Annual Meeting Proceedings Part 1 - American Society of Clinical ...

1604 General Poster Session (Board #9F), Sat, 1:15 PM-5:15 PM
Long-term survival and prognostic factors in neuroendocrine tumors:
Results from a large multicenter study. Presenting Author: Antongiulio
Faggiano, Department of Molecular and Clinical Endocrinology and Oncology,
Federico II University, Naples, Italy
Background: The clinical behavior of neuroendocrine tumors (NET) is highly
variable, but the only data available in literature on large series are mainly
based on retrospective register data collected in 3-5 decades, focusing on
short-term follow-up. These are clearly insufficient due to the frequent
evolution in classification criteria, diagnostic techniques and the scarcity of
clinical data. Methods: Data from a total of 1659 NET patient were
collected from 12 Italian referral centers. A specific software was developed
for the study. Only patients with histological diagnosis revised
according to the WHO Classification in active long term follow-up in the
period 1990-2010 were included in the study. Patients with incomplete
diagnostic work-up, without clinical data or lost at follow-up were excluded.
Cumulative survival were analyzed according to site of origin, histotype,
grading, ki67 score, secreting pattern (functioning or not functioning) and
staging. Results: At 2 yr cumulative survival do not differ between
pancreatic (pNET 94.9%), gastrointestinal (GINET 94.4%) and lung NET
(TNET 94.6%), functioning (93.5 %) and non functioning (93.9%), while
was significantly different between T1N0M0 (98%), T1N1M0 (92.9%),
T1N1M1 (90.2%) and grading (G1 98%, G2 96.8%, G3 84.1%). At 5, 10
and 15 yr, cumulative survival were respectively 90.9, 77.1, 62.7% for
pNET, 88.7, 83.5, 62.7% for GINET 90.3, 80.2, 67.9% for TNET. 88.4,
77.0, 59.0% in functioning and 89.8, 79.1, 64.6% in not functioning.
96.1, 89.5 and 77.0% for T1N0M0, 88.2, 83.5, 70.4 for T1N1M0 and
82.0, 55.8 and 43.9 for T1N1M1, 93.1, 82.3, 75.4% for G1, 87.8, 64.8,
48.6% for G2, 81.4, 75.2, 40.1% for G3. Conclusions: Brief (2y) and very
long term (15y) survival do not significantly differ between different site of
NET origin. Functioning tumors have the same survival rate at 2 y but lower
at 15 y. Staging and grading appear as the most significant prognostic
factors particularly at 10 and 15 y. Long-term cumulative survival in NET
results significantly higher than in historical series, probably due to the
anticipation of the diagnosis and the availability of new therapeutic
strategies.
1606 General Poster Session (Board #9H), Sat, 1:15 PM-5:15 PM
Breast cancer survival: Is the Asian population homogenous? Presenting
Author: Vincent Caggiano, Sutter Institute for Medical Research, Sacramento,
CA
Background: Study of the ER-/PR-/HER2- (TN) subtype has generated
interest in race/ethnicity with respect to breast cancer. Poor survival of
African-American (AA) women with breast cancer has been reported. Less
is known about the Asian population. This study examines survival of four
ER/PR/HER2 subtypes among 10 self-reported race/ethnicity categories
Methods: Using the California Cancer Registry 2000-2010, we examined
136,175 cases first primary female invasive breast cancer. For stages 1
and 2, Kaplan-Meier survival and the Log-Rank test were computed by
stage and race for the ER�/PR�/HER2-, ER-/PR-/HER2�, ER�/PR�/
HER2� (TP) and TN subtypes. Results: When the Asian population is
combined into the category Asian/Pacific Islander (API): ER�/PR�/
HER2-: AAs had worse 5-year survival than whites in stages 1 and 2 but
Hispanics and APIs had better survival in both stages; ER-/PR-/HER2�:
AAs and Hispanics were no different from whites in stage 1 but APIs had
better 5-year survival (0.96 vs 0.89, p�0.001). For stage 2, there were no
differences in survival among the races. ER�/PR�/HER2�: AAs had worse
and APIs had better survival in both stages; Hispanics had better survival
only in stage 1 (0.93 vs 0.92, p�0.03) and were no different from whites in
stage 2. ER-/PR-HER2-: AAs and Hispanics were no different from whites
in stage 1 but APIs had better survival (0.93 vs 0.88, p� .003); AAs had
worse survival than whites in stage 2 (0.71 vs 0.75, p� 0.04) Hispanics
were no different, and APIs had better survival (0.81, p � 0.001). When
the Asian population was expanded into 7 categories, Pacific Islanders and
Koreans were no different than whites in stages 1 or 2 for all four subtypes
examined. For Stage 1, Southeast Asians had better survival for all
subtypes except for the TN whereas Filipinos had better survival for all
subtypes except for TP. For the ER�/PR�/HER2- subtype, women from the
Indian Continent had better survival in stage 1 (0.98 vs 0.92, p�0.003)
and in stage 2 (0.94 vs 0.88, p�.001) and better survival for stage 1 of the
TN subtype (1.00, vs 0.88, p �0.04). Conclusions: There is heterogeneity
among the Asian population, but regardless of how categorized, Asians
have either the same or better 5-year survival than whites for all subtypes in
stages 1 and 2.
Cancer Prevention/Epidemiology
111s
1605 General Poster Session (Board #9G), Sat, 1:15 PM-5:15 PM
Survival of elderly Medicare patients after standard chemotherapy for
advanced lung and gastrointestinal cancers in the real world. Presenting
Author: Elizabeth B. Lamont, Massachusetts General Hospital Cancer
Center, Boston, MA
Background: Elderly cancer patients are under-represented on clinical trials
that determine standards of treatment, thus survival of such patients
following standard treatment in the real world is not known. We describe
unadjusted survivals for site, stage, and treatment-specific cohorts of
elderly Medicare cancer patients who were treated in usual care settings.
Methods: From SEER-Medicare data, we identified elderly Medicare patients
with advanced lung or GI cancers who received specific standard
chemotherapy regimens within six months of diagnosis. Of the 108,386
patients with the cancer sites and stages of interest, 39% (42,570/
108,386) received some form of chemotherapy within six months of
diagnosis. Only 32% (13,689/42,570) received one of the specific
standard regimens we studied. Results: Median survival times and interquartile
ranges (IQRs) varied according to cancer site, stage, and treatment. For
598 stage IV CRC patients on FOLFOX, the median survival was 19.4 mos
(IQR 9.3-43.0); this is comparable to PRIME Study patients (19.7 mos).
For 130 stage IV CRC patients on FOLFIRI, the median survival was 16.1
mos (IQR 5.6-30.0), which is lower than BICC-C Study patients (23.1
mos). For 3,815 advanced pancreatic cancer patients on gemcitabine, the
median survival was 4.3 mos (IQR 2.0-8.7), which is slightly lower than
CALGB 80303 patients (5.8 mos). For 8,040 stage IV NSC lung cancer
patients on carboplatin and paclitaxel, the median survival was 7.0 mos
(IQR 3.2-14.2); this is comparable to ECOG 1594 patients (7.8 mos). For
1,104 extensive stage SCLC patients on cisplatin and VP16, the median
survival was 8.5 mos (IQR 4.7-12.9), which is slightly lower than CALGB
9732 patients (10.0 mos). Conclusions: The observed survival of cancer
site, stage, and treatment-specific cohorts of elderly Medicare patients with
advanced lung or GI cancers who were treated in real world settings with
standard chemotherapy was, in general, similar to that of patients treated
with nominally identical regimens on trials. Further analyses should explore
the shorter survival for elderly Medicare patients with stage IV CRC treated
with FOLFIRI in the usual care setting compared to patients treated on
trials.
1607 General Poster Session (Board #10A), Sat, 1:15 PM-5:15 PM
Impact of obesity and overweight in the prognosis of women diagnosed with
non metastatic breast cancer in a Mexican cohort. Presenting Author: José
Luis Aguilar, Instituto Nacional de Cancerología, Mexico City, Mexico
Background: Mexico positions right up at the top with U.S. in worldwide
rankings of the most obese countries. In addition, breast cancer (BrCa) is
the main type of cancer among women in this country. Studies have shown
inconsistent results regarding obesity as a prognostic factor for worse
outcome. Methods: Our aim is to identify if overweight and obesity confer
poor prognosis in non-metastasic BrCa patients (pts). We identified 1799
Hispanic women with newly diagnosed BrCa who attended the National
Cancer Institute in Mexico from 2004-2008 and compared clinical and
pathological features and overall survival (OS) between pts with a body
mass index (BMI) � or � than 25. Results: The median age at diagnosis was
51 years. A BMI�25 was found in 71% of pts. Postmenopausal women
comprised 52%, and had a greater proportion of cases with a BMI�25 than
premenopausal pts (75% vs. 67%, p�0.0001). Pts with BMI�25 presented
with more advanced TNM stages and nodal involvement than their
counterparts (73% vs. 67%, p�0.005 and 76% vs. 71%, p�0.017;
respectively). Overall prevalence of hormone-receptor (HR), triple-negative
(TN) and HER2 positive disease was 62%, 23%, and 27%, respectively.
Differences according to receptor status between pre and postmenopausal
pts and BMI are shown in table. There was no difference in disease-free
survival and OS according to overweight and obesity in the overall
population, but when menopausal status was considered, premenopausal
pts with BMI�25 had a worse OS compared to pts with BMI�25 (HR 1.6,
p�0.037). This difference was not seen in the postmenopausal group.
Conclusions: Obesity may influence BrCa outcomes via several hormonal
and inflammatory mechanisms. In this study, overweight and obesity confer
a poor prognosis in premenopausal patients, possibly related to excess
estrogen availability and higher prevalence of TN BrCa. Therefore, overweight
and obesity deserve additional attention to assess possible causal
relationships that potentially could be modified to improve outcomes in
premenopausal patients.
Premenopausal Postmenopausal
25 (%) p 25 (%) p
HR - 34 41 0.028 45 34 0.003
� 66 59 55 66
TN - 79 73 0.043 76 81 0.079
� 22 27 24 1
HER2 - 71 76 0.094 65 73 0.010
� 29 24 35 27
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