This study examined the metastatic pattern and prognosis of both estrogen receptor-positive (ER D )/human epidermal growth factor receptor 2-positive (HER2 D ) and estrogen receptor-negative (ER L )/HER2 D breast cancer. A total of 54,147 patients with HER2 D breast cancer from the National Cancer Database and 31,946 patients with HER2 D breast cancer from the Surveillance, Epidemiology, and End Results database were examined. We found that patients with ER D /HER2 D and ER L /HER2 D breast cancers had different metastatic patterns, and ER L /HER2 D patients had worse prognosis. Background: Human epidermal growth factor receptor 2epositive (HER2 þ ) breast cancer is generally treated with HER2-targeted therapy combined with chemotherapy. Patients with HER2 þ and estrogen receptorepositive (ER þ ) cancer are additionally treated with long-term hormone therapy. This study examined the metastatic pattern and prognosis of both ER þ /HER2 þ and ER À /HER2 þ breast cancer. Patients and Methods: A total of 54,147 patients with HER2 þ breast cancer from the National Cancer Data Base (NCDB, 2010(NCDB, -2013 and 31,946 patients with HER2 þ breast cancer from the Surveillance, Epidemiology, and End Results Program (SEER, 2010(SEER, -2014 were examined. Sites of metastasis and overall survival (OS) were examined in the NCDB, while OS and breast cancerespecific survival were examined in the SEER database. Results: Compared to ER À /HER2 þ breast cancer, ER þ /HER2 þ breast cancer was more likely to metastasize to bone but less likely to brain, liver, and lung and less likely to result in multiple metastases. In univariate analysis based on the NCDB, patients with ER À /HER2 þ breast cancer had worse OS in all metastasis subsets, including patients who received HER2-targeted therapy. This poor survival for ER À /HER2 þ persisted in patients with metastasis to bone and lung, and multiple metastases. In multivariate analysis adjusting for age, tumor grade, surgery, chemotherapy, HER2-targeted therapy, and hormone therapy, ER À /HER2 þ patients with bone metastasis still had worse OS. In the SEER, ER À /HER2 þ patients had both worse OS and breast cancerespecific survival in univariate analysis. Conclusion: This large study showed patients with ER þ /HER2 þ and ER À /HER2 þ breast cancers had different metastatic patterns. Patients with ER À /HER2 þ breast cancer may require more aggressive treatment.

Background High‐grade neuroendocrine carcinomas are rare in the gastrointestinal tract. However, treatment patterns and outcomes have not been well described. Subjects, Materials, and Methods The National Cancer Database was analyzed. The primary objective was to describe the clinical outcomes and identify prognostic factors. Univariate and multivariate analyses were done to identify factors associated with patient outcome. Results A total of 1,861 patients were identified between 2004 and 2013. The mean age was 63 years (standard deviation ±13). The majority of the patients (78.1%) were non‐Hispanic whites. The most common primary sites were pancreas (pancreatic neuroendocrine tumor [PNET] = 19.4%), large intestine (18.1%), esophagus (17.8%), and rectum (15.5%). Stage at presentation was I (6.6%), II (10.5%), III (18%) and IV (64.6%). Only 1.6% of the patients had brain metastases. Surgical resection was the primary therapy in 27.9%, and their median overall survival (OS) was 13.3 months. Patients treated with palliative chemotherapy had a median OS of 11.2 months, compared with 1.7 months for untreated patients. The median OS for high‐grade PNET was 6 months, compared with 9.9 months for other high‐grade gastrointestinal neuroendocrine carcinomas (HG GI NEC). On univariable analysis, age < 65 years (hazard ratio [HR] 0.72; 0.66–0.8; p < .001) and treatment at an academic center (HR 0.88; 0.79–0.99; p < .034) were associated with improved survival. Multivariable analysis confirmed prognostic advantage of treatment at an academic center. Conclusion This is the largest series of HG GI NEC. Most patients present with metastatic disease, and overall survival remains poor. Treatment at an academic center, younger age, and use of chemotherapy were associated with improved survival. Multiagent chemotherapy was found to be associated with superior survival compared with single‐agent chemotherapy, which was superior to no chemotherapy. Temporal sequences of chemotherapy, surgery, and radiation administration were not found to be associated with survival differences on multivariable analysis. Implications for Practice Management of patients with high‐grade gastrointestinal neuroendocrine carcinomas (HG GI NEC) is based on experience with small‐cell lung cancer. In this retrospective review, most patients had advanced disease and pancreatic primary had worse outcomes. Treatment at an academic center, younger age, and use of chemotherapy are associated with improved survival. Patients with early‐stage disease treated with resection alone had inferior outcomes compared with patients who received neoadjuvant or adjuvant therapy, suggesting that micrometastases contribute to poor surgical outcomes. The relatively high proportion of positive surgical margin favors downstaging with neoadjuvant therapy to improve resection and lower the risk of systemic recurrence.

Background Hospital readmissions are costly and associated with inferior patient outcomes. There is limited knowledge related to readmissions following esophagectomy for malignancy. Our aim was to determine the impact of readmission following esophagectomy on survival. Methods This cohort study utilizes Surveillance, Epidemiology, and End Results-Medicare data (2002–2009). Survival, length of stay (LOS), 30-day readmissions and discharge disposition were determined. Multivariate logistic regression models were created to examine risk factors associated with readmission. Results 1,744 patients with esophageal cancer underwent esophagectomy. 80% (1390) of patients were male and mean age was 73 years. 71.8% (1251) of tumors were adenocarcinomas and 72.5% (1265) were distal esophageal tumors. 38% (667) of patients received induction therapy. Operative approach was transthoracic in 52.6% (918), transhiatal in 37.4% (653) and required complex reconstruction (intestinal interposition) in 9.9% (173). Stage distribution was: Stage I 35.3% (616), Stage II 32.5% (566), Stage III 27.9% (487) and Stage IV 2.3% (40). Median LOS was 13 days, hospital mortality was 9.3% (158) and 30-day readmission rate was 18.6% (212/1139 home discharges). 25.4% (443) were discharged to institutional care facilities. Overall survival was significantly worse for patients readmitted (p<0.0001, log-rank test). Risk factors for readmission were comorbidity score of 3+, urgent admission and urban residence. Conclusions Hospital readmissions following esophagectomy for cancer occur frequently and are associated with worse survival. Improved identification of patients at risk for readmission following esophagectomy can inform patient selection, discharge planning and outpatient monitoring. Optimization of such practices may lead to improved outcomes at reduced cost.

Background: Gastric squamous cell carcinoma (GSCC) and gastric adenosquamous carcinoma (GASC) comprise less than 2% of gastric cancers. The current knowledge about clinical presentation, treatment modalities and outcomes of GSCC and GASC is limited. The aim of this study is to characterize the clinicopathological features, treatment modalities, and outcomes of GSCC and GASC in comparison to gastric adenocarcinoma (GAC) in National Cancer Database (NCDB). Methods: Patients with GSCC, GASC and GAC between 2004 and 2013 were identified using ICD-O-3 histology and topography codes 8070/3, 8560/3, 8140/3 and C16.0-9. Univariate, and multivariate analysis were performed, and Kaplan-Meier curves was used to compare survival based on histological subtype.

Background and Objective Our objective was to compare clinical outcomes, costs, and resource use based on operative approach, transthoracic (TT) or transhiatal (TH), for resection of esophageal cancer. Methods This cohort analysis utilized the Surveillance, Epidemiology, and End Results—Medicare linked data from 2002 to 2009. Only adenocarcinomas of the lower esophagus were examined to minimize confounding. Medicare data was used to determine episode of care costs and resource use. Propensity score matching was used to control for identified confounders. Kaplan–Meier method and Cox-proportional hazard modeling were used to compare long-term survival. Results 537 TT and 405 TH resections were identified. TT and TH esophagectomy had similar complication rates (46.7% vs. 50.8%), operative mortality (7.9% vs 7.1%), and 90 days readmission rates (30.5% vs. 32.5%). However, TH was associated with shorter length of stay (11.5 vs. 13.0 days, P = 0.006) and nearly $1,000 lower cost of initial hospitalization (P = 0.03). No difference in 5-year survival was identified (33.5% vs. 36%, P = 0.75). Conclusions TH esophagectomy was associated with lower costs and shorter length of stay in an elderly Medicare population, with similar clinical outcomes to TT. The TH approach to esophagectomy for distal esophageal adenocarcinoma may, therefore, provide greater value (quality/cost).