Reports utilizing data from the Commission on Cancer's National Cancer Data Base (NCDB) have previously contained evaluations of time trends for stage of disease at diagnosis, treatment, and survival for multiple tumor sites. Data collected from 1989, 1990, 1994, and 1995 for carcinoma of the gallbladder are presented herein.The data presented in this review were collected from hospital cancer registries from across the U.S. Seven calls for data yielded a total of 5,850,000 cases for the years 1985-1995, including 2574 gallbladder carcinoma cases from 1989-1990 and 2914 cases from 1994-1995 from hospital cancer registries across the U.S. These data represent approximately 8.8% and 8.4% of the estimated cases of liver and biliary track cancers diagnosed in the U.S. during the two respective time periods.There were no changes in patient demographics between 1989-1990 and 1994-1995. Most gallbladder carcinoma patients were white women. The documentation of tumor stage improved noticeably between the two study periods. There was no increased frequency in the occurrence of early stage tumors between the two reporting times, an era that saw the development and widespread application of laparoscopic cholecystectomy. Treatment differed according to stage of disease. Surgery alone, particularly nonradical surgery, was performed more frequently in the initial treatment of gallbladder carcinoma. A large percentage of gallbladder carcinoma patients received no definitive therapeutic intervention because of the advanced stage of disease at presentation and the lack of effective treatments for these cancers. Multimodality treatment was utilized more often for young patients. Survival was closely related to tumor stage, with 60% 5-year survival for Stage 0 patients, 39% for Stage I patients, and 15% for Stage II patients, but only 5% for Stage III patients and 1% for Stage IV patients. Patient outcome was not demonstrably affected by more aggressive therapy, nor was an adverse effect in results seen in early stage cancers between 1989-1990 and 1994-1995.The NCDB data are valuable in the evaluation of trends in malignant diseases, treatments, and patient survival. No substantial differences were apparent in the diagnosis, treatment, and survival of patients during this 7-year study period. The data do not support any adverse effect on outcome results with the introduction of laparoscopic cholecystectomy in the U.S.
Although the conclusions reached in the National Surgical Adjuvant Bowel and Breast Protocol B-06 trial and other clinical trials appear to remain intact, questions persist regarding the equivalency of breast preservation compared with modified radical mastectomy for patients with invasive carcinoma. Documentation and assessment of comparative survival rates in a large cohort of nonrandomized breast carcinoma patients was undertaken to understand better these outcome patterns.Information gathered from the medical records of 96,030 women diagnosed with early stage carcinoma of the breast between 1985 and 1988 was reviewed to determine the age at diagnosis; tumor stage, grade, dimension; treatment; and disease status.Of these 96,030 Stage I and II (based on the American Joint Committee on Cancer staging system) patients, 8583 (8.9%) were treated with segmental mastectomy, axillary lymph node dissection, and radiotherapy without systemic treatment. Three thousand seven hundred and ninety-seven patients (4.0%) were treated with segmental mastectomy, axillary lymph node dissection, radiotherapy, and systemic therapy. Forty-four thousand two hundred and forty-nine patients (46.0%) were treated with modified radical mastectomy without systemic therapy, and 18,322 patients (19.1%) were treated with modified radical mastectomy with systemic therapy. Within each stage, reported survival was equal to or more favorable for patients managed with breast preservation compared with those treated with modified radical mastectomy. This comparability was observed in all subsets analyzed including those defined by age at diagnosis, histologic grade, and tumor dimension.These findings are consistent with the hypothesis that AJCC Stage I and II patients treated with breast preservation appear to have survival rates equivalent to those treated with modified radical mastectomy.
Journal Article Case-Control Study of Hodgkin's Disease. I. Results of the Interview Questionnaire Get access Guy R. Newell, Guy R. Newell 3Department of Epidemiology and Biostatistics, Tulane Medical Center, New Orleans, La. 70112 Search for other works by this author on: Oxford Academic PubMed Google Scholar William Rawlings, William Rawlings 3Department of Epidemiology and Biostatistics, Tulane Medical Center, New Orleans, La. 70112 Search for other works by this author on: Oxford Academic PubMed Google Scholar B. Kay Kinnear, B. Kay Kinnear 3Department of Epidemiology and Biostatistics, Tulane Medical Center, New Orleans, La. 70112 Search for other works by this author on: Oxford Academic PubMed Google Scholar Pelayo Correa, Pelayo Correa 4Biometry Branch, National Cancer Institute, National Institutes of Health, Public Health Service, U.S. Department of Health, Education, and Welfare, Bethesda, Md. 20014 Search for other works by this author on: Oxford Academic PubMed Google Scholar Brian E. Henderson, Brian E. Henderson 5University of Southern California School of Medicine, Los Angeles, Calif. 90033 Search for other works by this author on: Oxford Academic PubMed Google Scholar Ruth Dworsky, Ruth Dworsky 5University of Southern California School of Medicine, Los Angeles, Calif. 90033 Search for other works by this author on: Oxford Academic PubMed Google Scholar Herman Menck, Herman Menck 5University of Southern California School of Medicine, Los Angeles, Calif. 90033 Search for other works by this author on: Oxford Academic PubMed Google Scholar Ronald Thompson, Ronald Thompson 6University of California, Los Angeles, Calif. Search for other works by this author on: Oxford Academic PubMed Google Scholar William W. Sheehan William W. Sheehan 5University of Southern California School of Medicine, Los Angeles, Calif. 90033 Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 51, Issue 5, November 1973, Pages 1437–1441, https://doi.org/10.1093/jnci/51.5.1437 Published: 01 November 1973 Article history Received: 16 April 1973 Accepted: 27 June 1973 Published: 01 November 1973
Data on 349,154 prostate cancer cases diagnosed since 1986 have been entered to the American College of Surgeons National Cancer Data Base (NCDB). Previous annual reports have examined subsets of these data. The present report highlights major trends in the presentation and treatment of prostate cancer in the United States evident from longitudinal analyses of the entire data.NCDB data are collected following a computerized, standard format. Hospital participation is voluntary.Since the first year of data collection, the number of participating hospitals has increased from 496 to 996 and the number of prostate cancer patients reported to the NCDB increased from 19,531 to 84,408. The proportion of men diagnosed at ages younger than 70 years increased from 37.8% in 1986 to 46.9% in 1993. Completeness of reporting stage of disease and tumor grade has improved. The proportions of both the earliest (American joint Committee an Cancer [AJCC] Stage Groups 0 and I) and the most advanced (AJCC++ Stage Group IV) stages declined. The proportion of Grade 2 (moderately differentiated) tumors increased from 38.6% in 1986 to 57.5% in 1993. The proportion of AJCC Stage II prostate cancer increased from 19% in 1986 to 48.4% in 1993. The proportion of patients treated by prostatectomy increased from 9.9% in 1986 to 29.2% in 1993. The proportion of patients receiving no cancer directed treatment declined from 41.8% in 1986 to 21.6% in 1993. Less change was observed in the use of radiation and hormonal treatments.These data show that the clinical patterns of prostate cancer have changed markedly in recent years.
Commission on Cancer data from the National Cancer Data Base (NCDB) report time trends in stage of disease, treatment patterns, and survival for patients with selected cancers. The most current data (1993) for patients with colon cancer are described.Five calls for data yielded 3,700,000 cases of cancer for the years 1985 through 1993 from hospital cancer registeries across the U.S., including 36,937 cases of colon cancer from 1988 and 44,812 from 1993.Interesting trends are as follows: (1) the elderly ( > 80 years) present with earlier stage disease than younger patients; (2) the National Cancer Institute recognized cancer centers have more patients with advanced disease than other types of hospitals; (3) all ethnic groups have generally similar stages of disease at presentation, except for African-Americans who have a slightly higher incidence of Stage IV disease; (4) the proximal migration of the primary cancer continues with 54.7% of primary colon cancer arising in the right colon in 1993 compared with 50.9% in 1988; (5) an interaction between grade and stage of cancer seems present; and (6) patients with Stage III colon cancer who received adjuvant chemotherapy had a 5% improvement in 5-year relative survival.The NCDB data are useful for reporting what cancer treatments are being administered and what outcomes are occurring in the U.S. The data suggest an important biologic role for grade of cancer. They also suggest that African-Americans and other ethnic groups have the same outcome as non-Hispanic whites but that access to medical care may still be less. Finally, the utility of adjuvant therapy for Stage III colon cancer may just be beginning to be appreciated.
Epithelial ovarian carcinoma is the fifth most common cause of cancer death among African-American women. Although the incidence rate of ovarian carcinoma for whites is higher than that for African Americans, the relative survival rate for African Americans is poorer.Data were cases submitted to the National Cancer Data Base for invasive epithelial tumors of the ovary diagnosed between 1985-1988 and 1990-1993. African-American women with epithelial ovarian carcinoma were compared with non-Hispanic white women with the same disease. The groups of white women with which African-American women were compared were classified as "White-same facility" and "White-other facility." "White-same facility" were white patients from hospitals that contributed a substantial proportion of African-American patients. "White-other facility" were white patients from hospitals that contributed few or no African-American patients. No patient had a history of prior cancer.African-American women with advanced invasive epithelial ovarian carcinoma were less often treated with combined surgery and chemotherapy and more often treated with chemotherapy only. African-American women were twice as likely as white women not to receive appropriate treatment. African-American women had poorer survival rates than white women from the same or different hospitals, regardless of income. Among staged cases, African-American women were more often diagnosed with Stage IV disease than either group of white women.The current study findings show that African-American women with advanced epithelial ovarian carcinoma received less aggressive treatment than white women and had a poorer prognosis.
The National Cancer Data Base (NCDB) is a community-oriented cancer management and outcomes database that is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The ongoing assessment of patient care performed by the NCDB includes patient care evaluation studies as well as annual reports for individual disease sites. Patient care and outcome data from more than 1,600 hospitals are funneled to NCDB Central, where they are first subjected to edit checks and then analyzed. The data are then sent back to the 1,600 hospitals and their physicians and communities with findings and statistical comparisons. Dissemination is facilitated by a triad consisting of (1) a network of 2,000 oncologists affiliated with hospital cancer committees, (2) American Cancer Society state and local unit staff, and (3) more than 2,000 hospital-based cancer registrars. The NCDB assesses patient care using both hospital cancer registry data collected annually (longitudinal data)1, 2 and specifically targeted patient care evaluation hospital studies conducted periodically (cross-sectional data).3-6 These evaluations enable clinicians to appraise trends in specific treatments and survival in relation to stage and histologic type of malignancy. Further, the evaluations permit individual contributing hospitals to compare their results with state, regional, and national standards. The methodology of the NCDB has been described elsewhere.2 Case information for the highlights described in this article is based on six annual NCDB calls for data and recent NCDB/patient care evaluation studies.4, 5 The NCDB data received include 232,577 cases from 501 hospitals in 1985 (24% of estimated cases in the United States); 238,157 cases from 496 hospitals in 1986 (26%); 364,120 cases from 740 hospitals in 1987 (38%); 486,354 cases from 935 hospitals in 1988 (49%); 435,752 cases from 839 hospitals in 1990 (42%); 519,293 cases from 978 hospitals in 1991 (47%); 647,950 cases from 1,144 hospitals in 1992 (57%); and 608,289 cases from 996 hospitals in 1993 (52%). The cumulative total is 3,532,492 cases. Data have been received from a total of 1,601 hospitals for at least one diagnosis year. Data—which are voluntarily submitted to the NCDB in computerized form by hospitals, central registries, and software providers—comprise a large convenience sample of cancer cases. These data are diverse, including all forms of cancer diagnosed in patients of both sexes and all ages (including childhood cancer), in each of the 50 states, and in all ethnic groups. Patients are believed to be drawn from all nationalities, native and migrant, and to have been treated by a wide range of different clinicians in all types of hospitals in both rural and urban locations. In 1993, 31% of the patients were 70 years or older. The number of childhood cases (4,114) represented approximately 50% of all estimated childhood cancer cases in the United States.7 The percentages of males (49.5%) and females (50.5%) in the reported cases were similar. Numerous cases were reported from each of six regions, ranging from 29,906 cases reported from hospitals in the Mountain Region to 151,692 cases reported from the Midwest Region. Cases were widely reported from each state. Most (87.8%) patients were classified as non-Hispanic white; the remaining patients (12.2%) included 7.9% African-American, 2.9% Hispanic, 1.4% Asian, and 0.1% American Indian. Even the ethnic group with the smallest percentage, American Indians, included 5,448 patients in this large national sample. The 1993 cases were reported from hospitals with varying annual cancer caseloads, including 2% from hospitals with caseloads of fewer than 150 cases per year, 20% from those with 150 to 499 cases, 41% from those with 500 to 999 cases, 35% from those with caseloads of 1,000 or more, and 2% from those with unknown caseloads. In 1993 most of the cases were reported from hospitals with Commission on Cancer approval status, including 4% from National Cancer Institue (NCI)-designated cancer centers (comprehensive and clinical), 5% from government hospitals, 16% from teaching hospitals, 35% from community comprehensive cancer centers, 27% from community cancer centers, and 3% from for-profit hospitals. Ten percent of cases were reported from hospitals without approval status. The cumulative NCDB data file includes large numbers of the most common cancers—for example, 545,057 breast cancer cases and 421,082 prostate cancer cases. This allows a wealth of subset analysis without loss of sufficient sample size. In addition, rare tumors are present with some frequency—for example, 2,906 cancers of the eye and 5,744 nasopharyngeal cancers. In the future the NCDB should be a resource for patient care evaluation of rare tumors or other subgroups of interest. Since 1996 most hospitals have voluntarily submitted data for patient care evaluation studies in electronic form. Before 1996 all hospitals submitted data in paper questionnaire form.4 These studies are usually specific to a particular type of cancer and are designed to answer questions about patient demographics, diagnosis, treatment, staging, and outcomes in greater detail than is available from the NCDB longitudinal data. Feedback on the data collected for each study is returned to participating hospitals to help them develop their own patient care evaluations, which are required for approval status with the Commission on Cancer. In addition, aggregate analyses are published in peer-reviewed journals. Characteristics of hospitals participating in the studies and demographics of submitted cases are similar to those in the NCDB. However, not all hospitals that participate in the NCDB participate in the patient care evaluation studies. In general, about 700 to 1,000 hospitals participate in each study. Since 1976, 33 studies have been conducted by the Commission on Cancer. In addition, two studies were recently distributed to hospitals for patients diagnosed in 1997 with colorectal cancer or non-Hodgkin's lymphoma. The following highlights summarize the principal findings of the NCDB, which are presented in more detail in other reports, some of which have been pub-lished4-16 and others of which are in press or submitted awaiting review. Collectively, these findings present a broad pattern of NCDB assessment of cancer patterns of care. In addition to the resulting journal publications, 1,600 NCDB participating hospitals receive a customized summary of similar patterns of care and outcome at their facility compared with national norms, which is then used for quality assurance purposes. The mean hospital rate of American Joint Committee on Cancer (AJCC) staging was 87% in 1993, an increase over the 65% reported in 1988 (Fig. 1). Approximately 64% of hospitals staged more than 90% of their stageable cases; 3% staged less than 5%. Even facilities with “complete” staging implementation were unable to stage substantial portions of cancers at some sites. Accessibility of tumor and overall prognosis affected whether pathologic or clinical staging was chosen. Staging completeness and the mix of pathologic and clinical staging also differed by the category of the reporting hospital. AJCC staging is used frequently for common tumors for which treatment depends on the stage of disease. Percentage of stageable cancer cases classified with AJCC staging, 1985 to 1993. Current trends for bladder cancer are: (1) younger patients (49 years of age and younger) present with earlier stages of disease than do older patients; (2) women are slightly more likely to be diagnosed with stages II, III, and IV bladder carcinoma than are men; (3) African-Americans are less likely to be diagnosed with stage 0 or stage I disease than are either Hispanic or non-Hispanic whites; and (4) NCI-designated centers treat more patients with advanced disease than do other types of hospitals. These data reflect a decrease in the use of adjuvant chemotherapy. The use of chemotherapy increased between 1988 and 1993 (from 62% to 67%), and management of squamous carcinomas and adenocarcinomas of the anus differed substantially. The majority of squamous carcinomas were managed nonsurgically, principally with combined chemotherapy and radiation, whereas 75% of adenocarcinomas were treated with surgery. The most important factors for favorable 5-year survival were early stage (ranging from 71% for stage I to 23% for stage IV), squamous carcinoma histology (58% versus 41% for adenocarcinoma), and female gender (56% versus 50% for males). For stages I and II squamous carcinomas, the 5-year survival for patients receiving nonsurgical treatment with radiotherapy was equivalent to that of patients receiving surgical treatment (64% and 65%, respectively). Records of 4,000 and 8,500 women who were treated (nonrandomized) with segmental mastectomy, axillary dissection, and radiotherapy with and without systemic therapy, respectively, were compared with 18,000 and 44,000 women who were treated with modified radical mastectomy, with and without systemic therapy, respectively. Within each AJCC stage, reported survival was equal or more favorable for patients managed with breast preservation compared with those treated with modified radical mastectomy. This comparability was seen in all subsets analyzed, including those defined by age at diagnosis, histologic grade, and tumor diameter. The interrelationship of age and breast cancer was studied. A variety of findings, including survival comparison, are consistent with the hypothesis that younger women are at increased risk for biologically more aggressive breast carcinoma.8, 9 In an analysis of women 75 years or older diagnosed with breast cancer, fewer cancers were detected mammographically and needle localized biopsies were performed less often in the elderly. Most of these elderly women underwent breast-conserving surgery. The use of hysterectomy as definitive therapy increased markedly from 1984 to 1990 and was associated with low complication and high 5-year survival rates. Gynecologic oncologists now perform the majority of hysterectomies for this type of carcinoma, with general specialists playing a lesser role than in earlier years.4 A subset of pregnant patients diagnosed with cervical cancer was examined. The prognosis of these pregnant patients with invasive cervical carcinoma was similar to that of nonpregnant patients. Thirty-one percent of patients were diagnosed in the first trimester, 34% in the second, and 38% in the third. The significant number of patients diagnosed in the second and third trimesters and the frequent finding of large tumors in all trimesters emphasize the need for early prenatal evaluation, including cervical cytology and biopsy of any clinically abnormal cervix.6 For a sample of 4,400 children with cancer reported by more than 200 hospital cancer registries, an analysis was performed to better understand the national utilization of controlled clinical trials. Members of the Pediatric Oncology Group (POG) and the Children's Study Group (CSG) submitted 55% of the cases, and other institutions submitted 45%. More patients treated by POG and CSG members were on protocols (54%) than those treated at other institutions (25%); in general, the younger the patient, the greater the likelihood of being on protocol. The type of insurance seemed to have no effect on protocol participation, but less protocol participation occurred in the Mountain Region than in other regions. The continuing challenge of pediatric cancer centers is to encourage the participation of more children with cancer in controlled clinical trials. Specific emphasis must be placed on the adolescent age group. The elderly (aged 80 years or older) present with earlier stage disease than do younger patients. All ethnic groups have generally similar stages of disease at presentation, except for African-American patients who have a slightly higher incidence of stage IV disease. The proximal migration of colon cancer continues, with 55% of primary colon cancer arising in the right colon in 1993 compared with 51% in 1988. An interaction seems to be present between grade and stage of cancer. Patients with stage III colon cancer who received adjuvant chemotherapy had a 5% improvement in 5-year relative sur-vival.10 African-Americans and other ethnic groups have the same outcome as non-Hispanic whites but may have less access to medical care. African-Americans present with more advanced disease and subsequently have a decreased survival compared with non-Hispanic whites. Time trends indicate that nodal dissection is becoming a more common operative practice in this disease and that radiation therapy is used less often. The current AJCC staging accurately reflects differences in prognosis by stage.11 Renal cell carcinoma is being diagnosed at an earlier stage, most likely because of the increase in radiologic evaluations of patients who are asymptomatic but are being studied for other reasons. Surgery remains the most effective form of treatment, and partial nephrectomy is being used more frequently. Younger patients have longer stage-specific survival. Various treatments are available for patients with laryngeal and hypopharyngeal squamous cell carcinoma (SCC) within all four stage groups as shown by the differences in application of surgery, radiation therapy, and chemotherapy. A slight increase occurred between 1980 to 1985 and 1990 to 1992 in the proportion of patients with laryngeal SCC presenting with advanced disease (stage IV). The largest proportion of patients with early stage hypopharyngeal SCC either were asymptomatic or had the common and nonspecific complaint of gastroesophageal reflux. An association also appeared to exist in these patients between hypopharyngeal SCC and the presence of a simultaneous cancer. The present AJCC scheme of stratifying by anatomic extent of disease is a useful prognosticator of outcome for laryngeal SCC, with 5-year survival rates ranging from 90.7% for stage I to 41.8% for stage IV cases. However, a great difference in survival was noted within modified groupings of the T and N classifications that disaggregated stage III and IV cases into localized disease (87.5% for early and 76.0% for more advanced tumor progression) versus regionally metastatic disease (46.2% for nodal involvement). It is hoped that current efforts to revise the AJCC staging system will improve its prognostic utility. Outcomes for 12,000 primary lung cancer patients diagnosed with non-small cell carcinoma between 1985 and 1988 were examined. Large cell undifferentiated, squamous cell, and adenocarcinoma cases were compared in terms of local, regional, or distant type of recurrence and temporal recurrence patterns. Generally, the patterns of failure and temporal appearance of relapse were quite similar for the different histologic types. It seems reasonable to continue to generally group large cell undifferentiated carcinoma, squamous cell carcinoma, and adenocarcinoma together for cancer management purposes. Most women with epithelial ovarian cancers continue to present with advanced disease (Fig. 2). No improvements in early detection were apparent in the reference years studied. The benefits of the addition of chemotherapy to the treatment of this disease were most obvious in patients with stage II and III disease, grade 3 or 4, and those with stage IV disease. These benefits were less clear in early stage disease. There continues to be significant room for improvement in diagnosis and treatment.13 African-American women with advanced epithelial ovarian cancer appear to have received less aggressive treatment than have white women and experienced a poorer prognosis. Percentage stage group distribution for cancers of the breast (gray) and ovary (blue), 1993. The clinical patterns of prostate cancer have changed markedly in recent years.14 The proportion of men diagnosed when aged younger than 70 years increased from 38% in 1986 to 50% in 1993. The proportions of both the earliest (stages 0 and I) and the most advanced (stage IV) stages declined. The proportion of stage II prostate cancer increased from 19% in 1986 to 48% in 1993. The proportion of grade 2 (moderately differentiated) tumors increased from 39% in 1986 to 58% in 1993. The proportion of patients treated by prostatectomy increased from 10% in 1986 to 29% in 1993. The proportion of patients receiving no cancer-directed treatment declined from 42% in 1986 to 22% in 1993. A relative increase occurred in sarcomas originating in the pleura with a concurrent increase in mesotheliomas.15 A shift toward more advanced disease was also noted. Limb-sparing surgical procedures are now common. It appears from stage subset analysis that many stage II and III patients frequently do not have to have multimodality therapy. In a nonrandomized survival comparison of 3,800 stomach cancer patients, it was found that lymph node dissection of N2 nodes did not augment survival compared with gastrectomy without node dissection. This statement also reflects the inclusion of perigastric nodes in the resection. Subgroup analysis of patients with gastric carcinoma who had a curative resection did not show a benefit for the extragastric node dissection.16 A series of pathologically staged cases was reviewed. In recent years the tendency to use conservative surgery (partial or simple vulvectomy) has increased. In small node-negative lesions (smaller than 2 cm), conservative surgery without radiation was used 56% of the time. In node-positive lesions larger than 2 cm, radical vulvectomy was used 52% of the time, and 48% of the patients received radiation. The likelihood of receiving radiation increased from 40% for patients with one positive node to more than 55% for those with two or more positive nodes. Five-year relative survival for patients with node-negative lesions was 93% when lesions were smaller than 2 cm and 87% when lesions were larger than 2 cm; for patients with node-positive lesions, 5-year relative survival was 64% when lesions were smaller than 2 cm and 43% when lesions were larger than 2 cm. A larger number of positive nodes adversely affected survival.
