Mukherjee, Sarbajit

Gastric cancer is the fifth leading cause of cancer-related deaths worldwide. Over 95% of gastric cancers are adenocarcinomas, which are typically classified based on anatomic location and histologic type. Gastric cancer generally carries a poor prognosis because it is often diagnosed at an advanced stage. Systemic therapy can provide palliation, improve survival, and enhance the quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing has had a significant impact on clinical practice and patient care. Targeted therapies have demonstrated encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. This selection from the NCCN Clinical Practice Guidelines in Oncology for Gastric Cancer highlights recommendations for biomarker testing and discusses updates for the treatment of advanced disease, including peritoneal carcinoma as only disease and unresectable locally advanced, recurrent, or metastatic disease.

Cancers originating in the esophagus or esophagogastric junction constitute a major global health problem. Esophageal cancers are histologically classified as squamous cell carcinoma (SCC) or adenocarcinoma, which differ in their etiology, pathology, tumor location, therapeutics, and prognosis. In contrast to esophageal adenocarcinoma, which usually affects the lower esophagus, esophageal SCC is more likely to localize at or higher than the tracheal bifurcation. Systemic therapy can provide palliation, improved survival, and enhanced quality of life in patients with locally advanced or metastatic disease. The implementation of biomarker testing, especially analysis of HER2 status, microsatellite instability status, and the expression of programmed death-ligand 1, has had a significant impact on clinical practice and patient care. Targeted therapies including trastuzumab, nivolumab, ipilimumab, and pembrolizumab have produced encouraging results in clinical trials for the treatment of patients with locally advanced or metastatic disease. Palliative management, which may include systemic therapy, chemoradiation, and/or best supportive care, is recommended for all patients with unresectable or metastatic cancer. Multidisciplinary team management is essential for all patients with locally advanced esophageal or esophagogastric junction cancers. This selection from the NCCN Guidelines for Esophageal and Esophagogastric Junction Cancers focuses on the management of recurrent or metastatic disease.

Background: The incidence and prevalence of neuroendocrine neoplasms (NENs) are rapidly rising. Epidemiologic trends have been reported for common NENs, but specific data for lung NENs are lacking. Methods: We conducted a retrospective analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) database. Associated population data were utilized to report the annual age-adjusted incidence and overall survival (OS) trends. Trends for large-cell neuroendocrine carcinoma (LCNEC) and atypical carcinoid (AC) were reported from 2000–2015, while those for typical carcinoid (TC) and small cell lung cancer (SCLC) were reported from 1988–2015. Results: We examined a total of 124,969 lung NENs [103,890—SCLC; 3303—LCNEC; 8146—TC; 656—AC; 8974—Other]. The age-adjusted incidence rate revealed a decline in SCLC from 8.6 in 1988 to 5.3 in 2015 per 100,000; while other NENs showed an increase: TC increased from 0.57 in 1988 to 0.77 in 2015, AC increased from 0.17 in 2001 to 0.22 in 2015, and LCNEC increased from 0.16 in 2000 to 0.41 in 2015. The 5-year OS rate among SCLC, LCNEC, AC, and TC patients was 5%, 17%, 64%, and 84%, respectively. On multivariable analyses, OS and disease-specific survival (DSS) varied significantly by stage, sex, histological type, insurance type, marital status, and race, with a better survival noted in earlier stages, females, married, insured, Hispanic and other races, and urban population. Similarly, TC and AC had better survival compared to SCLC and LCNEC. Conclusion: The incidence of lung NENs is rising, possibly in part because of advanced radiological techniques. However, the incidence of SCLCs is waning, likely because of declining smoking habits. Such population-based studies are essential for resource allocation and to prioritize future research directions.

Abstract Background: Gastric cancer is one of the leading causes of cancer-related mortality worldwide, with a global burden of 5.7% new cases each year and 8.2% of cancer-related deaths. Area of residence has been found to affect survival in different cancers but their impact on gastric cancer remains largely unknown. The purpose of this study is to address the potential disparities between the rural and urban populations affected specifically by gastric adenocarcinoma. Methods: We conducted a retrospective study, analyzing different socio-economic factors associated with populations affected by gastric adenocarcinoma between 2004 and 2013. Data was obtained from the National Cancer Database (NCDB). Univariate and multivariable analyses were performed to evaluate overall survival (OS). Different socio-demographic factors, location of residence were included, urban area (UA) or rural area (RA), gender, race, insurance status and marital status were included in the analyses. Results: A total of 88,246 [RA, N=12,365; UA, N=75,881] patients were included in the study. Majority of the study population was white (N = 67,792, 77%) and male (N = 59,574, 68%). Univariate and multivariable analysis showed that RA had the worst OS (univariate - HR=1.08, p<0.001; multivariate HR=1.04; p<0.001) compared to UA. When comparing different racial backgrounds, univariate and multivariable analysis showed Native American and African American population had poor OS when compared to the white population, however, Asian patients tend to have better OS (univariate HR=0.66, multivariable HR=0.68, p<0.01). From quality of care standpoint, UA patients median days to undergo surgery (28 vs. 33; p<0.01) post diagnosis was significantly sooner, with significantly fewer positive margins (6.3% vs. 6.9%; p<0.01) when compared to RA patients. Though, there is no minimum number of lymph nodes examined during resection, but total of 15 or above is an accepted practice. When comparing the lymph node dissection, 19.6% UA patients underwent more than or equal to 15 lymph nodes dissection in comparison to 18.7% patients in RA (p=0.03). Discussion: This study identifies socio-demographic disparities in gastric adenocarcinoma. Access to healthcare, variations in patient care, environmental and lifestyle factors as well as genomic differences are all potential factors that affect the OS. This is consistent with the available literature in gastric cancer, including studies demonstrating survival differences in different populations undergoing surgical treatment in the United States. Based on the above data, it is imperative for future health policy initiatives to address these disparities in an effort to improve OS. Citation Format: Rohit Gosain, Navpreet Rana, Riccardo Lemini, Chong Wang, Sarbajit Mukherjee. Sociodemographic disparities in gastric adenocarcinoma: A population-based study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A054.

e19120 Background: The incidence and prevalence of Neuroendocrine Neoplasms (NENs) are rapidly rising. Epidemiologic trends have been reported for common NENs, but specific data for lung NENs has been lacking. Methods: We conducted a retrospective population-based analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) database, and studied lung NENs patients from 1988 to 2015. Associated population data was utilized to report the annual age-adjusted incidence and overall survival trends. Trends in the incidence and survival of large-cell lung cancer (LCLC) and atypical carcinoid (AC) were reported from 2000-2015, while that for typical carcinoid (TC) and small cell lung cancer (SCLC) were reported from 1988-2015. Results: We examined a total of 115,995 lung NENs [103,980 – SCLC; 3,303 – LCLC; 8,146 – TC; 656 – AC]. The age-adjusted incidence rate revealed decline in SCLC from 8.6 in 1988 to 5.3 in 2015 per 100,000; while other NENs showed an increase: TC increased from 0.57 in 1988 to 0.77 in 2015 per 100,000, AC increased from 0.17 in 2001 to 0.22 in 2015 per 100,000, and lastly, LCLC increased from 0.35 in 2001 to 0.41 in 2015 per 100,000. On multivariable analyses, the median overall survival (OS) and disease-specific survival (DSS) rate varied significantly by stage, grade, age at diagnosis, histological type, insurance type, marital status, and race. The 5-year OS rate among SCLC and LCLC patients was 5% and 17%, respectively, consistent with their high-grade nature. On the other hand, TC and AC, representing low-grade neuroendocrine tumors, had good 5-year OS: 84% and 64%, respectively. Conclusions: The incidence of lung NENs is rising, possibly because of advanced radiological techniques. However, we have seen a downtrend in the incidence of SCLCs likely because of declining smoking habits. Such population-based studies are essential for resource allocation and to prioritize future research directions.

Background: Gastric cancer is one of the leading causes of cancer-related mortality worldwide, accounting for 8.2% of cancer-related deaths. The purpose of this study was to investigate the geographic and sociodemographic disparities in gastric adenocarcinoma patients. Methods: We conducted a retrospective study in gastric adenocarcinoma patients between 2004 and 2013. Data were obtained from the National Cancer Data Base (NCDB). Univariate and multivariable analyses were performed to evaluate overall survival (OS). Socio-demographic factors, including the location of residence [metro area (MA) or rural area (RA)], gender, race, insurance status, and marital status, were analyzed. Results: A total of 88,246 [RA, N = 12,365; MA, N = 75,881] patients were included. Univariate and multivariable analysis showed that RA had worse OS (univariate HR = 1.08, p < 0.01; multivariate HR = 1.04; p < 0.01) compared to MA. When comparing different racial backgrounds, Native American and African American populations had poorer OS when compared to the white population; however, Asian patients had a better OS (multivariable HR = 0.68, p < 0.01). From a quality of care standpoint, MA patients had fewer median days to surgery (28 vs. 33; p < 0.01) with fewer positive margins (6.3% vs. 6.9%; p < 0.01) when compared to RA patients. When comparing the extent of lymph node dissection, 19.6% of MA patients underwent an extensive dissection (more than or equal to 15 lymph nodes) in comparison to 18.7% patients in RA (p = 0.03). Discussion: This study identifies socio-demographic disparities in gastric adenocarcinoma. Future health policy initiatives should focus on equitable allocation of resources to improve the outcomes.

INTRODUCTION: Gastric cancer is one of the leading causes of cancer-related mortality worldwide, with a global burden of 5.7% new cases each year and 8.2% of cancer-related deaths. Area of residence has been found to affect survival in different cancers but their impact on gastric cancer remains largely unknown. The purpose of this study is to address the potential disparities between the rural and urban populations affected by gastric cancer. METHODS: We conducted a retrospective study, analyzing different socio-demographic factors associated with populations affected by gastric cancer between 1973 and 2015. Data was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses were performed to evaluate disease-specific survival (DSS) and overall survival (OS). Different socio-demographic factors including location of residence, that is urban area (UA) or rural area (RA), gender, race, insurance status and marital status were included in the analyses. RESULTS: A total of 68,959 [RA, N = 6,841; UA, N = 60,282] patients were included in the study. The incidence of gastric cancer was noted to have a steady decline during the studied time period, in both RA and UA. Majority of the study population was non-Hispanic white (N = 42,806, 62%) and male (N = 46,504, 67%). Univariate and multivariate analysis showed that RA had the worst DSS (univariate - HR = 1.15, P < 0.001; multivariate - HR = 1.13, P < 0.001) and OS (univariate - HR = 1.13, P < 0.001; multivariate HR = 1.11; P < 0.001) compared to UA. Similarly, DSS and OS was poor in uninsured and single patient population compared to insured patients and married couples respectively. Multivariate analysis further showed female patients had better DSS (HR = 0.91, P < 0.001) and OS (HR = 0.88, P < 0.001) in comparison to their male counterparts. CONCLUSION: This study identifies socio-demographic disparities in gastric cancer. Access to healthcare, variations in patient care, environmental and lifestyle factors as well as genomic differences are all potential factors that affect the OS. This is consistent with the available literature in gastric cancer, including studies demonstrating survival differences in different populations undergoing surgical treatment in the United States. Based on the above data, it is imperative for future health policy initiatives to address these disparities in an effort to improve OS.