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R. Hubbard



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    MO09 - Mesothelioma I (ID 120)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track:
    • Presentations: 1
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      MO09.06 - Malignant Pleural Mesothelioma in the UK National Lung Cancer Audit: An analysis of 8503 cases (ID 916)

      16:45 - 16:50  |  Author(s): R. Hubbard

      • Abstract
      • Presentation
      • Slides

      Background
      The National Lung Cancer Audit is run jointly by the Royal College of Physicians and The Information Centre for health and social care with the aim of recording outcomes in lung cancer (and mesothelioma) on a population scale, explaining the wide variations seen within the UK and between the UK and other countries and ultimately improving outcomes. This abstract presents results for England only, focusing on mesothelioma.

      Methods
      All patients with mesothelioma seen in in secondary care 2006-2011 were analysed. A hierarchy of diagnosis from surgical histology to non-surgical histology to clinical diagnosis was used to exclude patients with potentially conflicting diagnoses. These records were further analysed to extract data on age/sex distribution, referral source, histological subtype, treatment regime and survival rates.

      Results
      There were 8,503 patients with mean age 72yrs (83% male), representing around 65% of expected incident cases (a substantial number diagnosed at autopsy and not included in the audit). 45% have right-sided disease, 28% were left-sided, and 1% were bilateral (data missing in 26%). The majority of patients (47%) were referred by their primary care physician, but at least 20% present to secondary care as emergencies. Overall, 89% of cases were histo-cytologically confirmed with that figure appearing to rise slowly over the audit period from 81% (2006) to 92% (2011). Survival data is shown below.

      n (%) Median survival (days) 1 year survival (%)
      All patients 8,503 (100%) 278 41
      Survival was slightly better in females (median 304 days vs 274 days HR 0.91, p=0.002)
      Subtype n (%) Median survival (days) 1 year survival (%)
      Unspecified 3,798 276 39.5
      Epithelioid 2,300 388 53.2
      Sarcomatoid 439 123 16.4
      Biphasic 268 274 36.0
      37% of patients received no anti-cancer treatment, but 28%, 26% and 30% of patients received “surgery”, chemotherapy or radiotherapy at any time. Most surgical operations (60%) were pleurodesis. Median survival varied by first treatment modality: surgery 378 days, chemotherapy 399 days, radiotherapy 308 days, no anti-treatment 140 days. Survival was highest in patients having “surgery” and chemotherapy (491 days). Use of chemotherapy varied across 28 regional cancer networks from 14% to 41% of patients, but overall increased over the audit period from 13% to 34%.

      Conclusion
      Mesothelioma is predominantly a cancer of elderly males, with a striking tendency for right-sided disease. Only 11% have no histological confirmation, but where this is obtained, the epithelioid subtype has best prognosis. Low rates of anti-cancer treatment may reflect therapeutic nihilism as well as patient fitness, but there is an encouraging trend towards wider use of chemotherapy which was associated with a greater than doubling in survival compared with no treatment.

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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): R. Hubbard

      • 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: 1
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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): R. Hubbard

      • 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.