Objective: Adenoid cystic carcinoma (ACC) is a rare malignant tumor that mainly arises in the head and neck area. We aimed to compare the long-term survival of patients with ACC based on their geographic regions within the United States using the Surveillance, Epidemiology, and End Results (SEER) registry data. Methods: We queried the SEER database to evaluate the geographic distribution of ACC patients based on inpatient admissions. The states included in the study were divided into four geographical regions (Midwest, Northeast, South, and West) based on the U.S. Census Bureau-designated regions and divisions. Demographic and clinical variables were compared between the groups. Kaplan–Meier curves and Cox regression were used to assess late mortality. Results: A total of 5150 patients were included (4.2% from the Midwest, 17.2% from the Northeast, 22.5% from the South, and 56.1% from the West regions). The median follow-up was 12.3 (95% CI: 11.6–13.1 years). Median overall survival was 11.0 (95% CI: 9.2-NR years), 14.3 (95% CI: 12.4–16.4 years), 11.3 (95% CI: 9.7–14.8 years), and 12.0 (95% CI: 11.3–13.0 years) for Midwest, Northeast, South, and West regions, respectively. In multivariable analysis, older age, male sex, thoracic cancer, the presence of regional and distal disease, receiving chemotherapy, not undergoing surgical resection, and being treated in the West vs. Northeast region were found to be independent predictors of poor survival. We identified a significant survival difference between the different regions, with the West exhibiting the worst survival compared to the Northeast region. Conclusions: In addition to the well-known predictors of late mortality in ACC (tumor location, stage, and treatment modalities), our study identified a lack of social support (being unmarried) and geographic location (West region) as independent predictors of late mortality in multivariable analysis. Further research is needed to explore the causal relationships.

In the manuscript ‘Is Underutilization of Adjuvant Therapy in Resected Non-small Cell Lung Cancer Associated with Socioeconomic Disparities?’ Rodriguez-Quintero et al. queered the National Cancer Database (NCDB) from 2010 to 2018 to identify all individuals who underwent surgical resection and adjuvant therapy for stage II–IIIA non-small-cell lung cancer. The study showed that individuals who received surgery followed by adjuvant therapy had a longer median overall survival of 76.4 months compared to 47.6 months in those who had surgery alone (P < 0.001). Using multivariable analysis, they also demonstrated that patients who were male, were older, uninsured or had public insurance, and those who had a low educational indicator were less likely to receive adjuvant therapy, thus resulting in a decrease in their overall survival [ 1]. This manuscript clearly identifies factors that influence adjuvant therapy delivery, specifically the type of insurance. In the past, there have been many studies that delineate the presence of healthcare gaps secondary to significant racial and income disparities leading to differences in insurance coverage in the USA [ 2]. There have been numerous studies that have described the linkage of social determinants of health with health care outcomes that expand beyond survival outcomes with lung cancer [ 2, 3]. For example, a recent study was conducted on 699 malignant cardiac tumour cases from the NCDB and illustrated that individuals who had either private insurance or Medicaid insurance had better survival compared to those who were uninsured or had Medicare insurance [ 4]. Similarly, Diaz et al. [ 5] queered the Surveillance, Epidemiology, and End Results database from 2007 to 2016 and identified 2278 patients who were diagnosed with nasopharyngeal carcinoma and illustrated that disease-free survival was better in patients who had private insurance compared to uninsured patients, further showing that there is a significant association between insurance status and health outcomes.

Immune-checkpoint inhibitors (ICIs) were proven effective in inducing tumor regression. However, its toxicity tends to be fatal. We sought to investigate the hospital volume/outcomes relationship. Databases were searched for studies reporting immune-checkpoint inhibitors adverse events (AEs) in patients with solid-organ malignancies. The outcomes were A) the pooled events rate (PER) of grade 5, grade 3–4, cardiac-related, and pulmonary-related AEs, and B) the assessment of the volume/outcomes relationship. One hundred and forty-seven studies met our inclusion criteria. The PER of grade 5, grade 3–4, and any-grade AEs was 2.75% (95%CI: 2.18–3.47), 26.69% (95%CI: 21.60–32.48), and 77.80% (95%CI: 70.91–83.44), respectively. The PER of pulmonary-related AEs was 4.56% (95%CI: 3.76–5.53). A higher number of annual cases per center was significantly associated with reduced grade 5 (p = 0.019), grade 3–4 (p = 0.004), and cardiac-related AEs (p = 0.035) in the meta-regression. In the current era of cancer immunotherapy, knowledge regarding the early diagnosis and management of immunotherapy-related AEs is essential. Our meta-analysis demonstrates the importance of center volume in improving outcomes and reducing the incidence of severe AEs.