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Background:
The 8[th] edition of the American Joint Committee on Cancer (AJCC) staging system for non-small cell lung cancer (NSCLC) has been released. The current study seeks to validate the prognostic significance of the new system among patients registered within the surveillance, epidemiology and end results (SEER) database.

Methods:
SEER database (2010-2013) has been accessed through SEER*Stat program and AJCC 8[th] edition stages were reconstructed utilizing the collaborative stage descriptions. Overall and lung cancer-specific survival analyses according to both 7[th] and 8[th] editions were conducted through Kaplan-Meier analysis and multivariate analysis was conducted through a Cox proportional hazard model.

Results:
A total of 127096 patients with NSCLC were identified in the period from 2010-2013. For overall survival assessment according to the 8[th] edition, P values for all pair wise comparisons among different stages were significant (<0.0001) except for the comparison between stage IIA and stage IIB (P = 0.102). For lung cancer-specific survival according to the 8[th] edition, P values for all pair wise comparisons among different stages were significant (<0.0001). Among patients with stage I disease, multivariate analysis for factors affecting overall and lung cancer-specific survival among patients with stage I disease was conducted. The following factors were associated with worse overall and lung cancer-specific survival (age ≥ 70 years, more advanced stage, male gender, squamous histology, no surgery and no radiotherapy) (P < 0.0001 for all factors).

Conclusions:
This SEER analysis supports the prognostic significance of the added sub-stages described within AJCC 8[th] edition stages I and III. Further work is needed to incorporate molecular markers and personalize the future editions of the AJCC staging system.

Clinical trial identification:


Legal entity responsible for the study:
Omar Abdel-Rahman

Funding:
Omar Abdel-Rahman

Disclosure:
The author has declared no conflicts of interest.

Background:
Epidermal growth factor receptor (EGFR) mutation represents a favorable prognostic factor in advanced-stage non-small cell lung cancer (NSCLC), which is predominantly contributed by its good response to EGFR-tyrosine kinase inhibitor. However, its impact on the prognosis of resectable NSCLC after complete surgery, which more closely reflects its natural course, remains controversial. Diverse results have been reported partially due to the small sample size of these studies; small studies bring bias especially in postoperative setting. Therefore, we sought to pool all current evidence to show the true effects.

Methods:
Electronic databases were searched for eligible studies. The primary endpoint was disease free survival (DFS), which will be less influenced by subsequent treatments after recurrence. The DFS between EGFR mutated and wild-type patients were compared with special interest in stage I patients who are rarely subjected to adjuvant therapy. In addition, DFS of patients with 19 exon deletion (19del) and 21 exon L858R mutation (L858R) were compared. Random effects models were used.

Results:
A total of 13 studies involving 2,652 cases were included; 1033 (39.0%) patients were EGFR-mutated, 47.7% were 19del and 44.1% were L858R. Most studies detected EGFR mutations with PCR-based methods. The DFS of EGFR-mutated patients were similar to wild type patients in overall population (HR 0.87, 95% CI 0.65 to 1.16) and stage I subgroup (HR 0.82, 95% CI 0.40 to 1.69). DFS of 19del patients was potentially inferior to L858R patients but the difference was not significant (HR 1.38, 95% CI 0.76 to 2.52).

Conclusions:
EGFR-mutated patients showed no significant difference in postoperative disease-free survival compared with wild-type resected NSCLC. There is still no sufficient evidence to support different postoperative treatment strategy (especially for stage I) for mutated and wild-type patients. However, 19del might be an adverse factor through indirect reasoning, which might require more intensive management. Thus, we strongly encouraged reporting specific prognostic impacts of different mutation types compared with wild-type patients in the following studies.

Clinical trial identification:


Legal entity responsible for the study:
The clinical research center of the first affiliated hospital of Guangzhou Medical Univeristy

Funding:
The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Disclosure:
All authors have declared no conflicts of interest.

Background:
Based on SEER database and a Chinese multicenter registry, we previously identified a benchmark for indicating sufficient lymph node (LN) examination among node negative NSCLC patients (Liang et al. J Clin Oncol 2016). Due to variability of LN examination practice, some patients with less than 16 examined LNs might be understaged and therefore have worse survival outcome. This benchmark agrees with the reported mean LN being harvested during complete pulmonary and mediastinal LN exploration, which could serve as a sign for adequate systematic LN sampling and theorectically be applicable to node positive patients as well. We sought to determine its prognostic value among node positive patients using SEER database.

Methods:
The United States Surveillance, Epidemiology, and End Results (SEER) database on stage I to IIIA completely resected NSCLC (1990-2010) were extracted. Patients were dichotomized according to examined LN count (<16 vs. > =16). Multivariate Cox regression model was used to compare the overall survival (OS) and cancer specific survival (CSS) between groups under adjustment for other prognostic factor.

Results:
A total of 12,407 cases met the inclusion criteria with complete data were studied. The median followup was 7.6 years (range 0.1 to 10.0). Patients with <16 examined LNs remained a significant unfavorable factor in terms of both OS (HR 1.34, 95% CI 1.27 to 1.43, P < 0.001) and CSS (HR 1.36, 95% CI 1.27 to 1.45) when compared to those with at least 16 LNs, after adjusting for diagnostic year, sex, age, tumor size, differentiation, pathology and positive LN count. Different subgroups showed consistent trends.

Conclusions:
This study confirmed that 16 exmamined LNs could also be considered a benchmark for systematic LN examination among node positive NSCLC patients despite the number of positive LNs. Node positive NSCLC with less than 16 LNs being harvested should be cautiously evaluated for the quality of LN examination and indication for subsequent treatment.

Clinical trial identification:


Legal entity responsible for the study:
The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Funding:
The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Disclosure:
T. D’Amico: Consulting or Advisory Role: Scanlan International. C.S.H. Ng: Leadership: Johnson & Johnson; Honoraria: J&J, Covidien, Medtronic; Consulting or Advisory Role: J&J, Covidien, Medtronic; Speakers’ Bureau: J&J, Covidien, Medtronic; Research Funding: J&J, Covidien, Medtronic. A. Brunelli: Honoraria: Bard Medical. C-C. Liu: Honoraria: Johnson & Johnson Consulting or Advisory Role: Johnson & Johnson Travel, Accommodation, Expenses: Johnson & Johnson (I). R.H. Petersen: Honoraria: Medtronic, Ethicon, Medela. J. He: Consulting or Advisory Role: Johnson & Johnson. All other authors have declared no conflicts of interest.

Abstract not provided

Background:
There is little evidence to guide the management of early limited-stage small cell lung cancer (LS-SCLC). We examined outcome of early LS-SCLC patients treated within a contemporary trial.

Methods:
This is an exploratory analysis of early (TNM stage I-II) LS-SCLC patients included in the CONVERT trial. This is a randomized phase III trial that compared twice-daily (45 Gray (Gy) in 30 twice-daily fractions over 3 weeks) and once-daily (66 Gy in 33 daily fractions over 6.5 weeks) radiotherapy starting on day 22 of chemotherapy cycle 1 in good performance score (PS) patients. Chemotherapy consisted of 4-6 cycles of cisplatin and etoposide. Prophylactic cranial irradiation (PCI) was offered if indicated. Radiotherapy was delivered using three-dimensional conformal or intensity modulated technique.

Results:
Between 2008 and 2013, 547 patients were recruited to this trial. Five hundred and thirteen patients were eligible for this analysis and 87 (17%) had early disease. Staging flurodeoxyglucose positron emission tomography (FDG-PET) use (68% versus 55.4%, p = 0.05) and baseline PS (PS0 57.5% versus 43.2%, p = 0.04) were different between early and non-early LS-SCLC patients, respectively. Early patients achieved longer overall survival (median 50 versus 25 months, p = 0.001) and time to local (median 40 versus 17 months, p = 0.0017) and metastatic progression (median 49 versus 16 months, p = 0.0004) compared to non-early patients, irrespective of treatment arm. In early patients, there was no significant overall survival difference between treatment arms, p = 0.31. Radiotherapy compliance was significantly higher in early patients (p = 0.004) and these patients were less likely to experience grade ≥3 acute oesophagitis, compared to non-early patients (11% versus 21%, p < 0.005).

Conclusions:
Early LS-SCLC patients achieve good long-term survival with minimal acute side-effects following chemo-radiotherapy and PCI. This study guides practice and provides a benchmark for future studies comparing a surgical to a non-surgical approach in this patient cohort.

Clinical trial identification:
ISRCTN91927162, NCT00433563

Legal entity responsible for the study:
MAHSC-CTU, The Christie NHS Foundation Trust, Manchester, UK

Funding:
Cancer Research UK

Disclosure:
All authors have declared no conflicts of interest.

Background:
Concurrent chemo-radiotherapy (CTRT) is the optimal treatment for limited-stage small cell lung cancer. The use of granulocyte colony stimulating-factor (G-CSF) in this context is controversial and its routine use is not recommended after a report of higher toxicity but the safety data is scarce. The use of prophylactic antibiotics is also not standardised.

Methods:
In a phase 3 trial, 547 patients (pts) were randomised between once-daily RT (66Gy 33 fractions) or twice-daily (45Gy 30 fractions) with chemotherapy (cisplatin/etoposide). The use of prophylactic G-CSF and antibiotics was permitted.

Results:
33% of pts received at least 1 cycle of prophylactic G-CSF and 41% received prophylactic and/or therapeutic G-CSF. Its use increased from 11% at cycle 1 to 27% at cycle 4. Prophylactic antibiotics were used in 48% of pts but its use decreased from 41% to 20%. The use of antibiotics and/or G-CSF was similar in both arms. The incidence of grade 3/4 thrombocytopenia was higher in pts with G-CSF (29.4% vs. 13%; p 

Conclusions:
The use of G-CSF with modern radiotherapy techniques during CTRT does not result in an increased risk of severe acute esophagitis or pneumonitis. Despite an increased incidence of severe thrombocytopenia and anaemia, the use of G-CSF was not detrimental in PFS or OS.

Clinical trial identification:
ISRCTN91927162 / NCT00433563

Legal entity responsible for the study:
The Christie NHS Foundation Trust

Funding:
The Christie NHS FT, Cancer Research UK, EORTC, GECP, GFPC, IFCT.

Disclosure:
All authors have declared no conflicts of interest.

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