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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.

Abstract Background Although the gastrointestinal tract (including the pancreas, gastroenteropancreatic (GEP) is the most common site for extrapulmonary neuroendocrine carcinoma (NEC), the current treatment patterns of locoregional GEP NEC and in particular, the role of surgical resection is unclear. Methods Data from the National Cancer Database between 2004 and 2016 were used for this study. Results Of 2314 GEP NEC cases (stages I–III), 52.5% were stage III. Colon was the most common site (30%); 30.9% of all cases were small cell morphology. Age, morphology, stage, and primary site were associated with significant differences in treatment patterns. Management of NEC mimicked that of adenocarcinomas arising at the respective sites: colon NEC most likely to be treated with surgery and chemotherapy; anal and esophageal NEC was primarily likely to receive chemotherapy and radiation, and rectal NEC mostly likely to receive trimodality therapy. However, 25%-40% of patients did not undergo surgical resection even at sites typically managed with curative resection, and there was a trend toward lesser resection over time. The prognostic impact of surgical resection was significant across all stages and correlated with variations in survival across primary sites. Even in patients undergoing chemoradiation, surgery was the only prognostic variable that significantly affected survival in stages I–II patients (HR 0.63) and showed a strong trend in stage III (HR 0.77) patients. Conclusions Treatment patterns in GEP NEC vary considerably according to stage and primary tumor site. Surgery significantly improved survival in stages I–II patients and showed a strong trend in stage III patients regardless of primary tumor location and other perioperative therapies. This article evaluates the effect of surgery on the survival of patients with locoregional gastroenteropancreatic neuroendocrine carcinomas, especially in those undergoing multimodality perioperative management with radiation and chemotherapy.

Background Robotic pancreatic surgery is expanding throughout centers across the country. We investigated national trends in the use and outcomes for robotic-assisted pancreaticoduodenectomy (RPD) and distal pancreatectomy (RDP) for primary pancreatic tumors. Methods The National Cancer Database was queried for RPD and RDP performed during three time periods: 2010–2012, 2013–2014, and 2015–2016. These time periods were compared for patient and center factors as well as surgical outcomes. Results The use of robotic surgery increased during the study period. Most centers performed a low volume of robotic surgery (RPD, 82% of centers averaged < 1 case/year; RDP, 87% averaged < 1 case/year). From the first to last time period, the proportion of cases performed at academic centers decreased (RPD, 83% to 56%; RDP, 77% to 58%, p  < 0.001) while patient characteristics remained largely unchanged. For RPD, improvements in mortality (6.7 to 1.8%, p  = 0.013) and lymphadenectomy (18 to 21 nodes, p  = 0.035) were observed, with no changes in conversion to open surgery, negative margin resections, or readmissions. For RDP, length of stay decreased (7 to 6 days, p  = 0.048), but there were no changes in other outcomes. Compared with academic centers, non-academic centers had equivalent rates of conversion to open surgery, negative margins, and 90-day mortality. On multivariate analysis, there was no difference in survival between academic and non-academic centers. Discussion Robotic pancreas surgery is expanding to a greater variety of centers nationwide with preservation of key surgical outcomes. These findings support the continued rigorous training and proliferation of qualified robotic pancreas surgeons going forward.

Background While solid pseudopapillary tumor (SPT) of the pancreas are oncologically low-risk tumors, their resection with pancreaticoduodenectomy (PD) or partial pancreatectomy (PP) carries a significant risk for morbidity. To balance the favorable prognosis with the surgical morbidity of pancreas resection, this study explores the oncologic safety of enucleation (EN). Patients and Methods The National Cancer Database (NCDB) was queried for resected SPT from January 2004 through December 2020. Perioperative outcomes and survival were analyzed with Kruskal–Wallis tests, and Kaplan–Meier analysis (with log-rank test). Survival analysis was performed to compare patients with and without lymph node (LN) metastases and binary logistic regression for predictors of LN metastasis. Results A total of 922 patients met inclusion criteria; 18 patients (2%) underwent EN, 550 (59.6%) underwent PP, and 354 (38.4%) underwent PD. Mean tumor size was 57.6 mm. Length of hospital stay was significantly shorter for EN compared with PP and PD groups (3.8 versus 6.2 versus 9.4 days, p < 0.001). There was a nonsignificant improvement in unplanned readmission [0% versus 8% versus 10.7% ( p = 0.163)], 30-day mortality [0% versus 0.5% versus 0% ( p = 0.359)], and 90-day mortality [0% versus 0.5% versus 0% ( p = 0.363)] between EN, PP, and PD groups. Survival analyses showed no difference in OS when comparing EN versus PP ( p = 0.443), and EN versus PD ( p = 0317). Patients with LN metastases ( p < 0.001) fared worse, and lymphovascular invasion, higher T category (T3–4) and M1 status were found as predictors for LN metastasis. Conclusions EN may be considered for select patients leading to favorable outcomes. Because survival was worse in the rare cohort of patients with LN metastases, the predictors for LN metastasis identified here may aid in stratifying patients to EN versus resection.

Adequate lymph node (LN) excision is imperative for pathologic staging and determination of adjuvant treatment. he 2004–2017 National Cancer Database (NCDB) was queried for curative colon cancer resections. Tumors were categorized by location: left, right, and transverse colon cancers. Adequate (12–20 LNs) vs. inadequate (<12 LNs) lymphadenectomy was examined and sub-analysis of <12 LNs, 12–20 LNs or >20 LNs. Primary outcome was predictors of inadequate lymph node retrieval. Of 101,551 patients, 11.2% (11,439) had inadequate lymphadenectomy. The inadequate lymphadenectomy rate steadily decreased. On multivariable analysis, inadequate LN retrieval was associated with transverse (OR 1.49, CI [1.30–1.71]) and left colon cancers (OR 2.66, CI [2.42–2.93], whereas income >$63,333 had decreased likelihood of inadequate LN retrieval (OR 0.68, CI[0.56–0.82]. We are making the grade as NCDB data demonstrates a steady decrease in inadequate lymphadenectomy (2004–2017). There remain socioeconomic risk factors for inadequate lymphadenectomy that need to be addressed. [Display omitted] •Adequate lymphadenectomy for colon cancer resections has steadily increased.•Patients with >20 lymph nodes retrieved had optimal 5 year overall survival.•There are socioeconomic variables that predict inadequate lymph node retrieval.

Studies evaluating the role of adjuvant chemotherapy (ACT) in Adrenocortical Carcinoma (ACC) are limited due to its rarity. The objective of this study was to evaluate if ACT provides a survival benefit in patients who underwent curative-intent resection of localized ACC and to determine factors associated with receipt of ACT. The National Cancer Data Base was queried to identify patients (2010–2016) with curative-intent resection of localized ACC (T1-T3, N0, M0). Of 577 patients with adrenalectomy, 389 (67%) had adrenalectomy alone, and 188 (33%) received ACT. Private insurance, lymphovascular invasion, stage II, and radiotherapy were predictors of ACT (P < 0.05). Advanced (T3) stage lymphovascular invasion, and being uninsured were associated with decreased OS (P < 0.05). There was no association between ACT and OS. For patient who underwent curative-intent resection of localized ACC, there was no association between ACT and OS. Private insurance, lymphovascular invasion, stage II disease, and radiotherapy were associated with receipt of ACT. •NCDB study of neoadjuvant therapy in surgically treated population of localized ACC.•Lymphovascular invasion and radiotherapy associated with adjuvant chemotherapy.•Adjuvant chemotherapy in non-metastatic T3 ACC not associated with increased survival.•Adjuvant chemotherapy for localized ACC not associated with increased survival. The National Cancer Data Base was queried to identify patients who underwent curative-intent resection of localized adrenocortical carcinoma (T1-T3, N0, M0), between 2010 and 2016. In this analytic cohort, adjuvant chemotherapy had no associated increase in OS. Several high-risk subgroups including those with T3 disease, lymphovascular invasion, and positive margin status also failed to demonstrate a survival benefit associated with the use of adjuvant chemotherapy.

Anal melanoma is rare. Surgery is standard of care for non-metastatic disease. There are limited data supporting adjuvant therapy. We sought to examine the impact of adjuvant radiation, chemotherapy and immunotherapy on survival. The National Cancer Database was queried. Factors associated with overall survival were examined by Kaplan-Meier and Cox proportional hazards analyses. Patients were grouped by treatment regimen. 450 patients had complete treatment data: surgery alone (63.8%), surgery + radiation (14.9%), surgery + chemotherapy (7.6%), surgery + immunotherapy (9.6%) and non-surgical treatment (4.2%). Median survival was 27.2 months. Node-positive patients had worse survival than node-negative (22.4 vs. 36.8 months; p = 0.0002). Non-surgical treatment yielded worse survival than any surgery-inclusive regimen (10.4 vs. 27.8 months; p = 0.0002). No adjuvant modality conferred a survival advantage. By multivariate analysis, increasing age (HR/1 year = 1.02, p = 0.012) and node positivity (HR = 2.10, p = 0.0002) negatively impacted survival. Adjuvant therapy for non-metastatic anal melanoma does not appear to influence survival. •Anal melanoma is a rare disease with poor prognosis.•Surgical (vs. non-surgical) treatment is associated with improved survival.•Adjuvant therapy (radiation, chemotherapy or immunotherapy) does not impact survival.

Background Treatment guidelines for stage I–III esophageal cancer indicate that management should include surgery in appropriate patients. Variations in utilization of surgery may contribute to racial differences observed in survival. We sought to identify factors associated with racial disparities in surgical resection of esophageal cancer and evaluate associated survival differences. Methods Patients diagnosed with stage I–III esophageal cancer from 2004 to 2015 were identified using the National Cancer Database. Matched patient cohorts were created to reduce confounding. Multivariate logistic regression was used to identify factors associated with receipt of surgery. Multi-level modeling was performed to control for random effects of individual hospitals on surgical utilization. Results A total of 60,041 patients were included (4402 black; 55,639 white). After 1:1 matching, there were 5858 patients evenly distributed across race. For all stages, significantly fewer black than white patients received surgery. Black race independently conferred lower likelihood of receiving surgery in single-level multivariable analysis (OR (95% CI); stage I, 0.67 (0.48–0.94); stage II, 0.76 (0.60–0.96); stage III, 0.62 (0.50–0.76)) and after controlling for hospital random effects. Hospital-level random effects accounted for one third of the unexplained variance in receipt of surgery. Risk-adjusted 1-, 3-, and 5-year mortality was higher for patients who did not undergo surgery. Conclusion Black patients with esophageal cancer are at higher risk of mortality compared to white patients. This increased risk may be influenced by decreased likelihood of receiving surgical intervention for resectable disease, in part because of between-hospital differences. Improving access to surgical care may improve disparities in esophageal cancer survival.

Fragmented care (FC) is associated with mixed outcomes. This analysis examines FC's impact on retroperitoneal sarcoma (RPS) treatment. The National Cancer Database was queried for adult patients with non-metastatic, surgically-resected RPS. FC was defined as diagnosis/treatment at >1 facility. Univariable and multivariable analyses examined factors associated with FC and its impact on overall survival. 4976 patients were included; 45.6 ​% experienced FC. Non-FC and FC cohorts were similar. Dedifferentiated liposarcoma were more common in FC cohort, as were poorly differentiated and undifferentiated tumors (p ​< ​0.05). FC cohort had greater travel distance and time-to-treatment (both p ​< ​0.001). Variables independently associated with FC included urban and rural setting and histology (poorly differentiated and undifferentiated) (all p ​< ​0.05). After controlling for other variables, FC was not associated with survival. FC patients experienced longer distance travelled and time-to-treatment without survival impact. National emphasis must be placed on broadening access to equitable, high-quality sarcoma care. •Fragmented care (FC) is associated with mixed oncologic outcomes.•For retroperitoneal sarcoma patients, fragmented care is common.•Fragmented care was associated with longer travel distance and time-to-treatment.•Fragmented care was not associated with improved survival.

Background The impact of fragmentation of care (FC), i.e., receipt of care at > 1 institution, on treatment of pancreatic cancer is unknown. The purpose of this study was to determine factors associated with FC in curative-intent treatment of pancreatic cancer (PDAC) patients and evaluate how FC affects survival outcomes. Methods Using the National Cancer Database (NCDB), data on stage I-III PDAC patients diagnosed 2006–2016 were extracted. Multiple logistic regression analyses were performed to identify factors predictive of FC and survival. Results Of the 20,013 patients identified, 24.1% had FC. Factors predictive of FC were stage-III tumors (odds ratio [OR] 1.36; p  = 0.014), higher median-income [third quartile (OR 1.38; p  = 0.006) and highest-quartile (OR 1.50; p  = 0.003)], care at high-volume facility (OR 1.47; p  < 0.001), and receipt of multi-modal therapy (OR 1.69; p  < 0.001). In contrast, age > 80 years (OR 0.82; p  = 0.018), Black (OR 0.85; p  = 0.013) or Asian race (OR 0.76; p  = 0.033), Charlson comorbidity-index 2 (OR 0.85; p  = 0.033), treatment at non-academic facility (OR 0.87; p  = 0.041), and non-private insurance were negatively predictive of FC. FC independently predicted decreased 30-day [OR 0.57; p  < 0.001] and 90-day mortality [OR 0.61; p  < 0.001] and improved overall survival [hazard ratio 0.91; p  < 0.001]. Discussion Sociodemographic factors are significantly associated with FC in curative-intent treatment of PDAC patients. FC was found to predict improved 30-day, 90-day, and overall survival outcomes.