Explore the vast range of titles available.

R73; The International Association for the Study of Lung Cancer (IASLC) has conducted an extensive initiative to inform the revision of the lung cancer staging system. This involved development of an international database along with extensive analysis of a large population of patients and their prognoses. This article reviews the recommendations of the IASLC International Staging Committee for the definitions for the TNM descriptors and the stage grouping in the new non-small cell lung cancer staging system.

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. Conclusion 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.

Purpose This study aims to clarify the association between metastatic pattern and prognosis in stage IV gastric cancer, with a focus on patients presenting with metastases limited to nonregional lymph nodes. Methods In this retrospective cohort study, the National Cancer Database was used to identify patients ≥ 18 years of age diagnosed with stage IV gastric cancer between 2016 and 2019. Patients were stratified according to pattern of metastatic disease at diagnosis: nonregional lymph nodes only (“stage IV-nodal”), single systemic organ (“stage IV-single organ”), or multiple organs (“stage IV-multi-organ”). Survival was assessed by Kaplan-Meier curves and multivariable Cox models in unadjusted and propensity score-matched samples. Results Overall, 15,050 patients were identified, including 1,349 (8.7%) stage IV-nodal patients. Most patients in each group received chemotherapy [68.6% of stage IV-nodal patients, 65.2% of stage IV-single organ patients, and 63.5% of stage IV-multi-organ patients ( p = 0.003)]. Stage IV-nodal patients exhibited better median survival (10.5 months, 95% CI 9.7–11.9, p < 0.001) than single organ (8.0, 95% CI 7.6–8.2) and multi-organ (5.7, 95% CI 5.4–6.0) patients. In the multivariable Cox model, stage IV-nodal patients also exhibited better survival (HR 0.79, 95% CI 0.73–0.85, p < 0.001) than single organ (reference) and multi-organ (HR 1.27, 95% CI 1.22–1.33, p < 0.001) patients. Conclusions Nearly 9% of clinical stage IV gastric cancer patients have their distant disease confined to nonregional lymph nodes. These patients were managed similarly to other stage IV patients but experienced a better prognosis, suggesting opportunities to introduce M1 staging subclassifications.

BackgroundNearly half of operative mortalities occur outside the traditionally studied 30-day period after surgery. To identify additional opportunities to improve surgical safety, the circumstances of deaths occurring 31–90 days after complex cancer surgery are analyzed.Patients and MethodsPatients aged ≥ 65 years who died within 90 days of complex cancer surgery for nonmetastatic cancer were analyzed in the Surveillance, Epidemiology, and End Results (SEER)-Medicare and the Connecticut Tumor Registry (CTR) databases.ResultsOf the 36,114 patients undergoing complex cancer surgery from 2004 to 2013 in SEER-Medicare, 1367 (3.8%) died within 31–90 days (“late mortalities”). Seventy-eight percent of late mortalities were readmitted prior to death. The highest proportion of late mortalities occurred during a readmission (49%), and 11% were never discharged from their index admission. Cause of death (COD) was largely attributed to the malignancy itself (56%), which is unlikely to be the underlying cause. Of the noncancer COD, cardiac causes were most frequent (34%), followed by pulmonary causes (18%). Death was rarely attributed to thromboembolic disease (< 1%). The CTR provided location of death, which was most commonly in a hospital (65%) or nursing facility (20%); death at home was rare (6%).ConclusionsThe vast majority of patients dying between 31 and 90 days of surgery were admitted to a hospital or nursing facility at the time of their death after initially being discharged, and few patients died at home. Greater clarity in death documentation is needed to identify specific opportunities to rescue patients from fatal complications arising in the later postoperative period.

Background This study evaluated the quality of cancer recurrence data in the National Cancer Database (NCDB) to determine if missingness and reporting consistency have improved enough to support national research. Methods This multi-methods study included NCDB analyses and a cancer registry staff survey. Trends in recurrence data missingness from 2004 to 2021 and multivariable analyses of factors associated with missingness from 2017 to 2021 were evaluated for 4,568,927 patients with non-metastatic cancer. A survey of cancer registry staff at Commission on Cancer-accredited hospitals investigated challenges with recurrence data abstraction. Results From 2004 to 2021, recurrence data missingness decreased from 15.7 to 8.4% for breast, 19.8 to 9.3% for colon, 20.5 to 7.4% for lung, 17.6 to 6.6% for melanoma, 29.3 to 9.0% for pancreas, and 18.5 to 9.2% for thyroid cancers. Driving distance ≥100 miles (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.90–2.02) and Southern geographic region (OR 2.86, 95% CI 2.80–2.93) were associated with increased data missingness. Of 565 completed surveys (39.1% response rate), the most common challenges identified were inadequate physician documentation of no evidence of disease (67.8%) and inadequate documentation of recurrence (50.5%). High variability was noted in the interpretation of registry rules specific to the assignment of cancer recurrence or new primary cancer, with discordant assignment occurring 25.5–40.8% of the time. Conclusion Despite overall low rates of recurrence data missingness in the NCDB, data quality concerns remain related to inadequate clinical documentation and discrepancies with abstracting practices. Multi-organizational efforts are underway to improve the abstraction of high-quality recurrence data to support outcomes research.