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A. Mellemgaard



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    P1.19 - Poster Session 1 - Imaging (ID 179)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P1.19-014 - Stage survival for lung cancer staged by PET/CT, EUS FNA and/or EBUS TBNA (ID 3371)

      09:30 - 09:30  |  Author(s): A. Mellemgaard

      • Abstract

      Background
      The seventh edition of the TNM classification of lung cancer was based on the 67.725 patients from 19 countries treated by all modalities between 1990 and 2000. There was no information about how the c TNM and pTNM was determined and there were probably differences in the preoperative staging methods. At Gentofte University Hospital diagnostic work-up and staging procedures included PET / CT, EUS FNA and EBUS TBNA early on after the introduction of these technologies. The purpose of the project was to evaluate the survival after lung cancer surgery in patients who were diagnosed and staged by PET / CT, EUS FNA and / or EBUS TBNA and to compare survival with the results from the IASLC's staging project.

      Methods
      All patients in the period 1.1.2005 to 12.1.2012 who had had PET / CT, EUS FNA and / or EBUS TBNA leading to a diagnosis of non small cell lung cancer before surgery were included in the project The date of surgery and the date of death if any were recorded. Survival was measured from the date of surgery and was calculated by the Kaplan-Meier method. cTNM and the methods by which the diagnosis and stage was determined was included in the analysis.

      Results
      In this period, 4090 lung cancer patients were diagnosed and staged at Gentofte University Hospital.1187 were staged by PET CT, EUS FNA and/or EBUS TBNA and of these 791 were operated. Over all, survival based on cTNM for patients staged at Gentofte University Hospital was on the same level level as found in the the IASLC's analysis for pTNM. In particular, the survival curves for cTNM stage IA, IB and IIIA found in this material appears to be identical with those found in the Stage survicalIASLC's project for the same pTNM stages. For example, the 3-year survival for the cIA in our study was 84% where the IASLC's pIA was 83% and cIIIA in our study was 32% while the IASLC's pIIIA was 37% The cTNM IIIB in our material shows a better survival than IASLC pTNM IIIB (33% vs 14%) There were too few patients in stages IIA and IIB for any meaningful conclusion.

      Conclusion
      As the treatment regime is based on the cTNM, it is important that it is as accurate as possible. Thus, concordance between cTNM and pTNM should ideally be very high. Using new technologies, the concordance at our institution has increased to the current level of 95%. It is therefore not surprising that the survival of the various cTNM stages in our study are similar to the survival curves from IASLCs staging project.

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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-042 - Role of comorbidity on survival after radio- and chemotherapy for non-surgically treated lung cancer (ID 2595)

      09:30 - 09:30  |  Author(s): A. Mellemgaard

      • Abstract

      Background
      Comorbidity, such as diseases of the cardiovascular, pulmonary, and other systems may influence prognosis in lung cancer as well as complicate its treatment. The performance status of patients, which is a known prognostic marker, may also be influenced by comorbidity. Due to the close link between tobacco smoking and lung cancer, and because lung cancer is often diagnosed in advanced ages (median age at diagnosis is 70 years), comorbidity iwill be present in a substancial proportion of lung cancer patients.

      Methods
      Patients with any stage lung cancer who did not have surgical treatment were identified in the Danish Lung Cancer Registry (DLCR). DLCR collects data from clinical departments, the Danish Cancer Registry, Danish National Patient Registry (DNPR) and the Central Population Register. A total of 22,999 patients with lung cancer were identified. Due to missing variables, 19,561 patients were available for analysis. Comorbidity was sought in the DNPR which is a register of all in and out patient visits to hospitals in Denmark. By record linkage, all lung cancer patients who had previously been diagnosed with any of a number of comorbid conditions was recorded using the Charlsson comorbidity score CCS. First treatment was categorized as chemotherapy, chemo-radiotherapy, radiotherapy or no therapy. Data on CCS, performance status, age, sex, stage, pulmonary function (Fev1), histology and type of first treatment (if any) were included in univariable and multivariable Cox proportional hazard analyses.

      Results
      For patients receiving chemotherapy as first treatment for lung cancer, survival was increasing worsened by increasing comorbidity (HR=1,00,1.10, 1.17, 1,15 for CCS scores 0, 1, 2, 3+ respectively). After adjustment for potential confounders, risk estimates was reduced somewhat (HR: 1.00, 1.05, 1.11, 1.11 for CCS scores 0, 1, 2, 3+ respectively). For patients receiving radiotherapy as first therapy, a different pattern was seen with better survival for patients with comorbidity (HR=1.00, 0.99, 0.94, 0.87 for CCS scores 0, 1, 2, 3+ respectively). After adjustment, this effect disappeared and survival was unaffected by CCS. For patients receiving combined radio/chemo therapy there was no significant association between CCS and survival.Throughout the analysis, performance score remained a strong and highly significant risk factor for survival, and was robust in multivariate analysis (HRunivariate, all patients= 1.0, 1.40, 1.95, 3.23, 5.91 for ECOG performance score 0,1,2,3 and 4 respectively).

      Conclusion
      Comorbidity has a limited effect on survival and only for patients treated with chemotherapy. It is rather the performance of the patient at diagnosis than the medical history that prognosticates survival in this patient group.