Management Trends and Outcomes for Stage I to II XXXX Using the National Cancer Data Base: Ascertaining the Ideal Treatment Paradigm.

@entity1 @entity1161 @entity1073 @entity7730 @entity1893 @entity34
PURPOSE: @entity1073 ( @entity1073 ) is a rare, albeit aggressive subset of @entity1893 , resulting in varied treatment approaches. Given the paucity of data defining the optimal management for early-stage @entity1073 , we conducted an analysis using the National Cancer Data Base (NCDB) to identify practice patterns and outcomes. METHODS AND MATERIALS: The NCDB was queried for @entity1 with stage I to II @entity1073 diagnosed from 1998 to 2012 receiving @entity7730 ( @entity7730 ) or @entity1161 ( @entity1161 ), or both ( @entity7730 + @entity1161 ). Univariate and multivariable analyses for factors associated with treatment selection were completed using logistic regression. Propensity scores with inverse probability treatment weighting (IPTW) were calculated based on the conditional probability of receiving @entity7730 + @entity1161 . The log-rank test and Cox proportional hazards modeling with IPTW adjustment were conducted for the survival analyses. RESULTS: In total, 2539 @entity1 were identified. The key characteristics were as follows: 69% were male, 71% were aged >= 60  years, 28% had extranodal involvement, and 51% had stage I disease. Of the 2539 @entity1 , 70% underwent @entity7730 , 11% underwent @entity1161 , and 19% underwent @entity7730 + @entity1161 . The use of @entity7730 + @entity1161 decreased from 23.1% to 14.1% in 1998 to 2002 and 2010 to 2012 (P<.001). @entity7730 + @entity1161 usage was lower for @entity1 with the following characteristics: age >= 60  years, female sex, @entity34 , and the presence of B symptoms. With a median follow-up period of 42.8  months, the unadjusted 3-year overall survival estimates for @entity1 receiving @entity7730 , @entity1161 , or @entity7730 + @entity1161 were 67.8%, 72.4%, and 79.8%, respectively (P<.001). After correcting for indication bias through IPTW-adjusted modeling, @entity7730 + @entity1161 reduced the risk of overall mortality compared with monotherapy (hazard ratio 0.65, P=.029). CONCLUSIONS: Although uncommon, @entity1 with stage I-II @entity1073 can have favorable outcomes. Despite a continued decline in the usage of consolidative @entity1161 , combined modality therapy improves survival in this cohort compared with monotherapy.
