Author of

• 11917

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  P2.21 - Poster Session 2 - Diagnosis and Staging (ID 170)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11922

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    P2.21-005 - Non-Small Cell Lung Cancer (NSCLC) in the United States Department of Defense (ID 2912)

    09:30 - 09:30  |  Author(s): A. Gunuganti
    • Abstract

    Background
    Lung cancer is the leading cause of cancer-related death in the United States, with non-small cell lung cancer (NSCLC) accounting for 87% of cases. Roughly half of all patients present with advanced disease and the majority with earlier stage disease eventually develop disease recurrence. The objectives of this study were to characterize patients diagnosed with NSCLC and assess overall survival in the United States Military who receive equal and open access to healthcare in the Department of Defense (DoD) medical system.

    Methods
    We identified patients (military service members and their dependents) ≥18 years old, with an initial diagnosis of NSCLC from January 2003- March 2013 in the DoD Cancer Registry (N=4,751). Descriptive statistics were generated for demographic and clinical characteristics. Kaplan Meier (KM) curves and Cox proportional hazards regression assessed overall survival (OS).

    Results
    Military service members comprised 63% of the cohort. The mean age at diagnosis was 66, 64% were male and 72% were Caucasian. Adenocarcinoma (AC) histology was the majority (45%), followed by 31% NSCLC not otherwise specified (NOS), 21% squamous cell (SC), and 2% Large Cell (LC). A majority (57%) were diagnosed at advanced stage and tended to be younger (mean age 65 vs. 67; p<.0001) and more likely male (66% vs. 61%; p<.0001) compared to patients diagnosed with earlier stage disease. In the early stage cohort 78% had stage I disease. Patients with advanced stage disease presented predominately with either AC (41%) or NOS (38%) compared to SC (20%) or LC (2%). Most of the cohort were either currently using or had a history of tobacco use (82%). The unadjusted OS for the cohort was 14.97 months (95% confidence interval (CI): 13.9-15.7) with significantly decreasing survival as stage increased (Table). In the multivariate survival analysis, older age, male gender, increasing stage (Table), squamous cell histology, higher number of comorbidities, and tobacco history were associated with a higher risk of death.

    Conclusion
    In this DoD cohort, NSCLC patients were diagnosed at a younger age and had a higher proportion of Stage I disease than often seen in the general US civilian population, perhaps due to more open access to health care. Stage at diagnosis was a significant predictor of mortality and further research comparing factors influencing survival relative to the general population is warranted including the role of open access to care.

    Table: Unadjusted and Adjusted Survival by Stage

    		Unadjusted		Adjusted
    Stage	N	Median Survival (Months)	95% CI	HR	95% CI
    I	1141	64.2	58.4-70.1	ref
    II	324	29.5	26.2-34.1	1.78	1.49-2.12
    III	1049	13.5	12.5-15.2	3.31	2.94-3.73
    IV	1678	6.5	6.0-7.0	7.15	6.38-8.02