Objective: To describe comorbidity burden and nonclinical factors associated with all-cause mortality of sinonasal cancer in the United States.Methods: The National Cancer Database (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) was queried for adult cases of sinonasal cancer (n = 10,518). Outcome of interest was all-cause mortality. Independent variables included comorbidity score and nonclinical factors such as age, gender, race, facility type, distance to facility, insurance, and income. Survival analysis was conducted via multivariable extended Cox regression with Heaviside adjustments.Results: Patients were mostly (79%), male (61%), and mean age of diagnosis was 63.5 years. Approximately one in five patients (18.7%) had a major comorbid condition (Charlson-Deyo score ≥ 1) at diagnosis. After adjusting for clinical factors, increasing comorbidity score was associated with a corresponding increase in hazard of mortality (aHR comorbidity score of 1 = 1.25; 95% CI, 1.16, 1.35), (aHR score of 2+ = 1.61; 95%, CI 1.41, 1.83). Hazard of mortality was also associated with being male (aHR = 1.11; 95% CI, 1.04, 1.17); black (aHR = 1.13, 95% CI, 1.03, 1.24); uninsured (aHR = 1.45; 95% CI, 1.25, 1.68) or on Medicaid (aHR = 1.50; 95% CI, 1.33, 1.69); residence in zip codes with lower median income quartile (aHR < $30,000 = 1.17; 95% CI, 1.06, 1.29); and treatment at community cancer programs (aHR = 1.14, 95% CI 1.01, 1.28).Conclusion: Comorbid disease is associated with all-cause sinonasal cancer mortality, and after accounting for known clinical factors, significant differences in mortality persist based on disparity-driven, nonclinical factors.
The migration and adhesion properties of tumors affect their metastatic rate. In the present study, we investigated carcinoembryonic antigen-related cell adhesion molecule (CEACAM) 1, 5, and 6 expression in high nitric oxide (HNO)-adapted lung cancer cells compared to parent cells. We observed high transcript levels of CEACAM 1 (4S, 4L), CEACAM 5, and CEACAM 6 in HNO cells compared to parent cells. However, the surface expression was low in HNO cells. Interestingly, the intracellular protein levels were high for these three CEACAMs. We confirmed these results with immunohistochemical experiments. Further, the adhesion and migration assays showed reduced clumping in HNO-adapted A549 (A549-HNO) cells and faster migration rates, respectively. These results document the altered adhesion and migration properties of cells adapted to HNO. Further, our studies also indicate a dynamic regulation of CEACAM protein expression and surface transport in HNO cells.
Introduction: The anatomical complexity of the sinonasal region contributes to the poor prognosis and relative rarity of sinonasal cancer. While several studies have focused on the major clinical factors associated with survival, the burden of comorbidities and its impact on all-cause mortality of sinonasal cancer is unknown. Objective: This study aimed at describing the impact of comorbidities and nonclinical factors on all-cause mortality of sinonasal cancer in the United States. Methods: In this retrospective cohort study (n=10769), adult cases of sinonasal cancer (International Classification of Diseases for Oncology, third edition typology codes: C30.0, C30.1, C31.0-C31.3, C31.8, C31.9) diagnosed from 2004 through 2013. The outcome of interest was all-cause mortality. Independent variables included treatment type, time to treatment, staging, comorbidity scoring, histology, HPV test status, age, gender, race, facility type, distance to facility, insurance, local income, and urban level. Survival analysis was conducted via multivariable extended Cox regression with Heaviside adjustment for time-varying component of treatment variables. Results: In this cohort, 79% were whites, 60% males, and mean age of diagnosis was 63.5 years. Approximately 1-in-5 patients (18.6%) had a major comorbidity (Charlson-Deyo score ≥ 1) at the time of sinonasal cancer diagnosis. In the final model, after controlling for clinical factors including stage of presentation, treatment modality, HPV status, and histological subtypes, increasing Charlson-Deyo comorbid score was associated with a corresponding increase in hazard of mortality [(aHR score of 1 = 1.25; 95% CI 1.16, 1.35), (aHR score of 2+ = 1.62; 95% CI 1.42, 1.84). There were significant effects of race and socioeconomic status on all-cause mortality. Males (aHR = 1.11; 95% CI 1.05, 1.18); blacks (aHR = 1.12, 95% CI 1.02, 1.24); those uninsured (aHR = 1.40; 95% CI 1.21, 1.62) or covered by Medicaid (aHR = 1.48; 95% CI 1.31, 1.66); and patients living in zip-codes with lower median income quartile (aHR <$30,000 = 1.17; 95% CI 1.06, 1.29) all had greater hazard of all-cause mortality. Additionally, treatment at community cancer programs was associated with increased hazard of mortality (aHR = 1.14, 95% CI 1.01, 1.28) compared with being treated at an academic/research program. Conclusions: Besides clinical factors such as stage of presentation, severe comorbid disease is most associated with all-cause mortality among patients with sinonasal cancer. Additionally, other nonclinical factors associated with sinonasal cancer all-cause mortality included race, insurance status, income, histological subtypes of the cancers, and comorbidity scores. Understanding the impact of these factors on mortality could help clinicians in disease prognostication and management of patients with sinonasal cancer. Note: This abstract was not presented at the meeting. Citation Format: Premal B. Desai, Aleksandr R. Bukatko, Matthew C. Simpson, Eric Adjei Boakye, Jason W. Greenberg, Greg M. Ward, Ronald J. Walker, Jastin L. Antisdel, Nosayaba Osazuwa-Peters. Impact of comorbidities and nonclinical factors associated with sinonasal cancer all-cause mortality in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4190.
Objectives: In 2009, there were 48,010 new cases of head and neck cancer in the United States. A decade later, it is projected that there will be 65,410 new cases in 2019, a 36% increase in new cases of the disease. While this number represents the general head and neck cancer population in the United States, only a few studies have described incidence and trends in head and neck cancer in the pediatric, adolescent, and young adult population—individuals who may have to live with the effects of cancer treatment due to a younger than average age of diagnosis. This study aimed to estimate head and neck cancer incidence and trends in the United States’ pediatric, adolescent, and young adult population. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1975-2016, we analyzed age-adjusted head and neck cancer incidence rates for pediatric cases (aged 0 to 14 years) and young adult cases (aged 15-39 years). We used Joinpoint regression analyses to examine incidence trends stratified by sex (male, female), race (white, blacks, and Others), and age groups (0-14, and 15-39 years). Results: There were 424 pediatric HNC cases and 6,936 adolescent and young adult cases in the study. Whites accounted for 70.6% of cancers, and 57.6% of cancers occurred in males. Overall, there was a 14.7% decrease in the incidence of HNC (1.32 per 100,000 in 1975 vs. 1.12 per 100,000 in 2016). For pediatric cases, there was a 51.2% decrease in incidence of HNC (0.18 per 100,000 in 1975 vs. 0.09 per 100,000 in 2016); in young adults, there was a 12.8% decrease in incidence of HNC (2.01 per 100,000 in 1975 vs. 1.75 per 100,000 in 2016). While there was overall decrease in incidence, we found differences based on sex. Among young adult males, the annual percent change (APC) from 1975 to 2016 was -0.46 (p < 0.05) while among young adult females, it significantly increased by 0.50 (p < 0.05). This difference in young adult male vs. female head and neck cancer incidence may have been driven by race: as stratified by race, the APC for white young adult males was -0.29 (ns) while white females had an APC of 0.55 (p < 0.05); and among black young adults, APC for males was -2.24 (p < 0.05) and APC for females was -0.82 (p < 0.05). Conclusions: Among pediatric, adolescent, and young adults in the United States, head and neck cancer has decreased markedly in all groups in the last four decades, except among white female adolescents and young adults where there has been a significant increase in the time period of the study. As this trend differs from the adult head and neck cancer population, it is critical that further investigations provide more insight into the epidemiology of head and neck cancer among white adolescent and young adult females. Note: This abstract was not presented at the conference. Citation Format: Nosayaba Osazuwa-Peters, Kara M. Christopher, Matthew C. Simpson, Premal B. Desai, Rebecca L. Rohde, Sai D. Challapalli, Adnan S. Hussaini, Neelima Panth, Eric Adjei Boakye. Incidence and trends in head and neck cancer among United States’ pediatric, adolescent, and young adult population [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A05.
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