A Surveillance, Epidemiology and End Results (SEER) program comparison of adult and pediatric Wilms' tumor

PURPOSE:

To compare the characteristics and outcome of adults and children diagnosed with Wilms' tumor.

METHODS:

The Surveillance, Epidemiology and End Results (SEER) database was analyzed for patients diagnosed with Wilms' tumor between 1973 and 2007. Patients were stratified into pediatric (<16 years) or adult (≥16 years) groups. Overall survival was the primary endpoint.

RESULTS:

A total of 2342 patients (2190 pediatric and 152 adult) with Wilms' tumor were identified. Adult patients were statistically more likely to be staged as localized than pediatric patients (62.5% vs 44.7%), to not receive any lymph node sampling (57.9% vs 16.2%), and to not receive any radiation treatment (74.3% vs 53.9%). Adults had a statistically worse overall survival (OS) than pediatric patients (5‐year OS, 69% vs 88%, P<.001) despite the earlier tumor stage. When stratified by treatment era, the OS of all patients treated after 1981 was statistically higher than those treated before (5‐year OS, 75% vs 89%, P<.001). Significant predictors of OS on univariate analysis for adults included treatment era, SEER stage, surgery, and radiation treatment. Significant predictors of OS on multivariate analysis of all patients included adult status (hazard ratio, 4.14; P<.001), treatment era, SEER stage, and surgery.

CONCLUSION:

Adults in the SEER database had statistically worse OS than pediatric patients despite previous studies showing comparable outcome when treated on protocol. The worse outcome of SEER adults likely stems from incorrect diagnosis, inadequate staging and undertreatment. We recommend lymph node samplings for all adult Wilms' tumor patients and collaboration with pediatric oncologists. Cancer 2012. © 2011 American Cancer Society.     

Adult glioblastoma multiforme survival in the temozolomide era: a population-based analysis of Surveillance, Epidemiology, and End Results registries

BACKGROUND:

Survival after a glioblastoma multiforme (GBM) diagnosis remained static during the several decades before 1999. We hypothesized that the progressive increase in temozolomide use for GBM treatment that began in 1999 in the United States would be paralleled by a corresponding improvement in survival.

METHODS:

We included 19,674 GBM cases, ages 20 years or greater, diagnosed 1993 to 2007 in the population‐based Surveillance, Epidemiology, and End Results Program database. We used proportional hazards models to calculate calendar period hazard ratios (HR) and 95% confidence intervals (CI), adjusted for demographic covariates. We compared survival across periods using the Kaplan‐Meier method.

RESULTS:

Starting with cases diagnosed in 1999 to 2001, we observed a progressive decrease in HRs compared with cases diagnosed in 1993 to 1995. The multivariate‐adjusted HR for 2005 to 2007 versus 1993 to 1995 was 0.69 (95% CI, 0.65‐0.72). Age‐stratified analyses revealed that this progressive decrease occurred in all age groups except 80+ years. Two‐year survival increased from 7% among cases diagnosed in 1993 to 1995 and 1996 to 1998 to 9% among cases diagnosed in 1999 to 2001, 13% in 2002 to 2004, and 17% in 2005 to 2007. The disparity in survival between young and old patients increased in the temozolomide era, with 2‐year survival of 39% among cases diagnosed at ages 20 to 44 years and 1% among cases diagnosed at 80+ years in 2005 to 2007.

CONCLUSIONS:

We observed a modest, but meaningful, population‐based survival improvement for GBM patients in the United States. Widespread adoption of temozolomide represents the most likely explanation, although other treatment advances, such as increased extent of surgical resection, also may have played a role. Cancer 2012;. © 2011 American Cancer Society.     

Response to Neoadjuvant Chemotherapy and Survival in Micropapillary Urothelial Carcinoma: Data From a Tertiary Referral Center and the Surveillance,Epidemiology, and End Results (SEER) Program

BackgroundMicropapillary urothelial carcinoma (MPC) is a rare urothelial carcinoma variant with conflicting data guiding clinical practice. In this study, we explored oncologic outcomes in relation to neoadjuvant chemotherapy (NAC) in a retrospective cohort of patients with MPC, alongside data from Surveillance, Epidemiology, and End Results (SEER)-Medicare.Patients and MethodsWe retrospectively identified patients with MPC or conventional urothelial carcinoma (CUC) without any variant histology undergoing radical cystectomy (RC) in our institution (2003-2018). SEER-Medicare was also queried to identify patients diagnosed with MPC (2004-2015). Clinicopathologic data and treatment modalities were extracted. Overall survival (OS) was estimated with the Kaplan-Meier method. Mann-Whitney-Wilcoxon and chi-square tests were used for comparative analysis and Cox regression for identifying clinical covariates associated with OS.ResultsOur institutional database yielded 46 patients with MPC and 457 with CUC. In SEER-Medicare, 183 patients with MPC were identified, and 63 (34%) underwent RC. In the institutional cohort, patients with MPC had significantly higher incidence of cN+ (17% vs. 8%), pN+ stage (30% vs. 17%), carcinoma-in-situ (43% vs. 25%), and lymphovascular invasion (30% vs. 16%) at RC versus those with CUC (all P < .05). Pathologic complete response (ypT0N0) to NAC was 33% for MPC and 35% for CUC (P = .899). Median OS was lower for institutional MPC versus CUC in univariate analysis (43.6 vs. 105.3 months, P = .006); however, MPC was not independently associated with OS in the multivariate model. Median OS was 25 months in the SEER MPC cohort for patients undergoing RC, while NAC was not associated with improved OS in that group.ConclusionPathologic response to NAC was not significantly different between MPC and CUC, while MPC histology was not an independent predictor of OS. Further studies are needed to better understand biological mechanisms behind its aggressive features as well as the role of NAC in this histology variant.     

Prognostic Factors of Adrenocortical Carcinoma: An Analysis of the Surveillance Epidemiology and End Results (SEER) Database

Objective: To define the prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS) for adrenocortical carcinoma (ACC). Patients and Methods: We used the Surveillance, Epidemiology and End Results (SEER) database (1973-2014) to identify ACC patients. Correlated variables, including age, sex, race, tumor laterality, marital status at diagnosis, treatment of primary site, lymph node dissection, radiation therapy, chemotherapy, tumor size and tumor stage, were extracted. Univariate and multivariate Cox regression were used to define the prognostic factors. Harrell’s concordance index (C index) was calculated to evaluate the discrimination ability for the prognostic predictive models. Results: There were 749 ACC patients identified from the database. The overall median survival time was 22 (95%CI, 18-25) months. In multivariate analysis, age, treatment, chemotherapy and tumor stage were independent risk factors for both overall and cancer-specific survival. Tumor stage had a dominant effect on the cancer prognosis. Additionally, the ENSAT stage had better discrimination than the AJCC stage group in different predictive models. Conclusion: Our study shows that age, treatment of primary site, chemotherapy and tumor stage were prognostic factors for overall and cancer-specific mortality in ACC patients. Among these factors, tumor stage had a dominant effect. The ENSAT stage was more discriminative than the 7th AJCC stage group. Further multi-center prospective validation is still needed to confirm these outcomes.     

Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program

An overview of cancer statistics and trends for selected cancers and all sites combined are given based on data from the Surveillance, Epidemiology, and End Results Program. Median age at diagnosis for all sites combined shows a 2-year increase from 1974 through 1978 to 1999 through 2003. Changes in cancer incidence rates from 1975 through 2003 are summarized by annual percent change for time periods determined by joinpoint regression analysis. After initial stability (1975-1979), incidence rates in women for all cancer sites combined increased from 1979 through 2003, although the rate of increase has recently slowed. For men, initial increases in all cancer sites combined (1975-1992) are followed by decreasing incidence rates (1992-1995) and stable trends from 1995 through 2003. Female thyroid cancer shows continued increasing incidence rates from 1981 through 2003. Blacks have the highest incidence and mortality rates for men and women for all cancer sites combined. Based on 2001 through 2003 data, the likelihood of developing cancer during one's lifetime is approximately one in two for men and one in three for women. Five-year relative survival for all stages combined (1996-2002) ranges from 16% for lung to 100% for prostate cancer patients. Cancer survival varies by stage of disease and race, with lower survival in blacks compared with whites. The risk of developing subsequent multiple primary cancers varies from 1% for an initial liver primary diagnosis to 16% for initial bladder cancer primaries. The impact on the future U.S. cancer burden is estimated based on the growing and aging U.S. population. The number of new cancer patients is expected to more than double from 1.36 million in 2000 to almost 3.0 million in 2050.     

Male Breast Cancer: An Updated Surveillance,Epidemiology, and End Results Data Analysis

Background

Male breast cancer is rare and understudied compared with female breast cancer. A current comparison with female breast cancer could assist in bridging this gap. Although conflicting data have been reported on male and female survival outcomes, data from 1973 through 2005 in the Surveillance, Epidemiology, and End Results (SEER) program have demonstrated that the improvement in breast cancer survival in men has fallen behind that of women. As treatment for breast cancer has improved significantly, an updated analysis using a contemporary population is necessary.

Marital status and stage at diagnosis of cutaneous melanoma: results from the Surveillance Epidemiology and End Results (SEER) program, 1973-2006

BACKGROUND:

We evaluated the effect of marital status on risk of late‐stage cutaneous melanoma diagnosis.

METHODS:

Information about melanoma patients was obtained from Surveillance Epidemiology and End Results (SEER), 1973‐2006. A multivariable logistic regression model was used to estimate relative risks of late‐stage disease at diagnosis.

RESULTS:

After exclusion criteria, 192,014 adult melanoma patients remained for analyses. After adjustment for age, race, year of diagnosis, tumor histology, anatomic site, socioeconomic status, and SEER site, the relationship between estimated risk of late‐stage melanoma diagnosis and marital status was dependent on sex (P < .0001 for interaction). Although unmarried patients had a higher risk of being diagnosed at a late stage among men and women, the magnitude of the effect varied by sex. Moreover, among married, single, and divorced or separated patients, men had more than a 50% increase in risk of late‐stage diagnosis when compared with women. Widowed men and widowed women, however, were not statistically different in their stage at diagnosis.

CONCLUSIONS:

Results from this study are important and may be used by clinicians and public health practitioners interested in increasing the proportion of melanoma patients diagnosed at an early stage through screening, perhaps by specifically targeting unmarried individuals in addition to having broad‐based skin cancer prevention programs. Cancer 2011. © 2010 American Cancer Society.     

Building the infrastructure for nationwide cancer surveillance and control--a comparison between the National Program of Cancer Registries (NPCR) and the Surveillance,Epidemiology, and End Results (SEER) Program (United States)

Objective: In preparation for jointly publishing official government cancer statistics, the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) compared incidence rates from NCI's Surveillance Epidemiology and End Results (SEER) program and CDC's National Program of Cancer Registries (NPCR). Methods: Data for 1999 covering 78% of the US population were obtained from SEER and selected NPCR registries that met high quality data criteria. incidence rates (per 100,000 population) were age-adjusted to the 2000 US standard population, and 95% gamma confidence intervals were estimated Results: NPCR rates for all sites combined were higher than SEER rates (males: NPCR 553.6, SEER 538.7; females: NPCR 420.8, SEER 412.5), but rates for specific cancer sites varied by registry program. Rates for colon cancer (males: NPCR 47.0, SEER 42.7; females: NPCR 36.5, SEER 33.8) and tobacco-related cancers were higher in NPCR than SEER. In contrast, NPCR rates were lower than SEER rates for cancers of the female breaset (NPCR 134.0, SEER 135.9), prostate (NPCR 162.0, SEER 170.2), and melanoma as well as for cancers more common among Asians and Pacific Islanders (e.g., stomach cancer).Conclusions: Rate differences may arise from population difference in socio-demographic characteristics, screening use, health behaviors, exposure to cancer causing agents or registry operations factors.     

Comparison of prognostic factors of esophageal cancer between a Chinese cohort and the Surveillance,Epidemiology, and End Results (SEER) database: a retrospective cohort study

BackgroundEsophageal cancer is a highly aggressive, early metastasis gastrointestinal malignancy, with geographic differences in prognosis. It is unknown whether there are differences in the survival in different regions among esophageal cancer patients who underwent the treatments. This study was to explore the influencing factors of esophageal cancer survival in patients from China and the Surveillance, Epidemiology, and End Results (SEER) database.MethodsThe retrospective cohort study were conducted with 605 Chinese esophageal cancer patients in the Wuxi People’s Hospital and 2,351 patients from the SEER database. The demographic and clinical data were collected from the two cohort, respectively. The outcome was the death during the follow-up. The follow-up ended on November 30, 2021. The Cox proportional hazards model was used in the univariate and multivariate survival analyses, with hazard ratio (HR) and 95% confidence interval (CI).ResultsIn group one, the following were identified as the prognostic factors: female gender (HR =0.568; 95% CI: 0.398–0.811), T3 and T4 stages (HR =3.312; 95% CI: 2.493–4.401), N2 and N3 stages (HR =3.562; 95% CI: 2.631–4.824), and other subtypes of cancer (HR =0.393; 95% CI: 0.223–0.693). The following prognostic were factors identified in group two: age ≥65 years (HR =1.16; 95% CI: 1.058–1.276), female gender (HR =0.843; 95% CI: 0.752–0.945), T3 and T4 stages (HR =1.523; 95% CI: 1.373–1.690), M1 stage (HR =2.554; 95% CI: 2.303–2.832), treatment with surgery and chemotherapy (HR =0.507; 95% CI: 0.457–0.562), and other subtypes of cancer (HR =1.432; 95% CI: 1.298–1.581).ConclusionsThere may be some differences in prognostic factors between Chinese and American patients with esophageal cancer. It is indicated that different management strategies of esophageal cancer should be considered in different populations to improve the prognosis of patients.