Hormone exposure and its suppressive effect on risk of high-grade gliomas among patients with breast cancer

BackgroundPrior reports demonstrate the expression of estrogen and progesterone receptors in high-grade gliomas (HGGs), but the relationship between hormone receptor-positive disease and risk of HHGs in patients with breast cancer (BC) remains uncharacterized.MethodsUsing the SEER 18 registries (2000–2017), we examined the temporal trend of the incidence of HGGs and BC. The standardized incidence ratio was calculated to assess the risk of subsequent HGG in BC patients.ResultsDuring the study period, the incidence of BC and HGGs remained comparable for men and women. Among 976,134 patients with BC, we found a decreased incidence of HGGs in females, but not in males. Female BC patients with hormone receptor-positive disease were at a lower risk of developing glioblastoma and anaplastic astrocytoma.ConclusionOur study findings allude to the protective role of hormone exposure in the development of HGGs, which may lead to the development of therapies targeting hormonal pathways.     

Pulmonary Carcinosarcoma: A Surveillance,Epidemiology, and End Results (SEER) Analysis

IntroductionPulmonary carcinosarcoma (PC) is a rare malignant neoplasm composed of epithelial and mesenchymal components. It accounts for < 1% of thoracic cancers and is not fully understood. This study examined Surveillance, Epidemiology, and End Results (SEER) data to describe demographic and clinical characteristics of patients with PC and assessed survival outcomes by treatment modality and stage.Patients and MethodsSEER data were reviewed to identify patients diagnosed with primary PC (1973-2012). Overall survival (OS) and disease-specific survival (DSS) were analyzed by univariate/multivariable Cox proportional hazards models and Kaplan-Meier methods.ResultsA total of 411 patients were included. Median age was 67 (range, 24-96) years. Disease stage at the time of initial diagnosis was known for 74.7% of the identified patients (307/411). Of these patients, 23.1% had localized disease. Survival was significantly better for patients with localized disease (OS: 31 vs. 6 months, P < .001; DSS: 54 vs. 8 months, P < .001). Additionally, patients who received surgery alone had significantly improved OS (20 months; P < .001) and DSS (32 months; P < .001) compared to patients who received combined surgery and radiotherapy (OS: 7 months; DSS: 8 months) or radiotherapy alone (OS: 4 months; DSS: 4 months).ConclusionTreatment with surgery alone resulted in superior survival outcomes compared to other treatment modality combinations, regardless of patient age and disease stage. Within the limitations of this study, providers may wish to consider these findings when devising patient treatment plans.     

Defining the Role of Surgery for Primary Gastrointestinal Tract Melanoma

Objective The objective of the study was to determine the outcomes for primary gastrointestinal melanomas (PGIM). Material and methods The Surveillance, Epidemiology, and End Results database (1973–2004) was queried. Results Overall, 659 cases of PGIM were identified. The annual incidence of PGIM was approximately 0.47 cases per million in 2000. Overall median survival time was 17 months. Tumors were identified in the oral–nasopharynx (32.8%), anal canal (31.4%), rectum (22.2%), esophagus (5.9%), stomach (2.7%), small bowel (2.3%), gallbladder (1.4%), and large bowel (0.9%). Univariate analysis demonstrated age, tumor location, stage, surgery, and lymph node status were significant predictors of improved survival. MST has not been reached for tumors located in the large bowel, while tumors located in the stomach demonstrated the shortest median survival (5 months). Improvement in MST was observed for those patients undergoing surgical resection. The presence of lymph node involvement conferred a poorer prognosis. Multivariate analysis of the cohort identified that location, advanced tumor stage, failure to undertake surgical resection, positive lymph node status, and age were all independent predictors of poorer outcome. Conclusion PGIM occurs most often in the oral–nasopharynx and anal canal. Surgical extirpation is the only identifiable treatment modality that significantly improves survival.     

Research on the cutoff tumor size of omitting radiotherapy for BCSS after breast conserving surgery in women aged 65 years or oder with low-risk invasive breast carcinoma: Results based on the SEER database

BackgroundRadiotherapy after breast-conserving surgery (BCS) is not always necessary in older women staged T1N0M0 with low-risk invasive breast cancer, but few studies have concluded the detailed tumor size as a reference for avoiding radiotherapy. The study was conducted to explore and identify the optimal cutoff tumor size.MethodsThe study population was from the Surveillance, Epidemiology, and End Results (SEER) database in 2010–2016. Propensity score matching was used to balance the confounders between groups. Predictors associated with survival were analyzed by Kaplan–Meier, X-tile, Cox proportional hazards model and competing risk model.ResultsA total of 52049 women and 3846 deaths were included in the cohort with a median follow-up of 34 months. Based on the cutoff value determined by X-tile analysis, the study population were divided into small tumor group (≤14 mm in diameter) and large tumor group (>14 mm in diameter). Small tumors and radiotherapy were correlated with better breast cancer-specific survival (BCSS). In subgroup analysis, the absolute benefit of BCSS in 6 years attributed to radiotherapy was only 0.90% (RT vs. non- RT:98.77% vs. 97.87%) for patients with small tumors but up to 3.33% (RT vs. non- RT:97.10% vs. 93.77%) for those with large tumors.ConclusionSmall tumors and adjuvant radiotherapy were associated with improved long-term prognosis, and 14 mm in diameter was the cutoff tumor size of omitting radiotherapy for patients aged 65 or older with T1N0M0 stage, ER+ and HER2-breast carcinoma after BCS.     

基于SEER数据库建立小肝癌患者远处转移预测模型

目的 建立可有效预测小肝癌患者远处转移风险的列线图。方法 从SEER（Surveillance,Epidemiology,and End Results）数据库提取2010年1月至2016年12月诊断的5 595例小肝癌患者的临床病理资料,采用随机数字法按7:3分为训练组（n=3 915）和验证组（n=1 680）。对训练组采用单因素及多因素Logistic回归分析筛选影响远处转移的独立危险因素并构建小肝癌患者远处转移预测模型。采用受试者工作特征（ROC）曲线及校正曲线评估模型的预测准确性,采用决策曲线评价列线图的临床效用。结果 训练组多因素Logistic分析显示婚姻状况（HR 1.541,95%CI 1.182~2.010,P=0.001）、癌结节数目（HR 2.005,95%CI 1.483~2.710,P<0.001）、T分期（HR 2.076,95%CI 1.176~3.664,P=0.012）、N分期（HR 7.753,95%CI 5.349~11.238,P<0.001）、病理分化程度（HR 1.706,95%CI 1.098~2.652,P=0.018）、甲胎蛋白（HR 1.830,95%CI 1.313~2.550,P<0.001）是小肝癌远处转移的独立危险因素。训练组、验证组中ROC曲线下面积（AUC值）分别为0.805（95%CI 0.778~0.832）和0.829（95%CI 0.791~0.868）,校准曲线表明预测值与实际值有良好的一致性,决策曲线显示模型有良好的临床效用。结论 基于SEER数据库建立小肝癌患者远处转移的预测模型具有良好的预测准度,有助于外科医师评估患者远处转移风险,从而为患者提供个体化的诊疗。     

Clinicopathological features and prognostic analysis of metastatic pulmonary sarcomatoid carcinoma: a SEER analysis

BackgroundPulmonary sarcomatoid carcinoma (PSC) is a rare type of non-small cell lung cancer (NSCLC). Metastases are often detected at the first diagnosis. Despite high rates of distant metastasis, there is insufficient data describing the characteristics of PSC metastasis.MethodsWe performed a Surveillance, Epidemiology, and End Results (SEER) database-based analysis of clinicopathological features and prognosis of distant metastasis in PSC patients. Data queried for this analysis included PSC patients in the database between 2010 and 2016.ResultsA total of 934 patients met the criteria for inclusion in the analysis and included, at the time of diagnosis, 512 (54.8%) patients with metastasis, including bone (n=152; 16.3%), brain (n=108; 11.6%), liver (n=70; 7.5%), lung (n=142; 15.2%) metastases. Binary logistic regression showed that patients with giant cell carcinoma [odds ratio (OR) 4.023, 95% confidence interval (CI): 2.113–7.661, P<0.001] and spindle cell carcinoma (OR 3.151, 95% CI: 1.699–5.843, P<0.001) were associated with metastasis. Log-rank test and Kaplan-Meier plots indicated poor prognosis in metastatic patients [the 1-, 3-, and 5-year overall survival (OS) rates were 14.1%, 5.5%, and 4.8%, respectively]. Multivariable analysis showed younger and chemotherapy as improved prognostic factors of PSC patients with single metastasis site.ConclusionsThe SEER database-based analysis revealed the clinical features of distant metastasis of PSC and showed that different histological types posed distinct metastasis potential. Besides, age and chemotherapy were the independent prognostic factors of PSC patients with single metastasis site.     

Incidence and risk factors for suicide death in male patients with genital-system cancer in the United States

BackgroundA diagnosis of cancer is associated with increased risks of suicidal ideation and suicide attempts. Genital-system cancer comprises nearly a third of all cancers in males. We used the SEER database to identify the incidence of and risk factors for suicide death in male patients with genital-system cancer in the United States.MethodPatients were selected from the SEER database, and X-tile software was used to find the best cutoffs for stratifying age. Logistic regression was used to identify independent risk factors for suicide death. Only variables that were statistically significant in the univariate logistic regression models were analyzed in multivariate logistic regression models.ResultThis study found that age (18–66 vs ≥ 76 years: OR = 3.300, P < 0.001; 67–75 vs ≥ 76 years: OR = 1.832, P < 0.001), being unmarried (OR = 1.332, P = 0.010), being divorced, separated, or widowed (OR = 1.338, P = 0.002), caucasian (OR = 2.074, P = 0.003) and not receiving surgery or having an unknown surgery status (OR = 1.405, P < 0.001) significantly increased the risk of suicide death. A particularly important finding was that a time of <1 year after the diagnosis was related to an increased risk of suicide death (<1 vs ≥ 10 years: OR = 1.761, P = 0.008).ConclusionWe found that a number of factors significantly increased the risk of suicide. Importantly, a time of <1 year after the diagnosis was related to an increased risk of suicide death, which indicates the importance of identifying and treating people at risk of suicide as early as possible. These can help clinicians to understand suicidal patients and provide them with appropriate support.