Age-related outcomes in patients with esophageal cancer: A propensity score matched analysis.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 326-326
Author(s):  
Paige Blinn ◽  
Taylor Maramara ◽  
Ravi Shridhar ◽  
Jamie Huston ◽  
Kenneth Lee Meredith
Keyword(s):  
Esophageal Cancer ◽  
Propensity Score ◽  
Adjuvant Therapy ◽  
Statistical Tests ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Younger Patients ◽  
Age Related ◽  
To Receive

326 Background: Esophageal cancer is increasing in incidence worldwide. It is estimated that there will be 17,650 new cases of esophageal cancer diagnosed, with 16,080 dying from the disease in the United States in 2019. There has been an increase in younger patients diagnosed with esophageal cancer. We sought to evaluate the outcomes in younger patients diagnosed with esophageal cancer. Methods: Utilizing the National Cancer Database we identified patients with esophageal cancer. We then stratified by age < 50, 51-60, 61-70, and > 70 years. Baseline univariate comparisons were made for continuous variables using both the Mann-Whitney U and Kruskal Wallis tests as appropriate. Pearson’s Chi-square test was used to compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method. All statistical tests were two-sided and p < 0.05 was significant. Propensity score matched analysis was performed and only exact matches were allowed. Results: We identified 20,324 patients ( < 50, 2157), (51-60, 5387), (61-70, 7853), and ( > 70, 4927). T-stages and N stages were higher in the younger age groups p < 0.001 and p < 0.001 respectively. Median lymph nodes positive were highest in the < 50 group (2.2 vs 1.8 vs 1.6 vs 1.7) p < 0.001. Additionally, tumor size was largest in this age cohort (3.7 vs 3.5 vs 3.5 vs 3.2) p = 0.002. Neoadjuvant therapy was administered in 69.4% of patients in the < 50, 68.5% (51-60), 65.5% (61-70), and 49.5% > 70 patients, p < 0.001. The < 50 age group was however more likely to receive adjuvant therapy (22.9% vs 20.5% vs 16.9% vs 13.4%) p < 0.001. Median and overall survival was 49.8 mo and 45% ( < 50), 45.4mo and 43% (51-60), 45.4mo and 43% (61-70), and 35.8mo and 39% > 70, p < 0.001. After propensity score matching, multivariate analysis found that age < 50, male gender, GEJ tumor location, grade, Charleson Deyo score, T-stage N stage, margin, facility volume, neoadjuvant and adjuvant therapy were predictors of survival. Conclusions: Although younger patients present with larger tumors, higher T-stages, and N stages, they are more likely to receive neoadjuvant and adjuvant therapies. It is these therapies which are most likely contributing to improved survival compared to their older counterparts.

scholarly journals Medical cannabis use in the United States: a retrospective database study

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
V. Kishan Mahabir ◽  
Jamil J. Merchant ◽  
Christopher Smith ◽  
Alisha Garibaldi
Keyword(s):  
United States ◽  
Medical Condition ◽  
Statistical Tests ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Medical Conditions ◽  
Comorbid Conditions ◽  
Medical Cannabis ◽  
Number Of Patients

Abstract Introduction Growing interest in the medicinal properties of cannabis has led to an increase in its use to treat medical conditions, and the establishment of state-specific medical cannabis programs. Despite medical cannabis being legal in 33 states and the District of Colombia, there remains a paucity of data characterizing the patients accessing medical cannabis programs. Methods We retrospectively reviewed a registry with data from 33 medical cannabis evaluation clinics in the United States, owned and operated by CB2 Insights. Data were collected primarily by face-to-face interviews for patients seeking medical cannabis certification between November 18, 2018 and March 18, 2020. Patients were removed from the analysis if they did not have a valid date of birth, were less than 18, or did not have a primary medical condition reported; a total of 61,379 patients were included in the analysis. Data were summarized using descriptive statistics expressed as a mean (standard deviation (SD)) or median (interquartile range (IQR)) as appropriate for continuous variables, and number (percent) for categorical variables. Statistical tests performed across groups included t-tests, chi-squared tests and regression. Results The average age of patients was 45.5, 54.8% were male and the majority were Caucasian (87.5%). Female patients were significantly older than males (47.0 compared to 44.6). Most patients reported cannabis experience prior to seeking medical certification (66.9%). The top three mutually exclusive primary medical conditions reported were unspecified chronic pain (38.8%), anxiety (13.5%) and post-traumatic stress disorder (PTSD) (8.4%). The average number of comorbid conditions reported was 2.7, of which anxiety was the most common (28.3%). Females reported significantly more comorbid conditions than males (3.1 compared to 2.3). Conclusion This retrospective study highlighted the range and number of conditions for which patients in the US seek medical cannabis. Rigorous clinical trials investigating the use of medical cannabis to treat pain conditions, anxiety, insomnia, depression and PTSD would benefit a large number of patients, many of whom use medical cannabis to treat multiple conditions.

Esophageal cancer in young patients: Is aggressive treatment associated with better outcomes?

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 54-54
Author(s):  
Alexander D Glaser ◽  
Miles Cameron ◽  
Khaldoun Almhanna ◽  
Sarah E. Hoffe ◽  
Jacques Fontaine ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Adjuvant Therapy ◽  
Late Stage ◽  
Young Patients ◽  
Stage At Diagnosis ◽  
Aggressive Treatment ◽  
Younger Patients ◽  
Pre Treatment ◽  
To Receive

54 Background: Recent studies suggest that survival in young patients with esophageal cancer (EC) is worse than their older counterpart, secondary theoretically to more aggressive disease and late stage at diagnosis. The aim of this study is to compare stage at diagnosis, patterns of treatment and outcomes of young patients with EC at Moffitt Cancer Center (MCC). Methods: Patients with EC treated surgically between 1996 and 2014 at MCC were recorded at an IRB approved database. We divided the patients into two cohorts, those younger or older than 50 years of age. Demographics, pre-treatment clinical data, therapeutic courses and treatment outcomes were analyzed. We compared clinical variables and defined p < 0.05 as statistically significant. Overall survival was examined using the Kaplan-Meier method. Results: Of the 816 patients treated surgically for EC 86 (10.5%) were < 50 years old. The majority of patients were male 622(85.2%) vs. 67(77.9%) in the younger group (p =.084). Of the 816 patients, 569 had pre-treatment staging information available. Pre-treatment clinical staging for the older and younger cohorts was, Stage0/TIS = 13(2.2%) vs. 1(1.4%); Stage I = 90(15.3%) vs. 6(8.3%); Stage IIA = 119(20.3%) vs. 16(22.2%); Stage IIB = 88(15.0%) vs. 8(11.1%); Stage III = 269(46%) vs. 40(55%); Stage IV = 8(1.4%) vs. 1(1.3%)(p =.44). Younger patients were more likely to receive neoadjuvant therapy (75.6% vs.62.1%)(p =.013), and also neoadjuvant combined with adjuvant therapy, 24(41.4%) compared to 48(12.1%) in the older cohort (p =.001). Pathological complete response (pCR) rate was higher in older patients (43.2% vs 32%)(p =.204); Median survival was higher in younger cohort 64.3 vs. 56.4 months. Neither of these were statically significant (p =.516). Conclusions: This retrospective study with several variables only included surgical patients. In our experience, younger age was not associated with late stage presentation. Younger patients were more likely to be treated with neoadjuvant therapy, and despite similar pathologic response rates they were more likely to receive adjuvant therapy. Although younger patients received more aggressive treatment, their overall survival did not differ from their older counterparts.

scholarly journals Testing telediagnostic obstetric ultrasound in Peru: a new horizon in expanding access to prenatal ultrasound

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marika Toscano ◽  
Thomas J. Marini ◽  
Kathryn Drennan ◽  
Timothy M. Baran ◽  
Jonah Kan ◽  
...  
Keyword(s):  
Excellent Agreement ◽  
Rural Areas ◽  
Intraclass Correlation ◽  
Standard Of Care ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Second Trimester ◽  
Obstetric Ultrasound ◽  
Biometric Measurements

Abstract Background Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist. Methods This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen’s Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables. Results Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81–0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound. Conclusion This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up.

Abstract 239: 911 Caller Description of Seizure-Like Symptoms and Delays to Starting Telecommunicator CPR

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Kara Kronemeyer ◽  
Kameron Shee ◽  
Vatsal Chikani ◽  
Normandy Villa ◽  
Lesley Osborn ◽  
...  
Keyword(s):  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Process Measures ◽  
Younger Patients ◽  
Improve Accuracy ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Data Points ◽  
Chi Square Analysis ◽  
Hospital Cardiac Arrest

Background: Bystander cardiopulmonary resuscitation (BCPR) improves survival after out-of-hospital cardiac arrest (OHCA). Identifying delays to starting Telecommunicator CPR (TCPR) may improve outcomes. Identifying terms callers use to describe seizure-like symptoms may improve accuracy and expedite TCPR. Methods: A total of 586 confirmed OHCA calls from 3 regional 911 centers in Arizona were reviewed between 2013 to 2016. Frequency of terms callers use to describe seizure-like symptoms were assessed. Demographics and TCPR process measures were compared between the seizure and non-seizure cohorts using Chi-square analysis for categorical variables and Kruskal-Wallis test for continuous variables. Other data points were time to start of seizure description, time to end of description, and time to start of seizure intervention. Results: There were 545 calls after exclusions. Twenty-six (.05%) had seizure-like symptoms described. Of these, “seizure” or “seizing” were used in 22 (84.6%) calls, “shaking” in 6 (23.1%), “cramping up” in 2 (7.7%) and convulsing in 2 (7.7%). Descriptions were more common in witnessed arrests [65.4% (17/26) vs. 34.6% (9/26); p=0.045] and in younger patients [median age=57 (QI=45, Q3=68) vs. 66 (Q1=51, Q3=77); p=0.036.] In calls with descriptions, telecommunicators were less likely to recognize OHCA [56.0% (14/25) vs. 74.5% (382/513), .031% (17/545) missing; (p=0.041] but bystanders were not less likely to start compressions [42.3% (11/26) vs. 57.6% (289/501), .033% (18/545) missing; p=0.122]. Median time to recognition in calls with descriptions was delayed vs. calls without descriptions [142 s (Q1=74 s, Q3=194 s), n=13, vs. 63 s (Q1=40 s, Q3=112 s), n=336; p=0.005], as was time to first chest compression [262 s (Q1=182 s, Q3=291 s), n=6 vs. 154 s (Q1=110 s, Q3=206 s), n=155; p=0.011]. Median times to start of description, end of description, and start of intervention were respectively: 33 s (Q1=20 s, Q3=40 s; 54 s (Q1=37 s, Q3=138 s; and 50 s (Q1=38 s, Q3=162 s). Conclusion: Description of seizure-like symptoms were uncommon and were associated with reduced and delayed OHCA recognition and delayed start of compressions.

Pharmacotherapy of Chronic Heart Failure in the Elderly: A Review of the Evidence

2010 ◽  
Vol 2 ◽  
pp. CMT.S2794
Author(s):  
Toni L. Ripley ◽  
Thomas A. Hennebry
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Older Patients ◽  
The Elderly ◽  
The United States ◽  
Response To Therapy ◽  
Clinical Endpoints ◽  
Age Related ◽  
Prevalent Disease ◽  
To Receive

Heart failure (HF) is a very prevalent disease in the United States and in Europe, with the highest prevalence among older patients. Population estimates suggest substantial growth among the elderly over the next four decades. However, older patients are underrepresented in clinical trials evaluating HF therapies and are less likely to receive the medications shown in these trials to reduce the morbidity and mortality associated with HF. Age-related differences exist in cardiovascular function that may affect disease progression, clinical presentation, and/or response to therapy. Further, medication use in older patients is complicated by physiologic changes in pharmacokinetics and the presence of multiple co-morbidities, which leads to polypharmacy and the related complications. We reviewed the pharmacotherapy clinical trials in HF to review the results specifically in older patients. Trials were included in this review if clinical endpoints were evaluated, if data regarding the participants’ age was reported, and if the intervention studied was in a medication class that is generally recommended for patients with HF by published guidelines. Although some non-randomized data shows benefits of standard therapies may be maintained among patients with HF ≥ 60 years old, the randomized controlled trials that have been published to date showed no benefit and no harm in this group. Cautious HF management among older patients is critical as additional evidence is pursued.

scholarly journals A multidisciplinary pulmonary embolism response team (PERT)—experience from a national multicenter consortium

2019 ◽  
Vol 9 (3) ◽  
pp. 204589401882456 ◽  
Author(s):  
Jacob Schultz ◽  
Nicholas Giordano ◽  
Hui Zheng ◽  
Blair A. Parry ◽  
Geoffrey D. Barnes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Patient Characteristics ◽  
Risk Groups ◽  
The United States ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Exact Test ◽  
Advanced Therapy ◽  
Chi Squared

Background We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. Methods We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. Results There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions ( P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions ( P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. Conclusions The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability.

The association of PET response with complete pathological response (CPR) and residual nodal disease (RND) after induction chemoradiotherapy (CRT) and resection of esophageal cancer: A review of 493 cases

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4552-4552
Author(s):  
S. A. Barnett ◽  
N. P. Rizk ◽  
P. S. Adusumilli ◽  
B. J. Park ◽  
M. S. Bains ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prolonged Survival ◽  
Categorical Variables ◽  
R0 Resection ◽  
Continuous Variables ◽  
Nodal Disease ◽  
Poor Survival ◽  
Chi Square ◽  
Kaplan Meier ◽  
Adeno Carcinoma

4552 Background: RND and lack of CPR of the primary tumor correlate with poor survival after induction CRT and resection of esophageal cancer. PET response to CRT (SUVmax change and post-induction SUVmax) is used by some clinicians as an indicator of CPR and RND in order to stratify patients after CRT to observation alone vs completion resection. We aimed to investigate the association of PET response with CPR and RND after induction CRT and resection of esophageal cancer. Methods: An IRB-approved retrospective review of an institutional surgical database identified patients who underwent resection of esophageal squamous cell (SCC) and adeno carcinoma (AC) following CRT. The database was locked on Sept 30, 2008. Categorical variables were analyzed by chi square, continuous variables by t-test, and survival by the Kaplan-Meier method. Results: From 1/96 to 3/08, 493 patients were identified, 82% were male. Median age was 62, chemotherapy cisplatin-based in 87%, mean radiation 50 Gy, in-hospital mortality 4.1% and R0 resection rate 88%. Pathology revealed AC in 80%, lack of CPR in 73% and RND in 35%. While in AC patients CPR and lack of RND were both associated with prolonged survival, PET response was not associated with either. In SCC patients, prolonged survival was associated with CPR but not with lack of RND. In SCC, PET response was associated with CPR but not RND. In these patients, reduction in SUVmax <50, 50–75 and >75% was associated with CPR rates of 29, 44 and 85% respectively (p=0.02). Conclusions: These results do not support the use of PET response to justify observation alone after CRT in esophageal AC. With respect to SCC, though exploratory, these provocative results support further study of the use of PET response to predict CPR. [Table: see text] No significant financial relationships to disclose.

scholarly journals AGE-RELATED DIFFERENCES IN CO-MORBIDITY NUMBER, FUNDUS ATHEROSCLEROSIS LEVEL AND THE SERUM VALUES OF GSH-PX, HS-CRP AND HDL-C IN ELDERLY CHINESE PATIENTS

2016 ◽  
pp. 1-7
Author(s):  
Q. Ruan ◽  
Z. Yu ◽  
C. Ma ◽  
Z. Bao ◽  
J. Li ◽  
...  
Keyword(s):  
Oldest Old ◽  
Univariate Analysis ◽  
Apoe Genotype ◽  
Chinese Patients ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Old Patients ◽  
Biomarkers Of Aging ◽  
Age Related ◽  
Co Morbidity

Background: The ApoE genotype, atherosclerosis, status of inflammation, oxidative stress and co-morbidity may be detrimental to the elderly. Objectives: To identify biomarkers of aging. Setting: All subjects were Chinese elderly in Shanghai. Subjects: 549 outpatients (489 male, 60 female), divided into ≤74 year-old, 75-84 year-old and the oldest old (≥85 year-old ) groups. Methods: A univariate analysis was used to investigate 5 age-related categorical variables and 26 continuous variables. The related variables were used to find the independent biomarkers of aging by Multivariate logistic regression analyses. Results: The serum values of Glutathione peroxidase, HDL-C and C reactive protein, the number of co-morbidities and fundus atherosclerosis level were the main independent age-associated factors that influenced aging. Compared with ≥85 year-old individuals, ≤74 year-old individuals had fewer co-morbidities [OR, 0.757 (95% CI, 0.636, 0.902)], lower grades of fundus atherosclerosis [Grade 0: OR, 26.059 (95% CI, 4.705, 144.324)] and [Grade I: OR, 8.539 (95% CI, 3.555, 20.513)] and lower serum levels of HDL-C [OR, 0.127 (95% CI, 0.037, 0.433)]. However, 75-84 year-old patients had significantly lower plasma levels of GSH-px [OR, 0.986, (95% CI, 0.972, 1.00)], HDL-C [OR, 0.158 (95% CI, 0.054, 0.457)] and HsCRP [Grade I: OR, 8.516 (95% CI,1.630, 44.484)], [Grade II: OR,7.699 (95% CI,1.544, 38.388)] and [Grade III: OR,7.251 (95% CI,1.346, 39.070)]. Conclusion: The oldest old patients had significantly high anti-oxidant capability and serum HDL-C level. However, these patients also had a significantly high systemic inflammation, number of co-morbidities and grades of fundus atherosclerosis.

PS02.106: THE IMPACT OF HISTOPATHOLOGICAL LYMPH NODE METASTASES AFTER PREOPERATIVE CHEMO-RADIOTHERAPY ON THE PROGNOSIS IN ESOPHAGEAL CANCER PATIENTS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 151-151
Author(s):  
Kentaro Murakami
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Lymph Node Metastases ◽  
Conflicts Of Interest ◽  
Locally Advanced ◽  
The United States ◽  
Node Metastases ◽  
The Impact

Abstract Background Esophageal cancer does not have a good prognosis despite being resectable. A recent randomized controlled trial (the Dutch CROSS study) showed the superiority of preoperative chemo-radiotherapy over surgery alone with regard to the five-year survival. At present, this therapeutic approach is regarded as the standard care in the United States and Europe. However, the prognosis in cases where part of the tumor remains is poor, so additional adjuvant therapy is required. The impact of the histopathological lymph node metastases status after preoperative chemo-radiotherapy on the prognosis is unknown, and is which patients require additional adjuvant therapy to manage lymph node metastases. Methods Esophageal cancer patients with more than five lymph node metastases or lymph node metastases spreading into three fields have a poor prognosis, despite their tumor being resectable. We therefore performed neoadjuvant chemo-radiotherapy in these patients in 1998 (NACRT group). We also performed chemo-radiotherapy for initially unresectable locally advanced esophageal cancer invading adjacent organs and curative surgery for the above-mentioned patients in whom the invasion had disappeared after chemo-radiotherapy (conversion group). The chemo-radiotherapy regimen was the same for both groups and consisted of radiotherapy 40 Gy/20 fr and chemotherapy with 5-FU (500 mg/m2 days 0–4) and CDDP (15 mg/m2 days 1–5). We then examined the impact of the histopathological lymph node metastasis status after preoperative chemo-radiotherapy on the prognosis in our institute. Results Patients with three or more histopathological lymph node metastases had a significantly poorer prognosis than those with fewer metastases in both groups. In the NACRT group, the 5-year survival rate was 35.5% vs. 36.1% (number of lymph node metastases 0 vs. ≥ 1; P = 0.889), 34.0% vs. 36.7% (0–1 vs. ≥ 2; P = 0.678), and 47.1% vs. 0% (0–2 vs. ≥ 3; P = 0.003). In conversion group, it was 40.4% vs. 43.6% (number of lymph node metastases 0 vs. ≥ 1; P = 0.841), 45.6% vs. 33.6% (0–1 vs. ≥ 2; P = 0.106), and 49.5% vs. 20.0% (0–2 vs. ≥ 3; P = 0.025). Conclusion Patients with three or more histopathological lymph node metastases after preoperative chemo-radiotherapy had a significantly poorer prognosis than those with fewer metastases and required additional adjuvant therapy. Disclosure All authors have declared no conflicts of interest.

Clinical, sociodemographic, and pathological characteristics of breast cancer in the United States: A cross-sectional analysis from the National Cancer Database (NCDB).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13623-e13623
Author(s):  
Zeina A. Nahleh ◽  
Nadeem Bilani ◽  
Leah Elson ◽  
Elizabeth Blessing Elimimian ◽  
Emily Craig Zabor
Keyword(s):  
Breast Cancer ◽  
Academic Research ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Integrated Network ◽  
Hormone Receptor Positive ◽  
Kaplan Meier ◽  
Facility Type

e13623 Background: Breast cancer (BC) remains the most commonly-diagnosed malignancy in women. BC encompasses great heterogeneity in patient pathologic and clinical characteristics, as well as treatment approaches and outcome by stage and subtype. This study aims to explore recent differences in characteristics and overall survival (OS) of BC across different facility types. Methods: We conducted a retrospective analysis of patients with BC, diagnosed between 2004-2016, based on the NCDB. Categorical variables were summarized using frequencies/percentages, whereas continuous variables were summarized using the median/interquartile range (IQR). OS was explored using the Kaplan-Meier method. Results: A total of 2,671,549 patients with BC were captured in this dataset. The median age at diagnosis was 61 (range 18-90 years). The majority n = 1,986,450 (75%) were non-Hispanic (NH) white; 286,176 (11%) were NH-black; 124,877 (4.7%) were Hispanic-white; 2,977 (0.1%) were Hispanic-black and 90,484 (6.1%) were Asian. The most common BC subtype was hormone receptor-positive (HR+)/HER2- (58%), followed by HR+/HER2+ (26%), HR-/HER2-negative (10%) and HR-/HER2+ (6.4%). 73% of cases were ductal; 15% lobular; the remaining histological subtypes included 0.9% epithelial-myoepithelial, 0.1% fibroepithelial, 0.4% metaplastic, < 0.1% mesenchymal, 1.6% rare breast carcinomas and 7% other carcinomas. The majority of patients received therapy at comprehensive community cancer programs (CPs) (45%), followed by academic/research CPs (30%), integrated network CPs (15%) and community CPs (9.5%). OS was best at academic (72% 10-year OS), followed by integrated network (69% 10-year OS), comprehensive community (68% 10-year OS) and community (63% 10-year OS) CPs. Significant differences in OS according to facility type remained when stratified by stage of disease (all p < 0.0001). OS was also significantly better for white (69% 10-year OS) versus black (63% 10-year OS) patients. Conclusions: This large database from the NCDB provides a comprehensive, recent overview of BC over the last 12 years. Facility type appears to be significantly associated with OS, such that academically designated centers have superior OS across all stages.

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