Anteneh A. Tesfaye

Comparision of survival rates of patients (pts) with localized prostate cancer (T1-2N0M0) treated with brachytherapy (BT) and external beam radiation therapy (EBRT): Surveillance Epidemiology and End Results (SEER) database review.

124 Background: Unlike in localized prostate cancer with low recurrence risk features, the role of BT in localized prostate cancer with intermediate and high risk features is not well defined. The aim of this study is to compare the survival rates of such pts treated with BT & EBRT using the SEER database in the 3 different risk levels. METHODS The 1973-2009 SEER database was reviewed for men with T1-2N0M0 prostate cancer treated with radiation therapy alone between 2004-2009. Pts with additional malignancies and combination radiation therapy were excluded. Localized Prostate cancer was stratified into low (T1, T2a and PSA<10 and Gleason ≤6), intermediate (T2b or PSA=10-20 or Gleason =7) and high (T2c or PSA >20 or Gleason ≥8) risk for recurrence. RESULTS A total of 73,867 pts were retrieved from the database, of which 24,661 (33.4%) were treated with BT and 49,206 (66.6%) with EBRT. Pts treated with BT had younger median age, lower PSA, Gleasons score, and T staging than EBRT. Five year overall survival (OS) and cancer specific survival (CSS) rates are shown in the table. On multivariate analyses, T staging, PSA level, Gleasons score and type of radiation therapy were independent prognostic factors for 5 year CSS & OS. In pts with localized prostate cancer, those treated with EBRT had 47% higher odds of dying from prostate cancer compared to those treated with BT at the end of 5 years. (HR (95% CI) =1.47 (1.113-1.94); p=0.007). CONCLUSIONS In patients with localized prostate cancer treated with radiation alone, BT is seen to have superior 5 year OS over EBRT in all 3 risk levels. BT also has superior 5 year CSS in low and high risk levels, while being comparable in intermediate risk levels. Prospective randomized controlled trials are needed to validate this finding. [Table: see text].

Behavior of breast cancer in young women: A Surveillance Epidemiology and End Results (SEER) database review.

6 Background: Advanced age is a major risk factor for breast cancer in women. Small sized studies have reported variable outcome of breast cancer in young women. Our study was done to evaluate tumor characteristic and cancer specific survival among young women. METHODS The 1973-2009 SEER database was reviewed for women with breast cancer diagnosed between 2004 and 2009. Patients were grouped by age into: A (≤35 years), B (36-50 years) and C (>50 years). Age, ethnicity, staging, lymph nodes status, micrometastasis in negative lymph nodes, tumor size, tumor grade, hormone receptor status were extracted. Data and survival were analyzed using chi square, Kaplan-Meier, Life table, and Cox proportional hazard model. The primary outcome was 5-year cancer-specific survival. RESULTS A total of 248,280 patients were included in the study, group A, B and C making 2.8%, 25.5% and 71.7% of study subjects respectively. The median tumor size was 2.4, 1.9, and 1.6 cm in groups A, B and C respectively (p=0.0001). Positive lymph nodes were seen in 52.5%, 43% and 34% in groups A, B and C respectively (p=0.0001). Regional disease was seen in 47.5%, 39.5% and 29.9% in groups A, B and C respectively (p=0.0001). Higher Grade histology was seen in 63.5%, 44.3% and 33.8% in groups A, B and C respectively (p=0.0001). ER-PR negative were found in 42.1%,26.4%, 22.6% of Groups A, B and C respectively (p=0.0001). Five year cancer specific survival was 82%, 89%, 86% in groups A, B and C respectively (p=0.0001). Independent prognostic factors are given in the table. CONCLUSIONS Breast cancer is uncommon among young women (age <35). Compared to other age groups, breast cancer in young women presents with bigger tumor, higher nodal positivity, an advanced stage, higher tumor grade, higher hormone receptor negativity, and worse 5-year cancer-specific survival. [Table: see text].

Lymphopenia as a prognostic factor in renal cell carcinoma.

470 Background: Lymphopenia is known to be a negative prognostic marker for NHL and hematological malignancies, recent observational studies evaluated the presence of lymphopenia and its impact in solid tumor like colon, lung and pancreatic cancer. We aim to assess the effect of Lymphopenia at the renal cell carcinoma (RCC) survival. METHODS A retrospective review of 207 patients diagnosed with RCC between 1995 and 2008 in a community hospital setting was done. Patients with additional malignancies, lymphoma of the kidneys, with no follow up data or no preoperative complete blood count test were excluded. Demographics, preoperative complete blood count, pathology, disease stage, operative note, and subsequent follow up data were reviewed. Lymphopenia was defined as absolute lymphocytic count < 1200/µl. Last follow up date was used to calculate the 3 year overall survival. The primary outcome was 3 year overall survival. RESULTS A total of 207 patients were included in the study. Caucasians were 176(85.9%), African Americans were 13.7% and Asians were 1(0.5%). Males (M) were 127 (62.3%) and females (F) were 77(37.7%). The median age of the study population was 65 (22-91. Clear cell histology was seen in 79%. Stage I was seen in 53.9%, II in 23.5%, III in 13.7% and IV in 8.8% of the study population. Lymphopenia was seen in 81 (40%) patients (95 CI 34-48). Lymphopenia was seen in 31.8% of stage I; 50% of stage II, 41.4% of stage III, and 65% of stage IV patients (p=0.017). Lymphopenia was seen in 28.6% of African Americans and 42.7% of Caucasians (p=0.11). Lymphopenia was seen in 32.1% of females and 45.7% of males (p=0.03). The 3 year overall survival for the study population was 67.3% (95% CI: 60.4-73.7). The 3-year overall survival for patients with lymphopenia was 60.5%, compared to 73.6% in non-lymphopenic patients (p=0.04). CONCLUSIONS Lymphopenia was seen to be higher among males and Caucasians, more frequently at advanced stage at diagnosis. Patients with lymphopenia were observed to have significantly worse survival when compared to patients with normal lymphocytic count in RCC. We conclude that lymphopenia is considered as a negative prognostic factor for RCC, and needed to be studied in the correlation of other known prognostic factors.

Prognostic significance of degree of anemia in renal cell carcinoma.

469 Background: Anemia can precede the diagnosis of renal cell carcinoma (RCC). It has been well studied that it has a negative effect on the outcome of RCC. The impact of the severity of anemia on the overall all survival of patients with RCC is not well known. Our study examined the impact of severity of anemia on the overall survival of patients with RCC. METHODS We retrospectively reviewed 204 patients diagnosed with RCC between 1995 and 2008 in a community hospital setting. Patients with additional malignancies, lymphoma of the kidneys, with no follow up data or no preoperative Hemoglobin levels (Hg) measurement were excluded from the study. Demographics, preoperative complete blood count (CBC), pathology, disease stage, operative note, and subsequent follow up data were reviewed. Patients were grouped based on their preoperative Hg. Anemia was defined as Hg <12g/dl for females and <13g/dl for males. Patients were divided based on Hg to Group A (females with Hg<10 g/dl, males with Hg<11g/dl), group B (females with Hg 10-12 g/dl, males with Hg 11-13 g/dl), group C (females with Hg >12 g/dl, males with Hg >13g/dl). Last follow up date was used to calculate the 3 year overall survival for patients. The primary outcome was 3 year overall survival. RESULTS A total of 204 patients were reviewed, 127 (62.3%) were males, 176 (85.9%) were Caucasians. The median age of the study population was 65 (22-91). Clear Cell was the commonest histology (79%). Anemia was found in 90 (44.1%) patients. The median Hg was 12.8 g/dl (Range: 7.2-18.2). Anemia was present in 41.8% of females and 46.2% of males. The median Hg level for stages I, II, III, IV were (13.05, 12.45, 12.45, 11.45) respectively. The 3 year overall survival for the study population was 67.3% (95% CI: 60.4-73.7). The 3-year overall survival for anemic patients was 51.2% (95% CI: 40-61) compared to 81.6% (95% CI: 72-87) in non anemic (p<0.0001). The 3-year overall survival significantly decreased with Hg levels, as shown by the Groups A (33.3%), B (60.7%), and C (81.6%) (p<0.0001). CONCLUSIONS Our finding was consistent with other studies in portraying anemia as a negative prognostic factor in patients with renal cell carcinoma. Our study also showed that the severity of anemia corresponds to poorer overall patients survival.

Does lobular carcinoma in situ (LCIS) affect biology of future breast cancer? Surveillance Epidemiology and End Results (SEER) database review.

37 Background: Lobular carcinoma in situ (LCIS) is a recognized risk factor of breast cancer. Data evaluating the behavior of breast cancer arising after LCIS is lacking. Our study compared the characteristics of breast cancer arising after LCIS with the breast cancer arising de novo. METHODS From the 1973-2009 SEER database, women with breast cancer who were diagnosed and treated between 1990 and 2009 were abstracted. Patients were divided to group A: breast cancer after LCIS, group B: de novo breast cancer. Age, ethnicity, staging, tumor size, grade and hormone receptor status were reviewed. Data were analyzed using chi square, Kaplan-Meier, Life table, and Cox proportional hazard model. RESULTS Patients with LCIS were 7,258 with 547 (7.5%) developing breast cancer subsequently. The mean (SD) time to develop breast cancer after LCIS was 68 (2.14) months. Of the total 557,309 patients with breast cancer, group A had 547 patients and group B had 556,762 patients. The median tumor size was 1.3 and 1.8 cm in groups A and B respectively (p<0.0001). Grade 1 and 2 tumors were 78.5% and 60.8% in groups A and B respectively (p<0.0001). Local disease alone was seen in 70% and 61% of groups A and B respectively (p<0.0001). ER-PR negative tumor was seen in 14.9% and 24.5 % in groups A and B (p<0.0001). On univariate analysis, 5 year cancer specific survival was 91% and 85% in groups A and B respectively (p< 0.0001). Unlike grade, hormone receptor status and stage, prior history of LCIS was not an independent predictor of survival on multivariate analysis (see Table). CONCLUSIONS Breast cancer diagnosed after prior LCIS has favorable features like smaller tumor, lower grade, earlier stage and less ER-PR negativity. Some of these might be a result of more diligent subsequent screening. A history of LCIS per se is not an independent prognostic factor in breast cancer. [Table: see text].