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M.O. Smith



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    P1.07 - Poster Session 1 - Surgery (ID 184)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P1.07-045 - Prognostic Implications of Blood Tests Performed Routinely Prior to Surgical Resection of Non-Small Cell Lung Cancer (ID 3108)

      09:30 - 09:30  |  Author(s): M.O. Smith

      • Abstract

      Background
      Routinely performed blood tests may yield important information regarding the risks of post-operative morbidity and survival. Whilst the association between systemic pre-operative inflammatory response and survival in NSCLC chemotherapy patients is recognized, the clinico-pathological correlates in NSCLC surgical patients are less clear.

      Methods
      NSCLC patients undergoing surgery between 29/8/2007 and 30/3/11 were included. Preoperative blood tests were retrieved from laboratory databases and correlated with prospectively collected data held in our surgical database including clinico-pathological factors, pathological TNM stage and survival. Survival analysis was performed on 17/06/13.

      Results
      722 patients underwent surgery for suspected NSCLC. In 563 (78.0%) patients (54.2% males, median age 68.5 (range 37.8 - 90.8) years), complete data for all factors enabled subsequent multivariate analysis. At the time of analysis, 377 (60%) were alive and were censored in survival analyses. In univariate analysis, the following factors were identified as poor prognostic factors; serum fibrinogen >4g/dL (p=0.011), haemoglobin <13.1g/dL (p=0.003), platelet count >370x10[9 ]or<140x10[9 ](p=0.006), ALT >63 IU/L or <17 IU/L (p=0.039), total protein >80g/L or <60g/L (p<0.001), albumin >48g/L or <35g/L (p=0.005), globulin >36g/L or <18g/L (p=0.001), cholesterol <5mmol/L (p=0.011). Other factors identified as poor prognostic factors were, age (p<0.001), male gender (p=0.033), nodal stage (p=0.001), tumour size (p=0.001), completeness of resection p=0.025), and histological grade (p=0.008). In multivariate analysis of the factors identified from the blood tests, total protein (HR 2.263 95% CI 1.357-3.775, p=0.002), globulin (HR 1.507 95% CI 1.015-2.238 p=0.042), and haemoglobin (HR 1.462 95% CI 1.091-1.958 p=0.011) Including stage, age and gender in the model, stage (HR 1.286 95% CI 1.164-1.442 p<0.001), age (HR 1.028 95% CI 1.011-1.046 p=0.001), gender (HR 1.419 95% CI 1.048-1.920 p=0.024), total protein (HR 2.503 95% CI 1.465-4.274 p=0.001) and haemoglobin (HR 1.500 95% CI 1.110-2.026 p=0.008) remained independent prognostic factors.

      Conclusion
      Although survival data are not yet fully mature, pre-operative anaemia and an abnormal serum total protein level are adverse prognostic factors for survival following lung cancer surgery, being independent of other variables including stage, age and gender. Further work is required to determine the clinical implications of these findings.

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    P2.07 - Poster Session 2 - Surgery (ID 190)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 2
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      P2.07-041 - Talc pleurodesis or IPC for malignant pleural effusion. Is it Time to change? (ID 3130)

      09:30 - 09:30  |  Author(s): M.O. Smith

      • Abstract

      Background
      Indwelling pleural catheters (IPCs) have a role in the management of pleural effusions. The TIME-2 trial demonstrated equivalence in dyspneoa relief for first time pleurodesis. This single centre study aimed to compare experience of patients receiving talc pleurodesis versus IPC.

      Methods
      A retrospective review of all patients undergoing IPC insertion or talc pleurodesis within a single Trust between October 2007 and September 2012. We had a policy of selective IPC insertion for trapped lung or recurrent pleural effusion, with talc pleurodesis the procedure of choice for expansile lungs. We examined resource utilisation including pre-operative intervention, length of stay (LOS), re-accumulation and re-intervention.

      Results
      130 patients were identified. 61 (47%) patients underwent talc pleurodesis; 69 had an IPC inserted. 13.1% of talc patients and 59.4 % in the IPC group had received a previous pleural intervention (p<0.001). 23.0% of the talc and 29.0% of the IPC group received their procedure on an urgent basis (p=0.44 ). Significantly more patients underwent a general anaesthetic in the talc group (IPC 26 (37.7%), talc 57 (93.4%) p<0.001). Patients treated with IPC had a significantly shorter post-operative stay than those treated with talc (IPC median 2 (range 2-46) days; talc 5 (0-36), p<0.001). Significantly fewer patients experienced re-accumulation following IPC than talc pleurodesis at 30 days (8 (11.6%) vs 19 (31.3%) p=0.006), and overall (12 (17%) vs 27(44%) p<0.001). There were no differences in post-procedure mortality (IPC 3 (4.35%), talc 1 (1.64%) p=0.372); effusion requiring re-admission to hospital (IPC 5(7.25%), talc 7 (11.5%) p=0.406, or re-intervention rates (IPC 6 (8.7%), talc 7 (11.5%) p=0.60).

      Conclusion
      Despite being used in patients with more complicated pleural effusion, IPC placement was associated with a significantly shorter post-operative length of stay and fewer cases of effusion re-accumulation. IPC placement should be considered for the treatment of pleural effusion.

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      P2.07-042 - Is plasma fibrinogen a novel independent prognostic factor in patients undergoing surgery for Non-Small Cell Lung Cancer? (ID 3131)

      09:30 - 09:30  |  Author(s): M.O. Smith

      • Abstract

      Background
      Plasma fibrinogen levels have been shown to correlate with outcomes in various extra-thoracic malignancies. In patients with NSCLC, positive associations have been shown between fibrinogen levels and tumour pathology, but the clinical correlates are unclear. We aimed to examine whether pre-operative fibrinogen levels are a prognostic factor in patients undergoing surgical resection for suspected NSCLC.

      Methods
      All NSCLC patients undergoing surgery between 29/8/2007 and 30/3/11 were included. Pre-operative plasma fibrinogen levels were measured and correlated with clinicopathological factors, pathological TNM stage and survival. Survival analysis was performed on 17/06/13.

      Results
      722 patients underwent surgery for suspected NSCLC. In 519 (71.9%) patients (54.5% males, median age 68.5 (range 37.8 - 90.8) years), pTNM stage and preoperative fibrinogen level were available. Median fibrinogen level was 4.1 (range 1.7 - 10.2) g/dL. 330 (63.6%) of patients had fibrinogen level > reference range (2-4g/dL). Fibrinogen correlated with tumour size (p<0.001) and pTNM stage (p<0.001), but not with nodal stage, histological grade or cell type. At the time of analysis, 309 (59.5%) patients were alive. Fibrinogen > 4g/dl (p=0.01), pTNM stage (p<0.001), Nstage (p=0.001) and tumour size (p=0.003) were univariate prognostic factors. In Cox multivariate analysis, fibrinogen level (p=0.02), pTNM stage (p<0.001), age (p<0.001) and gender (p=0.023) were independent predictors of prognosis.

      Fibrinogen <4g/dL Fibrinogen >4g/dL p
      n Median Survival n Median Survival
      StageI 125 Not reached 176 63.0 0.011
      Stage II 45 55.4 97 Not reached 0.677
      Stage III 19 42.3 57 34.5 0.396

      Conclusion
      Fibrinogen is associated with tumour size and pTNM stage. Whilst survival data are not yet mature, pre-operative fibrinogen > 4 g/dl may be a novel independent prognostic factor following surgical resection of NSCLC. Further work is required to determine the clinical implications of high fibrinogen levels, and to investigate the underlying mechanisms.