The Cancer Data Modeling pillar of the ACS Cancer Research Program (ACS CRP®) aims to use available data to evaluate and describe the current state of cancer care delivery, as well as guide patient-specific surgical and comprehensive cancer care decisions.
A recent article published online in the Journal of the American College of Surgeons (JACS)1 highlights observations and trends in cancer diagnoses, patient demographics, and treatments using data from the 2022 National Cancer Database® (NCDB®) Participant User File (PUF). Specifically, the authors of the article examined changes in neoadjuvant systemic therapy use in solid tumors with a focused analysis on esophageal, melanoma, and prostate cancers. This article and the PUF on which it is based follow the first annual report from the 2021 NCDB PUF (published in JACS in early 20252 and highlighted breast, colon, and pancreatic cancers).
The NCDB is a clinical oncology registry that collects data available at Commission on Cancer (CoC) hospitals. The current report highlights the patient demographics, treatments, and outcomes of 1,331,740 adult cancer diagnoses in the US that were reported to the NCDB in 2022. Data added in 2022 were provided by 1,250 CoC hospitals and cover an estimated 74% of all patients with cancer diagnoses across the US.3
The five most common cancers in the 2022 NCDB PUF included breast, prostate, lung (bronchus—non-small cell carcinoma), colon, and melanoma of the skin.
The PUF report describes key quality improvement metrics, including operative mortality, inpatient length-of-stay trends, and the association between first-course treatment and long-term outcomes stratified by biomarkers. These findings serve as a resource for clinicians and researchers to understand trends and generate hypotheses for further study using the case-level PUF.
The annual reports are based on an analysis of data from each subsequent year of PUF and are intended to facilitate a broader understanding of changes in cancer practices and outcomes for cancer clinicians, researchers, and patients.
Systemic Therapy
The NCDB captures the first course of treatment for cancer patients, including systemic therapy, surgical procedures, and radiotherapy. The 2022 annual report includes a closer focus on rate of use of neoadjuvant systemic therapy, which integrates systemic disease control (to minimize distant disease); surgical optimization (often increasing resectability and/or decreasing extent of resection required); and biologic insight (to guide additional therapies).
This PUF report demonstrates that use of systemic therapy as the first course of treatment (i.e., neoadjuvant systemic therapy) has increased in recent years for several solid tumors—most notably for pancreatic cancer, selected female genital organ-related cancer, and peritoneum, omentum, and mesentery tumors.
Use of systemic therapy in patients with pancreas cancer increased from 11.6% in 2010 to 39.8% in 2022. Both selected female genital organ tumors and those of the peritoneum, omentum, and mesentery had similar increases from 7.3% and 22.5% to 34.0% and 46.8%, respectively. Esophageal cancers had a smaller increase of neoadjuvant systemic therapy use from 55.4% to 63.7% over the same time period.
Esophageal Cancer
The NCDB files include 240,024 cases of esophageal cancer diagnosed from 2004 to 2022. Of these, 14,207 adult patients diagnosed with esophageal cancer were reported to the NCDB in 2022, at a median age of 68 years. Most patients were White (83.9%) and insured by Medicare (59.9%). Although squamous cell histology is most common in most geographic regions,4 the distribution of histology in the US differs: the NCDB reports most esophageal patients (74.8%) had adenocarcinoma histology.
Only 29.5% of patients were surgically treated, likely due in part to roughly half of patients presenting with stage IV disease. Esophageal cancer is treated at select facilities; in fact, more than 90% of facilities reporting to NCDB saw 25 or fewer cases in 2022. Esophagectomy decreased from 28.6% of esophageal cases in 2018, to 24.8% in 2022; this decrease was observed in both high- and low-volume centers.
While the median number of surgically treated esophageal cancers per facility was two in 2022, one-third were treated at facilities reporting more than 25 cases per year. Use of both chemotherapy and radiation therapy were high (73.4% and 61.6%, respectively), and immunotherapy use increased—from 7.8% in 2018 to 29.5% in 2022 (p <0.001). While length of stay slightly decreased for patients undergoing esophagectomy over the past 5 years, from 9 days in 2018 to 8 days in 2022; readmission and mortality remained stable.
Melanoma
The NCDB files include 963,415 cases of melanoma diagnosed from 2004 to 2022, including, 65,546 new primary melanoma cases reported to the NCDB in 2022. Melanoma is the least-represented cancer in the NCDB at 52.0% of the estimated total melanomas in the US,3 likely due to the large variety of clinical settings where melanomas may be diagnosed or treated, including many outpatient clinics.5
Roughly half (46.3%) of melanomas were diagnosed at stage I; there have been no substantial shifts in stages at diagnosis of melanoma in the past 5 years of NCDB reporting (2018–2022). Melanomas were most frequently diagnosed at the site of trunk (30.3%), followed by upper limb and shoulder (25.1%).
Site-specific characteristics of melanoma available in the NCDB include presence of ulceration present in 19.3% of invasive melanomas and Breslow thickness (median 0.9 mm in 2022); notably, these characteristics are not observable in administrative data culled from billing records.
Most patients with melanoma underwent surgery (93.5%); while the majority of patients underwent wide local excision of the lesion (60.3%), less than 4% underwent Mohs surgery, the use of which has been stable over recent years. The NCDB showed an increase in the use of immunotherapy for melanoma over the past few years (from 12.4% in 2018 to 17.5% in 2022, p <0.001, while use of chemotherapy and radiation remained low (≤3%).
Poorer survival was associated with higher clinical stage as well as presence of ulceration; with respect to tumor site, melanomas of the scalp and neck had the poorest long-term survival.
Prostate Cancer
The NCDB files from 2004–2022 contain data on a total of 2,320,369 prostate cancer diagnoses, of which 144,147 were identified in NCDB data in 2022. Patients were diagnosed at a median 68 years, and roughly three-quarters (74.5%) were White.
Prostate cancer-specific characteristics available in NCDB include prostate-specific antigen (median 7.6 ng/mL in 2022) and Gleason score. Similar to what is noted earlier in this article for melanoma’s site-specific variables, these characteristics are not observable in administrative data culled from billing records.
In 2022, the majority of men (61.5%) diagnosed with prostate cancer did not undergo surgical treatment, up from 53.5% in 2018, reflecting a recent trend of surveillance for low-risk prostate cancer. Nonsurgical treatments remained common, with 38.1% of patients receiving radiation therapy for prostate cancer in 2022 and 35.5% hormone therapy. Interestingly, radiation therapy has become more common for treatment of stage IV prostate cancers and less so for stage I. Chemotherapy and immunotherapy both increased over the years between 2018 and 2022.
Looking Ahead
The next annual report describing the 2023 NCDB PUF is currently being prepared as the ACS CRP continues to disseminate highlights and insights from each year’s PUF release. Each annual report will include overviews of three different cancers; furthermore, work is underway on a pediatric cancers special report, supporting the ongoing goal to inform cancer clinicians, patients and others of trends in cancer diagnoses, care delivery, and outcomes in the US.
Dr. Elizabeth Habermann is a professor of health services research at the Mayo Clinic in Rochester, MN, where she also serves as deputy director of research in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the Robert D. and Patricia E. Kern Scientific Director for Surgical Outcomes. She is Chair of the ACS CRP Cancer Data Modeling Pillar.
References
- Habermann EB, Day CN, Palis BE, Boffa D, et al National Cancer Statistics: American College of Surgeons Cancer Programs Annual Report from 2022 Participant User File. J Am Coll Surg. In press.
- Habermann EB, Day CN, Palis BE, et al. American College of Surgeons Cancer Program Annual Report from 2021 Participant User File. J Am Coll Surg. 2025;240(1):95-110.
- Palis BE, Janczewski LM, Browner AE, et al. The National Cancer Database conforms to the standardized framework for registry and data quality. Ann Surg Oncol. 2024;31(9):5546-5559.
- Morgan E, Soerjomataram I, Rumgay H, et al. The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040: New estimates from GLOBOCAN 2020. Gastroenterology. 2022;163(3):649-658 e2.
- Baranowski MLH, Yeung H, Chen SC, et al. Factors associated with time to surgery in melanoma: An analysis of the National Cancer Database. J Am Acad Dermatol. 2019;81(4):908-916.
