Atrium Health Union

e22080 Background: An estimated 100,000 new diagnoses of malignant melanoma are expected in 2020. Systemic treatment with immune checkpoint inhibitors (ICIs) and targeted therapy with BRAF/MEK inhibitors have impacted the natural history for resectable and unresectable/advanced disease. ICIs and the combination of dabrafenib plus trametinib have been shown to decrease the risk of recurrence. Eligibility to receive adjuvant treatment has been based on melanoma specific survival (MSS) reported by AJCC. Romano et al. (JCO 2010) have previously reported their single institution 5yr data from 1998-2004 for stage IIIa/b/c melanoma relapse free survival (RFS) to be 63%, 32% and 11% respectively. Per the AJCC 8th edition, the 5yr MSS for stage IIIa/b/c is 93%, 83% and 69% respectively. We report our single institution data for recurrence rate (RR) and RFS. Methods: Our prospective database was queried for patients with stage IIb/c, IIIa/b/c (per AJCC 7th edition) from 2005 to 2019. Time to recurrence and relapse free survival were calculated using time from surgery date to chart review. Results: 529 patients with stage IIb/c, IIIa/b/c patients were identified. The cohort was 63% male and 98% white, with a median age of 60 (IQR 48-70). The distribution of disease stage was: IIb, 27%; IIc, 10%; IIIa, 23%; IIIb, 22%; IIIc, 17%. The median time to recurrence for all patients was 1.15yrs (IQR 0.57-2.3). The overall RR was 36%. RR by stage were: IIb, 28%; IIc, 36%; IIIa, 26%; IIIb, 47%; IIIc, 46%. Recurrence most often was associated with a primary lesion on the trunk (36%), followed by head/neck (26%), lower extremity (23%) and upper extremity (15%). Distant recurrence accounted for 54% of all first recurrences, followed by regional (34%) and local (12%). The 2yr and 5yr RFS were significantly different by stage (p < 0.0001) (Table). Conclusions: 5yr RFS for stage IIIa disease in our study is considerably higher compared to the Romano et al. data (71% vs 63%). The 5yr MSS has improved from 78% to 93% (AJCC 7th vs 8th edition). Our group has demonstrated improvement in RFS when compared to historical reports suggesting further investigation is needed into IIIa patients most likely to benefit from adjuvant therapy. [Table: see text]

e17526 Background: Recent data suggest that socioeconomic disparities impact the outcome of oncologic disease. This retrospective analysis investigates the role of socioeconomic variables on clinical to pathologic staging of prostate cancer (PC). Methods: 455,773 males with stage 1-3 adenocarcinoma of prostate who underwent surgical intervention (96% radical prostatectomy) were extracted from the National Cancer Database from 2004-2016. Patients were stratified into age groups based on American Urologic Association PSA screening recommendations ( < 40, 40-54, 55-69, > 70 years). Changes from clinical to pathological staging were the primary outcomes. Demographics, income level, education status and distance to treatment facility ( < 12.5, 12.5-49.9, > 50 miles) were analyzed using Chi-square and logistic regression to find upstaging predictors. Results: Rates of stage changes are summarized in Table. Increased distance ( > 50 vs < 12.5 mi) was associated with upstaging in all age groups (40-54: OR 1.10 95%CI 1.05-1.16; 55-69: OR 1.20 95%CI 1.18-1.23; > 70: OR 1.42 95%CI 1.35-1.50) except for < 40 years (OR 1.15, 95%CI 0.60-2.21). Other predictors of upstaging included black or other race compared to white (OR 1.06 95%CI 1.04-1.09 and OR 1.10 95% CI 1.06-1.14, respectively) and in men with government insurance vs private insurance (OR 1.19 95%CI 1.17-1.21). Lower risk of upstaging was seen for those who were not insured vs private insurance (OR 0.70 95%CI 0.67-0.73), lived in areas with the highest vs lowest high school education rate (OR 0.95, 95%CI 0.92-0.98), or lived in the lowest vs highest income areas (OR 0.93, 95%CI 0.90-0.96). Conclusions: Socioeconomic disparities directly impact the outcome for prostate cancer. Our study suggests age, distance from treatment facility, and race are associated with a greater risk for clinical to pathologic upstaging. Investigation should continue to better understand at-risk populations. [Table: see text]

e24065 Background: To determine factors associated with the development of post-treatment hypothyroidism (HY) in the head and neck (HN) population as well as evaluate the impact of socio-economic factors and survivorship program. Methods: We collected demographics, insurance coverage, disease staging, treatment characteristics, and details of thyroid function measurement as well as supplementation for all HN oncology patients (n = 608) who presented between January 2011 and January 2019 at Levine Cancer Institute, Charlotte, North Carolina. Insurance was categorized as Government (Medicaid or Medicare), Private, or Uninsured. Patient malignancies were grouped as oropharynx, oral cavity, larynx/hypopharynx, nasopharynx, nasal cavity/sinus, or primary salivary gland. Thyroid function was evaluated by use of laboratory thyroid stimulating hormone (TSH) values. Timing of thyroid supplementation was standardized to start of treatment. Details of thyroid hormone supplementation was collected. Data was analyzed with Chi-square and ANOVA methods, using SAS 9.4 (Cary, NC). Results: 483 patients (79%) had post treatment surveillance with TSH. The patients (n = 125, 21%) with no identifiable thyroid surveillance did not have any racial or socioeconomic disparities identified. Caucasian and African American thyroid surveillance rates were similar at 79% and 81%, respectively. There was no difference based on insurance: Government 81%, Uninsured 81%, and Private 76%. Of patients with thyroid surveillance, 203 (42%) developed post-treatment HY. The mean and median time frame until HY identification was 544 days and 450 days, respectively. A mean and median dose of thyroid hormone supplementation of 75 mcg of levothyroxine. Most patients had lower rates of thyroid dysfunction with TSH levels between 5-10. Fewer African Americans (24%) developed HY than Caucasians (47%). Patients with laryngeal cancer were at greatest risk to develop HY (57%), followed by oropharynx (40%) and oral cavity (40%). Staging did not demonstrate a significant difference between development of HY. Conclusions: This study is the largest cohort of HN patients to be evaluated for post HN treatment induced HY. Oncology team providers and primary care physicians should be aware of the significant rates of HY. In our institution we identified a consistency of care provided regardless of socioeconomic and racial factors.

Purpose Neurofibromatosis type 1 (NF1) is characterized by a highly variable clinical presentation, but almost all NF1-affected adults present with cutaneous and/or subcutaneous neurofibromas. Exceptions are individuals heterozygous for the NF1 in-frame deletion, c.2970_2972del (p.Met992del), associated with a mild phenotype without any externally visible tumors. Methods A total of 135 individuals from 103 unrelated families, all carrying the constitutional NF1 p.Met992del pathogenic variant and clinically assessed using the same standardized phenotypic checklist form, were included in this study. Results None of the individuals had externally visible plexiform or histopathologically confirmed cutaneous or subcutaneous neurofibromas. We did not identify any complications, such as symptomatic optic pathway gliomas (OPGs) or symptomatic spinal neurofibromas; however, 4.8% of individuals had nonoptic brain tumors, mostly low-grade and asymptomatic, and 38.8% had cognitive impairment/learning disabilities. In an individual with the NF1 constitutional c.2970_2972del and three astrocytomas, we provided proof that all were NF1-associated tumors given loss of heterozygosity at three intragenic NF1 microsatellite markers and c.2970_2972del. Conclusion We demonstrate that individuals with the NF1 p.Met992del pathogenic variant have a mild NF1 phenotype lacking clinically suspected plexiform, cutaneous, or subcutaneous neurofibromas. However, learning difficulties are clearly part of the phenotypic presentation in these individuals and will require specialized care.

The objective of this study was to assess the performance and reproducibility of the two currently used ocular surface staining scores in the assessment of keratoconjunctivitis sicca in Sjögren syndrome (SS) research classification. In a multidisciplinary clinic for the evaluation of sicca, we performed all tests for the American European Consensus Group (AECG) and the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, including the van Bijsterveld score (vBS) and the Ocular Staining Score (OSS), in 994 participants with SS or with non-SS sicca. We analyzed the concordance between the scores, the diagnostic accuracy and correlation with clinical variables, and interrater and intrasubject reproducibility. A total of 308 (31.1%) participants had a discordant vBS and OSS that was due to extra corneal staining points in the OSS. The presence of one or more of the additional points was highly predictive of SS classification (odds ratio = 3.66; P = 1.65 × 10e-20) and was associated with abnormal results of all measures of autoimmunity and glandular dysfunction. Receiver operating characteristic curves showed optimal cutoff values of four for the vBS (sensitivity = 0.62; specificity = 0.71; Youden's J = 0.33) and five for the OSS (sensitivity = 0.56; specificity = 0.75; Youden's J = 0.31). Notably, there was very poor consistency in interobserver mean scores and distributions ( P < 0.0001) and in intrasubject scores after a median of 5.5 years (35% changed status of the ocular criterion). Ocular surface staining scores are useful for SS research classification; however, they are subject to significant interrater and intrasubject variability, which could result in changes in classification in 5%-10% of all subjects. These results highlight the need for objective and reproducible markers of disease that have thus far remained elusive for SS.