Mercy Catholic Medical Center

Abstract Disclosure: S. Bajwa: None. H. Ali: None. U. Bajwa: None. A. Imran: None. F. Mohsin: None. F. Tuz Zahra: None. J. Santhi: None. R. Thirumaran: None. Background:Neuroendocrine Carcinomas (NC) are rare, high grade poorly differentiated tumors originating from neuroendocrine cells. These tumors have a relatively poorer prognosis than well differentiated neuroendocrine tumors, and factors like CD117 positivity or vascular invasion are associated with higher mortality. Data on Neuroendocrine carcinoma mortality and survival trends is limited; hence our purpose is to determine these trends from the latest data on SEER stat database. Methods: Data was collected from Surveillance, Epidemiology and End Result database Research Plus Data, 17 Registries, Nov 2023 Sub (2000-2021), using the ICD Code 8246/3 for neuroendocrine carcinoma. The analysis was stratified based on age, sex, race, year of diagnosis, stage, primary site labelled and various treatment modalities. Survival curves were compared using the Log-Rank test (GraphPad Prism).Results:Total 41353 cases of NC were extracted, of which 51.9% were males. The neoplasm was most seen in Caucasian (70.9%) followed by Black (11.5%), Hispanics (10.8%), Asians/Pacific Islanders (5.8%), Alaskans/American Indians (0.55%) and unknown race (0.5%). Median age of diagnosis was 66 years. 5-yearly Mortality-to-Incidence Ratio (MIR) was calculated as 90.3% for 2000-2005, 80.2% for 2006-2010, 67.5% for 2011-2015, and 57.9% for 2016-2021 (p <0.0001, Log-Rank test for trend). Overall median of survival (OS) was 16 months, with 1-year OS of 54% (CI 95%, 53.5%-54.5%), 3-year OS of 38.1% (CI 95%, 37.6%-38.6%), and 5-year OS of 32.1% (CI 95%, 31.6%-32.6%). The median of survival (MoS) was higher in younger age groups, with a progressive decline in survival with advancing age (p <0.0001). Survival calculated for males was 13 months and 20 for females (p <0.0001). While MoS was higher in Hispanics (21 months), followed by Blacks and Asians/PI (20), Caucasians (14) and Alaskans (12) (p <0.0001). MoS for stage was notable for localized (169 months), regional (60), distant (7), unknown stage (9) (p <0.0001). Anatomically, survival analysis revealed higher MoS for connective tissue (64 months), carotid/aortic body (61) and lowest in disease involving unknown primary site (6) and thoracic cavity (8) (p <0.0001). Treatment based survival revealed: surgery (55 months) vs no surgery (8) (p<0.0001), chemotherapy (11 months) vs no chemotherapy (28) (p <0.0001), XRT (12 months) vs No XRT (18) (p <0.0001).Conclusion:Neuroendocrine carcinoma is an aggressive neoplasm, more prevalent in males and Caucasians. Our study revealed a progressive decline in 5-year MIR from 2000 to 2021, likely attributable to earlier diagnosis and advancement in therapeutic modalities. Superior survival was associated with younger age, female sex, Hispanic race, localized tumor, disease primarily involving the connective tissue, and surgical management. Presentation: Sunday, July 13, 2025

e22555 Background: Oropharyngeal cancers are linked to tobacco, alcohol use, and HPV infection. The 5-year survival rate for oropharyngeal cancer patients in the U.S. is estimated at 52%, according to SEER data. This study analyzes mortality trends for oropharyngeal carcinoma in the U.S. from 1999 to 2020, examining trends across different demographic and geographic groups. Methods: Data from the CDC WONDER database (1999–2020) were used to identify deaths from oropharyngeal neoplasms (ICD-10 code C10). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) were computed for different demographic and geographic subgroups using Joinpoint regression (Version 5.1.0, National Cancer Institute). Results: Over the past two decades, there were 21,842 deaths from malignant oropharyngeal cancer. The age-adjusted mortality rate (AAMR) increased from 0.239 in 1999 to 0.394 in 2020, with an annual increase of 1.113% from 1999 to 2013, followed by a more pronounced rise of 4.520% from 2013 to 2020. For females, the AAMR increased modestly (APC: 1.132%), while for males, it rose slightly from 1999 to 2009 (APC: 0.317%), then increased sharply from 2009 to 2020 (APC: 3.998%). AAPC analysis revealed a significant difference between males and females (−1.100, p = 0.009), with males exhibiting a higher increase. Regionally, the South had the highest AAMR (0.322), followed by the Midwest (0.284), Northeast (0.277), and West (0.262). Urban areas had a higher overall AAMR (0.304) compared to rural areas (0.279). Rural areas showed a consistent AAMR increase (APC: 2.485%), while urban areas initially decreased from 1999 to 2006 (APC: −1.474%) before increasing from 2006 to 2020 (APC: 2.967%). The crude death rate was highest in those aged 85+ (1.688). AAMR trends for Black individuals remained higher but showed a decreasing trend (APC: 0.496%), whereas White individuals experienced a modest increase from 1999 to 2008 (APC: 0.908%) and a rapid rise thereafter (APC: 4.070%). The average APC difference between these groups was −3.200 (p < 0.0001), indicating a higher overall mortality trend among Black individuals. Conclusions: The increasing age-adjusted mortality rate for oropharyngeal cancer, especially among males and in urban areas, points to a rising public health concern that demands targeted prevention and early detection. Disparities between Black and White individuals underscore the need for tailored interventions to address these inequalities. Regional differences suggest that implementing region-specific public health policies could help mitigate the rising burden of this disease.

e22561 Background: Older cancer patients, particularly those with colorectal cancer (CRC), are at increased risk for incidence and complications of cerebrovascular diseases due to shared risk factors and treatment-related adverse effects. Despite being a leading cause of death worldwide, the burden of cerebrovascular diseases mortality in colorectal cancer patients and mortality trends for cerebrovascular diseases-related deaths in older colorectal cancer patients in the United States (US) remain unexplored. Methods: We analyzed CDC WONDER data (1999–2020) to assess cerebrovascular diseases related deaths among older adults (≥65 years) with CRC in the US. Cases were identified using ICD-10 codes I65-I69 for cerebrovascular diseases as the “underlying” cause and C18.0-C18.3 for CRC as the “contributing” cause. Age-adjusted mortality rates (AAMRs) were calculated by sex, age, ethnoracial groups, and geographical regions. Trends were evaluated using Joinpoint Regression to calculate the average annual percentage change (AAPC) with significance set at ≤0.05. Results: From 1999 to 2020, there were 10,185 cerebrovascular diseases-related deaths among older adults with CRC, showing a significant overall decline (AAPC: -6.01; 95% CI: -6.61 to -5.50). Older men had higher AAMRs compared to older women (1.31 vs. 0.99 per 100,000), with both groups following significant declines (Table). Based on ethnoracial stratification, the non-Hispanic (NH) Black population had a higher overall AAMR (1.21) compared to the NH White population (1.17), with a significant decline in both groups (Table). Non-metropolitan areas had a higher overall AAMR (1.33) compared to metropolitan areas (1.07), with both showing significant declines (Table). Among census regions, the Midwest had the highest mortality burden (AAMR: 1.27), followed by the West (1.18), Northeast (1.07), and South (0.98). The states with the highest AAMRs were North Dakota (2.29) and Vermont (1.84), while Louisiana (0.53) and Arizona (0.50) had the lowest. Conclusions: Cerebrovascular disease-related mortality among older adults with CRC has significantly declined over the past two decades, but disparities persisted, with higher burdens in older men, NH Black populations, non-metropolitan areas, and the Midwest region. Future research should investigate the factors contributing to these disparities and explore targeted interventions to reduce cerebrovascular disease-related mortality in high-risk CRC populations. Variable Duration AAPC Lower 95% CI Upper 95% CI p-value Overall 1999-2020 -6.01 -6.61 -5.50 < 0.01 Female 1999-2020 -5.72 -6.63 -5.11 < 0.01 Male 1999-2020 -6.32 -7.07 -5.65 < 0.01 Black or African American 1999-2020 -6.58 -7.80 -5.52 < 0.01 White 1999-2020 -5.73 -6.33 -5.23 < 0.01 Metropolitan 1999-2020 -6.22 -6.93 -5.66 < 0.01 Non-Metropolitan 1999-2020 -4.80 -5.28 -4.27 < 0.01

805 Background: There is a significant gap in oncologic research, which arises from the exclusion of LGBTQ+ individuals from cancer clinical trials, compromising the development of personalized cancer therapies and limiting the generalizability of findings. Despite known health disparities in this population, including higher cancer risk factors and unique psychosocial stressors, data on clinical trial participation remains sparse. This study aims to elucidate the extent of underrepresentation of LGBTQ+ individuals in cancer clinical trials and examine its impact on treatment efficacy, safety, and overall management. Methods: We conducted a systematic review of literature and clinical trial databases, including PubMed, ClinicalTrials.gov, and other registries, focusing on cancer trials from 2010 to 2024. We extracted data on LGBTQ+ enrollment, analyzed demographic inclusivity criteria, and identified barriers to participation. Subgroup analyses evaluated the correlation between LGBTQ+ representation and treatment outcomes, considering variables such as trial design, recruitment strategies, and data collection on sexual orientation and gender identity. The review also examined policy changes and inclusivity initiatives aimed at improving trial access for this community. Results: The review identified a significant underrepresentation of LGBTQ+ individuals in cancer trials, with sexual orientation and gender identity data reported in only 6.2% of trials. Structural and sociocultural barriers, including heteronormative trial designs, lack of inclusive recruitment strategies, and pervasive discrimination, were frequently cited as impediments. Trials that included LGBTQ+ participants rarely conducted stratified analyses to assess differential treatment responses, leading to a paucity of data on drug safety, efficacy, and toxicity profiles specific to this population. The absence of these data may contribute to suboptimal therapeutic decision-making and potential adverse outcomes in clinical practice. Conclusions: The substantial underrepresentation of LGBTQ+ individuals in cancer clinical trials impairs the ability to develop inclusive, evidence-based oncology care. Addressing this gap requires systematic changes, including the integration of sexual and gender minority data collection, implementation of LGBTQ+-specific recruitment frameworks, and stratified analyses of treatment outcomes. Enhancing trial inclusivity will not only improve the external validity of oncologic research but also support the development of tailored therapeutic approaches that address the unique needs of LGBTQ+ cancer patients, ultimately advancing health equity in cancer care.