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Background: Esophageal cancer (EC) remains a global health challenge due to its poor prognosis. China and the United States of America (USA) represent two distinct epicenters of EC burden. Understanding the EC disparities in these two countries is vital for tailoring prevention strategies, optimizing treatment, and enhancing outcomes in both countries. Yet, there lacks a comprehensive comparison of EC characteristics between the two countries. Methods: In this multicenter, retrospective hospital-based study, we enrolled primary EC patients who received their initial treatment at one of 23 hospitals in China during 2016–2017. Using electronic medical records and cancer registration records, information on demographics, lifestyle, and clinicopathological characteristics (including tumor site, pathology, stage, metastases, differentiation, and treatment) were collected. Additionally, we compared these data with the clinicopathological information of invasive EC patients diagnosed in 2016–2017 from the Surveillance, Epidemiology, and End Results (SEER) database in the USA. Results: A total of 6,658 EC patients in China and 8,555 EC patients in the USA were included finally. 85.5% (n = 5,694) of EC were esophageal squamous cell carcinoma (ESCC) in China, while esophageal adenocarcinoma (EAC) was prominent in the USA (58.9%, n = 5,041). Among EC patients with known staging, the proportion of early stage was higher in China compared to the USA (48.3% vs. 30.5%). Among ESCC patients, early-stage cases were higher in China than in the USA (49.8% vs. 31.8%), while among EAC patients, late-stage cases were higher in China than in the USA (77.3% vs. 68.5%) (all P < 0.001). In China, EC mainly occurred in the middle third (60.2%) of the esophagus, whereas in the USA, it was more common in the lower third (59.9%) of the organ. Compared with EC patients with known metastatic status in the USA, China had fewer cases of lymph node metastases (51.4% vs. 57.7%) and distant metastases (7.9% vs. 33.8%). Regarding treatment, China had more surgical therapy (53.7% vs. 22.6%), less radiotherapy (35.6% vs. 53.3%), and less chemotherapy (46.7% vs. 59.7%) compared to the USA. Conclusions: This study reveals notable disparities in EC between China and the USA, encompassing epidemiological, clinicopathological, and treatment dimensions. These findings provide insight for tailored strategies addressing regional variations in clinicopathological and therapeutic characteristics.

Background: Non-small cell lung cancer (NSCLC) accounts for 85 % of lung cancer cases. Among NSCLC subtypes, lung adenocarcinoma (LUAD) stands as the most prevalent. Regrettably, LUAD continues to exhibit a notably unfavorable overall prognosis. This study's primary aim was to develop and validate prognostic tools capable of predicting the likelihood of cancer-specific survival (CSS) in patients with LUAD. Methods: We retrospectively collected 21,099 patients diagnosed with LUAD between 2010 and 2015, and 8290 patients diagnosed between 2004 and 2009 from SEER database. The cohort of 21,099 patients served as the prognostic group for the exploration of LUAD-related prognostic risk factors. The cohort of 8290 patients was designated for external validation. We created a training set and an internal validation set in the prognostic group for the development and internal validation of CSS nomograms. CSS predictors were identified through the least absolute shrinkage and selection operator (Lasso) regression analysis. Prognostic model was constructed via Cox hazard regression analysis, presented in the form of both static and dynamic network-based nomograms. Results: Several independent prognostic factors were incorporated into the construction of nomogram. The nomogram accurately predicted CSS at 1, 3, and 5 years, with respective AUC values of 0.769, 0.761, and 0.748 for the training group, and 0.741, 0.752, and 0.740 for the testing group. The study demonstrated a strong agreement between anticipated and actual CSS values, supported by decision curve analysis (DCA) and time-dependent calibrated curves. High-risk patients based on the nomogram exhibiting significantly lower survival rates compared to their low-risk counterparts according to Kaplan-Meier (K-M) curves. The nomogram demonstrates excellent predictive power in the external validation cohort. Conclusions: A dependable and user-friendly nomogram has been developed, available in both static and online dynamic calculator formats, to facilitate healthcare professionals in accurately estimating the likelihood of CSS for patients diagnosed LUAD.

Background: Retinoblastoma (RB) is a rare primary malignant tumor primarily affecting children. Our study aims to compare the overall survival (OS) between pediatric and adult RB patients and establish a predictive model for adult RB patients' OS to assist clinical decision-making. Methods: This study retrospectively analyzed data from 1938 RB patients in the Surveillance, Epidemiology, and End Results (SEER) database, covering the period from 2000 to 2015. Propensity score matching (PSM) ensured balanced characteristics between pediatric and adult groups. A Cox proportional hazards regression model was used to assess prognostic factors, and selected variables were utilized to construct a predictive survival model. The Nomogram model's performance was evaluated through the C-index, time-dependent ROC curves, calibration curves, and decision curve analysis (DCA). Results: Following PSM, adult RB patients had lower OS compared to pediatric RB patients. Independent prognostic factors for adult RB OS included age, gender, disease stage, radiation therapy, income, and diagnosis confirmation. In the training cohort, the Nomogram achieved a C-index for OS of 0.686 and accurately predicted 2-year, 3-year, and 5-year OS with AUC values of 0.672, 0.680, and 0.660, respectively. The C-index, time-dependent ROC curves, calibration curves, and DCA in both training and validation cohorts confirmed the Nomogram's excellent performance. Conclusion: In this study, adult RB patients have worse OS than pediatric RB patients. Consequently, we constructed a Nomogram to predict the risk for adult RB patients. The Nomogram demonstrated good accuracy and reliability, making it suitable for widespread application in clinical practice to assist healthcare professionals in assessing patients’ prognoses.

Background: The association between small-bowel adenocarcinoma (SBA) tumor size and prognosis is unclear, and we used the Surveillance, Epidemiology, and End Results (SEER) database to assess the prognostic value of SBA tumor size. Methods: Patients with postoperative SBA were selected from the SEER database, and overall survival (OS) and cancer-specific survival (CSS) were used as outcome variables. Tumor size was used as a categorical and continuous variable, respectively, to adjust for confounders and analyze the association between SBA tumor size and prognosis using Cox proportional hazard regression, and the results were visualized using restricted cubic splines (RCS). Spearman correlation coefficient was used to evaluate the statistical correlation between tumor size and tumor invasion depth (T-stage). Kaplan-Meier survival curves were used to estimate OS at different T stages. Results: When the tumor size was analyzed as a quantitative variable, the adjusted covariate model showed that the HR was 1.008 (P = 0.04) for OS and 1.021 (P = 0.03) for CSS. And regardless of OS or CSS, when the tumor size < 3–4 cm, there was a close linear relationship between tumor size and HR. What's more, in the SEER database, the 5-year survival rates of T1, T2, T3 and T4 patients were 81.8 %, 81.1 %, 66.0 % and 50.9 % (P

Purpose: Stage IV ovarian cancer is a tumor with a poor prognosis and lacks prognostic models. This study constructed and validated a model to predict overall survival (OS) in patients with newly diagnosed stage IV ovarian cancer. Methods: The data of this study were extracted from SEER database. Cox regression analysis was used to construct the nomogram model and implemented it in an online web application. Concordance index (C-index), calibration curve, area under receiver operating characteristic curve (ROC) and decision curve analysis (DCA) were used to verify the performance of the model. Results: A total of 6062 patients were collected in this study. The analysis showed that age, race, histological grade, histological differentiation, T stage, CA125, liver metastasis, primary site surgery, and chemotherapy were independent prognostic parameters, and were used to construct the nomogram model. The C-index of the training group and the verification group was 0.704 and 0.711, respectively. Based on the score of the nomogram responding risk classification system is constructed. The online interface of Alfalfa-IVOC-OS is free to use. In addition, the racial analysis found that Asian or Pacific Islander people had higher survival rates than white and black people. Conclusion: This study established a new survival prediction model and risk classification system designed to predict OS time in patients with stage IV ovarian cancer to help clinicians evaluate the prognosis of patients with stage IV ovarian cancer.

Background: Osteosarcoma is the most common primary bone malignancy. It has classically been described as having a bimodal incidence by age. We sought to identify whether the bimodal incidence distribution still exists for osteosarcoma using the SEER and NIS databases. Methods: Incidence rates of primary osteosarcoma between 2000–2021 were analyzed by age at diagnosis, year of occurrence, sex, and tumor site from the SEER Research Data, 17 Registries, Nov 2023 Sub (2000–2021). The incidence of cases in 35–64 year-olds and 65 and above was compared statistically to determine if there is an increased incidence in the later ages. Incidence of tumors of the long bones of the lower limbs from the NIS discharge database 2012–2019 was also analyzed for comparison. Results: Overall, 5,129 cases of osteosarcoma were reported in the SEER database. Across the 22 calendar year span, a consistent first peak appeared in the second decade of life. There was no consistent second peak in the 35+ age group. There were 86,100 discharges with long bone tumors analyzed in the NIS data which exhibited nearly identical patterns. Conclusions: Our analysis shows that the incidence of osteosarcoma is no longer bimodally distributed but rather unimodally distributed.

Background: The prognosis of patients with hepatoblastoma has been unsatisfactory. This study analyzed the effects of different treatment methods on cancer-specific survival (CSS) in children with hepatoblastoma. Method: From 2000 to 2018, patients with hepatoblastoma were included in the Surveillance, Epidemiology, and End Results (SEER) database. CSS was estimated using the Kaplan–Meier method. Cox regression analysis assessed prognostic factors. The predictive models were validated using the concordance index (C-index), calibration curve and receiver operating characteristic (ROC) curve. Result: Of the 785 included patients, 730 (93.0 %) underwent chemotherapy, 516 (65.7 %) underwent liver tumour resection and 129 (16.4 %) underwent liver transplantation. Both chemotherapy and surgery could significantly improve the CSS rate (all p 0.05) had a similar prognosis. Multivariate analysis revealed that age (p = 0.003), race (p = 0.001), operative method (p

Background: The effect of combined radiation and chemotherapy (combination therapy) versus monotherapy on anaplastic thyroid carcinoma (ATC) has not yet been clear. Methods: We identified 516 ATC patients during 2010–2015 from the Surveillance, Epidemiology and End Results (SEER) database and evaluated their survival outcome using the Kaplan-Meier method, Cox regression analysis and propensity score matching (PSM) technique. Results: The median overall survival (OS) among the entire cohort was 3 months (95 % confidence interval [CI], 2.58–3.42 months), and the 6- and 12-month OS rates were 29 % (95 % CI, 25.01%–32.88 %) and 13 % (95 % CI, 10.60%–16.58 %), respectively. Multivariable analysis demonstrated that ATC patients not receiving radiotherapy or chemotherapy were unquestionably associated with worse OS (hazard ratio [HR] 3.000, 95 % CI, 2.390–3.764) and cancer-specific survival (CSS) (HR = 3.107, 95 % CI, 2.388–4.043), compared with those receiving combination therapy. However, combination therapy did not predict better prognosis compared with monotherapy (all P > 0.05). After PSM, the median OS and CSS were also not significantly improved in patients undergoing chemoradiotherapy versus chemotherapy alone (OS, P = 0.382; CSS, P = 0.420) or radiotherapy alone (OS, P = 0.065; CSS, P = 0.251). Conclusion: Combination therapy, compared to monotherapy, does not have the expected improvement in survival beyond the benefits achievable with each single-modality treatment, necessitating further prospective research to tailor its treatment management.

Background: Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer with limited treatment options for advanced disease. A small subset exhibits mixed MTC histology with both medullary and well-differentiated components. We investigated survival outcomes with systemic therapy in isolated versus mixed MTC using a large population-based cohort. Methods: Patients diagnosed with MTC from 2000 to 2019 were identified in the National Cancer Institute's Surveillance, Epidemiology, and End Results database. The overall and thyroid cancer-specific survivals were compared between isolated (n = 1814) and mixed (n = 113) MTC cohorts. The impact of postoperative systemic therapy on survival was analyzed. Results: No significant difference in 10-year overall survival was observed between isolated (77.4 %) and mixed (75.2 %) MTC in a cohort of 1927 patients. Median overall survival was similar between isolated (136.9 months) and mixed MTC (129.0 months), p = 0.81. While systemic therapy improved 10-year survival in isolated MTC (83.2 % vs. 76.9 %, p

Background: Thyroid cancer (TC) is the most common malignant tumor in the endocrine system, is also one of the head and neck tumor. Follicular Thyroid Carcinoma (FTC) plays an important role in the pathological classification of thyroid cancer. This study aimed to develop an innovative predictive tool, a nomogram, for predicting cancer specific survival (CSS) in middle-aged FTC patients. Methods: We collected patient data from the Surveillance, Epidemiology, and End Results (SEER) database. The data from patients between 2004 and 2015 were used as the training set, and the data from patients between 2016 and 2018 were used as the validation set. To identify independent risk factors affecting patient survival, univariate and multivariate Cox regression analyses were performed. Based on this, we developed a nomogram model aimed at predicting CSS in middle-aged patients with FTC. The consistency index (C-index), the area under the receiver operating characteristic (ROC) curve (AUC), and the calibration curve were used to evaluate the accuracy and confidence of the model. Results: A total of 2470 patients were enrolled in this study, in which patients from 2004 to 2015 were randomly assigned to the training cohort (N = 1437) and validation cohort (N = 598), and patients from 2016 to 2018 were assigned to the external validation cohort (N = 435) in terms of time. Univariate and multivariate Cox regression analysis showed that marriage, histological grade and TNM stage were independent risk factors for survival. The C-index for the training cohort was 0.866 (95 % CI: 0.805–0.927), for the validation cohort it was 0.944 (95 % CI: 0.903–0.985), and for the external validation cohort, it reached 0.999 (95 % CI: 0.997–1.001). Calibration curves and AUC suggest that the model has good accuracy. Conclusions: We developed an innovative nomogram to predict CSS in middle-aged patients with FTC. Our model after a rigorous internal validation and external validation process, based on the time proved that the high level of accuracy and reliability. This tool helps healthcare professionals and patients make informed clinical decisions.

Background: To identify key clinical factors affecting the survival of elderly patients with early-stage cervical cancer and to construct a nomogram for predicting their prognosis. Methods: Patients (aged ≥ 65 years old) diagnosed with cervical cancer between 2004 and 2015 at clinical stages IA to IIA were included in this study. Diagnosis was confirmed via pathological examination, and the cases were randomly divided into a training or a validation group in a 7:3 ratio. Univariate and multivariable Cox regression analyses were performed to identify independent factors affecting the prognosis of elderly early-stage cervical cancer patients, based on which a nomogram was constructed to predict their 12-, 24- and 36-month overall survival (OS). The nomogram's performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) curves. Results: A total of 686 patients were identified as eligible and assessed. Multivariable Cox proportional hazard regression analysis revealed that age, tumor diameter, marital status and surgical intervention were independent prognostic factors for elderly individuals with early-stage cervical cancer, which were then used to construct the nomogram. The calibration curves showed a strong correlation between predicted and observed survival rates, and Kaplan-Meier survival curves for different risk subgroups demonstrated significant survival differences (P

Background: Lung adenosquamous carcinoma (ASC) is a rare tumor with high invasive and metastatic potential. Few studies have explored metastatic patterns in patients with advanced-stage ASC. Methods: Patients diagnosed with ASC in the Surveillance, Epidemiology, and End Results database from 2010 to 2015 were selected. Descriptive statistics were obtained to characterize the metastatic sites of the study participants. The Kaplan–Meier method was applied to compare survival curves among patients with different metastatic patterns. Cox regression analysis was performed to evaluate risk factors for metastasis. Results: A total of 858 eligible patients with ASC were enrolled; the mean age was 71.5 years (standard deviation ± 7.8 years). There was a slightly higher proportion of male patients (54.0 %). A total of 63.2 % of patients harbored single-site metastasis (median OS: 5 months), 23.6 % of patients had two-site metastasis (median OS: 4 months), and approximately 10 % of patients harbored three or more sites metastasis (median OS: 3 months). Bone (56.9 %) was the most frequent site of metastasis (median OS: 4 months), followed by lung metastasis (37.6 %, median OS: 5 months), liver metastasis (22.1 %, median OS: 5 months), and brain metastasis (21.4 %, median OS: 4 months). Chemotherapy decreased the risk of death by 70 % (HR = 0.296, 95 % CI 0.241–0.363), 70 % (HR = 0.302, 95 % CI 0.224–0.406), 78 % (HR = 0.218, 95 % CI 0.151–0.314), and 70 % (HR = 0.302, 95 % CI 0.231–0.396) in patients harboring bone, liver, brain and lung metastases, respectively. The brain increased the risk of death by 50 % (HR = 1.501, 95 % CI 1.209–1.865), 64 % (HR = 1.644, 95 % CI 1.126–2.402), and 128 % (HR = 2.284, 95 % CI 1.653–3.157) in patients harboring bone, liver and lung metastases, respectively. Conclusion: Patients with advanced-stage ASC have unfavorable outcomes. Early detection and aggressive treatment can improve patients outcomes.

Background: Primary tumor resection is associated with survival benefits in patients with metastatic lung adenocarcinoma (mLUAD). However, there are no established methods to determine which individuals would benefit from surgery. Therefore, we developed a model to predict the patients who are likely to benefit from surgery in terms of survival. Methods: Data on patients with mLUAD were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Depending on whether surgery was performed on the primary tumor, patients were categorized into two groups: cancer-directed surgery (CDS) and no-cancer-directed surgery (No-CDS). Propensity Score Matching (PSM) was utilized to address bias between the CDS and No-CDS groups. The prognostic impact of CDS was assessed using Kaplan-Meier analysis and Cox proportional hazard models. Subsequently, we constructed a nomogram to predict the potential for surgical benefits based on multivariable logistic regression analysis using preoperative factors. Results: A total of 89,039 eligible patients were identified, including 6.4% (5705) who underwent surgery. Following PSM, the CDS group demonstrated a significantly longer median overall survival (mOS) compared with the No-CDS group (23 [21–25] vs. 7 [7–8] months; P

Background: On average, 5–10% of patients are diagnosed with metastatic breast cancer (MBC) at the initial diagnosis. This study aimed to develop a nomogram to predict the overall survival (OS) in these patients. Methods: The nomogram was based on a retrospective study of 9435 patients with de novo MBC from the Surveillance, Epidemiology, and End Results (SEER) database. The predictive accuracy and discriminative ability of the nomogram were determined using the concordance index (C-index), area under the time-dependent receiver operating characteristic curve (AUC), and calibration curve. Decision curve analysis (DCA) was employed to evaluate the benefits and advantages of our new predicting model over the 8th edition of the American Joint Committee on Cancer (AJCC) Tumor Node Metastasis (TNM) staging system. The results were validated in a retrospective study of 103 patients with de novo MBC from January 2013 to June 2022 at an institution in northwest China. Results: Multivariate analysis of the primary cohort revealed that independent factors for survival were age at diagnosis, pathological type, histological grade, T stage, N stage, molecular subtype, bone metastasis, brain metastasis, liver metastasis, lung metastasis, surgery, chemotherapy, and radiotherapy. The nomogram achieved a C-index of 0.688 (95% confidence interval [CI], 0.682–0.694) in the training cohort and 0.875 (95% CI, 0.816–0.934) in the validation cohort. The AUC of the nomograms indicated good specificity and sensitivity in the training and validation cohorts, respectively. Calibration curves showed favorable consistency between the predicted and actual survival probabilities. Additionally, the DCA curve produced higher net gains than by the AJCC-TNM staging system. Finally, risk stratification can accurately identify groups of patients with de novo MBC at different risk levels. Conclusions: The nomogram showed favorable predictive and discriminative abilities for OS in patients with de novo MBC. Other populations from different countries or prospective studies are needed to further validate the nomogram.

Background: Parathyroid carcinoma is a rare endocrine malignancy. Considering that clinicians develop appropriate treatment strategies based on patients' survival expectations. Therefore, the present study aimed to develop a survival prediction model to guide clinical decision-making. Methods: We retrospectively analyzed 362 parathyroid carcinoma patients diaagnosed in the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. Correlations between outcome events and variables were analyzed using univariate and multifactorial Cox regression, and variables screened by the multifactorial Cox risk proportional model were used to construct a survival prediction model. The model was evaluated using Receiver Operating Characteristic (ROC) curves, decision curve analysis (DCA), and C-index and calibration curves. Results: Univariate and multifactorial COX analyses revealed five independent prognostic factors for parathyroid carcinoma patients, which were subsequently used to develop the nomogram prediction model. In the training cohort, the C-index of the nomogram in predicting the overall survival (OS) was 0.747 (0.686–0.808), the area under the receiver operator characteristics curve(AUC)values of the nomogram in prediction of the 3, 5, and 10-year OS were 0.718 (0617-0.819), 0.711 (0.614–0.808) and 0.706 (0.610–0.803), respectively. In the validation cohort, the C-index was 0.740 (0.645–0.835), The AUC for 3, 5, and 10-years OS were 0.736 (0.584–0888), 0.698 (0.551–0.845) and 0.767 (0.647–0.887), respectively. The C-index, time-dependent ROC curve, calibration curve, and DCA showed that the Nomogram had a clear advantage. Conclusion: The developed nomogram can be applied in clinical practice to help clinicians to assess patient prognosis.

Objective: Diffuse large B-cell lymphoma (DLBCL) is the most common histopathological type of non-Hodgkin's lymphoma and might arise from various extranodal sites. Little is known about the clinical characteristics and survival outcomes of primary DLBCL of the brain, including the cerebrum, cerebellum, brain steam and ventricle (CCSV). Thus, we performed this study to explore the independent prognostic factors of CCSV-DLBCL using the Surveillance, Epidemiology, and End Results (SEER) database. Materials and methods: We extracted the data of patients diagnosed with CCSV-DLBCL between 1975 and 2016 from the SEER database. Variables including demographic characteristics, Ann Arbor stage and therapies, such as surgery, radiation and chemotherapy, were all collected. The prognostic factors on overall survival (OS) and disease-specific survival (DSS) were analysed using Kaplan–Meier curves. Results: One thousand three hundred and twenty-eight patients were finally enrolled in the analysis. The median age was 62 years old. More than half of the cases of CCSV-DLBCL (54.22%) originated from the cerebrum. Patients older than 75 years had the worst OS and DSS. Moreover, black people had the worst survival outcomes compared with white and other people. Surgery, radiation and chemotherapy all significantly improved OS and DSS. Conclusion: To the best of our knowledge, this is the largest population-based study of CCSV-DLBCL. Advanced age, black race, lack of surgical resection, radiation or chemotherapy were all poor prognostic factors.

Background: The matter of postoperative radiotherapy (PORT) in esophageal cancer (ESCA) was far from conclusive. Some evidence indicated that lymph node status could affect treatment. We evaluated lymph node ratio (LNR) as an indicator that could be applied to predict PORT benefit. Methods: Retrospective cohort study collected the data of N1, N2, N3 stage ESCA patients from the Surveillance, Epidemiology, and End Results database (SEER) to analyze the association between LNR and prognosis from 2004 to 2015. Patients were categorized into two subsets based on the LNR cut-off value of 0.23 using receiver operating characteristic curve (ROC). Kaplan–Meier analysis was utilized to estimate the proportion of overall survival (OS) and esophagus cancer-specific survival (CSS) in two LNR groups. Cox regression analysis and competitive risk model was adopted to investigate the impacts of LNR on prognosis. Results: Of 2,165 ESCA patients identified, 1,165 (53.8%) had LNR>0.23. The LNR was an independent prognostic factor and associated with better OS and CSS of LNR≤0.23 (P 0.23 (HR = 1.71; 95% CI 1.53–1.91). Subgroup analyses indicated that PORT was associated with favorable OS and CSS. Furthermore, when stratified by Node stage, PORT was associated with a survival benefit only in N1 stage with higher LNR (LNR>0.23) after adjusting for other covariates. Conclusions: LNR exceeding 0.23 was negatively associated with prognosis in ESCA. The survival benefit from PORT in ESCA seems to be limited to LNR of 23% or more only in N1 stage. This study highlights the biomarker meaning of LNR on identifying PORT beneficiary in N1 stage.

Introduction: The “borderline” pituitary tumor category between typical benign adenomas and pituitary carcinomas is a subject of ongoing controversy. Surveillance, Epidemiology, and End Results (SEER) database classifies uncertain behavior pituitary tumors (UPTs) under the “borderline” category including atypical adenomas with presumed propensity for aggressive behavior. Very little is known about UPT patient survival prognostic factors. We aimed to characterize survival risk factors of patients with UPT according to the SEER database. Methods: SEER 17 database was queried for pituitary tumors and further separated by SEER classification of “Borderline” under the category “ICD-O-3 Hist/behav, malignant”. Patient demographics, tumor characteristic, extent of disease and treatment data were extracted and analyzed. A nomogram was built assessing survival. Results: Three hundred and thirty-two patients diagnosed between 2004 and 2019 were included. The survival rates at 1, 5 and 10 years were 86.8 %, 78.6 % and 65.1 %, respectively. Female sex and age

Background: There is a lack of evidence on whether resectable locally advanced gastric cancer (LAGC) patients could benefit from neoadjuvant or adjuvant radiotherapy (RT). Methods: Patients with surgically diagnosed LAGC from 2004 to 2015 were retrieved from the SEER database. Kaplan-Meier method and the log-rank test were used to evaluate survival analysis between neoadjuvant and adjuvant RT. Univariate Cox regression was used to evaluate the hazard ratio (HR) and 95 % confidence interval (CI). Results: A total of 4790 LAGC patients who treated with surgery and RT were identified, including 3187 patients with intestinal subtype and 1603 patients with diffuse subtype. For patients with both intestinal and diffuse subtypes, median cancer-specific survival (mCSS) was better with adjuvant RT or neoadjuvant RT. Moreover, patients benefited more from adjuvant RT than neoadjuvant RT (intestinal subtype: mCSS 49 vs. 36 months, P

Background: With the development of medical technology and change of life habits, early-stage lung adenocarcinoma (LUAD) has become more common. This study aimed to systematically analyzed clinicopathological factors associated to the overall survival (OS) of patients with Stage IA LUAD. Methods: A total of 5942 Stage IA LUAD patients were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier methods and log-rank tests were used to compare the differences in OS. A nomogram constructed based on the Cox regression was evaluated by Concordance index (C index), calibration curve, decision curve analysis (DCA) and area under curve (AUC). And 136 patients were recruited from Shandong Province Hospital for external validation. Results: Cox analysis regression indicated that 12 factors, such as Diagnosis to Treatment Interval (DTI) and Income Level, were independent prognostic factors and were included to establish the nomogram. The C-index of our novel model was 0.702, 0.724 and 0.872 in the training, internal and external validation cohorts, respectively. The 3-year and 5-year survival AUCs and calibration curves showed excellent agreement in each cohort. Some new factors in the SEER database, including DTI and Income Level, were firstly confirmed as independent prognostic factors of Stage IA LUAD patients. The distribution of these factors in the T1a, T1b, and T1c subgroups differed and had different effects on survival. Conclusion: We summarized 12 factors that affect prognosis and constructed a nomogram to predict OS of Stage IA LUAD patients who underwent operation. For the first time, new SEER database parameters, including DTI and Income Level, were proved to be survival-related.

Objective: To investigate the prognostic factors in and role of postoperative radiotherapy (PORT) for surgically resected thymomas. Methods: A total of 1540 patients with pathologically confirmed thymomas undergoing resection between 2000 and 2018 were identified retrospectively from the SEER (Surveillance, Epidemiology, and End Results) database. Tumors were restaged as local (limited to thymus), regional (invasion to mediastinal fat and other neighboring structures), or distant stage. Disease-specific survival (DSS) and overall survival (OS) were estimated by the Kaplan–Meier method and the log-rank test. Adjusted hazard ratios (HRs) with 95% CIs were calculated by Cox proportional hazards modeling. Results: Tumor stage and histology were independent predictors of both DSS (regional: HR, 3.711; 95% CI, 2.006-6.864; distant: HR, 7.920; 95% CI, 4.061-15.446; type B2/B3: HR, 1.435; 95% CI, 1.008-2.044) and OS (regional: HR, 1.461; 95% CI, 1.139-1.875; distant: HR, 2.551; 95% CI, 1.855-3.509; type B2/B3: HR, 1.409; 95% CI, 1.153-1.723). For patients with regional stage and type B2/B3 thymomas, PORT was associated with better DSS after thymectomy/thymomectomy (HR, 0.268; 95% CI, 0.099-0.727), but the association was not significant after extended thymectomy (HR, 1.514; 95% CI, 0.516-4.44). Among patients with lymph node metastases, those who received PORT (HR, 0.372; 95% CI, 0.146-0.949), chemotherapy (HR, 0.843; 95% CI, 0.303-2.346), or both (HR, 0.296, 95% CI, 0.071-1.236) had a better OS. Conclusions: The extent of invasion and tumor histology were independent predictors of worse survival following surgical resection of thymoma. Patients with regional invasion and type B2/B3 thymoma who undergo thymectomy/thymomectomy may benefit from PORT, while patients with nodal metastases may benefit from multimodal therapy, including PORT and chemotherapy.

Background: As an important kidney-sparing treatment for upper urothelial carcinoma (UTUC), whether endoscopic excision can be performed without sacrificing oncologic outcomes remains indefinite. This study aimed to investigate the prevalence and efficacy of endoscopic excision, in patients with non-muscle invasive UTUC (NMIUTUC) and compare them to those of radical nephroureterectomy (RNU). Methods: Using the Surveillance, Epidemiology, and End Results database, we reviewed 4347 cases with NMIUTUC (cTis/Ta/T1-N0-M0,≤ 5.0 cm) between 2004 and 2020. Surgical treatment modalities included endoscopic excision and RNU. Propensity score matching analysis was used to minimize the selection bias between endoscopic excision and RNU, selecting 1:1 matched patients in the two group. Results: A total of 794 patients with NMIUTUC were included after matching (397:397). Patients who underwent endoscopic excision had worse survival outcomes compared with those of patients who underwent RNU (5-year OS: 65.3 % vs. 80.3 %, p

Objective: Endometrial cancer diagnosis in younger women is increasing in Puerto Rico and the United States. The study aims to evaluate the endometrial cancer trends in incidence, mortality, and survival by comparing US ethnic groups (NHW, NHB, and Hispanic) to women living in PR to assess whether disparities exist by age and stage at diagnosis on outcomes of interest. Methods: We performed a secondary data analysis and comparison of the age-specific and age-adjusted incidence rates, mortality rates, and the survival of endometrial cancer in PR with that of NHB, NHW, and Hispanic using data from the PR Central Cancer Registry, the SEER Program, and PR Demographic Registry from 2000 to 2018. Results: PR had the highest incidence rates (41.3 per 100,000 women) of endometrial cancer, followed by NHW, NHB, and Hispanic. Women in PR younger than 65 years old had higher incidence rates of endometrial cancer than compared groups. NHB have higher overall mortality rates (12.5 per 100,000 women). Between ages 20–34 and 35–49, women in PR have the highest mortality rates, and after age 50, mortality rates are higher for NHB. Conclusions: Women in PR had higher endometrial cancer incidence rates in increasing trend from 2000 to 2018 compared to similar NHB, Hispanic, and NHW cohorts. Also, women in PR experienced higher incidence and mortality rates below 50 years old among all races and ethnicities. Future studies are needed to evaluate histology, obesity trends, and the impact on the quality of life for this cohort.

Purpose: Triple-negative apocrine carcinoma (TNAC) is a sort of triple-negative breast cancer (TNBC) that is rare and prognosis of these patients is unclear. The present study constructed an effective nomogram to assist in predicting TNAC patients overall survival (OS). Methods: A total of 373 TNAC patients from the surveillance, epidemiology, and end results (SEER) got extracted from 2010 to 2016 and were divided into training (n = 261) and external validation (n = 112) groups (split ratio, 7:3) randomly. A Cox regression model was utilized to creating a nomogram according to the risk factors affecting prognosis. The predictive capability of the nomogram was estimated with receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Results: Multivariate Cox regression analysis revealed age, surgery, chemotherapy, stage, and first malignant primary as independent predictors of OS. A prediction model was constructed and virtualized using the nomogram. The time-dependent area under the curve (AUC) showed satisfactory discrimination of the nomogram. Good consistency was shown on the calibration curves in OS between actual observations and the nomogram prediction. What's more, DCA showed that the nomogram had incredible clinical utility. Through separating the patients into groups of low and high risk group that connects with the risk system that shows a huge difference between the low-risk and high risk OS (P

Background: This study aimed to investigate the role of postoperative radiation therapy in a large population-based cohort of patients with stage I–III male breast cancer (MaBC). Methods: Patients with stage I–III breast cancer treated with surgery were selected from the Surveillance, Epidemiology, and End Results cancer database from 2010 to 2015. Multivariate logistic regression identified the predictors of radiation therapy administration. Multivariate Cox regression model was used to evaluate the predictors of survival. Results: We identified 1321 patients. Age, stage, positive regional nodes, surgical procedure, and HER2 status were strong predictors of radiation therapy administration. There was no difference between patients who received radiation therapy and those who did not (P = 0.46); however, after propensity score matching, it was associated with improved OS (P = 0.04). In the multivariate analysis of the unmatched cohort, the factors associated with better OS were administration of radiation therapy and chemotherapy. In the subset analysis of the unmatched cohort, postoperative radiation therapy was associated with improved OS in men undergoing breast-conserving surgery (BCS), with four or more node-positive or larger primary tumours (T3/T4). Furthermore, we found no benefit of radiation therapy, regardless of the type of axillary surgery in mastectomy (MS). In older MaBC patients with T1-2N1 who underwent MS, radiation therapy showed no significant effects, regardless of chemotherapy. Conclusion: Postoperative radiation therapy could improve the survival of MaBC patients undergoing BCS, with four or more node-positive or larger primary tumours. Moreover, it should be carefully considered in patients undergoing MS and older T1-2N1 patients.

Background: Lung metastatic tumor (LM) is one of testicular germ cell tumors' most common metastatic sites. Our study aimed to develop a nomogram for predicting the risk of LM among patients with testicular germ cell tumors (TGCTs). Methods: Clinicopathological information of 4078 patients with TGCT between 2010 and 2015 was obtained from SEER. Univariate and multivariate logistic regression analyses were performed to identify risk factors for LM, and a nomogram was developed based on these factors. Calibration curves, area under the receiver operating curve (AUC), and decision curve analysis (DCA) were used to evaluate the accuracy and discrimination of the model. Results: Study participants included 4078 people with TGCTs, including 305 people with LM. They were randomly divided into two groups (training cohort = 2854 and validation cohort = 1224) at a ratio of 7:3. The following variables were incorporated in the nomogram: marital status, tumor histological type, T stage, brain metastasis, liver metastasis, lactate dehydrogenase (LDH), and chemotherapy. Besides, the AUC of it was 0.922 in the training cohort, while was 0.930 in the validation cohort. Training and validation cohort calibrations showed that the nomogram had excellent predictive abilities. DCA suggested it was more clinically relevant than the traditional TN staging. Conclusion: We have established a nomogram to predict the risk of LM in patients with TGCTs. Doctors and patients can use this nomogram to monitor and identify lung metastasis of tumors through active monitoring and follow-up.

Background: Prior research has demonstrated racial disparities in the treatment of colon cancer. We sought to determine if treatment disparities persist. Methods: Patients with colon adenocarcinoma diagnosed from 2012 to 2016 were identified using the Surveillance, Epidemiology and End Results database. Associations between race and clinical characteristics were assessed using Chi square tests. The likelihood of receiving treatment based on race was assessed using logistic regression. Results: Of 18,841 patients, 69.7% were White, 10.2% Black, 8.7% Hispanic and 11.4% Asian. Among patients with early-stage disease (stage I or II), 96.1% of Whites, 94.6% of Blacks, 95.6% of Hispanics and 97.7% of Asians underwent surgery (p = 0.01), while 8.9% of Whites, 9.3% of Blacks, 12.4% of Hispanics and 8.9% of Asians received chemotherapy (p = 0.03). For years 2012 to 2016 collectively, Blacks with early-stage disease were less likely than Whites to undergo any surgery (aOR = 0.54; 95% CI: 0.36 – 0.81) and more likely to receive neither surgery nor chemotherapy (aOR = 1.91; 95% CI: 1.25 – 2.93). However, when assessing each year individually, the most recent years revealed no difference in the likelihood of receiving surgery in (aOR = 0.45; 95% CI: 0.16 – 1.29 in 2016) or receiving neither surgery nor chemotherapy (aOR = 2.17; 95% CI: 0.70 – 6.70 in 2016). Conclusion: Racial disparities in the treatment of colon adenocarcinoma have improved in recent years. Health care providers must continue to provide equitable, evidence-based care to ensure that treatment disparities are eliminated.

Background: Pulmonary neuroendocrine tumors, including small cell lung cancer (SCLC) and non-small cell neuroendocrine tumor (NSCLC-NET), have obvious heterogeneity. The comparison between SCLC and NSCLC-NET, and prognostic nomogram of resected NSCLC-NET have not been performed. Methods: We retrieved data from SEER database. The incidence and prognostic factors were compared between SCLC and NSCLC-NET. By Cox regression, we constructed prognostic nomogram of resected NSCLC-NET. The nomogram was evaluated by ROC, calibration plot and decision curve analysis (DCA) and compared with 8th TNM staging system. A Chinese cohort was used for external validation. Results: The age-adjusted incidence of SCLC declined after 1991 but the incidence of NSCLC-NET continuously rose. Patients with typical carcinoid had the best prognosis in both overall survival and lung cancer specific survival, followed by atypical carcinoid, large cell neuroendocrine tumor and SCLC after operation. Patients receiving sleeve resection in NSCLC-NET had longer survival but segmental resection was more recommended in SCLC. High-smoking index was associated with worse overall survival in both SCLC and NSCLC-NET. Histological subtype, age, surgery type, N, M stage and chemotherapy were independent prognostic factors and used to construct prognostic nomogram of resected NSCLC-NET. The nomogram performed well with good discrimination, calibration and clinical usefulness, which was validated by a Chinese cohort (1, 3, 5-year AUC: SEER cohort 0.873, 0.901, 0.875; Chinese cohort 0.867, 0.892, 0.874). Compared to the 8th staging system, the nomogram had higher C-index (0.87 vs 0.728, P

Background: Merkel cell carcinoma of lower limb and hip skin is a rare skin tumor that has a high recurrence rate. Objective: To assess epidemiology and survival outcomes of the lower limb and hip Merkel cell carcinoma, which are less addressed in the literature. Methods: The Surveillance, Epidemiology, and End Results database was searched for all cases of skin Merkel cell carcinoma between 2000 and 2018. Demographic and clinicopathologic features were compared between lower limb and other skin localizations using the t test or χ2 test. The overall survival (OS) of lower limb Merkel cell carcinoma was calculated using the Kaplan-Meier method. Subgroups were compared using the log rank test. Multivariate cox regression was used to identify independent prognostic factors. Results: In total, 976 patients were identified. The mean age was 72.7 years. The median OS was 68 months, better than that of other localizations. Older age, regional lymph node, and distant metastasis were associated with low OS. Surgery with >1-cm margins, when associated with radiotherapy, had the best OS. Age, tumor size, lymph node status, presence of metastasis, and treatment sequence were identified as independent prognostic factors. Conclusion: Lower limb and hip Merkel cell carcinomas have better OS than tumors in other skin localizations. In this dataset, the best OS was ensured using surgery with >1-cm margins and adjuvant radiotherapy.

Objective: To investigate the risk of occurrence of second primary malignancies (SPMs) in survivors of ovarian cancer (OC) using large data from the Surveillance, Epidemiology, and End Results (SEER) database. Materials and methods: Multiple primaries standardized incidence ratios (MP-SIRs) to calculate the risk of developing second primary malignancies after a diagnosis of ovarian cancer. Results: Of our included 59,880 women with OC, 3972 cases (6.6%) developed 4495 s primary malignancies over an average follow-up period of 114.39 (±102.66) months. Overall, the risk of occurrence of second primary malignancies after a diagnosis of OC was greater than what would be expected for a reference US population (SIR = 1.05, 95%CI = 1.02–1.08, p-value < 0.05). The occurrence of second myeloid malignancies and second thyroid cancer were most notable across our latency periods. Among the most significant second primary malignancies by latency were malignancies of the appendix (SIR = 14.04, 95%CI = 5.65–28.93, p-value

Background: The prognosis of gallbladder cancer (GBC) is dismal. This study aimed to compare the outcomes of adjuvant chemoradiotherapy (ACR) with those of surgery alone (S) and adjuvant chemotherapy (AC). Method: The Surveillance, Epidemiology, and End Results (SEER) Program database was used to identify patients diagnosed with GBC and undergoing surgery between 2004 and 2015. The patients were divided into the S, AC, and ACR groups according to their treatment. Categorical variables were compared by Pearson’s chi-square test, and a 1:1:1 propensity score matching analysis (PSM) was performed. Overall survival was assessed by Kaplan-Meier curves with log-rank tests. Subgroup analyses were conducted. Result: A total of 5451 patients were identified in the SEER database. After PSM, the two-year survival among patients who received S, AC, and ACR was 36%, 39%, and 45%, respectively. ACR was associated with improved two-year survival (p 0.05), ACR was associated with significantly improved two-year survival in stage Ⅲa (p = 0.008), Ⅲb (p

Background: Thyroid cancer (TC) accounts for more than 90% of endocrine tumours and is a typical head and neck tumour in adults. The aim of this study was to develop a predictive tool to predict cancer-specific survival (CSS) in middle-aged patients with papillary thyroid carcinoma (PTC). Methods: The patients from 2004 to 2015 were randomly divided into a training cohort (n = 25,342) and a internal validation cohort (n = 10,725). The patients from 2016 to 2018 were treated as an external validation cohort (n = 11353). COX proportional hazard model was used to screen meaningful independent risk factors. These factors were constructed into a nomogram to predict CSS in middle-aged patients with PTC. The performance and accuracy of the nomogram were then evaluated using the concordance index (C-index), calibration curve and the area under the curve (AUC). The clinical value of nomogram was evaluated by decision curve analysis (DCA). Results: Age, gender, marriage, tumour grade, T stage, N stage, M stage, surgery, chemotherapy, and tumour size were independent prognostic factors. The C-indexes of the training, internal validation, and external validation cohorts were 0.906, 0.887, and 0.962, respectively. The AUC and calibration curves show good accuracy. DCA shows that the clinical value of the nomogram is higher than that of Tumour, Node and Metastasis (TNM) staging. Conclusion: We developed a new prediction tool to predict CSS in middle-aged patients with PTC. The model has good performance after internal and external validation, which can be friendly to help doctors and patients predict CSS.

Background: Cancer-specific survival in older patients with gastric cancer is competitively affected by death from other causes. This study aimed to investigate cancer-specific survival and associated risk factors by competing-risk analysis in older patients with gastric cancer., Methods: The data of this study are from the SEER database, using univariable and multivariable analysis of competitive risk model to weaken the impact of competitive events, explore the risk factors of cancer-specific survival, and developed a nomogram model. Then, the performance of the model is verified by C-index, ROC curve, calibration curve and DCA, and the new model is compared with the traditional TNM stage by NRI and IDI., Results: Our study encompassed a total of 8183 patients, with 5731 in the training cohort and 2452 in the validation cohort. Univariable and multivariable analysis showed that age, years of diagnosis, race, site, SEER stage, TNM stage, surgery, radiation or chemotherapy, LNE, tumor grade and size are independent risk factors for cancer-specific survival in older patients with gastric cancer. Based on the risk factors, we developed a diagram model to predict cancer-specific survival. C-index, ROC curve, calibration curve and DCA also show good results. We compared the new model with the traditional TNM stage model, and the NRI and IDI showed the new model has been significantly improved., Conclusion: This study developed a nomogram to predict the cancer-specific survival of older patients with gastric cancer, which can accurately predict the prognosis and contribute to clinical treatment decision-making., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In lower extremity sarcoma treatment, limb salvage approaches present superior alternatives to amputation due to reduced postoperative morbidity and improved quality of life. This study provides a novel analysis of socioeconomic disparities that may affect reception of limb-sparing surgery., Methods: Patients with lower extremity bone or soft tissue sarcoma who received either limb-sparing surgery or amputation from 2007 to 2021 were identified in the Surveillance, Epidemiology and End Results (SEER) database. Demographic, socioeconomic, and oncologic variables were collected for each patient. Multivariate binary logistic regression was conducted to assess preoperative demographic and oncologic risk factors for amputation (p < 0.05)., Results: A total of 6465 patients were identified in the final cohort, 586 (9.1%) of whom received amputation. After controlling for tumor size, stage, and neoadjuvant therapy administration, non-Hispanic American Indian/Alaskan Native race/ethnicity predicted the highest odds of amputation (OR: 1.78, 95% CI: 1.12-2.85, p = 0.015). Nonmetropolitan residence (OR: 1.69, 95% CI: 1.43-2.00, p < 0.001) also conferred higher risk of amputation compared with residence in a large metropolitan area. Overall, amputation was associated with a higher risk of ten-year cancer-specific mortality (p < 0.001) even when controlled by sociodemographic and clinical characteristics., Conclusions: There are significant disparities in limb-sparing surgery and amputation rates in lower extremity sarcoma management, even when accounting for differences in baseline oncologic characteristics. Further study into socioeconomic drivers of these trends will allow the development of initiatives that improve disparities in reconstructive outcomes., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: This retrospective study aims to provide a comprehensive analysis of the demographics, survival rates, and therapeutic approaches of small-cell neuroendocrine carcinoma (SCNEC) and large-cell neuroendocrine carcinoma (LCNEC) while highlighting key differences compared to common urinary bladder cancers., Methods: Our analysis utilized the Surveillance, Epidemiology, and End Results database (SEER), and data was collected from 2000-2020., Results: A total of 1040 cases of urinary bladder SCNEC and LCNEC were identified. Most patients were over the age of 80 years (33.2%), male (78.9%), and Caucasian (83.6%). Most tumors were over 4.1cm (47.4%) and in the lateral wall of the bladder (37.8%). The overall 5-year survival was 22.1% (95% confidence interval (95% CI):20.7-23.5). The 5-year survival by sex was greatest for the female population (28.0%; (95% CI: 24.5-35.0). For treatment modality, the 5-year survival for each was as follows: surgery, 12.5% (95% CI: 10.5-14.5) multimodality therapy (surgery and chemotherapy), 31.1% (95% CI: 28.5-33.7) and combination (surgery, chemotherapy, and radiation) 32.8% (95% CI: 29.1-36.5). On multivariable analysis, positive nodal status hazar ratio (HR)(HR3.65 [95% CI: 2.34-5.71], P < .001) was identified as a negative predictor for survival, and increasing age was nearly significant for a worse prognosis (P = .052). The prognostic nomogram that was created to predict patient survivability mirrored the findings from the statistical analysis, with a statistically significant difference found in race, treatment modality, and tumor stage., Conclusions: SCNEC and LCNEC are rare yet highly intrusive subtypes of bladder cancer that usually affect Caucasian males over the age of 80 years old. The study identifies older age and positive nodal status as adverse prognostic indicators. Our findings offer crucial insights that can inform future clinical guidelines and serve as a basis for more tailored treatment strategies for these aggressive subtypes of bladder cancer., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Follicular lymphoma is a common non-Hodgkin lymphoma that can start in a diverse array of tissues throughout the body. While the majority of patients may be able to live many years with this disease, cure remains very difficult to achieve., Objective: We sought to investigate the impact of follicular lymphoma primary disease site in early-stage disease on patient outcomes using a large national database., Methods: Baseline demographic and disease data for patients diagnosed with follicular lymphoma from 2000-2015 was identified and extracted from the NCI Surveillance, Epidemiology, and End Results (SEER) database. Primary disease sites were grouped into one of two cohorts: nodal disease (lymph nodes and spleen) and extranodal disease (everything else). Analysis was performed using summary statistics, Kaplan-Meier method, and Cox-proportional hazards models for univariate and multivariate analysis., Results: A total of 13,400 patients were included in the final analysis and the majority were non-Hispanic white (81%), with stage I (63%), and nodal FL (79%). Median overall survival for nodal disease was 15.1 years [95% CI (14.6-15.6)] while median overall survival for extranodal disease was 15.8 years [95% CI (14.9-16.3)]. Overall survival was slightly better for patients with extranodal disease [HR = 0.89, 95% CI (0.84-0.96); p-value = 0.00012]. This finding remained consistent after controlling for age and race [HR = 0.84, 95% CI (0.79-0.90); p-value <0.0001]., Conclusions: The primary site of involvement by early-stage follicular lymphoma may have an impact on patient outcomes and warrants further investigation., Competing Interests: Disclosure The authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The incidence rate of primary intramedullary spinal cord astrocytoma (IMSCA) is approximately 0.047 per 100,000 individuals per year, making it the second most common type of intramedullary spinal cord tumor. Due to its rarity, there is a scarcity of related research, and prognostic factors remain unclear. The aim of this study is to identify risk factors affecting the prognosis of patients with primary IMSCA. Based on these factors, we aim to develop and visualize a prognostic model for predicting the overall survival time of patients with this condition, thereby facilitating individualized predictions of overall survival time for patients with primary IMSCA., Methods: This study selected patients diagnosed with primary IMSCA between 1975 and 2016 from the United States Surveillance, Epidemiology, and End Results database, incorporating a total of 582 eligible patients. We employed the Kaplan-Meier method for survival analysis of various factors to preliminary screen for potential prognostic influences. Univariate and multivariate Cox regression analyses were utilized to identify independent risk factors. A multivariate Cox regression model was constructed, and the model was visualized using a nomogram. Finally, various methods were applied to validate and evaluate the model., Results: Multivariate Cox analysis revealed that tumor grade, age, and surgical approach are independent prognostic factors for overall survival. A multivariate Cox regression model and a nomogram were developed based on these factors. The overall C-index of the model was 0.764, indicating good discriminative ability. Time-dependent receiver operating characteristic curve analysis showed the model had a good distinction with a 1-year survival rate area under the curve (AUC) of 0.801 (95% confidence interval [CI]: 0.763-0.839), a 3-year survival rate AUC of 0.842 (95% CI: 0.809-0.874), and a 10-year survival rate AUC of 0.855 (95% CI: 0.821-0.888). Calibration plots also demonstrated good model calibration. Decision curve analysis indicated that the nomogram had good clinical utility in predicting 1-year, 3-year, and 10-year overall survival. Internal validation based on enhanced bootstrap resampling showed good consistency between nomogram predictions and actual observations., Conclusions: Lower World Health Organization's tumor grade, younger age groups, and undergoing gross total resection surgery are significant protective factors affecting the prognosis of patients with primary IMSCA. Among patients with Grade II astrocytoma, being female appears to be a protective factor, whereas being male seems to be a protective factor in Grade III astrocytoma. Radiation therapy and chemotherapy do not appear to improve long-term survival; specifically, radiation therapy may lead to worse outcomes for low-grade spinal cord astrocytomas. The study found no impact of tumor size, year of diagnosis, race, or marital status on prognosis. We have developed the first model and nomogram to predict the prognosis of patients with primary IMSCA, which demonstrates good predictive ability. The nomogram performed well in internal validation, offering a tool to help clinicians predict the overall survival time of patients with primary IMSCA on an individual basis., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The role of primary tumor ablation (pTA) in metastatic renal cell carcinoma (mRCC) is unknown. We compared pTA-treated mRCC patients to patients who underwent no local treatment (NLT), as well as patients who underwent cytoreductive nephrectomy (CN)., Methods: Within the Surveillance, Epidemiology, and End Results database (SEER, 2004-2020), we identified mRCC patients who underwent either pTA, NLT or CN. Endpoints consisted of overall survival (OM) and other-cause mortality (OCM). Propensity score 1:1 matching (PSM), multivariable cox regression models (OM), as well as, multivariable competing risk regressions (CRR) models (OCM) were used., Results: We identified 27,087 mRCC patients, of whom 82 (0.3%) underwent pTA, 17,266 (64%) NLT and 9,739 (36%) CN. In comparisons of pTA vs. NLT mRCC patients addressing OM, after 1:1 PSM, median survival was 19 months for pTA vs. 4 months for NLT patients (multivariable HR 0.3, 95% CI 0.22-0.47, P < 0.001). No statistically significant OCM differences were recorded in multivariable CRR (HR 1.13 95%, CI 0.52-2.44, P = 0.8). In comparisons of pTA vs. CN, after 1:1 PSM, no statistically significant differences in OM (HR 1.22, 95% CI 0.81-1.83, P = 0.32), as well as OCM (HR 1.4, 95% CI 0.56-3.48, P = 0.5) were recorded., Conclusion: In mRCC patients, pTA is associated with significantly lower mortality compared to NLT. Interestingly, OM rates between pTA and CN mRCC patients do not exhibit statistically significant differences. This preliminary report may suggest that pTA may provide a comparable survival benefit to CN in highly selected mRCC patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Breast cancer brain metastasis (BCBM) prognosis has not been evaluated dynamically, which may underestimate patient survival. This study aimed to perform a conditional survival (CS) analysis and develop and validate an individualized real-time prognostic monitoring model for survivors., Methods: The study included patients with BCBM from the Surveillance, Epidemiology, and End Results database (training group, n = 998) and our institution (validation group, n = 45) and updated patient overall survival (OS) over time using the CS method: CS(t2|t1)=OS(t1+t2)OS(t1). Multivariate Cox regression was used to identify prognostic factors for the nomogram, which estimated individualized OS. Furthermore, a novel CS-nomogram and its web version were further developed based on the CS formula., Results: CS analysis showed that the 5-year OS of BCBM survivors gradually improved from 13.5% estimated at diagnosis to 26.0%, 39.7%, 57.9%, and 77.6% (surviving 1-4 years, respectively). Cox regression identified age, marital status, estrogen receptor status, human epidermal growth factor receptor 2 (Her-2) status, histological grade, surgery, and chemotherapy as significant factors influencing OS (P < .05). We then constructed and deployed the CS-nomogram based on the CS formula and the nomogram to predict real-time prognosis dynamically (https://wh-wang.shinyapps.io/BCBM/). During performance evaluation, the model performed well in both the training and validation groups., Conclusions: CS analysis showed a gradual improvement in prognosis over time for BCBM survivors. We developed and deployed on the web a novel real-time dynamic prognostic monitoring system, the CS-nomogram, which provided valuable survival data for clinical decision-making, patient counseling, and optimal allocation of healthcare resources., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To test the association between number as well as locations of organ-specific metastatic sites and overall survival (OS) in systhemic-therapy exposed metastatic urothelial carcinoma of urinary bladder (mUCUB) patients., Methods: Within Surveillance, Epidemiology and End Results database (2010-2020), all systhemic therapy-exposed mUCUB patients were identified. Kaplan-Meier and multivariable Cox regression (CRM) models first addressed OS in patients according to number of metastatic organ-locations: solitary versus 2 versus 3 or more. Subsequently, separate analyses stratified according to location type were completed in patients with solitary metastatic organ-location as well as in patients with 2 metastatic organ-locations., Results: Of 1,310 mUCUB, 1,069 (82%) harbored solitary metastatic organ-location versus 193 (15%) harbored 2 separate metastatic organ-locations versus 48 (3%) harbored 3 or more metastatic organ-locations. Median OS decreased with increasing number of metastatic organ-locations (solitary vs. 2 vs. 3 or more, P < .0001). In multivariable CRM, relative to solitary metastatic organ-location, 2 (HR: 1.57, 95 Confidence interval [CI], 1.33-1.85) as well as 3 or more (HR: 1.69, 95% CI, 1.23-2.31) metastatic organ-locations independently predicted higher overall mortality (OM) (P = .001). In patients with solitary metastatic organ-location, brain metastases independently predicted higher OM (HR 1.67; 95% CI, 1.05-2.67; P = .03) than other locations. In patients with 2 metastatic organ-locations, no differences in OM were recorded according to organ type location., Conclusion: In systemic therapy exposed mUCUB, number of metastatic organ-locations (solitary vs. 2 vs. 3 or more), independently predicted increasingly worse prognosis. In patients with solitary metastatic organ-location, brain purported worse prognosis than others., Competing Interests: Disclosure The authors declare no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: We investigated regional differences in patients with stage III nonseminoma germ cell tumor (NSGCT). Specifically, we investigated differences in baseline patient, tumor characteristics and treatment characteristics, as well as cancer-specific mortality (CSM) across different regions of the United States., Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2004-2018), patient (age, race/ethnicity), tumor (International Germ Cell Cancer Collaborative Group [IGCCCG] prognostic groups) and treatment (systemic therapy and retroperitoneal lymph dissection [RPLND] status) characteristics were tabulated for stage III NSGCT patients, according to 12 SEER registries representing different geographic regions. Multinomial regression models and multivariable Cox regression models testing for cancer-specific mortality (CSM) were used., Results: In 3,174 stage III NSGCT patients, registry-specific patient counts ranged from 51 (1.5%) to 1630 (51.3%). Differences across registries existed for age (12%-31% for age 40+), race/ethnicity (5%-73% for others than non-Hispanic whites), IGCCCG prognostic groups (24%-43% vs. 14-24% vs. 3%-20%, in respectively poor vs. intermediate vs. good prognosis), systemic therapy (87%-96%) and RPLND status (12%-35%). After adjustment, clinically meaningful inter-registry differences remained for systemic therapy (84%-97%) and RPLND (11%-32%). Unadjusted 5-year CSM rates ranged from 7.1% to 23.3%. Finally in multivariable analyses addressing CSM, 2 registries exhibited more favorable outcomes than SEER registry of reference (SEER Registry 12): SEER Registry 4 (Hazard Ratio (HR): 0.36) and SEER Registry 9 (HR: 0.64; both P = .004)., Conclusion: We identified important regional differences in patient, tumor and treatment characteristics, as well as CSM which may be indicative of regional differences in quality of care or expertise in stage III NGSCT management., Competing Interests: Disclosures The authors declare that they have no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Using a multi-institutional oncology database, we investigate the survival rates and the impacts of demographic, clinical, and management characteristics on overall survival among adult patients diagnosed with spinal ependymoma., Methods: Utilizing the SEER registry, patients with histologically or radiologically confirmed ependymomas were included. Factors impacting overall survival were analyzed using Kaplan-Meier survival curves and log-rank statistical analyses., Results: A total of 1,580 patients were included. Their mean ± standard deviation age was 46.68 ± 15.96 years, and 51.1% were women. Gross total resection (GTR) was achieved in 66.4% of patients. The 5- and 10-year survival rates were 96.7% and 95.4%, respectively. A multivariable backward Cox regression showed that age ≥65 years was a significant predictor for mortality (hazard ratio [HR]: 3.93; 95% confidence interval [CI]: 2.21-7.00; P < 0.001). Likewise, tumor grade 3 (HR: 6.36; 95% CI: 1.95-20.76; P = 0.002), tumor grade 4 (HR: 7.74; 95% CI: 3.97-15.11; P < 0.001), presence of extra-neural metastasis (HR: 13.81; 95% CI: 3.67-51.96; P < 0.001), and receiving radiotherapy (HR: 2.50; 95% CI: 1.50-4.19; P < 0.001) were significant risk factors for mortality, while GTR was significantly associated with improved overall survival compared with subtotal resection or nonsurgical management (HR: 0.42; 95% CI: 0.25-0.73; P = 0.002). There were no significant effects for gender, race, marital status, income, residential area, chemotherapy, tumor size, and the presence of other benign or malignant tumors on the survival hazards (P > 0.05 for each)., Conclusion: Early diagnosis and surgical management of spinal ependymomas, such as GTR, were associated with remarkable survival benefits. Old age, high-grade spinal ependymoma, and extra-neural metastasis were associated with worse overall survival, whereas radiotherapy's role remains unclear., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The advent of immune checkpoint inhibitors (ICI) has brought about a significant transformation in the treatment of immunogenic tumors. On November 23, 2015, the United States Food and Drug Administration approved Nivolumab to treat metastatic renal cell carcinoma (RCC). We aimed to assess potential changes in the survival rates of patients with metastatic RCC at a population level after the approval of Nivolumab., Methods: We used data from the latest version of the Surveillance, Epidemiology, and End Results (SEER) database which encompasses data up to the year 2020. We included patients with age ≥ 20 years who were diagnosed with 'distant' RCC from 2011 through 2020. Based on the approval of Nivolumab, the period from 2011 to 2020 was further grouped into 2011-2015 (pre-ICI era) and 2016-2020 (ICI era)., Results: The median overall survival (OS) was 8 months in the pre-ICI era compared to 11 months in the ICI era (log-rank test, χ2 = 102.53, p < 0.001). Patients diagnosed with metastatic RCC in the ICI era had a significantly lower risk of dying [Cox proportional Hazard Ratio of 0.77, 95 % CI (0.74-0.80)] compared to patients diagnosed in the pre-ICI era. Additionally, patients under the age of 75 had a lower risk of death compared to those aged 75 years or older. Patients who received chemotherapy (systemic therapy), radiotherapy, or surgery faced a significantly lower risk of mortality. Individuals with metastasis to the brain, bone, liver, or lung had a significantly higher risk of death than those without metastasis to these locations. Marital status also played a role, as married individuals had a significantly lower risk of death compared to those who were divorced, separated, or widowed at the time of diagnosis. Furthermore, income level influenced survival, with patients earning a median annual household income of more than USD 75,000 exhibiting a significantly lower risk of mortality compared to those earning between USD 50,000 and USD 74,000. There was no significant difference in survival observed between non-Hispanic blacks and non-Hispanic whites., Conclusion: The advent of immune checkpoint inhibitors has led to a substantial improvement in the median overall survival of individuals diagnosed with metastatic renal cell carcinoma., Competing Interests: Declaration of Competing Interest The authors report no potential conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)