Cathryn Phillips

BACKGROUND: Survival from metastatic cutaneous melanoma is substantially lower than for localized disease. Treatments for metastatic melanoma have been limited, but remarkable clinical improvements have been reported in clinical trials in the last decade. We described the characteristics of US patients diagnosed with cutaneous melanoma during 2001-2013 and assessed trends in short-term survival for distant-stage disease. METHODS: Trends in 1-year net survival were estimated using the Pohar Perme estimator, controlling for background mortality with life tables of all-cause mortality rates by county of residence, single year of age, sex, and race for each year 2001-2013. We fitted a flexible parametric survival model on the log-hazard scale to estimate the effect of race on the hazard of death because of melanoma and estimated 1-year net survival by race. RESULTS: Only 4.4% of the 425 915 melanomas were diagnosed at a distant stage, cases diagnosed at a distant stage are more commonly men, older patients, and African Americans. Age-standardized, 1-year net survival for distant-stage disease was stable at approximately 43% during 2001-2010. From 2010 onward, survival improved rapidly, reaching 58.9% (95% confidence interval = 56.6% to 61.2%) for patients diagnosed in 2013. Younger patients experienced the largest improvement. Survival for distant-stage disease increased in both Blacks and Whites but was consistently lower in Blacks. CONCLUSIONS: One-year survival for distant-stage melanoma improved during 2001-2013, particularly in younger patients and those diagnosed since 2010. This improvement may be a consequence of the introduction of immune-checkpoint-inhibitors and other targeted treatments for metastatic and unresectable disease. Persistent survival inequalities exist between Blacks and Whites, suggesting differential access to treatment.

Comorbid diabetes mellitus has been shown to be associated with outcomes among cancer patients, but population-based data have been limited to elderly patients through linkages between the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program database and Medicare databases. Reporting of comorbidity to the population-based Connecticut SEER registry is not required, but the extent of voluntary reporting of comorbid diabetes was assessed in this preliminary study. Of 15,145 Connecticut residents diagnosed at age 20+ years with invasive cancer in 2006, who were ascertained from 33 registry sources, 8688 (57.4%) from 21 sources were included in the analysis of comorbid diabetes. The prevalence of comorbid diabetes was 12.5%, and was lowest for patients with prostate cancer (8.5%) and highest for with liver-pancreas cancer (25.9%), consistent with the literature. Diabetes prevalence was substantial (9.5%) within the non-elderly subgroup aged 20-64 years at cancer diagnosis who comprised 45% of the 8688 patients. These results indicate an opportunity for future large-scale studies of the impact of diabetes on outcomes among all newly diagnosed cancer patients (both non-elderly and elderly) in the Connecticut SEER registry and other US central cancer registries.

Data from US population-based cancer registries have shown increasing incidence rates for cancer of the base of the tongue, interpreted as related to the epidemic of human papillomavirus (HPV) infection, but rates could be underestimated due to miscoding of some base of tongue cancers to tongue "not otherwise specified" (NOS). Tongue NOS was the most commonly coded subsite among incident (2000-2011) invasive cancers of the oral tongue (tongue excluding base of tongue and lingual tonsil which together comprise the posterior one-third of the tongue) in the 18 Surveillance, Epidemiology and End Results (SEER) Program registries combined and in the Connecticut SEER registry. All 173 cases of tongue NOS cancer in the Connecticut SEER registry diagnosed in selected years were reviewed. Only 5% were recoded to base of tongue, decreasing from over time from 8% to 2%, resulting in minimal impact on the incidence rate for base of tongue cancer in Connecticut. Most (76%) of the 173 tongue NOS cases were recoded to anterior two-thirds of tongue NOS, ruling out base of tongue as the actual site but resulting in underestimation of incidence rates for anterior two-thirds NOS in Connecticut. Similar studies are needed on tongue NOS cancers in other US cancer registries, along with studies on the HPV status of tumors at specific subsites of the oral tongue, to enhance surveillance and interpretation of trends in cancer incidence in relation to the HPV epidemic.

Myelodysplastic syndromes (MDS), a heterogeneous group of myeloid neoplasms diagnosed mostly in elderly persons, are of increasing interest in an aging population and are associated with variable risk of progression to acute myeloid leukemia (AML). The numbers of deaths related to MDS in the population are underestimated in routine US cancer mortality statistics which are based on only the underlying cause (UC) rather than multiple causes (MCs) of death recorded on death certificates. Additional MDS-related deaths, however, may be missed if some MDS patients die with mention of leukemia but not MDS on their death certificate. This requires studies of MCs of death among all MDS patients in population-based tumor registries. This study examined MCs of death among patients diagnosed with MDS in 2001- 2009 and reported to the population-based Connecticut Tumor Registry. MDS was the UC for 199 deaths (25.7% of all 773) and was coded as other than UC for 160 (20.7%). Another 121 (15.7%) death records, however, had leukemia without mention of MDS; the majority were coded to AML and most of the others as unspecified type of acute leukemia. If these 121 deaths are added to the 359 with mention of MDS, the total of MDS-related deaths would be 480 (or 62.1% of all 773 deaths). A total of 178 deaths (23.0% of all 773) were coded to leukemia as the UC, and would be included with leukemia (not MDS) in routine cancer mortality statistics. Leukemia diagnosed since 2010 in MDS patients is reportable to registries as a new primary cancer. This new rule will help central cancer registries to confirm leukemia diagnoses coded on death records, as part of the process of improving surveillance of cancer mortality rates in the population.