Impact of hospital volume and type on survival in hepatocellular carcinoma: Results from the National Cancer Database.

417 Background: To assess the impact of hospital volume and type on survival in patients with hepatocellular carcinoma (HCC). Methods: Patients with histopathological or imaging-based diagnosis of HCC were identified from the 2003-2015 National Cancer Database (NCDB). First-line treatment was stratified as liver transplant, surgical resection, interventional oncology (IO) and chemotherapy. Hospital volume was stratified as high (ranking among top 10% in case numbers) and low volume, separately for each treatment modality. Hospital type was categorized as academic and non-academic. Overall survival was assessed using multivariable Cox proportional hazards models. Results: A total of 63,877 patients were included (transplant n = 10,596, surgical resection n = 11,132, IO n = 12,286, chemotherapy n = 29,863). Of 1,261 hospitals systems which treated HCC, 226 (17.9%) were academic centers and 1,035 (82.1 %) were non-academic centers. Mean number of cases treated annually was higher in academic centers (55.2; 34.6; 40.7; 79.9) versus non-academic centers (10.7; 6.25; 6.6; 11.9 for transplant; surgical resection; IO and chemotherapy; p < 0.001, respectively). Young African American patients and those with private insurance, high income and education were more likely to receive treatment at academic centers. Geographical difference were evident among US regions, with highest proportion of HCC treated at academic centers in New England states (83.6%) and lowest in South Atlantic states (48.6%). Overall survival was superior for academic versus non-academic centers (HR = 0.89, 95% CI: 0.87-0.91, p < 0.001) and high versus low volume centers (HR = 0.79, 95% CI: 0.77-0.81, p < 0.001), after multivariable adjustment for potential confounders. These effects were evident among all HCC treatment modalities. Conclusions: HCC treatment in academic centers shows distinct patterns according to patient demographics and US geography. Among all treatment modalities, both academic setting and hospital volume independently affected HCC outcomes, with highest patient survival observed in high-volume academic centers.

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Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study

Cancer Control ◽

10.1177/1073274820956615 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482095661

Author(s):

Bryce D. Beutler ◽

Mark B. Ulanja ◽

Rohee Krishan ◽

Vijay Aluru ◽

Munachismo L. Ndukwu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Cohort Study ◽

Native American ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Private Insurance ◽

Insurance Status ◽

The Impact ◽

To Receive

Background: Race, gender, insurance status, and income play important roles in predicting health care outcomes. However, the impact of these factors has yet to be fully elucidated in the setting of hepatocellular carcinoma (HCC). Methods: We designed a retrospective cohort study utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with resectable HCC (N = 28,518). Demographic factors of interest included race (Asian/Pacific Islander [API], African American [AA], Native American/Alaska Native [NA], or White [WH]) and gender (male [M] or female [F]). Insurance classifications included those having Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]. Median household income was estimated for all diagnosed with HCC. Endpoints included: (1) overall survival; (2) likelihood of receiving a recommendation for surgery; and (3) specific surgical intervention performed. Multivariate multinomial logistic regression for relative risk ratio (RRR) and Cox regression models were used to identify pertinent associations. Results: Race, gender, insurance status, and income had statistically significant effects on the likelihood of surgical recommendation and overall survival. API were more likely to receive a recommendation for hepatic resection (RRR = 1.45; 95% CI: 1.31-1.61; Reference Race: AA) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73-0.82; Reference Race: AA) as compared to members of any other ethnic group; there was no difference in these endpoints between AA, NA, or WH individuals. Gender also had a significant effect on survival: Females exhibited superior overall survival (HR = 0.89; 95% CI: 0.85-0.93; Reference Gender: M) as compared to males. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Conclusions: Race, gender, insurance status, and income have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation.

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Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate stage hepatocellular carcinoma: A propensity score matching analysis

10.21203/rs.2.22284/v2 ◽

2020 ◽

Author(s):

Chih-Wen Lin ◽

Yaw-Sen Chen ◽

Gin-Ho Lo ◽

Yao-Chun Hsu ◽

Chia-Chang Hsu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Radiofrequency Ablation ◽

Propensity Score ◽

Propensity Score Matching ◽

Surgical Resection ◽

Cox Regression ◽

Cox Regression Analysis ◽

Tace Group ◽

The Impact

Abstract Background: Patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are recommended to undergo transcatheter arterial chemoembolization (TACE). However, TACE in combination with radiofrequency ablation (RFA) is not inferior to surgical resection (SR), and the benefits of surgical resection (SR) for BCLC stage B HCC remain unclear. Hence, this study aims to compare the impact of SR, TACE+RFA, and TACE on analyzing overall survival (OS) in BCLC stage B HCC. Methods: Overall, 428 HCC patients were included in BCLC stage B, and their clinical data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Results: One hundred forty (32.7%) patients received SR, 231 (53.9%) received TACE+RFA, and 57 (13.3%) received TACE. The OS was significantly higher in the SR group than that in the TACE+RFA group [hazard ratio (HR): 1.78; 95% confidence incidence (CI): 1.15-2.75, p=0.009]. The OS was significantly higher in the SR group than that in the TACE group (HR: 3.17; 95% CI: 2.31-4.36, p<0.0001). Moreover, the OS was significantly higher in the TACE+RFA group than that in the TACE group (HR: 1.82; 95% CI: 1.21-2.74, p=0.004). The cumulative OS rates at 1, 3 and 5 years in the SR, TACE+RFA, and TACE groups were 89.2%, 69.4% and 61.2%, 86.0%, 57.9% and 38.2%, and 69.5%, 37.0% and 15.2%, respectively. After propensity score matching, the SR group still had a higher OS than those of the TACE+RFA and TACE groups. The TACE+RFA group had a higher OS than that of the TACE group. Conclusion: The SR group had higher OS than the TACE+RFA and TACE groups in BCLC stage B HCC. Furthermore, the TACE+RFA group had higher OS than the TACE group.

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Impact of insurance status on survival in neuroendocrine tumors: A multi-institutional Study from the U.S. Neuroendocrine Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.371 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 371-371

Author(s):

Paula Marincola Smith ◽

Alexandra G Lopez-Aguiar ◽

Mary Dillhoff ◽

Eliza W Beal ◽

George A. Poultsides ◽

...

Keyword(s):

Overall Survival ◽

Surgical Resection ◽

Neuroendocrine Tumors ◽

Private Insurance ◽

The United States ◽

Study Group ◽

Insurance Status ◽

Insured Patients ◽

The Impact ◽

The U.S

371 Background: Insurance status predicts access to medical care in the United States. Previous studies show uninsured and government insured patients have worse outcomes than those with private insurance. However, the impact of insurance status on survival in patients with Gastrointestinal Neuroendocrine Tumors (GI-NETs) is unclear. We evaluate the association between insurance status and survival in patients with GI-NETs. Methods: Our analysis includes 2022 patients who had surgical resection of GI-NETs at 8 institutions in the U.S. Neuroendocrine Study Group. Patients were categorized based on insurance as private (PI), government (GovI) or uninsured (UI). Factors associated with insurance status were assessed by uni- and multi-variate analysis. Primary endpoint was overall survival. Results: Patient demographics between the insurance categories were similar in ECOG performance status and tumor size at presentation. GovI patients had a higher median age than PI or UI (66 vs. 54 vs. 56 years respectively; p<0.01). Uninsured patients were more likely African American (21.5%) or Latino (5%) compared to PI (11.5%, 2%) or GovI (15%, 2%) (p<0.01). The UI group had a higher proportion of patients who underwent no surveillance imaging post-operatively (39%) compared to PI (26%) and GovI patients (26%) but this was not statistically significant (p=0.15). There was no difference in operative intent (curative vs. palliative) between groups (p=0.2). Five-year overall survival was 86% for PI, 82% for GovI, and 73% for UI patients (p<0.01). On multivariate regression analysis, being uninsured was independently associated with reduced survival when controlling for ASA Class, ECOG, race, tumor location, neoadjuvant and adjuvant chemotherapy, Somatostatin analog, or radiation therapy (HR 1.39, p = 0.012). Conclusions: This is the first systematic analysis of insurance status’s association with overall survival in GI-NET patients. Our analysis shows uninsured or government insured patients have shortened survival compared to the privately insured. The disparity is likely underrepresented in this study, as we examined only patients who underwent surgical resection.

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Comparison of Surgical Resection and Systemic Treatment for Hepatocellular Carcinoma with Vascular Invasion: National Cancer Database Analysis

Liver Cancer ◽

10.1159/000515554 ◽

2021 ◽

pp. 1-12

Author(s):

Rajalakshmi Govalan ◽

Marie Lauzon ◽

Michael Luu ◽

Joseph C. Ahn ◽

Kambiz Kosari ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Surgical Resection ◽

Systemic Therapy ◽

Vascular Invasion ◽

Systemic Treatment ◽

Multivariable Analysis ◽

National Cancer Database ◽

Factors Associated ◽

The Usa

Introduction: Small studies from outside of the USA suggest excellent outcomes after surgical resection for hepatocellular carcinoma (HCC) with vascular invasion. The study aims to (1) compare overall survival after surgical resection and systemic therapy among patients with HCC and vascular invasion and (2) determine factors associated with receipt of surgical resection in a US population. Methods: HCC patients with AJCC clinical TNM stage 7th T3BN0M0 diagnosed between 2010 and 2017 from the National Cancer Database were analyzed. Cox and logistic regression analyses identified factors associated with overall survival and receipt of surgical resection. Results: Of 11,259 patients with T3BN0M0 HCC, 325 (2.9%) and 4,268 (37.9%) received surgical resection and systemic therapy, respectively. In multivariable analysis, surgical resection was associated with improved survival compared to systemic therapy (adjusted hazard ratio: 0.496, 95% confidence interval: 0.426–0.578) with a median survival of 21.4 and 8.1 months, respectively. Superiority of surgical resection was observed in noncirrhotic and cirrhotic subgroups and propensity score matching and inverse probability of treatment weighting adjusted analysis. Asians were more likely to receive surgical resection, whereas Charlson comorbidity ≥3, elevated alpha-fetoprotein, smaller tumor size, care in a community cancer program, and the South or West region were associated with a lower likelihood of surgical resection. Conclusion: HCC patients with vascular invasion may benefit from surgical resection compared to systemic therapies. Demographic and clinical features of HCC patients and region and type of treating facility were associated with surgical resection versus systemic treatment.

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Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate stage hepatocellular carcinoma: A propensity score matching analysis

10.21203/rs.2.22284/v1 ◽

2020 ◽

Author(s):

Chih-Wen Lin ◽

Yaw-Sen Chen ◽

Gin-Ho Lo ◽

Yao-Chun Hsu ◽

Chia-Chang Hsu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Radiofrequency Ablation ◽

Propensity Score ◽

Propensity Score Matching ◽

Surgical Resection ◽

Cox Regression ◽

Cox Regression Analysis ◽

Tace Group ◽

The Impact

Abstract Background: Patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are recommended to undergo transcatheter arterial chemoembolization (TACE). However, TACE in combination with radiofrequency ablation (RFA) is not inferior to surgical resection (SR), and the benefits of surgical resection (SR) for BCLC stage B HCC remain unclear. Hence, this study aims to compare the impact of SR, TACE+RFA, and TACE on analyzing overall survival (OS) in BCLC stage B HCC.Methods: Overall, 428 HCC patients were included in BCLC stage B, and their clinical data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Results: One hundred forty (32.7%) patients received SR, 231 (53.9%) received TACE+RFA, and 57 (13.3%) received TACE. The OS was significantly higher in the SR group than that in the TACE+RFA group [hazard ratio (HR): 1.78; 95% confidence incidence (CI): 1.15-2.75, p=0.009]. The OS was significantly higher in the SR group than that in the TACE group (HR: 3.17; 95% CI: 2.31-4.36, p<0.0001). Moreover, the OS was significantly higher in the TACE+RFA group than that in the TACE group (HR: 1.82; 95% CI: 1.21-2.74, p=0.004). The cumulative OS rates at 1, 3 and 5 years in the SR, TACE+RFA, and TACE groups were 89.2%, 69.4% and 61.2%, 86.0%, 57.9% and 38.2%, and 69.5%, 37.0% and 15.2%, respectively. After propensity score matching, the SR group still had a higher OS than those of the TACE+RFA and TACE groups. The TACE+RFA group had a higher OS than that of the TACE group. Conclusion: The SR group had higher OS than the TACE+RFA and TACE groups in BCLC stage B HCC. Furthermore, the TACE+RFA group had higher OS than the TACE group.

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Racial and socioeconomic disparities in the treatment of resectable hepatocellular carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19026 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19026-e19026

Author(s):

Young soo Rho ◽

Ian Pagano ◽

Jared David Acoba

Keyword(s):

Hepatocellular Carcinoma ◽

Survival Data ◽

Proportional Hazards ◽

Private Insurance ◽

Cox Proportional Hazards ◽

Socioeconomic Disparities ◽

Clinical Predictors ◽

Case Volume ◽

The Us ◽

The Impact

e19026 Background: Cancer surgeries performed at high case volume centers (hCVCs) are associated with improved surgical and clinical outcomes. Resectable hepatocellular carcinoma (rHCC) is not common in the US and the impact of surgery at hCVCs has not been well assessed. We analyzed the impact of surgery at hCVCs on survival, and the potential racial and socioeconomic disparities associated with obtaining care at hCVCs. Methods: We collected demographic, diagnostic, treatment, and survival data of 96,215 patients with stage I-III HCC diagnosed between 2004 – 2015 from the National Cancer Database. To estimate the average surgical volume/year, number of reported cases were divided by the number of years the facility was represented in the database. Logistic regression was used to determine the associations between case volume, facility type and the demographic and clinical variables. We assessed demographic and clinical predictors of overall survival (OS) using Cox proportional hazards regression. Results: In total, 10,419 resected HCC patients were included in the analysis. The median age was 64 (18 – 90), 68.4% were male and 69.5% were white. Facilities were divided into quartiles by average number of surgical CV/year: 1st quartile (1Q) 0.08-1.60, 2Q 1.61 – 3.91, 3Q 3.92 – 8.34, and 4Q 8.35 – 45.34. In a multivariate model, improved OS was seen with each increase in quartiles with the highest CVCs (i.e 4Q) HR 0.70 (95% CI 0.63 – 0.77). Treatment at academic centers did not show an OS advantage (HR 0.93; 95% CI 0.86 – 1.01). Factors including black race (OR 0.83; 95% CI 0.75-0.93), age 65+ (OR 0.91; 95% CI 0.82 – 1.00), and living in a metro area with a population of 250,000 – 1 million people (OR 0.68; 95% CI 0.62 – 0.74) were less likely to be associated with treatment at hCVCs. Conversely, Asians/Pacific Islanders (OR 2.28; 95% CI 2.04 – 2.55) and those with private insurance (OR 1.33; 95% CI 1.18– 1.40) or Medicare (OR 1.21; 95% CI 1.05 – 1.38) were more likely to be treated at hCVCs. Conclusions: rHCC is not common in the US and having surgery at hCVCs improves OS. However, racial and socioeconomic disparities exist in receiving care at these hCVCs.

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Impact of geography and travel distance on outcomes in epithelial ovarian cancer: a national cancer database analysis

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001807 ◽

2020 ◽

pp. ijgc-2020-001807

Author(s):

Ava Daruvala ◽

F Lee Lucas ◽

Jesse Sammon ◽

Christopher Darus ◽

Leslie Bradford

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Healthcare Delivery ◽

High Volume ◽

Cox Proportional Hazards ◽

Travel Distance ◽

Cancer Center ◽

National Cancer Database ◽

Significant Difference ◽

The Impact

BackgroundAs ovarian cancer treatment shifts to provide more complex aspects of care at high-volume centers, almost a quarter of patients, many of whom reside in rural counties, will not have access to those centers or receive guideline-based care.ObjectiveTo explore the association between proximity of residential zip code to a high-volume cancer center with mortality and survival for patients with ovarian cancer.MethodsThe National Cancer Database was queried for cases of newly diagnosed ovarian cancer between January 2004 and December 2015. Our predictor of interest was distance traveled for treatment. Our primary outcomes were 30-day mortality, 90-day mortality, and overall survival. The effect of treatment on survival was analyzed with the Kaplan-Meier method. Multiple logistic regression for binary outcomes and Cox proportional hazards regression for overall survival were used to assess the effect of distance on outcome, controlling for potential confounding variables.ResultsA total of 115 540 patients were included. There was no statistically significant difference in 30- or 90-day mortality among any of the travel distance categories. A statistically significant decrease in 30-day re-admission was found among patients who lived further away from the treating facility. A total of 105 529 patients were available for survival analysis, and survival curves significantly differed between distance strata (p<0.0001). The adjusted regression models demonstrated increased long-term mortality in patients who lived farther away from the treating facility after controlling for potential confounding.ConclusionAlthough 30- and 90-day mortality do not differ by travel distance, worse survival is observed among women living >50 miles from a high-volume treatment facility. With a national policy shift toward centralization of complex care, a better understanding of the impact of distance on survival in patients with ovarian cancer is crucial. Our findings inform the practice of healthcare delivery, especially in rural settings.

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Impact of Early Lenvatinib Administration on Survival in Patients with Intermediate-Stage Hepatocellular Carcinoma: A Multicenter, Inverse Probability Weighting Analysis

Oncology ◽

10.1159/000515896 ◽

2021 ◽

pp. 1-10

Author(s):

Toshifumi Tada ◽

Takashi Kumada ◽

Atsushi Hiraoka ◽

Kojiro Michitaka ◽

Masanori Atsukawa ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Proportional Hazards ◽

Survival Rates ◽

Intermediate Stage ◽

Cox Proportional Hazards ◽

Probability Weighting ◽

Cumulative Survival ◽

Inverse Probability ◽

The Impact

Aim/Background: Transarterial chemoembolization (TACE) is recommended for patients with intermediate-stage hepatocellular carcinoma (HCC). In this study, we investigated the impact of early lenvatinib administration in patients with intermediate-stage HCC, especially those with tumors beyond the up-to-7 criteria. Materials/Methods: A total of 208 patients with intermediate-stage HCC whose initial treatment was early lenvatinib administration or TACE were enrolled. Multivariate overall survival analysis was performed in this cohort. In addition, the impact of early lenvatinib administration on survival in patients with HCC beyond the up-to-7 criteria was clarified using inverse probability weighting (IPW) analysis. Results: The overall cumulative survival rates at 6, 12, 18, and 24 months were 94.4, 79.9, 65.8, and 50.1%, respectively. Multivariate analysis with Cox proportional hazards modeling showed that HCC treatment with lenvatinib (hazard ratio [HR], 0.199; 95% confidence interval [CI], 0.077–0.517; p < 0.001), α-fetoprotein ≥100 ng/mL (HR, 1.687), Child-Pugh class B disease (HR, 1.825), and beyond the up-to-7 criteria (HR, 2.016) were independently associated with overall survival. The 6-, 12-, 18-, and 24-month cumulative survival rates were 96.0, 90.4, 65.7, and 65.7%, respectively, in patients treated with lenvatinib, and 94.1, 78.5, 65.3, and 48.4%, respectively, in patients who received TACE (p < 0.001). In addition, univariate analysis with Cox proportional hazards modeling adjusted by IPW showed that lenvatinib therapy was significantly associated with overall survival in patients with HCC beyond the up-to-7 criteria (HR, 0.230; 95% CI, 0.059–0.904; p = 0.035). Conclusions: Lenvatinib may be a suitable first-line treatment for patients with intermediate-stage HCC beyond the up-to-7 criteria.

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The Impact of Radiation Therapy Variables on Pediatric High-Grade Glioma Outcomes: A National Cancer Database Analysis

10.21203/rs.3.rs-435118/v1 ◽

2021 ◽

Author(s):

Christopher Williamson ◽

Shayla Williamson ◽

Renjian Jiang ◽

Lisa Sudmeier ◽

Natia Esiashvili ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Private Insurance ◽

Multivariable Analysis ◽

High Grade Glioma ◽

National Cancer Database ◽

High Grade ◽

Who Grade ◽

The Impact ◽

Pediatric High Grade Glioma

Abstract Purpose Pediatric high-grade glioma (HGG) is a devastating disease with a poor prognosis. The purpose of this analysis is to evaluate the impact of Radiation Therapy (RT) variables on outcomes of pediatric HGG patients in the National Cancer Database (NCDB). Methods The NCDB was used to select patients age < 22 with histologically proven WHO Grade III and IV gliomas treated with ≥ 50Gy and < 76Gy RT between 2004 and 2013. RT variables including RT dose, timing between diagnosis and RT initiation (< 4 weeks, 4–6 weeks, or > 6 weeks), and RT modality were analyzed along with baseline demographic, tumor and treatment variables to assess the impact on overall survival in univariate and multivariable analyses. Results 498 pediatric HGG patients were included. Histologies included glioblastoma (30%), astrocytoma (55%), oligogendroglioma (5%) and gliomas not otherwise specific (10%). The median RT dose was 59.4 Gy (SD 2.9 Gy) starting a median of 4.4 weeks from diagnosis (SD 2.5 weeks). Median follow-up was 19.6 months with 1- and 3-year OS of 78.4% and 40.4%, respectively. On Multivariable analysis, female gender, older age, and private insurance remained independently associated with lower rate of overall death. Radiation initiation ≤ 4 weeks from diagnosis, and glioblastoma histology were significantly associated with higher rate of overall death. There was no relationship between radiation dose or whether radiation was delivered with proton or photon therapy and overall survival. Conclusions Outcomes for pediatric HGG are poor. Early initiation of RT within 4 weeks from diagnosis was negative associated with overall survival and may be related to unknown prognostic factors.

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RADT-34. PREDICTIVE FACTORS FOR OVERALL SURVIVAL IN SURGICAL CASES OF GLIOMATOSIS CEREBRI FROM THE NATIONAL CANCER DATABASE

Neuro-Oncology ◽

10.1093/neuonc/noaa215.787 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii188-ii189

Author(s):

Adham Khalafallah ◽

Srujan Kopparapu ◽

Debraj Mukherjee

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Gliomatosis Cerebri ◽

Cox Proportional Hazards ◽

Treatment Modalities ◽

Prognostic Indicators ◽

Bivariate Analysis ◽

National Cancer Database ◽

Cerebral Tumor ◽

Comorbidity Index

Abstract Gliomatosis Cerebri (GC) is a rare, aggressive, diffusely infiltrating cerebral tumor. Prognostic indicators and management strategies are currently poorly characterized. The National Cancer Database was queried for patients with histologically confirmed GC between 2004 and 2016. Demographic, tumor, and treatment characteristics were collected, including the Charlson/Deyo score, a comorbidity index adapted from the Charleston Comorbidity Index. Allowable values for the Charlson/Deyo score are 0 (no recorded comorbidities), 1, 2, and 3+ (most severe). Factors associated with overall survival were identified via bivariate log-rank tests and multivariate stepwise Cox proportional hazards models. The query returned 108 GC patients. The median age was 60.0 years, males were predominantly affected (63%), and most patients were white (86%). While 12% of cases achieved near/gross total resection and 27% of cases achieved partial resection, most surgeries were for biopsy (61%). Treatments included radiation therapy in 64% and chemotherapy in 63% of patients. The median overall survival was 15.1 (95% confidence interval [CI]=11.1-24.8) months. On bivariate analysis, chemotherapy improved overall survival (p=0.01) while radiation therapy (p=0.07) and extent of resection (p=0.48) did not. On multivariate analysis, older patients (hazard ratio [HR]=1.07, CI=1.03-1.11, p< 0.01) and Charlson/Deyo scores of ≥1 versus 0 (HR=3.47, CI=1.40-8.60, p< 0.01) had significantly increased mortality risk following surgery. In particular, the Charlson/Deyo score is a novel prognostic factor for GC that may guide clinical and surgical decision-making for this rare, rapidly fatal tumor. Further prospective studies are warranted to clarify the effects of chemotherapy versus radiation as treatment modalities for GC.

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