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E. Taioli
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MINI 19 - Surgical Topics in Localized NSCLC (ID 138)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:D. Jablons, B. Stiles
- Coordinates: 9/08/2015, 16:45 - 18:15, 605+607
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MINI19.14 - Survival After Sub-Lobar Resection for Early Stage Lung Cancer: Methodological Obstacles in Comparing the Efficacy to Lobectomy (ID 1583)
18:00 - 18:05 | Author(s): E. Taioli
- Abstract
- Presentation
Background:
Surgery is the treatment of choice for early stage lung cancer (LC). While lobectomy (L) is the historic standard, whether long term outcomes of sub-lobar resection (SL) are comparable is still under debate. The only randomized trial was conducted 20 years ago; 5 subsequent meta-analyses showed inconclusive or conflicting results. We present a comprehensive review of the literature on 5 year-survival after SL compared to L for early stage LC.
Methods:
A priori inclusion criteria were: 1) observational studies, 2) L compared to SL for early stage LC, 3) at least CT staging, 4) 5-year survival reported. A Medline search through January 2015 resulted in 32 studies, representing 24 distinct datasets. The absolute difference in 5-year survival was calculated and plotted for each study.
Results:
There were 4,702 cases treated with L, 2,323 treated with SL. Of 20 studies reporting the reason for SL, 11 indicated that SL was performed because of comorbidities, or impaired cardiopulmonary function. Among all 24 studies, 4 showed no difference in 5-year survival, 13 favored L, and 7 favored SL (Figure 1). Of the two studies using propensity scores, one favored L and the other SL. No meta-estimate could be calculated due to high statistical heterogeneity. Of 21 studies reporting recurrence rate (Figure 2), 11 favored L and 10 favored SL. Figure 1
Conclusion:
Studies comparing 5-year survival rates of SL to L are heterogeneous, and traditional meta-analytic summary estimates of survival and recurrence could not be calculated. SL survival is often similar to L survival, despite the fact that SL is performed in patients with comorbidities or impaired cardiopulmonary function. New approaches to comparing L to SL survival are needed.
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P1.06 - Poster Session/ Screening and Early Detection (ID 218)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.06-014 - Impact of Surgery for Stage I Non-Small Cell Lung Cancer on Quality of Life (ID 1586)
09:30 - 09:30 | Author(s): E. Taioli
- Abstract
Background:
The literature is mixed regarding the impact of lung cancer surgery on physical and mental health quality of life (QoL)[1-4]. Some studies have found an improvement in QoL post surgery[1] while others have indicated a decrease in various aspects of QoL[2,3]. Further, the impact on QoL is often dependent on numerous factors such as type of surgery. The current study aims to assess the impact of surgery on both physical and mental health QoL in screening-diagnosed patients with early stage lung cancer, an under-studied population.
Methods:
SF-12 QoL indicators were collected from 86 participants (40 women, 46 men) at baseline CT screening and one-year follow up post-surgery for clinical stage IA non-small cell lung cancer. 69 had lobectomy and 17 had sublobar resection. Average time of follow up was 12 months since surgery (SD: 1.5 months; range: 9-15 months post surgery). Univariate and multivariate analyses were performed to examine the difference in physical (PHC) and mental (MHC) health component scores of the SF-12 before and after surgery using the Wilcoxon signed rank and Mann Whitney tests.
Results:SF-12 Quality of Life Scores Pre and Post Surgery
There was no significant change in PHC post-surgery (Wilcoxon signed rank test, S=-216, p=0.32), but MHC significantly improved from baseline to post-surgery (S=527, P=0.01). Mean MHC was significantly higher among males as compared to females at both baseline (Chi-square=3.95, p=.047) and post-surgery (Chi-square=4.23, p=.039) and after controlling for age, ethnicity, and education, while no differences in PHC was observed. Further, there was an improvement in PCS score post-surgery among participants who underwent limited resection while a decrease in PCS score was observed among those who underwent lobectomy. The change in PCS score was significantly different between type of surgery (t=-2.01, p=0.048). After controlling for demographics, the difference was borderline significant (F=3.62, p=0.06).ALL M(SD) MALE M(SD) FEMALE M(SD) LIMITED RESECTION M(SD) LOBECTOMY M(SD) PHC Baseline (Pre-Surgery) 49.4(6.8) 49.8(5.8) 49.0(7.8) 47.8 (7.8) 49.8(6.5) Post-Surgery 48.7(7.1) 48.5(7.7) 49.0(6.4) 50.3(6.3) 48.3(7.2) Difference (Post-Pre) -0.7(7.6) -1.3(7.5) 0.0(7.6) 2.5*(6.0) -1.5(7.7) MHC Baseline (Pre-Surgery) 53.7(8.6) 55.5(7.6) 51.7(9.3) 52.3(13.4) 54.0(7.1) Post-SurgerY 55.8(8.2) 57.3(8.1) 54.1(8.2) 55.7(6.3) 55.8(8.7) Difference (Post-Pre) 2.0*(9.6) 1.7*(8.5) 2.4*(10.9) 2.9(10.7) 1.8(9.4) *p<.05
Conclusion:
Surgery for early stage lung cancer was associated with an increase in mental health QoL one year after surgery, however, physical health QoL was not affected by surgery overall, but it did marginally improve among participants who underwent limited resection as compared to lobectomy. Further, although mental health QoL improved for both males and females, females had lower mental health QoL as compared to males at both time points. Current study findings have implications for lung cancer health professionals regarding how to most effectively present the possible impacts of surgery on the QoL of this subset of patients in which disease has not yet significantly progressed.
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P2.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 225)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.08-002 - Germline BAP1 Mutation Is Associated with a Significant Increased Survival and Multiple Cancer in Mesothelioma Patients (ID 961)
09:30 - 09:30 | Author(s): E. Taioli
- Abstract
Background:
Because the diagnosis is often made at a late stage, malignant mesothelioma (MM) prognosis is very poor, with a median survival of 6-12 months and a five-year survival of less than 5%. We found that germline BAP1 mutation is associated with a new cancer syndrome, including rare malignancies such as MM and uveal carcinoma (UV), and other cancers. We noted that some MM cases that we followed from BAP1 mutated families had prolonged survival. We carried out a pooled analysis of BAP1 mutated MM patients to test the hypothesis that they had a better survival compared to sporadic MM.
Methods:
: We included all published BAP1 germline mutated MMs with available data on BAP1 status, site of MM, age at diagnosis, gender, and age at death or status at end of follow-up, in addition to the BAP1 mutated MM cases from families that we are following. Twenty-three BAP1 MM patients were included. Using the Kaplan-Meier method and Wilcoxon test, we compared survival among BAP1 mutated MM patients with that of all MMs (N = 10 556) recorded in the US SEER data from 1973 to 2010.
Results:
In our BAP1 cohort, ten patients had peritoneal MM, ten pleural MM, and three MM in both locations. Thirteen patients had one or more malignancies in addition to MM. Actuarial median survival for the MM patients with germline BAP1 mutations was five years, as compared with less than one year in the SEER MM control group. Five-year survival was 47%, 95%CI [24-67%], as compared with 6.7% [6.2-7.3%] in the SEER MM control group. The small size of our BAP1 cohort did not allow for significant statistical comparisons. However, patients with peritoneal MM (median survival of 10 years, P=0.0571), or with a second malignancy in addition to MM (median survival of 10 years, P=0.0716), survived for a longer time compared to patients who only had pleural MM, or MM patients without a second malignancy, respectively. Figure 1
Conclusion:
MM patients with germline BAP1 mutations have an overall seven-fold increased survival, independently of sex and age. This better prognosis was associated with multiple cancer and/or peritoneal MM. Appropriate genetic counseling and clinical management should be considered for MM patients who are also BAP1 mutation carriers.
