%, 25% and 29%, p < 0.001). This advantage persisted when CRT-S was measured as continuous variable in weeks (OR: 1.11, 95% CI = 1.078-1.143, p < 0.001). However, 90-day mortality significantly increased as CRT-S increased across quintiles (5.7%, 6.2%, 6.8%, 8.5% and 8.2%, p = 0.02) and through weeks (OR = 1.05, 95%CI = 1.005-1.106, p = 0.03). Mean OS across CRT-S quintiles was 59.2, 58.8, 55.4, 56.6 and 51.5 months, respectively. Multivariate Cox regression showed significantly worse OS per week increase in CRT-S interval (HR 1.02, 95% 1.003-1.037, p = 0.02), especially among the last quintile (CRT-S = 65-90 days: HR 1.2, 95% CI 1.04-1.32, p = 0.009). Those with no-pCR had worse OS as time to surgery increased (p < 0.001), while pCR group had similar OS across CTR-S intervals. Conclusions: Despite higher pCR rate as CRT-S interval increasing, surgery is preferred to be done in less than 65 days after CRT to avoid worse 90-day mortality and achieve better OS. Further randomized studies are needed to consolidate our findings.

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Efficacy of High-Intensity Local Treatment for Metastatic Urothelial Carcinoma of the Bladder: A Propensity Score–Weighted Analysis From the National Cancer Data Base

Journal of Clinical Oncology ◽

10.1200/jco.2016.66.7352 ◽

2016 ◽

Vol 34 (29) ◽

pp. 3529-3536 ◽

Cited By ~ 37

Author(s):

Thomas Seisen ◽

Maxine Sun ◽

Jeffrey J. Leow ◽

Mark A. Preston ◽

Alexander P. Cole ◽

...

Keyword(s):

Radiation Therapy ◽

Urothelial Carcinoma ◽

High Intensity ◽

Cox Regression ◽

Local Treatment ◽

National Cancer Data Base ◽

Cancer Data ◽

Kaplan Meier ◽

Metastatic Urothelial Carcinoma ◽

Carcinoma Of The Bladder

Purpose Evidence from studies of other malignancies has indicated that aggressive local treatment (LT), even in the presence of metastatic disease, is beneficial. Against a backdrop of stagnant mortality rates for metastatic urothelial carcinoma of the bladder (mUCB) at presentation, we hypothesized that high-intensity LT of primary tumor burden, defined as the receipt of radical cystectomy or ≥ 50 Gy of radiation therapy delivered to the bladder, affects overall survival (OS). Patients and Methods We identified 3,753 patients within the National Cancer Data Base who received multiagent systemic chemotherapy combined with high-intensity versus conservative LT for primary mUCB. Patients who received no LT, transurethral resection of the bladder tumor alone, or < 50 Gy of radiation therapy delivered to the bladder were included in the conservative LT group. Inverse probability of treatment weighting (IPTW) –adjusted Kaplan-Meier curves and Cox regression analyses were used to compare OS of patients who received high-intensity versus conservative LT. Results Overall, 297 (7.91%) and 3,456 (92.09%) patients with mUCB received high-intensity and conservative LT, respectively. IPTW-adjusted Kaplan-Meier curves showed that median OS was significantly longer in the high-intensity LT group than in the conservative LT group (14.92 [interquartile range, 9.82 to 30.72] v 9.95 [interquartile range, 5.29 to 17.08] months, respectively; P < .001). Furthermore, in IPTW-adjusted Cox regression analysis, high-intensity LT was associated with a significant OS benefit (hazard ratio, 0.56; 95% CI, 0.48 to 0.65; P < .001). Conclusion We report an OS benefit for individuals with mUCB treated with high-intensity versus conservative LT. Although the findings are subject to the usual biases related to the observational study design, these preliminary data warrant further consideration in randomized controlled trials, particularly given the poor prognosis associated with mUCB.

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