Search

1511 Background: In the US, Human Papillomavirus (HPV) vaccination coverage is low, particularly in adolescents aged 13-15 years with respect to the Healthy People 2020 goal of 80%. There has been variability in the definition of measuring vaccination coverage in published studies. We examined complete HPV vaccination coverage in a population of privately insured individuals in the US. Methods: This retrospective study used IBM MarketScan Commercial Database, years 2006 to 2018. Inclusion criteria were ages 9 to 45 years and continuous enrollment from age 9 years or from 2006. Complete HPV vaccination coverage was defined as receipt of 2 doses (age 9-15 years) or 3 doses (age 16-45 years) within 12 months and stratified by year, demographics, and US region. Mean vaccination costs per dose were summarized by vaccine brand and health plan type. Results: The table summarizes complete HPV vaccination coverage by selected age groups for 2006 (n=12,221,938), 2010 (n=4,692,633), 2014 (n=2,808,132), and 2018 (n=1,662,148). From 2017 to 2018, the percentage of members who received HPV vaccine increased; for females ages 13-15 by 1% and 16-17 by 5% while for males ages 13-15 by 6% and 16-17 by 15%. In 2018, by region, the highest coverage was in females aged 18-26 at 53% and males aged 16-17 at 43% in the Northeast, and mean cost for each brand was $120 (-6% from 2017), $165 (-3%) and $220 (+5%) for Cervarix (n=151), Gardasil (n=8,201) and Gardasil 9 (n=139,356), respectively. The rate of utilization of Gardasil 9 increased from 33% (2015) to 94% (2018) of all vaccines. The lowest mean HPV vaccine cost by health plan type and brand was with Point-of-Service (POS) and Cervarix at $106, and the highest was with POS with Capitation and Gardasil 9 at $243. Conclusions: In a commercially insured US population, complete HPV vaccination coverage was lower than the Healthy People 2020 goal, but increased over time. Coverage varied according to health plan type and by region. In 2018, Gardasil 9 had the highest mean cost but was the most utilized vaccine, which may be related to broader coverage of HPV types. This study was limited by the transient nature of member enrollment and complexity of measuring complete vaccination coverage. These results should inform policy makers and practicing clinicians about the gap in vaccination coverage. [Table: see text]

e16559 Background: Gastric adenosquamous carcinoma (ASC) is an extremely rare form of stomach malignancy. To date, the limited knowledge of its biology and outcomes stems from mostly small, single institution experiences. We analyzed the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2016 to explore the treatment of ASC together with its prognostic factors to gain relatively large and consolidated insights. Methods: Propensity score matching (PSM) and Kaplan–Meier analyses were used to compare the prognosis between gastric ASC and typical gastric adenocarcinoma (AC). We assessed overall survival (OS) after patient stratification according to summary stage and treatment choice. Cox hazards regression analysis was performed to determine independent predictors of overall survival (OS). Results: A total of 171 gastric ASC were included (mean 65.20 ± 11.71 years-of-age). Patients with gastric ASC had similar OS to matched individuals with typical gastric AC (p = 0.915). In terms of treatment, 45.6% of gastric ASC patients underwent surgery, and 37.4% received radiotherapy (RT), and 64.3% received chemotherapy. Patients who underwent surgery had longer OS than those who did not receive surgery (p < 0.001), patients who received radiation therapy had longer OS than those who did not receive RT (p < 0.001), and patients who received chemotherapy had longer OS than those who did not receive chemotherapy (p < 0.001). A multivariate Cox analysis for OS showed that distant stage (HR, 3.334, 95% CI 1.544-7.199; p < 0.01) was independent prognostic factors for gastric ASC. Conclusions: Analysis of its outcomes indicates that gastric ASC is not a more malignant tumor as previously suspected. Gastric ASC shows a similar prognosis to typical gastric AC. Surgery, RT, and chemotherapy was associated with prolonged OS. Distant stage was associated with poor OS.

756 Background: We sought to assess the impact of LND in non metastatic pT2-3 patients utilizing a large population-based dataset. Methods: The National Cancer Database was queried for patients with cN0pT2-3 RCC that underwent radical nephrectomy (RN) +/- LND from 2004-2015. Descriptive analyses and Multivariable cox regression (MVA) were performed to elucidate factors associated with all-cause mortality (ACM) on a per stage basis (pT2 and pT3 RCC). Kaplan-Meier analyses (KMA) were used to determine the impact of LND on ACM. Results: 43,143 patients were analyzed, 9,491 (22.0%) underwent LND, 6.7% were positive (pN+). MVA demonstrated increasing age (HR 1.04, p10cm tumor (HR 1.67 p10cm. LND in patients with cN0pT2-T3 disease may identify higher risk cohorts.

66 Background: Many studies aiming to improve supportive care of patients with cancer have been single or bundled large population intervention(s). Potential use of unified clinical data architectures has not been realized in oncology, despite large patient-specific data sources generated during routine clinical care (electronic health records). Such systems can systematically apply clinical algorithms and data analytics to identify care gaps in individual patients with specific needs. Methods: Utilizing a design-think paradigm, we developed the LCRC, a near real-time interactive dashboard identifying actionable care gaps in all patients with lung cancer currently followed at Geisinger. Using an iterative process, data analysts served an expanded role in clinical delivery of targeted supportive oncology care, including recommending measures of risk for admission. Results: The table shows aggregate data as of 6/30/2019. Using the LCRC, we were able to identify 174 open care gaps in a population of 1199 active patients. We were also able to identify ‘high-risk’ clinical features in individual patients and the entire patient population. This was completed with analytics alone, without the need for lengthy chart review. Conclusions: By utilizing a population health view, the health system can more accurately estimate resources needed to better address patient needs. The LCRC can be used to directly determine the choice of supportive care interventions for specific patients with lung cancer. [Table: see text]

184 Background: Population level data regarding incidence of immune-related adverse events (irAE) is lacking. This study evaluated the frequency of irAEs among a large population of patients with non-small cell lung cancer (NSCLC) who received immune checkpoint inhibitors. Methods: Administrative claims data from a large U.S. commercial insurance database (OptumLabs Data Warehouse) were used to retrospectively identify patients with NSCLC who received PD-1 or PD-L1 inhibitors between January 1, 2015 to December 31, 2017. The frequencies of irAEs were reported, identified by having a new medical claim with a corresponding ICD-9 or ICD-10 code during the time period in which the patient was on immunotherapy. Results: Of 2,798 patients with NSCLC (median age at PD-(L)1 initiation: 69 years, interquartile range: 60-75, 1558 male [55.7%], 1240 [44.3%] female), 1,998 (71.4%) received nivolumab, 699 (25.0%) received pembrolizumab, and 101 (3.6%) received atezolizumab. Most patients (1463, 52.3%) received a PD-(L)1 inhibitor as second line therapy; the majority of patients (744) received alkylating agents and antimetabolites prior to receiving PD-(L)1 therapy. See Table 1 for frequencies of irAEs. Conclusions: The current study suggests that the frequencies of some irAEs related to immune checkpoint inhibitor therapies may be higher than those which were reported in the initial trials that led to the FDA approvals for immunotherapies. For example, hypophysitis was noted to occur in 0.6% of patients in the KEYNOTE-024 trial, but was identified in 2.4% of patients in this large cohort. Real world data may refine provider and patient expectations for outcomes beyond what is observed in clinical trials. [Table: see text]

24 Background: Large population-based studies on TNBC epidemiology and treatment pattern in the US were generally limited due to lack of routinely data collection on these biomarkers until recent years. This study examined and documented general treatment status and factors associated with the treatments among TNBC patients in the US. Methods: We used the latest released NPCR and SEER combined cancer registry data, which covers 100% of the US population. All women in the US with a primary invasive TNBC breast cancer diagnosed between 2013 and 2015 were included. First course treatment patterns by AJCC staging on TNBC were examined based on corresponding year’s NCCN guideline recommendations. Regression analysis were performed to identify factors associated with treatments. Results: There were 74,952 TNBC women included in the study. Ninety three percent of women with early stage of TNBC had surgery, and 35% women with mastectomy chose to undergo contralateral prophylactic mastectomy. Among stage I-III patients, those aged < 35, Non-Hispanic Asian Pacific Islander, living in other regions than northeast or metropolitan were more likely to have mastectomy compared to BCS. Radiation therapy were only received for 65% women with breast conserving surgery (BCS), which were less likely to be performed in non-Hispanic Black, Hispanic, and among those aged < 35 or > 70+. Chemotherapy were received for 75% of TNBC women, ranged from 63% (stage I) to 86% (stage III). Treatment variations among different demographic and geographic characteristics in chemotherapy were also observed. Conclusions: Overall, current treatment practice for TNBC in the US is generally concordance with the recommended breast cancer care except a relative low radiation therapy among BCS women. However, treatment disparities existed within the limited treatment options, and factors associated with the disparities also varied. More effective treatment options and treatment equality are warranted to improve overall care of this subtype.

There are more than 2 million prostate cancer survivors in the United States. Primary therapy with surgery or radiation results in permanent changes in sexual function. More than half of these men are subsequently treated with androgen deprivation therapy (ADT) at some point. The addition of ADT further compromises sexuality, intimacy, and a couple's relationship. This review will highlight the challenges faced by patients and couples and reveal the tremendous need for better education of physicians, patients, and couples as well as for more research in sexuality and intimacy with the goal of improving quality of life for this large population of survivors. Suggestions for clinicians to better help patients and their partners regarding sexuality and intimacy are offered.

e16027Background: Studies have shown BMI could affect long-term survival in advanced gastric cancer. In this analysis, based on a large population, we further investigated the effects of BMI on the...

6051Background: Over 63,000 Americans develop head and neck cancer (HNC) yearly. The 5-year survival rate for HNC patients is 40-90%. HNC shares risk factors to cardiovascular disease (CVD), such a...

646 Background: Gender disparity in the proportion of patients receiving nephron sparing strategies (NSS) for the treatment of localized renal masses has been demonstrated in large population series as well as in single centers of excellence. Reasons for the discrepancy remain elusive. We aimed to assess urologist treatment patterns for localized renal masses in both genders to gauge the existence of provider-based gender biases. We hypothesize that female patients may be recommended more aggressive treatment due to provider biases related to patient gender. Methods: Urologists were randomly emailed 1 of 2 surveys including 6 vignettes of various patients with renal masses. Both surveys were identical other than the vignette patient gender (VPG) which was male in 50% and female in 50%. Self-selected respondents chose the single best treatment option from the following choices: active surveillance (AS), percutaneous or laparoscopic ablation (ABL), partial nephrectomy (PN), and radical nephrectomy (RN). Fisher’s exact test was used to assess differences in treatment recommended based on VPG. Nominal logistic regression was performed to assess the magnitude of differences. Results: Of the 423 urologists who completed the survey there was an even response to both surveys (210 vs. 213). Most respondents were male (93%), married (89%) and in private practice (44%). Age and time practicing were evenly distributed and median number of nephrectomies done per year was 15. There were no significant differences in demographics between the respondents of the 2 surveys. When comparing AS, ABL, PN, and RN the only vignette that differed based on VPG was question 3 (p = 0.019). Comparison of any NSS vs. RN in question 3 showed male VPG was 1.67 times more likely to be recommended RN (p = 0.040). Urologist gender had no effect on these findings. Conclusions: In this survey study of practicing urologists we found that male patient gender increased recommendations for radical surgery and less nephron sparing strategies in a hypothetical older patient with a localized renal mass. Provider biases do not appear to be solely responsible for gender disparities seen in the treatment of a localized renal mass.

Purpose The prevalence of long-term survivors after treatment for testicular cancer (TC) is increasing, and most studies display normal or only slightly reduced quality of life (QOL) in TC survivors (TCSs). Impaired QOL is claimed to be associated with treatment modality and its side effects, although most studies in this field can be criticized for various methodologic shortcomings. We wanted to examine variation in long-term QOL in TCSs in relation to TC treatment modality, side effects, and TC-related stress in a large population. Patients and Methods QOL, side effects, and TC-related stress were self-rated by a questionnaire at a mean of 11 years of follow-up in 1,409 TCSs treated from 1980 to 1994. Norm data was obtained from 2,678 males who were representative of the general population. QOL was measured with the Short Form-36 (SF-36), and TC-related stress was measured with the Impact of Event Scale. Results There were no clinically relevant differences in QOL between TCSs and age-adjusted norm data, although there was a slightly lowered SF-36 Physical Component Summary Score in TCSs. Variation of QOL in TCSs was related to self-reported side effects and TC-related stress but not to TC treatment modality. A significant association was found between side effects and TC-related stress. Conclusion TCSs do not suffer long term from reduced QOL, and only minor differences in QOL were found between different treatment modalities. TCSs who report more side effects or TC-related stress have increased risk for reduced QOL, but these associations are not explained by TC treatment modalities. Further QOL research in this area should explore vulnerability factors for side effects and TC-related stress.

Purpose Breast cancer diagnosed before the age of 50 years has become a common disease in many developed countries. Although average remaining life expectancy in the affected age groups is usually several decades, data regarding survival perspectives beyond 10 to 20 years after diagnosis are sparse. The aim of this study was to assess long-term survival in a large population-based sample of patients diagnosed with breast cancer before age 50 years. Patients and Methods Relative survival within up to 40 years after diagnosis was assessed for cohorts of women diagnosed with breast cancer before age 50 years and notified to the nationwide Finnish Cancer Registry within various time intervals since 1953. In addition, up-to-date estimates of 40-year relative survival were obtained by exclusively looking at the survival experience of breast cancer patients in recent years (1993 to 1999) using period analysis, a new method of survival analysis. Results Prognosis of patients diagnosed with breast cancer before age 50 years has considerably improved during the past decades. According to the latest estimates from period analysis, cumulative 40-year relative survival is now approximately 43% for all cancers combined, 57% for localized cancers, and 24% for cancers with regional tumor spread. Nevertheless, patients diagnosed with breast cancer before age 50 years continue to have increased mortality throughout at least four decades after diagnosis. This applies even if breast cancer is diagnosed in a localized stage and in the absence of a second primary breast cancer. Conclusion Despite major improvement in prognosis over time, breast cancer occurring among patients who are younger than 50 years remains a chronic disease that affects prognosis for decades.

7057 Background: The HMA azacitidine improved overall survival (OS) compared to conventional care in patients with HR-MDS in the landmark randomized clinical trial AZA-001 by a median of 9.5 months compared to conventional care regimens. However recent registry data from USA (Zeidan et al, 2016) and Spain (Bernal et al, 2015) did not show substantial population-level gains in OS. We used HMA market entry in the US (2004-06) as a natural experiment to assess the effect of HMA on OS. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results-Medicare data.Individuals were included if they were 66 years or older in age, had refractory anemia with excess blasts (RAEB, considered to have HR-MDS), and were diagnosed in 2001-11.We performed 2-stage residual inclusion instrumental variable (IV) analysis, using diagnosis year as the IV. Residuals from the first stage model were added to the second stage regression to control for effects of unobserved factors between HMA treatment and OS. We also adjusted for demographic characteristics, comorbidity, disability status and transfusion receipt. Results: Among 2,581 patients with RAEB, the median OS from diagnosis was 9 months, and 35.8% received HMAs. In the first stage model, diagnosis year was a strong predictor of HMA (2001-06 vs. 2011, Odds Ratio = 0.004-0.56, P-value < .01). In IV analysis, patients who received HMAs showed no gain in OS (Hazard Ratio (HR) = 0.93, 95% Confidence Interval (CI) = 0.76-1.14), while there was a strongly protective effect of unobservable characteristics on OS (HR = 0.58, 95% CI = 0.47-0.73). Conclusions: In our US population-based analysis,HMA use was not associated with survival prolongation in older adults with HR-MDS. It is unclear if this is related to suboptimal use of HMAs (alternate schedules, doses, number of cycles), use of decitabine (which did not show survival benefit in randomized studies), or the unselected nature (compared to strict eligibility in clinical trials) of patients receiving HMAs at the community level. Better understanding of these issues is vital for optimal HMA patient selection and administration.

4097Background: Functional neuroendocrine tumors (NETs) secrete bioactive amines and cause carcinoid syndrome, with its incumbent symptom burden of flushing and diarrhea. However, the frequency of ...

7022Background: ALL is a rare disease with markedly poor prognosis in older adults. As large population-based mortality data are limited, we described the risk of death among older adults diagnosed...

340 Background: Several new therapies have changed the landscape of prostate cancer (PCa) treatment, primarily due to their effectiveness in treating patients with mCRPC. Enza has garnered much attention, but is relatively expensive (~$3175/month). Met is less expensive (~$8.00/month) and has been used for decades to treat patients with non-insulin dependent diabetes. Two recent large population-based studies of PCa have demonstrated that diabetics taking Met had improved PCa specific and overall survival compared to those not taking Met. As a result, we hypothesized that Met has the potential to be a cost-effective adjunct therapy to Enza, although it is not currently used as such. Methods: We constructed a Markov-based decision analytic model to compare the cost-effectiveness of Enza alone versus Enza combined with Met. Through expert elicitation, we assumed that adding Met to Enza increases its efficacy by 15%. All other costs, utilities, and transition probabilities were derived from existing literature or expert elicitation. Effectiveness was measured using quality-adjusted life years (QALYs). Costs and QALYs were considered over a lifetime horizon and discounted at 5% per annum. Cost-effectiveness was considered using a willingness to pay threshold of $50 000/QALY. Results: Adding Met to Enza increases expected lifetime costs per patient by $83 651, and improves the expected effectiveness of treatment by 3.74 QALYs, compared to Enza alone. The incremental cost-effectiveness ratio is $22 374/QALY. Accounting for parameter uncertainty, adding Met to Enza has a 72% probability of being cost-effective. Conclusions: Although Met is not currently used as an adjunct therapy to Enza, doing so would likely be cost-effective provided it is as effective as we have assumed in our model. Additionally, our results indicate that the combination of Enza and Met could be among the most cost effective interventions in oncology. However, given the uncertainty around the effectiveness of such an adjunct therapy, our results support the need for further clinical trials to provide more robust evidence of the effectiveness of such a combination therapy in clinical practice.

10571 Background: Primary soft tissue sarcomas (STS) of the chest wall are rare entities with limited information regarding treatment and oncological outcomes. The aim of this study is to evaluate the outcomes of surgical treatment in malignant primary chest wall STS and identify factors affecting survival using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: We conducted a retrospective analysis using the SEER database (1988 -2010) and queried for all patients with primary chest wall STS. Only adult patients with histologically confirmed single primary tumor undergoing curative surgical resection were included in the study. Primary outcome was overall survival; covariates included demographics, tumor pathology, radiation and type of surgical procedure as coded in SEER (Simple/Partial or Total/Radical). Chi-square tests were performed to analyze categorical variables. Kaplan-Meier and Cox regression analyses were used to evaluate overall survival. Results: A total of 1053 cases o...

7046 Background: Secondary acute promyelocytic leukemia (sAPL) is an uncommon entity with no prior large population-based studies. It is unclear whether there is any difference in the overall survi...

1567 Background: CRC screening is recommended in average-risk individuals aged 50 years or older. Our aims were 1) to evaluate the proportion of CRC in a large population-based setting that were di...

9593 Background: Increased long-term risks of cardiovascular (CV) disease after CHEM for testicular cancer are well established whereas few studies have quantified the association of cisplatin-based chemotherapy with arterial thromboembolic events (ATE). We examined CVM in a large population-based cohort of TN survivors managed with modern combination CHEM, which usually includes cisplatin. Methods: Standardized mortality ratio (SMR) of CVM stratified by time since TN diagnosis were calculated for 15,006 TN survivors reported to the SEER program (1980-2010) initially managed with CHEM (n=6,909) or SURG (n=8,097) alone without RT, with each cohort accruing 60,065 (median 6.5) and 81,227 (median 7.9) person-years (PY) of follow up, respectively. Results: After CHEM, significant excesses of CVM occurred (n=54; SMR 1.4; 95% CI 1.03-1.8; absolute excess risk (AER) 2.4 per 10,000 PY) including deaths from heart disease (n=42; SMR 1.3; 95% CI 0.9-1.7), cerebrovascular disease (CVA) (n=10; SMR 2.4; 95% CI 1.2-4.4...

7033 Background: Despite its common occurrence, there are few large population-based studies on low-grade myelodysplastic syndromes (MDS). We evaluated the outcomes for the two low-risk MDS subtypes. Methods: The Surveillance, Epidemiology and End Results (SEER) database was searched for patients with refractory anemia (RA) or RA with ringed sideroblasts (RARS), diagnosed between 2001 and 2009 with complete demographic information. Incidence rates were calculated from SEERStat 7.1. Overall survival (OS) and disease-specific survival (DSS) were calculated from diagnosis to death from any cause and death from MDS or acute leukemia, respectively. Univariate survival was estimated by the Kaplan-Meier method and curves compared by log rank. Univariate and multivariable Hazard ratios (HR) were calculated by Cox Proportional Hazards. Results: Among the 6,505 patients who met the inclusion criteria, there were 3,866 (59%) RA and 2,639 (41%) RARS. Age-adjusted incidence rates per 100,000 population for RA and RARS were 0.55 and 0.44 respectively. Medians OS for RA and RARS were 39 and 48 months respectively. Although RARS was associated with improved 5-year OS compared to RA (41.3% vs 37.7%; HR 0.86; 95% CI 0.81-0.92, p < 0.0001), there were no differences in 5-year DSS (74.2% vs 76.3%; HR 1.01, 95% CI 0.90-1.14, p = 0.41). Altogether, 2,112 deaths were accrued among RA patients and 1,352 among the RARS subclass. The number of deaths due to MDS or acute leukemia were 610 (28.8%) in RA and 457 (33.8%) in RARS. Acute leukemia was the cause of death in 190 (9.0%) RA patients and in 143 (10.6%) of RARS patients. Cardiovascular disease accounted for 25% of total deaths in RA and RARS. After adjusted for age, gender, race and year of diagnosis, RARS was associated with increased OS (HR 0.81; 0.76-0.87; p < 0.0001) but not DSS (HR 0.95; 0.84-1.07, p = 0.41). Conclusions: Both RA and RARS are indolent diseases with a high 5-year DSS and death occurring mostly from other causes, particularly cardiovascular disease. Although RARS was associated with better 5-year OS compared to RA, there were no differences in 5-year DSS.

1538 Background: Gestational diabetes mellitus, a state of glucose intolerance associated with pregnancy is increasing in prevalence. Data regarding the risk associated with Gestational diabetes is...

e12016 Background: Breast cancer is one of the leading causes of death in China. There is limited information available from large population-based cancer registries to describe the variability in ...

4654 Background: The dominant factor associated with risk of recurrence for patients (pts) with CSI nonseminoma (CSI NS) is presence or absence of lymphovascular invasion (LVI+, LVI-) at the time of orchiectomy with LVI+ pts having about a 50% and LVI- pts a 15% risk of recurrent disease after orchiectomy. LVI is used in a number of guidelines to drive risk-adapted strategies such as intense and prolonged active surveillance for LVI- and adjuvant BEP for LVI + pts. Methods: Our IRB-approved population-based database from Oregon and British Columbia was reviewed. Our current clinical guidelines recommend active surveillance for all CSI pts and thus we have a large population of both LVI + and LVI- pts who did not receive active therapies after orchiectomy. All CSI pts were reviewed and clinical characteristics of relapse were correlated with LVI. Results: 59/223 consecutive pts with CSI NS relapsed on active surveillance. Detailed pathological information was available on 49/59 pts. All 59 pts relapsed wit...

e12014 Background: Gastric cancer (GC) is one of the leading cancers both in terms of incidence and mortality in China. No large population-based epidemiological study of clinical characteristics a...

1606 Background: TM are rare, and there has been limited epidemiologic literature analyzing large population-based cohorts. Methods: We used data from the Surveillance, Epidemiology and End Results...

603 Background: The 21 gene Recurrence Score (RS) assay (Oncotype DX) has been validated to quantify the risk of distant recurrence in tamoxifen-treated (tam+) pts with N-, ER+ breast cancer (BC) (Paik et al, NEJM, 2004). The relation between gene expression and BC mortality in a community hospital setting for ER+ tam+ pts, as well as for tam- and ER- pts, was not known. Methods: We conducted a nested case-control study in BC pts diagnosed from 1985–94 at 14 Kaiser hospitals. Eligibility included negative nodes, age < 75 yrs, and no chemotherapy. Cases died of BC prior to 2002. Up to 3 controls were matched to each case on age, race, tam treatment, facility, diagnosis yr, and follow-up time. Using pre-specified methods, archived tumor tissue was analyzed using the RT-PCR 21 gene expression assay and RS algorithm. Pre-specified primary and secondary endpoints were analyzed by conditional logistic regression to estimate the association between gene expression (for RS, proliferation gene group score, and ind...