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M. Krasnik
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MO22 - Advanced Disease and Outcomes (ID 103)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track: Surgery
- Presentations: 1
- Moderators:T. Yano, J. Roth
- Coordinates: 10/30/2013, 10:30 - 12:00, Parkside 110 A+B, Level 1
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MO22.01 - High procedure volume is strongly associated with improved survival after lung cancer surgery (ID 1704)
10:30 - 10:35 | Author(s): M. Krasnik
- Abstract
- Presentation
Background
Surgical resection is the first line treatment offered to patients with early stage non-small cell lung cancer (NSCLC) who are considered medically fit. Many studies have shown that patients undergoing surgery for lung cancer benefit from receiving treatment in hospitals where high numbers of lung cancer resections are carried out. This study explores the association between hospital volume and survival among all NSCLC patients diagnosed in England who underwent surgical resection and takes into account the differences in case selection and propensity to resect.Methods
We analysed data on 134,293 patients with NSCLC diagnosed in England between 2004 and 2008 of whom 12,862 (9·6%) underwent surgical resection. Hospital volume was defined according to the number of patients with resected lung cancer in each hospital in each year of diagnosis. Cox proportional hazard regression analyses were used to assess the association between hospital volume and survival among resected patients. We calculated multivariable hazard ratios according to hospital volume, with adjustment for potential confounders (sex, age, socioeconomic deprivation, comorbidity and resection quintile). In addition, to account for the risk of death potentially varying between groups of patients treated within a given hospital, a shared frailty Cox model was used, with hospital as a random effect. The follow-up period was divided into three pre-defined periods: 0-30 days, 31-365 days and >365 days post-surgery.Results
There was increased survival in hospitals performing more than 150 surgical resections compared with those carrying out less than 70 [HR 0·78 (95% CI 0·67-0·90), p~trend~ <0·01]. The association between hospital volume and survival was present in all three periods of follow-up, but the magnitude of the association was greatest in the period 0-30 days (HR for the 150+ hospital volume group compared with less than 70: 0·58, 95% CI 0·38-0·89) and smallest in the period after 365 days (HR 0·84, 95% CI 0·71-0·99).Conclusion
High volume hospitals have higher resection rates, operate on patients who are older, have lower socioeconomic status, more comorbidities and despite that they achieve better survival, most notably in the early post-operative period.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P2.24 - Poster Session 2 - Supportive Care (ID 157)
- Event: WCLC 2013
- Type: Poster Session
- Track: Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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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): M. Krasnik
- 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.
