8595 Background: The role of consolidative thoracic and prophylactic brain radiation in extensive stage small cell lung cancer patients is controversial. We investigated the factors associated with the use of any radiation therapy (RT) and whether Radiation has a benefit to overall survival (OS) in the total patient group and whether this benefit is the same if Chemotherapy (CT) only is used, or chemo-immunotherapy (CT-IO) is used. Methods: The NCDB database was queried from years 2017-2019. Patients receiving systemic therapy- STX (CT or CT-IO) had to have at least 6 months of follow-up and have no brain metastases at diagnosis. All RT patients had to receive upfront systemic therapy, were treated 2 to 6 months from diagnosis, and if treated to the brain received 25Gy in 10 fractions only. Multi-variate analyses (MVA) were used to determine factors associated with OS and selection for any radiation. Propensity matching for factors affecting OS were used to generate Kaplan-Meier OS curves. Log-rank tests were used to determine differences in Kaplan Meier survival curves for the effects of RT on OS. Results: The total number of patients receiving RT or systemic therapy alone as well as their median follow-ups(months(mn) were (981, 33.02mn) and (8909, 30.59mn). The median time to the start of STX and RT were 22days and 135 days respectively. MVA noted that RT had a greater effect on OS (Thoracic, Brain, Both – HRs = 0.78, 0.75, and 0.68) than other interventions including IO (HR 0.87) and palliative care without RT (HR 1.07). Selection for radiation depended significantly upon factors affecting OS(HR) including liver metastases (0.59), females (1.21), age/10yr(0.78) and Charlson co-morbidity index of > 3(0.66), but did not depend upon insurance status, race, or county income/high school graduation rates. Propensity score matched OS curves noted the same effects of RT on OS whether CT or CT-IO was given. The lowest HRs were noted when both thoracic and brain RT were given (see table). Conclusions: The patient with extensive stage small cell lung cancer who reach candidacy and receive RT may have a significant improvement in OS compared to the patients treated only with CT or CT-IO. Combined thoracic and prophylactic brain RT seems to be better than either one alone. The impact of radiation whether given to one or two sites may be more beneficial than immunotherapy added to chemotherapy. [Table: see text]

Objective: The diagnostic criteria of lymphatic vascular invasion have not been standardized. Our investigation assesses the factors associated with lymphatic vascular invasion positive tumors and the impact of lymphatic vascular invasion on overall survival for patients with non-small cell lung cancer undergoing (bi)lobectomy with an adequate node dissection. Methods: The National Cancer Database was queried from the years 2010 to 2015 to fi nd surgical patients who underwent lobectomy with at least 10 lymph nodes examined (adequate node dissection) and with known lymphatic vascular invasion status. Paired t tests were used to distinguish differences between the patients with and without lymphatic vascular invasion in their specimen. Multivariable analysis was used to determine factors associated with overall survival. Propensity score matching adjusting for overall survival factors was used to determine the lymphatic vascular invasion's overall survival impact by grade, histology, p-T/N/overall stage, and tumor size. Results: Lymphatic vascular invasion status was reported in 91.6% and positive in 23.4% of 28,842 eligible patients. Academic medical centers, institutions with populations more than 1,000,000, and the mid-Atlantic region reported higher rates of lymphatic vascular invasion positive tumors as well as overall survival compared with other cancer centers. Lymphatic vascular invasion was independently associated with a significant decrement in overall survival as per multivariable analysis and propensity score matching. Propensity score matching demonstrated that lymphatic vascular invasion was associated with a significant decrement in overall survival for all histologies, tumor grades, tumor sizes, and stages, except for more advanced pathologic stages T3/III/N2 and larger tumors greater than 4 cm for which overall survival was trending worse with lymphatic vascular invasion positive. Conclusions: Lymphatic vascular invasion positive varies based on hospital location/type and population, but it was associated with a decrement in overall survival that was independent of pathologic T/N/overall stage, histology, and tumor grade. Lymphatic vascular invasion must be standardized and considered as a staging variable and should be considered as a sole determinant for prognosis, especially for those with earlier-stage and smaller tumors. (JTCVS Open 2024;21:313-40)

The diagnostic criteria of lymphatic vascular invasion (LVI) have not been standardized. Our investigation assesses the factors associated with LVI positive (LVI+) tumors and the impact of LVI on overall survival (OS) for all NSCLC patients undergoing (bi)lobectomy as well as those who are not consistently identified as candidates for adjuvant systemic therapy.

e20507 Background: Pulmonary typical carcinoid tumors(TC) are rare and the treatment of these tumors has not been well studied. The purpose of our investigation is to find whether or not these tumors are increasing in frequency and to assess the value of different treatment options. Methods: The National Cancer Database was queried from the years 2004-2015 for those patients who underwent a surgical resection((bi)lobectomy(L+) or sub-lobar resection(L-)) of TC. Multi-variate analysis for overall survival (OS) in surgical patients was used for propensity matching to determine the benefits of (L-) vs (L+) and to assess the role of chemotherapy or radiation in node positive disease(N+). SEER-18 was used to estimate the age-adjusted rates of TC and the percentage of N+ tumors during the years of our study. Results: With a median follow-up of 62.1 months, 16337 patients underwent surgical resection of TC of which 7846, 7538, 644, 302, and 7 patients had NX, N1, N2, and N3 disease. The rate of TC per 100,000 population progressively and significantly increased from 3.2 to 5.4 while the rate of node positivity remained flat at 0.3-0.4/100,000 population. Adjuvant therapy was given to 155 patients with radiation and 945 with chemotherapy. In the total population, a significant OS benefit was noted in those undergoing a L+ compared to L- (HR = 1.35 p < 0.0001), which was not seen in patients with node negative tumors < 2cm, but was seen in node negative tumors > 2cm (HR = 2.00, p 0.0088) and N1(HR = 3.2, P < 0.0001) and N2 disease(HR = 4.2, p < 0.0001. N2(HR = 2.25, p < .0001 and N1 disease(HR = 1.53 p = 0.0021) had a significant lower OS than N0 disease which were not improved not with radiation therapy(p-value 0.4055) and worsened with both adjuvant chemotherapy(median OS HR p value = < 0.0001). Conclusions: Typical carcinoid tumors are increasing in the US population and should undergo a lobectomy when the size > 2cm or when node positive disease is present. Despite the worse prognosis of patients with node positive disease, radiation did not improve and chemotherapy worsened OS.

The criteria for diagnosis of lymphatic vascular invasion have not been standardized. Our investigation uses the National Cancer Database (NCDB) to assess the impact of this factor on survival (OS) and determine factors associated with the diagnosis (LVI-D) of LVI and whether it is positive (LVI+).

The Association of Pathology Chairs, an organization of American and Canadian academic pathology departments, has a record percent of women department chairs in its ranks (31%), although still not representative of the percent of women pathology faculty (43%). These women chairs were surveyed to determine what had impeded and what had facilitated their academic advancement before becoming chairs. The 2 most frequently identified impediments to their career advancement were heavy clinical loads and the lack of time, training, and/or funding to pursue research. Related to the second impediment, only one respondent became chair of a department which was in a top 25 National Institutes of Health-sponsored research medical school. Eighty-nine percent of respondents said that they had experienced gender bias during their careers in pathology, and 31% identified gender bias as an important impediment to advancement. The top facilitator of career advancement before becoming chairs was a supportive family. Strikingly, 98% of respondents have a spouse or partner, 75% have children, and 38% had children younger than 18 when becoming chairs. Additional top facilitators were opportunities to attend national meetings and opportunities to participate in leadership. Previous leadership experiences included directing a clinical service, a residency training program, and/or a medical student education program. These results suggest important ways to increase the success of women in academic pathology and increasing the percent of women department chairs, including supporting a family life and providing time, encouragement and resources for research, attending national meetings, and taking on departmental leadership positions.

Pulmonary Langerhans cell histiocytosis (PLCH) is a diffuse cystic lung disease that is strongly associated with exposure to cigarette smoke. Recently, activating pathogenic mutations in the mitogen-activated protein kinase pathway have been described in the dendritic cells in patients with PLCH and have firmly established PLCH to be an inflammatory myeloid neoplasm. Disease course and prognosis in PLCH are highly variable among individual patients, ranging from spontaneous resolution to development of pulmonary hypertension and progression to terminal respiratory failure. A subset of patients with PLCH may have extrapulmonary involvement, typically involving the skeletal system in the form of lytic lesions, skin lesions, or the central nervous system most commonly manifesting in the form of diabetes insipidus. Smoking cessation is the cornerstone of treatment in patients with PLCH and can lead to disease regression or stabilization in a substantial proportion of patients. Further insight into the underlying molecular pathogenesis of PLCH has paved the way for the future development of disease-specific biomarkers and targeted treatment options directed against the central disease-driving mutations.

Pulmonary Langerhans cell histiocytosis (PLCH) is a diffuse cystic lung disease that is strongly associated with exposure to cigarette smoke. Recently, activating pathogenic mutations in the mitogen-activated protein kinase pathway have been described in the dendritic cells in patients with PLCH and have firmly established PLCH to be an inflammatory myeloid neoplasm. Disease course and prognosis in PLCH are highly variable among individual patients, ranging from spontaneous resolution to development of pulmonary hypertension and progression to terminal respiratory failure. A subset of patients with PLCH may have extrapulmonary involvement, typically involving the skeletal system in the form of lytic lesions, skin lesions, or the central nervous system most commonly manifesting in the form of diabetes insipidus. Smoking cessation is the cornerstone of treatment in patients with PLCH and can lead to disease regression or stabilization in a substantial proportion of patients. Further insight into the underlying molecular pathogenesis of PLCH has paved the way for the future development of disease-specific biomarkers and targeted treatment options directed against the central disease-driving mutations.

AbstractPulmonary Langerhans cell histiocytosis (PLCH) is a diffuse cystic lung disease that is strongly associated with exposure to cigarette smoke. Recently, activating pathogenic mutations in the mitogen-activated protein kinase pathway have been described in the dendritic cells in patients with PLCH and have firmly established PLCH to be an inflammatory myeloid neoplasm. Disease course and prognosis in PLCH are highly variable among individual patients, ranging from spontaneous resolution to development of pulmonary hypertension and progression to terminal respiratory failure. A subset of patients with PLCH may have extrapulmonary involvement, typically involving the skeletal system in the form of lytic lesions, skin lesions, or the central nervous system most commonly manifesting in the form of diabetes insipidus. Smoking cessation is the cornerstone of treatment in patients with PLCH and can lead to disease regression or stabilization in a substantial proportion of patients. Further insight into the underlying molecular pathogenesis of PLCH has paved the way for the future development of disease-specific biomarkers and targeted treatment options directed against the central disease-driving mutations.

e21060 Background: The criteria for diagnosis of lymphatic vascular invasion(LVI) have not been standardized. Our investigation uses the National Cancer Database(NCDB) to assess the impact of this factor on survival(OS) and whether there are differences in the diagnosis of LVI based upon institution type and regional location in patients undergoing definitive resection. Methods: The NCDB was queried from the years 2010-2014 to find a patient population who underwent (bi)lobectomy with at least ten lymph nodes examined. Multivariable analysis was used to find factors associated with diagnosis of LVI, and the impact of LVI on OS. Propensity score matching(PSM) was used to adjust for bias in diagnosing LVI while testing the impact of LVI on OS. Results: 18,057 patients were eligible for our study with a median follow-up of (36.1 months). LVI status was determined in 91.8%. 19.1% of surgical specimens were found to be LVI positive. 2,323 patients had positive nodes with 50.8% of specimens having LVI, while 14.0% of specimens with negative nodes had LVI. Academic medical centers(AC); Medical centers associated with populations > 1,000,000(1M); and Mid-Atlantic(MA) region had higher rates of LVI(all p values < 0.0001, AC 22.7% vs 16.5%, OR = 1.49; 1M 21.1% vs 16.8%, OR = 1.32; MA 27.6% vs 17.1%, OR = 1.85), and higher rates of LVI associated with positive nodes (all p values < 0.0001, AC 34.6% vs 7.9%, OR = 6.14; 1M 36.4% vs 7.7%, OR = 6.82; MA 31.0% vs 6.2%, OR = 6.76). LVI was most frequently diagnosed in the MA region and least frequently found in the Mountain location( 27.6% vs 12.2%, OR = 2.73). LVI was associated with a significant decrement in OS that was independent of institution type, regional population, and institution location. PSM demonstrated that LVI was associated with a decrement in OS to the same degree per each nodal stage(N0,N1,N2) (p < 0.0001, HRs = 1.21 N0, 1.26 N1, 1.18 N2). Conclusions: LVI diagnosis and its association with positive nodes varies based upon hospital location/type and population. LVI was associated with a decrement in OS that was independent of N-Stage. LVI must be standardized and considered as a prognostic factor for staging cancer patients.

Leadership development and succession planning are critical to ensure continued strength of academic pathology. The Association of Pathology Chairs developed the Pathology Leadership Academy to prepare future academic leaders. The purpose of this report is to describe: (1) Pathology Leadership Academy’s development and curriculum, (2) how Pathology Leadership Academy has met leadership development needs for individuals and academic departments in its first 2 years, (3) Pathology Leadership Academy’s future directions based on program feedback. Results were analyzed from pre- and postprogram needs assessment surveys of pathology chairs and from evaluations from Pathology Leadership Academy participants in the first 2 years. Pathology Leadership Academy curriculum was developed from topics identified as priorities in the chairs’ survey. Twenty-eight (90%) of 31 responding participants were very satisfied/satisfied with Pathology Leadership Academy. Of the 18 responding chairs who sent a participant to Pathology Leadership Academy, 11 (61%) reported that Pathology Leadership Academy met their faculty development goal. Of all responding chairs, 13 (32%) of 41 reported uncertainty as to whether Pathology Leadership Academy is meeting chairs’ goals. Chairs reported that Pathology Leadership Academy provided value to their faculty through preparation for a future leadership role, enhancing skills for a current role, and enhancing understanding of opportunities and challenges in academic medicine. Most chairs (27/43, 66%) said Pathology Leadership Academy should be offered again; 13 (32%) of 43 were uncertain, and 1 (2%) of 43 said no. Initial experience of Pathology Leadership Academy is positive and promising and provides opportunity for leadership succession planning in academic pathology. Pathology Leadership Academy will use participant and chair feedback for ongoing curricular development to ensure topics continue to address major needs of academic pathology.

There has been a recent recognition of the need to prepare PhD-trained scientists for increasingly diverse careers in academia, industry, and health care. The PhD Data Task Force was formed to better understand the current state of PhD scientists in the clinical laboratory workforce and collect up-to-date information on the training and certification of these laboratorians. In this report, we summarize the findings of the PhD Data Task Force and discuss the relevance of the data collected to the future supply of and demand for PhD clinical laboratory scientists. It is clear that there are multiple career opportunities for PhD scientists in academic medical centers, commercial clinical laboratories, biotechnology and pharmaceutical companies, and the federal government. Certified PhD scientists have and will continue to form an important resource for our technologically advancing field, bringing training in scientific methods, and technologies needed for modern laboratory medicine. The data gathered by the PhD Data Task Force will be of great interest to current and future PhD candidates and graduate PhD scientists as they make decisions regarding future career directions.