OBJECTIVE: This study aimed to extract and analyze comprehensive data from the National Cancer Database (NCDB) to gain insights into the epidemiological prevalence, treatment patterns, and survival outcomes associated with intracranial ependymomas in pediatric patients.
METHODS: The authors examined data extracted from the NCDB spanning the years 2010 to 2017, with a specific emphasis on intracranial ependymomas in individuals aged 0-21 years. The study used logistic and Poisson regression, along with Kaplan-Meier survival estimates and Cox proportional hazards models, for analysis.
RESULTS: Among 908 included pediatric patients, 495 (54.5%) were male, and 702 (80.6%) were White. Kaplan-Meier analysis determined overall survival (OS) rates of 97.1% (95% CI 96%-98.2%) at 1 year postdiagnosis, 89% (95% CI 86.9%-91.1%) at 3 years, 82.9% (95% CI 80.3%-85.7%) at 5 years, and 74.5% (95% CI 69.8%-79.4%) at 10 years. Grade 3 tumors predicted a more than fourfold higher mortality hazard (p < 0.001; reference = grade 2). Infratentorial localization was also associated with a 1.7-fold increase in mortality hazard (p = 0.002; reference = supratentorial). Larger maximum tumor size (> 5 cm) correlated with a lower mortality hazard (HR 0.64, p = 0.011; reference ≤ 5 cm). The vast majority of patients (85.9%, n = 780) underwent resection. Uninsured patients had over fourfold higher prolonged length of stay (LOS) odds than those privately insured (OR 4.645, p = 0.007). Radiotherapy was received by 76.1% of patients, and the highest rates of radiotherapy occurred among children aged 5-12 years (p < 0.001). Only 25.6% received chemotherapy at any point during their treatment. Peak chemotherapy use emerged within ages 0-4 years, reaching 33.6% in this age group. Kaplan-Meier analysis indicated chemotherapy was associated with significantly worse OS (p = 0.041).
CONCLUSIONS: This comprehensive analysis of the NCDB provides valuable insights into the epidemiology, treatment patterns, and survival outcomes of intracranial ependymomas in pediatric patients. Higher tumor grade, infratentorial localization, and chemotherapy use was associated with worse OS, while larger tumor size correlated with lower mortality hazard. Disparities in care were identified, with uninsured patients experiencing prolonged LOS. These findings underscore the need for tailored treatment strategies based on patient and tumor characteristics and highlight the importance of addressing socioeconomic barriers to optimize outcomes for children with ependymomas.

The National Comprehensive Cancer Network guidelines provide evidence-based consensus for optimal individual site- and stage-specific treatments. This is a cohort study of 11,121 late-stage oral cancer patients in the National Cancer Database from 2010 to 2016. We hypothesized that patient travel distance may affect treatment choices and impact outcome. We split travel distance (miles) into quartiles (D1-4) and assessed treatment choices, type of facility, and survival outcome in relation to distance traveled. Univariate and multivariate analyses addressed contributions of specific variables. White patients were most likely to travel farthest (D4) for treatment compared to Black patients (D1). Urban area patients traveled shorter distances than those from rural areas. Greater travel distance was associated with patients undergoing surgical-based therapies and treatment at academic centers. Patients in D1 had the lowest median survival of all distance quartiles. Surgery-based multimodality treatment (surgery and radiation) had a median survival significantly greater than for non-surgical therapy. Several factors including travel distance and treatment facility were associated with survival outcomes for late-stage oral cavity cancers. Consideration of these factors may help improve the outcome for this patient population.

Nationwide datasets are frequently used to examine cancer trends and outcomes in the U.S. Understanding the strengths and limitations of the commonly used Surveillance, Epidemiology, and End Results (SEER) Program and the National Cancer Database (NCDB) is important when designing studies and interpreting results. We used colorectal cancer (CRC) as a case study to compare information available. We identified 575,128 (SEER) and 1,578,046 (NCDB) adults diagnosed with CRC between 2004 and 2021. The distribution of age, tumor location, stage, and treatment did not meaningfully differ between SEER and NCDB. SEER represents racially and ethnically diverse populations, including a higher proportion of Hispanic (11.7% vs 5.8%) and Asian/Pacific Islander (8.6% vs 3.3%) persons. SEER includes more information on area-level characteristics, such as county-level measures of poverty, unemployment, and migration and census tract-level measures of socioeconomic status. Age-adjusted incidence, mortality rates, and cause-specific survival are only available in SEER, facilitating detailed analyses of racial, ethnic, and socioeconomic differences in cancer incidence and mortality. NCDB provides information on tumor characteristics and treatment not available in SEER, including microsatellite instability, KRAS mutation, palliative treatment, unplanned readmissions, and 30-day mortality after surgery, facilitating analyses of treatment effectiveness and outcomes. Five-year overall survival was similar in SEER (55.6%) vs NCDB (57.5%).

With increasing life expectancies and population aging, the incidence of elderly patients with grade 2 and 3 gliomas is increasing. However, there is a paucity of knowledge on factors affecting their treatment selection and overall survival (OS). Geriatric patients aged between 60 and 89 years with histologically proven grade 2 and 3 intracranial gliomas were identified from the National Cancer Database between 2010 and 2017. We analyzed patients\' demographic data, tumor characteristics, treatment modality, and outcomes. The Kaplan-Meier method was used to analyze OS. Univariate and multivariate analyses were performed to assess the predictive factors of mortality and treatment selection. A total of 6257 patients were identified: 3533 (56.3 %) hexagenerians, 2063 (32.9 %) septuagenarians, and 679 (10.8 %) octogenarians. We identified predictors of lower OS in patients, including demographic factors (older age, non-zero Charlson-Deyo score, non-Hispanic ethnicity), socioeconomic factors (low income, treatment at non-academic centers, government insurance), and tumor-specific factors (higher grade, astrocytoma histology, multifocality). Receiving surgery and chemotherapy were associated with a lower risk of mortality, whereas receiving radiotherapy was not associated with better OS. Our findings provide valuable insights into the complex interplay of demographic, socioeconomic, and tumor-specific factors that influence treatment selection and OS in geriatric grade 2 and 3 gliomas. We found that advancing age correlates with a decrease in OS and a reduced likelihood of undergoing surgery, chemotherapy, or radiotherapy. While receiving surgery and chemotherapy were associated with improved OS, radiotherapy did not exhibit a similar association.

Surgical margins following rectal cancer resection impact oncologic outcomes. We examined the relationship between margin status and race, ethnicity, region of care, and facility type. Patients undergoing resection of a stage II-III locally advanced rectal cancer (LARC) between 2004 and 2018 were identified through the National Cancer Database. Inverse probability of treatment weighting (IPTW) was performed, with margin positivity rate as the outcome of interest, and race/ethnicity and region of care as the predictors of interest. In total, 58,389 patients were included. After IPTW adjustment, non-Hispanic Black (NHB) patients were 12% (p = 0.029) more likely to have margin positivity than non-Hispanic White (NHW) patients. Patients in the northeast were 9% less likely to have margin positivity compared to those in the south. In the west, NHB patients were more likely to have positive margins than NHW patients. Care in academic/research centers was associated with lower likelihood of positive margins compared to community centers. Within academic/research centers, NHB patients were more likely to have positive margins than non-Hispanic Other patients. Our results suggest that disparity in surgical management of LARC in NHB patients exists across regions of the country and facility types. Further research aimed at identifying drivers of this disparity is warranted.

OBJECTIVE: Query the National Cancer Database (NCDB) to delineate epidemiologic frequency, care patterns, and survival outcomes of pediatric intramedullary spinal cord tumors (IMSCTs).
METHODS: IMSCTs included ependymoma, astrocytoma, and hemangioblastoma. We examined data from the NCDB spanning 2004-2018, focusing on IMSCT in children aged 0-21 years. Our analysis included logistic and Poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models.
RESULTS: This study included 1066 patients aged 0-21 years. 59.4 % of patients were male, while 83.1 % were white. The most common tumor histology was ependymoma (57.5 %), followed by astrocytoma (36.1 %) and hemangioblastoma (6.4 %). 24.9 % of patients received radiotherapy, with radiotherapy utilization being highest among patients aged 6-10 years. Chemotherapy utilization was highest in patients aged 0-5 years. 87.2 % of patients underwent surgical resection, with higher rates in patients aged 16-21 years. Overall survival did not differ significantly between resected and non-resected patients (p = 0.315). Patients in rural areas had worse OS than those in metro areas (HR = 4.42, p = 0.048). Patients with astrocytoma had worse OS compared to other histologies (HR = 2.21, p = 0.003). Astrocytoma patients were over twice as likely to have prolonged LOS compared to ependymoma patients (OR = 2.204, p < 0.001).
CONCLUSIONS: In summary, our analysis utilizing the NCDB database provides a comprehensive overview of demographics, care patterns, and outcomes for the largest cohort of pediatric IMSCTs to date. These insights underscore the complexity of managing IMSCTs and emphasize the need for tailored approaches to improve patient outcomes.

BACKGROUND: The current research on geriatric patients with spinal chondrosarcoma is limited. This study aimed to investigate the demographics, patterns of care, and survival of geriatric patients with chondrosarcoma of the mobile spine.
METHODS: The National Cancer Database was queried from 2008 to 2018 for geriatric patients (60-89 years) with chondrosarcoma of the mobile spine. The primary outcome of this study was overall survival (OS). The secondary outcome was treatment utilization patterns. Survival analyses were conducted using log-rank tests and Cox proportional hazards regressions. Logistic regression models were utilized to assess correlations between baseline variables and treatment utilization.
RESULTS: The database retrieved 122 patients. While 43.7% of the patients presented with tumors exceeding 5cm in size, the incidence of regional lymph node involvement or distant metastases was relatively low, affecting only 5% of the patients. Furthermore, 22.3% of the patients had tumors graded as 3-4. The five-year OS rate was 52.9% (95% confidence interval 42-66.6). The mortality risk was significantly associated with age, tumor grade and stage, and treatment plan. Most patients (79.5%) underwent surgery, while 35.9% and 4.2% were treated with radiotherapy and chemotherapy, respectively. Age, race, comorbidities, geographical region, tumor stage, and healthcare facility type significantly correlated with treatment utilization.
CONCLUSIONS: Surgical resection significantly lowered the mortality risk in geriatric patients with spinal chondrosarcomas. Demographic and geographical factors significantly dictated treatment plans. Further studies are required to assess the role of radiotherapy and chemotherapy in treating these patients in the modern era.

OBJECTIVE: We conducted a National Cancer Database (NCDB) study to investigate the epidemiological characteristics and identify predictors of outcomes associated with geriatric meningiomas.
METHODS: The NCDB was queried for adults aged 60-89 years diagnosed between 2010 and 2017 with grade 2 and 3 meningiomas. The patients were classified into three age groups based on their age: 60-69 (hexagenarians), 70-79 (septuagenarians), and 80-89 (octogenarians). The log-rank test was utilized to compare the differences in overall survival (OS). Univariate and multivariate Cox proportional hazards regressions were used to evaluate the mortality risk associated with various patient and disease parameters.
RESULTS: A total of 6585 patients were identified. Hexagenerians were the most common age group (49.8%), with the majority of meningiomas being classified as grade 2 (89.5%). The incidence of high-grade meningiomas increased in all age groups during the study period. Advanced age, male sex, black race, lower socioeconomic status, Charlson-Deyo score ≥ 2, and higher tumor grade were independent factors of poor survival. Among the modes of treatment, the extent of surgical resection, adjuvant radiotherapy, and treatment at a noncommunity cancer program were linked with better outcomes.
CONCLUSIONS: In geriatric patients with high-grade meningiomas, the greater extent of surgical resection and radiotherapy are associated with improved survival. However, the management and outcome of geriatric patients with higher-grade meningiomas are also associated with several socioeconomic factors.

OBJECTIVE: Changing location of postoperative radiotherapy (PORT) after treatment at a high-volume facility (HVF) is associated with worse survival in various head and neck cancers. Our study investigates this relationship in salivary gland cancer (SGC).
METHODS: The 2004-2016 National Cancer Database was queried for all cases of adult SGC treated with surgery and PORT with or without adjuvant chemotherapy. Patients with multiple cancer diagnoses, metastatic disease, or unknown PORT facility were excluded. Reporting facilities with >95th percentile annual case volume were classified as HVFs, the remainder were classified low-volume facilities (LVFs).
RESULTS: A total of 7885 patients met inclusion criteria, of which 418 (5.3%) were treated at an HVF. Patients treated at an HVF had higher rates clinical nodal positivity (18.2% vs. 14.0%, p < 0.001) and clinical T3/T4 (27.3% vs. 20.7%, p = 0.001) disease. Patients at HVFs changed facility for PORT at lower rates (18.9% vs. 24.5%, p = 0.009). Patients treated at an HVF had higher 5-year overall survival (5-OS) than those treated at an LVF (79.0% vs. 72.0%, p = 0.042). Patients treated at an HVF that changed PORT facility had worse 5-OS (60.8% vs. 83.2%, p < 0.001). Radiation facility change was an independent predictor of worse survival in patients treated at an HVF (HR: 8.99 [3.15-25.67], p < 0.001) but not for patients treated at a LVF (HR: 1.11 [0.98-1.25], p = 0.109).
CONCLUSIONS: Patients treated at an HVF changing facility for PORT for SGC experience worse survival. Our data suggest patients treated surgically at an HVF should be counseled to continue their PORT at the same institution.
METHODS: 3 Laryngoscope, 2024.

BACKGROUND: Standardization of procedures for data abstraction by cancer registries is fundamental for cancer surveillance, clinical and policy decision-making, hospital benchmarking, and research efforts. The objective of the current study was to evaluate adherence to the four components (completeness, comparability, timeliness, and validity) defined by Bray and Parkin that determine registries\' ability to carry out these activities to the hospital-based National Cancer Database (NCDB).
METHODS: Tbis study used data from U.S. Cancer Statistics, the official federal cancer statistics and joint effort between the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), which includes data from National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) to evaluate NCDB completeness between 2016 and 2020. The study evaluated comparability of case identification and coding procedures. It used Commission on Cancer (CoC) standards from 2022 to assess timeliness and validity.
RESULTS: Completeness was demonstrated with a total of 6,828,507 cases identified within the NCDB, representing 73.7% of all cancer cases nationwide. Comparability was followed using standardized and international guidelines on coding and classification procedures. For timeliness, hospital compliance with timely data submission was 92.7%. Validity criteria for re-abstracting, recording, and reliability procedures across hospitals demonstrated 94.2% compliance. Additionally, data validity was shown by a 99.1% compliance with histologic verification standards, a 93.6% assessment of pathologic synoptic reporting, and a 99.1% internal consistency of staff credentials.
CONCLUSIONS: The NCDB is characterized by a high level of case completeness and comparability with uniform standards for data collection, and by hospitals with high compliance, timely data submission, and high rates of compliance with validity standards for registry and data quality evaluation.