Search Results (217)

Background and Objectives: Colorectal cancer is a significant global health burden, with lung metastasis contributing substantially to mortality. Accurate risk stratification of synchronous lung metastasis (sLM) in patients with T1 colorectal cancer is important for informing staging decisions, yet no validated tool exists to guide selective chest computed tomography (CT) in this population. This study aimed to develop and validate two complementary nomograms: a clinicopathologic model (Model A) for pre-imaging risk stratification to guide chest CT decisions, and a post-staging model (Model B) incorporating concurrent organ metastasis status for comprehensive risk profiling. Materials and Methods: We utilized data from the Surveillance, Epidemiology, and End Results database, including patients diagnosed with T1 colorectal cancer between 2010 and 2020. Logistic regression analyses identified significant predictors of synchronous lung metastasis. A nomogram was constructed based on these predictors and validated using a split-sample approach. Results: The study included 41,728 patients with T1 colorectal cancer. Significant predictors of synchronous lung metastasis included tumor grade, size, location, lymph node involvement, and concurrent metastases in other organs. Two models were developed: Model A (clinicopathologic-only) demonstrated moderate discriminatory ability (AUC = 0.728, 95% CI: 0.710–0.746), while Model B (including concurrent organ metastasis status) demonstrated good discrimination (AUC = 0.856, 95% CI: 0.843–0.869): Model A validation AUC = 0.716; Model B validation AUC = 0.849. Calibration plots showed good agreement between predicted and observed probabilities of synchronous lung metastasis. Conclusions: This study developed and internally validated two nomograms for predicting sLM in patients with T1 CRC. Model A, using readily available clinicopathological factors, may support selective chest CT decisions during initial staging. Model B, incorporating post-staging information, may assist in prognostic counseling. External validation is required before clinical implementation. Full article

Background: Adjuvant radiation therapy for breast cancer improves survival but may expose thoracic organs to low-dose radiation, increasing the risk of second primary lung cancer (SPLC). Racial and ethnic disparities and social factors influencing SPLC risk remain underexplored. Objectives: We quantified racial and ethnic differences in SPLC incidence and survival among radiotherapy-treated breast cancer survivors and assessed the potential protective role of marital status. Methods: Using SEER-17 (2000–2022), we identified patients with first primary breast cancer receiving radiotherapy, excluding those who died within two months. Standardized incidence ratios (SIRs) assessed observed versus expected SPLC cases by race and ethnicity and marital status, and five-year overall survival (OS) after SPLC and mean age at death were calculated. Racial categories included White, Black, Asian or Pacific Islander (API), and American Indian or Alaska Native (AI/AN); ethnicity was categorized as Hispanic or non-Hispanic. Results: Among 558,493 patients, 6674 developed SPLC (1.19%). Risk varied significantly by race (p < 0.05). AI/AN patients had the highest overall risk (SIR 1.82), particularly 12–59 months and ≥120 months post-treatment. Black (SIR 1.21) and API (SIR 1.23) survivors had sustained elevated risk, while White survivors showed no overall increase (SIR 0.96) and Hispanic survivors had lower risk (SIR 0.72). Married individuals had 12% lower SPLC incidence (SIR 0.88). Five-year overall survival after SPLC was 28.0%, with significant variation by race and ethnicity (p = 0.002). API (32.2%) and AI/AN (32.5%) patients had the highest survival, followed by White (28.0%) and Black patients (25.6%). Married patients had higher five-year survival (31.8% vs. 25.0%) and older mean age at death (64.3 vs. 48.6 years) compared to unmarried patients. Conclusions: SPLC risk and prognosis after breast radiotherapy differ by race, ethnicity, and marital status. These findings highlight the importance of context-aware survivorship counseling and support the consideration of personalized lung cancer screening for breast cancer survivors. Full article

Objective: This study aimed to assess the impact of the number of metastatic lymph nodes (LNs) on survival and propose a subdivision of the N2b category in colorectal cancer (CRC) patients. Methods: We retrospectively analyzed from two sources: clinicopathologic data of CRC patients with stage pTxN2bM0 who initially underwent radical surgery at Cancer Hospital, Chinese Academy of Medical Sciences/National Cancer center (NCC), and patients with stage pTxN0-2bM0-1 in the Surveillance, Epidemiology and End Results (SEER) database from January 2010 to December 2015. The optimal cutoff value of the number of positive lymph nodes (PLNs) was determined based on the principle of maximum chi-square value. We constructed survival curves using the Kaplan–Meier method, assessed survival differences with the log-rank test, and conducted univariate and multivariate analyses using the Cox proportional hazard regression model. Results: A total of 68,335 CRC patients were included: 240 from the NCC cohort, and 68,095 from the SEER cohort. Within the SEER cohort, 65,189 patients had M0 stage disease and 2,906 had M1 stage disease. The optimal PLN cutoff value determined by X-tile software (Version 3.6.1) was 13. According to PLN, stage N2b patients were divided into two groups: stage N2b# (7 ≤ PLN < 13) and stage N3 (PLN ≥ 13). In the NCC cohort, the 5-year overall survival (OS) rates of stage N2b# and N3 patients were 66.0% and 45.7%, respectively (p < 0.001). In the SEER cohort, the 5-year cancer-specific survival (CSS) rate was 57.1% for stage N2b# patients compared with 40.2% for stage N3 patients (p < 0.001). The results of multivariate Cox analysis demonstrated that modified stage pN was the independent prognosis factor of OS in the NCC cohort (HR = 1.869, 95%CI:1.253–2.787, p = 0.002); modified stage pN was also the independent prognosis indicator of CSS in the SEER cohort (N3:N0, HR = 8.170, 95%CI: 7.298–9.146, p < 0.001). There was no survival difference between TxN3M0 and TxN0-2b#M0 (5-year CSS rate: 40.2% vs. 30.1%, p = 0.050; 5-year OS rate: 35.3% vs. 27.8%, p = 0.358). Conclusions: The N category served as a strong independent prognostic indicator in CRC patients. Furthermore, PLN emerged as an independent prognostic factor specifically in stage N2b CRC patients. These findings suggest that clinicians may utilize PLN for prognostic stratification and tailor adjuvant therapeutic strategies accordingly for patients diagnosed with stage N2b CRC. Full article

Background: Colorectal cancer (CRC) incidence and mortality have declined in the United States over the past two decades, yet disparities persist by age, sex, race/ethnicity, and geography. To characterize population-level survival signals, we examined trends in age-adjusted incidence rates (AAIR), mortality rates (AAMR), and the mortality-to-incidence ratio (AAMIR) from 1999 to 2021, stratified by key subgroups. Methods: This retrospective analysis utilized de-identified data from the CDC WONDER United States Cancer Statistics database, encompassing incident CRC cases (SEER codes 21041–21052) and deaths (ICD-10 codes C18–C20) in adults aged 20 years and older. Age-adjusted rates (per 100,000, 2000 U.S. standard population) and AAMIR were calculated using Stata 17.0. Joinpoint regression identified trends (annual or average annual percent change [APC/AAPC], p < 0.05). Results: Among 3,489,881 cases and 1,225,986 deaths, AAIR decreased from 78.24 (1999) to 50.79 (2021; AAPC: −2.20%, 95% CI: −2.52 to −1.89), AAMR decreased from 29.34 to 17.92 (AAPC: −2.33%, −2.46 to −2.20), and AAMIR from 0.375 to 0.353 (AAPC: −0.08%, −0.47 to 0.30; p = 0.669). Women showed a significant AAMIR decline (AAPC: −0.29%), unlike men (AAPC: 0.07%). Young adults (20–39 years) had rising AAIR (AAPC: 2.42%) and AAMR (0.87%) but improving AAMIR (AAPC: −1.71%). Non-Hispanic Black individuals had the highest AAMIR (0.400 in 2021; AAPC: −0.54%). The Northeast had the most favorable AAMIR trend (AAPC: −0.40%), while the Midwest, South, and West were stable. States like New Jersey and Massachusetts achieved low AAMIR (0.292 and 0.304 in 2021), contrasting with Nebraska and Arizona (0.402 in both). Conclusions: Although colorectal cancer incidence and mortality have declined substantially in the United States from 1999 to 2021, the mortality-to-incidence ratio improved only marginally and remained markedly uneven across subgroups. Targeted interventions—enhancing screening and treatment access for men, racial/ethnic minorities, younger adults, and high-burden regions and states—can promote equitable outcomes. Full article

Background/Objectives: We describe the real-world survival and utilization of lung biopsy in Medicare patients with unresected stage I-IIB (N0) non-small-cell lung cancer (NSCLC) receiving primary stereotactic body radiotherapy (SBRT) in the US. Methods: Patients (aged ≥66 years) with unresected stage I-IIB (N0) NSCLC who received primary SBRT were identified in the SEER-Medicare database (2007–2020) and followed from SBRT initiation until death/data end. Outcomes included overall and disease-stage-specific real-world event-free survival (rwEFS), overall survival (OS), lung cancer-specific cumulative incidence of death, and time to death or distant metastasis (TDDM). rwEFS, OS, and TDDM were described using Kaplan–Meier analysis. Median times from lung biopsy to SBRT were summarized. Results: Of 3014 patients (median follow-up: 2.9 years), 2302 (76.4%), 454 (15.1%), 168 (5.6%), and 90 (3.0%) had stage IA, IB, IIA, and IIB disease, respectively. The mean age at diagnosis was 77.3 years, 37.7% were male, and 86.9% were White. Overall, the 5-year rwEFS rate was 23.8% (median 26.2 months), the 5-year OS rate was 42.3% (median 48.9 months), and the 5-year lung cancer-specific cumulative incidence of death was 25.3%. rwEFS and OS rates declined with more advanced disease stage at diagnosis. Most patients (90.1%) underwent lung biopsy within 12 months before SBRT. Conclusions: Among older US patients with unresected NSCLC receiving SBRT, prognosis remains limited, with many deaths due to non-lung cancer causes. Recurrence and survival were lower among subgroups with more advanced disease. These findings benchmark real-world outcomes for future studies assessing novel strategies in this patient population. Full article

Background: Social determinants of health critically impact outcomes along the care continuum of patients with hepatocellular carcinoma (HCC). This systematic review summarizes the effect of socioeconomic status (SES) factors on HCC outcomes in the United States. Methods: Electronic databases were queried for the concepts of “liver cancer”, “health disparities”, and “socioeconomic factors” on 1 March 2021. Eligible studies included an individual- or area-level SES measure such as income, education, employment, and insurance and one of the following outcomes across the clinical continuum of HCC care: incidence, screening/surveillance, diagnosis, treatment, survival, and end-of-life. Results: Of 3331 studies screened, a total of 63 studies encompassing 179 separate analyses were included in our narrative synthesis: 13 on incidence, 5 on surveillance, 19 on diagnosis, 79 on treatment, 61 on survival, and 2 on end-of-life. Insurance was the most frequent SES measure represented (50%), followed by mostly area-level income (39%), education (9%), and employment (2%). The included studies were heterogeneous regarding both SES definitions (e.g., individual vs. area-level measures) and outcome reporting. Trends of worse outcomes were generally observed with lower indicators across all SES domains and HCC outcomes, particularly in analyses using national cancer registry data (e.g., SEER and NCDB). Unadjusted racial and ethnic disparities in outcome were attenuated in six out of 23 analyses that adjusted for an SES measure. Conclusions: Our findings highlight the need for social risk screening and interventions early in the HCC care pathway. Future research should focus on HCC surveillance and end-of-life/survivorship, with greater emphasis on examination of modifiable individual-level social determinants. Full article

Background/Objectives: Metformin is one of the most frequently used concomitant medications among prostate cancer (PCa) patients. However, the effects of metformin on all-cause and PCa-specific mortality among men diagnosed with advanced/metastatic PCa treated with androgen-deprivation therapy (ADT) remain poorly understood, but they may be specifically explained by emulating a target trial. Methods: We emulated a target trial of metformin therapy and survival using observational data on 7361 patients diagnosed with advanced PCa, who were treated with ADT, from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2008–2019), with completed follow-up until 2020. We included patients with diabetes, and participants were assigned as either “initiator of metformin within 6 months after advanced PCa diagnosis” or “non-initiator of metformin.” We estimated mortality risks using Cox proportional hazards models with adjustment for risk factors via inverse probability weighting using both intention-to-treat and per-protocol analyses. Results: Over 13 years of follow-up, with a maximum 3 years of follow-up after PCa diagnosis, all-cause mortality occurred in 52 metformin initiators (47.7%) versus 3052 non-initiators (42.1%), while PCa-specific mortality occurred in 36 initiators (33.0%) versus 1919 non-initiators (26.5%). In the intention-to-treat analysis, metformin initiation was not associated with all-cause mortality (Hazard Ratio [HR] = 1.38, 95% CI: 0.98–1.95) or PCa-specific mortality (HR = 0.99, 95% CI: 0.63–1.55). Similarly, in per-protocol analysis, there was no evidence of risk reduction with all-cause (HR = 1.20, 95% CI = 0.80–1.81) or PCa-specific mortality (HR = 1.45, 95% CI = 0.88–2.38) after adjusting for time-varying covariates and allowing a 30-day gap for metformin discontinuation, adjusted for via inverse probability weighting. Conclusions: Our findings align with prior randomized trials showing no survival benefit of metformin in advanced PCa patients receiving ADT. Timing of metformin discontinuation also showed no significant effect. However, the small size of the metformin initiator group precluded subgroup analyses for hormone-sensitive (HSPC) and castrate-resistant prostate cancer (CRPC), limiting our ability to explore potential differential effects. Full article

Background and Objectives: Malignant germ cell tumors (GCTs) are rare but clinically significant neoplasms arising in gonadal and extragonadal sites. Malignant GCTs, divided into seminomatous and non-seminomatous subtypes, show diverse biological behavior. Although molecular studies have advanced understanding of their origins and genetic features, little is known about metastatic patterns due to their rarity and generally favorable outcomes. This study aimed to describe metastatic patterns of malignant GCTs across primary sites and histologic subtypes using population-based database. Materials and Methods: Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) program for patients diagnosed with malignant GCTs between 2010 and 2022. Cases were stratified by primary site (testis, ovary, mediastinum), age group (<8 years vs. ≥8 years), and histologic subtype. Metastatic patterns were assessed using both overall and organotropic metastasis rates, and differences between groups were evaluated descriptively using appropriate statistical tests. Results: A total of 32,015 malignant GCTs were identified, comprising 93.0% testicular, 5.6% ovarian, and 1.4% mediastinal tumors. In patients aged ≥8 years, ovarian tumors tended to show generally lower lymph node and distant metastasis rates. In contrast, mediastinal tumors appeared to have the highest distant metastasis rates. Organotropic analysis suggested distinct subtype- and site-specific differences. For seminoma/dysgerminoma, the organotropic metastasis pattern was generally consistent across different primary sites, whereas the other subtypes showed variable organotropic metastasis rates depending on the primary site. Conclusions: The metastatic patterns of GCTs appear to differ by histologic subtype and primary site. These findings suggest that both subtype and site of origin should be considered when assessing metastatic risk and may provide a framework for improved risk stratification in clinical practice. Full article

Importance: Neuroendocrine tumors (NETs) have traditionally been considered rare (orphan) diseases; however, improvements in diagnostic methods and heightened awareness about NETs may have altered their epidemiologic profile in the U.S. Objective: To evaluate trends in incidence, prevalence, and survival of NETs in the United States from 2000 to 2021 using updated data from the SEER-22 registry. Method: This population-based, retrospective cohort study used the SEER-22 database for incidence, prevalence, and survival analyses. Data included 231,659 patients diagnosed with NETs between 2000 and 2021. Age-adjusted incidence, limited-duration prevalence, 5-year overall survival (OS), and hazard ratios (HRs) for survival by grade, stage, year of diagnosis, race, and primary site were investigated. Results: From 2000 to 2021, NET incidence nearly doubled, from 4.6 to 8.2 per 100,000 persons. The prevalence in 2021 reached 0.064%, with grade 1 tumors showing the steepest increase. Five-year OS was 77.4% overall and highest among localized NETs (82.3%) and grade 1 tumors (80.0%). Multivariable analysis showed improved survival over time (HR for 2015–2021 vs. 2000–2004, 0.92; 95% CI, 0.89–0.95). Black and American Indian/Alaska Native patients had significantly worse outcomes than White patients. Conclusions and Relevance: NETs are no longer orphan diseases based on current U.S. incidence and prevalence trends. With increasing survival and patient numbers, there is an urgent need for expanded multidisciplinary NET care and research efforts focused on survivorship and quality of life. Full article

Background/Objectives: Solitary plasmacytoma of bone (SPB) results from abnormal proliferation of plasma cells and accounts for 2–5% of all plasmacytic malignancies. Radiation therapy is the standard of care in treating SPB due to its efficacy in controlling disease progression and optimizing patient survival. However, prior studies have highlighted disparities in radiation therapy receipt among various cancer types. In this study, we aim to investigate whether similar sociodemographic and clinical disparities exist in the treatment of SPB through use of the Surveillance, Epidemiology, and End Results (SEER) database. Methods: The SEER database was queried for biopsy-confirmed cases of SPB between 2000 and 2021 using the ICD-O-3 histology code 9731/3 and primary site codes C40.0–41.9. Chi-square tests, Fisher’s exact tests, and multivariable logistic regression were completed using SPSS v29.0.2, with significance set to p < 0.05. Results: A total of 4139 patients were identified, of which 75.3% received treatment with radiation therapy. Multivariable analysis revealed that low-income patients making less than $74,999 annually (aOR 0.80, 95% CI 0.67–0.97), as well as those from non-Hispanic Asian/Pacific Islander (aOR 0.49, 95% CI 0.33–0.73) and Hispanic (aOR 0.77, 95% CI 0.60–0.98) racial and ethnic groups, were significantly less likely to receive radiation therapy. Conclusions: These findings reveal notable disparities in radiation therapy utilization for SPB patients based on income and race and ethnicity, emphasizing the need for interventions to address systemic inequities, improve access to care, and ensure that all patients receive high-quality cancer care to optimize long-term outcomes. Full article

Background: The optimal timing of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) remains a subject of debate, particularly in the immunotherapy era. This study compares survival outcomes between deferred CN (dCN) and upfront CN (uCN) in mRCC patients receiving modern immunotherapy regimens in the real-world setting. Methods: We retrospectively analyzed the SEER database for mRCC patients diagnosed between 2016 and 2021 who underwent dCN or uCN. The primary endpoint was overall survival (OS), while the secondary endpoints were disease-specific survival (DSS) and other-cause specific survival (OCSS). Statistical analyses included propensity score matching (PSM), Kaplan–Meier survival curves, Cox proportional hazards modeling, as well as sensitivity, subgroup, and landmark analyses. Results: A total of 1892 mRCC patients were included, with 346 patients (18.3%) undergoing dCN and 1546 patients (81.7%) receiving uCN. Patients in the uCN group were characterized with lower T stage (p < 0.001), while those in the dCN group exhibited a higher incidence of lymph node involvement (p = 0.02) and sarcomatoid dedifferentiation (p = 0.002). Following 1:2 PSM, dCN demonstrated significantly better OS and DSS, but comparable OCSS to uCN. The sensitivity and subgroup analyses suggested that dCN may substantially improve the prognosis of mRCC patients across conditions. The landmark analysis showed that the survival advantage of dCN diminished after two years of follow-up. Conclusions: dCN may be associated with improved survival outcomes compared to uCN in selected mRCC patients receiving immunotherapy, and careful patient selection for dCN or uCN is essential. Full article

Previous studies linked disadvantaged neighborhoods to poor cancer outcomes. The Neighborhood Deprivation Index (NDI) quantifies socioeconomic disadvantage, but its impact on gastroesophageal adenocarcinoma outcomes remains understudied. We conducted a retrospective analysis of 40,589 patients with esophageal or gastric adenocarcinoma from the SEER database (1996–2015), stratifying them by NDI: less disadvantaged (NDI < 60) and highly disadvantaged (NDI ≥ 60). Multivariate regression showed NDI ≥ 60 was independently associated with worse overall survival (OS) (HR 1.027, p = 0.017) and disease-specific survival (DSS) (HR 1.025, p = 0.04). Other predictors of poor OS and DSS included older age (≥60 years old), male sex, single marital status, lack of insurance, advanced stage/grade, and gastric tumor site. In contrast, Hispanic and non-Hispanic Black ethnicity, urban residence, and undergoing surgery were associated with better outcomes. Disadvantaged neighborhoods are linked to poorer survival in upper GI cancers, likely due to socioeconomic barriers. Addressing social determinants of health is crucial to reducing these disparities. Full article

Background. Axillary lymph node biopsy (ALND) has traditionally been considered the gold standard for axillary staging and treatment in clinically node-positive breast cancer patients. However, in patients with nodal disease, the therapeutic benefit of ALND is uncertain. This study, based on a large cohort, aims to evaluate breast cancer-specific survival depending on the extent of axillary surgery in non-metastatic breast cancer using real-world data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods. This retrospective cohort study comprised 825,240 patients diagnosed with breast cancer between 2000 and 2020. Results. ALND was associated with a worse survival outcome in pN0 and pN1 populations (respectively, hazard ratio [HR] 1.16; 95% confidence interval [CI] 1.12–1.2; p < 0.001 and HR 1.38; 95%CI 1.3–1.46; p < 0.001). In pN2 and pN3 populations, there was ~4.3% relative reduction in the hazard of breast cancer-related death for each additional node removed; and higher positive-to-removed lymph node ratio was associated with worse prognosis (HR 3.450; 95%CI 2.99–3.98; p < 0.001). Conclusions. SLNB is associated with significantly better specific survival compared to ALND in negative/low axillary involvement, in higher axillary involvement categories extensive axillary surgery was associated with better prognosis. Full article

Immune checkpoint inhibitors (ICIs) display efficacy in non-small cell lung cancers (NSCLCs) with brain metastases (BMs) and studies suggest potential synergy with cranial radiation (CR). However, population-based evaluations of optimal time between ICI-CR combinations are limited in the US. Using SEER-Medicare database (2010–2019), we analyzed patients aged ≥65 years with NSCLC and BM receiving ICI-CR within 6 months of diagnosis, excluding those receiving targeted therapies. First treatment after diagnosis (ICI or CR) was defined as index treatment; followed by subsequent treatment. Findings were validated using an independent cohort from the TriNetX LIVE™ Platform. Patients were grouped by interval between the end of the index treatment and the start of the subsequent treatment: ≤15 days (n = 117), 16–30 days (n = 42), and >30 days (n = 77). Overall survival (OS) was measured from the start of the subsequent treatment until death, end of insurance coverage, or study end. Kaplan–Meier survival curves and multivariable Cox proportional hazards models estimated differences between groups. Among 236 patients, median OS was 134 days, 92 days, and 209 days, respectively. No significant OS differences were found across intervals. However, a survival benefit emerged approximately 300 days after follow-up when ICI was administered within 15 days of CR. These findings offer insight into treatment sequencing in NSCLC with BM and support further investigation in larger cohorts. Full article

Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy with very poor survival. Prior research suggests rural–urban disparities on a regional scale. We aimed to elucidate these disparities in treatment and disease-specific survival (DSS) for ICC patients on a national scale using the SEER database. Methods: The SEER database was queried to identify biopsy-confirmed cases of ICC from 2000 to 2021. Differences in clinicopathologic features and treatment between rural and urban patients were assessed using Chi-square and Fischer’s exact tests. Disease-specific survival was compared using Kaplan–Meier and log-rank tests as well as multivariable Cox regressions. Results: A total of 14,940 ICC patients were identified. Rural patients were less likely than urban patients to receive chemotherapy (789 of 1588 [49.7%] vs. 7112 of 13,352 [53.3%], p = 0.006) and surgical treatment (305 of 1588 [19.2%] vs. 2922 of 13,352 [21.9%], p = 0.013). Rural patients experienced reduced 5- and 10-year DSS rates (7.0% and 4.0%) compared to urban patients (9.0% and 6.0%, p < 0.001). In multivariable analysis, rural residence independently demonstrated a 17% increased risk of disease-specific mortality compared to their urban counterparts (aHR 1.17, 95% CI 1.03–1.32). Conclusions: This study demonstrates significant rural–urban disparities in ICC treatment and survival throughout the US, independent of other prognostic factors. Further investigation into factors driving these disparities is warranted to improve outcomes for rural ICC patients. Full article