Background And Objectives: IO has transformed cancer management, but its adoption in advanced cancer patients varies by tumor type. With more Stage IV patients undergoing surgery, understanding site-specific outcomes in these challenging patients is essential. We aimed to evaluate IO use and survival trends for Stage IV cancer patients across high-incidence cancers in the US.
Methods: Patients diagnosed with Stage IV prostate, breast, melanoma, colorectal, renal, bladder, lung, or pancreas cancer were identified from the National Cancer Database (2004-2020). Cochrane-Armitage test and Kaplan-Meier methods assessed IO and overall survival across three periods: 2004-2010, 2011-2015, and 2016-2020.
Results: Among 1 425 731 Stage IV cancer patients, most had lung (50.0%), pancreas (12.5%), and breast cancer (9.3%), while the least had melanoma (2.2%). From periods 1 to 3, IO use increased from 1.0% to 24.6%, notably in melanoma (9.5% to 58.5%, p < 0.001). Melanoma exhibited the greatest survival gains (median survival: 7.1 to 14.9 months). Absolute increases in 3-year overall survival rates ranged from 3.4% in pancreas (1.7% to 5.1%) to 21.4% in melanoma (15.7% to 37.1%).
Conclusions: Utilization of IO is tumor-site specific and associated with improved survival rates for Stage IV cancer, with varied success across types. Variations in receipt highlight ongoing challenges to ensure equitable adoption.
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