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J. Fu
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ORAL 35 - Surgical Approaches in Localized Lung Cancer (ID 155)
- Event: WCLC 2015
- Type: Oral Session
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:M. de Perrot, J. Mitchell
- Coordinates: 9/09/2015, 16:45 - 18:15, 601+603
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ORAL35.01 - Surgical Approach and Disease Recurrence in NSCLC Patients in the MAGRIT Study (ID 318)
16:45 - 16:56 | Author(s): J. Fu
- Abstract
- Presentation
Background:
Surgical resection is the standard treatment for early stage Non-Small Cell Lung Cancer (NSCLC). Anatomical resection with lymphadenectomy is recommended in surgically treated patients with Stage I-IIIA NSCLC. Whether mediastinal lymph node dissection (MLND) or mediastinal lymph node sampling (MLNS) should be performed remains controversial, and there is currently no consensus within the literature. We describe surgical approaches and patterns of disease recurrence in patients enrolled in MAGRIT: a large global randomized study of the MAGE-A3 Cancer Immunotherapeutic versus placebo after complete tumor resection (Phase III trial, MAGRIT, NCT00480025).
Methods:
Study participants were aged ≥18 years, with histologically-proven, MAGE-A3-positive Stage IB, II or IIIA NSCLC (AJCC 6.0) who had undergone R0 anatomic resection of their tumor (lobectomy or pneumonectomy) with mediastinal lymphadenectomy. Patients were randomized to MAGE-A3 or placebo in a 2:1 ratio. A total of 2,272 patients were treated at 556 centers in 34 countries. Because MAGRIT did not demonstrate efficacy overall, and because the number of recurrences in the placebo arm was small (n=271), recurrence patterns by surgical technique are presented in the overall population. An analysis of the placebo population was also conducted as the overall population results are subject to potential bias (a limited treatment effect in small sub-groups cannot be excluded). Cox regression models were used to explore whether lymphadenectomy procedure could be prognostic for disease-free survival (DFS) or overall survival (OS).
Results:
In the total treated population, 76% were men, 52% had squamous cell carcinoma, and 52% received adjuvant chemotherapy. More than half (57%) of patients were enrolled in Europe, with 23% in East Asia, 16% in North America and 4% in other countries. 47% of patients had Stage IB, 6.5% IIA, 30% IIB, and 17% IIIA disease. Lobectomy (including bi- and sleeve-lobectomy) was performed in 85% of patients, and 14% required pneumonectomy. MLNS was performed in 53% and MLND in 47% of patients. MLNS and MLND patients had a similar disease stage distribution. By region, the percentage of patients who underwent MLNS was: 36% in Europe, 65% in East Asia, 94% in North America and 59% in other countries. Among patients who had undergone MLNS or MLND, 37% (n=447/1202) and 36% (379/1067) developed recurrent disease, respectively. Loco-regional recurrence was observed in 40% (177/447) of patients after MLNS and 31% (118/379) after MLND, with distant recurrence observed in 55% (244/447) and 64% (244/379), respectively. There was no difference in the pattern of distant metastases between patients who had MLNS or MLND. Cox modeling showed no impact of the extent of lymphadenectomy on either DFS or OS. A separate analysis of patients in the placebo arm demonstrated similar trends to those of the total study population.
Conclusion:
Lobectomy (including bi- and sleeve-lobectomy) was the most frequently used treatment for patients who participated in the MAGRIT study. Important regional differences in lymphadenectomy were observed. Although the patterns of recurrence varied to some extent with the type of lymphadenectomy, our study did not demonstrate any prognostic impact related to the type of lymphadenectomy performed.
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P1.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 224)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.08-036 - Long-Term Survival after Surgical Treatment for Thymic Carcinoma (ID 262)
09:30 - 09:30 | Author(s): J. Fu
- Abstract
Background:
Thymic carcinoma is a type of highly malignant tumor that originates from the thymic epithelium. It is rare and distinct from thymoma. Treatment methods and prognosis of thymic carcinoma remain controversial. To date, three studies with relatively large sample populations have been conducted based respectively on the Surveillance, Epidem iology and End Results database in the United States, the European Society of Thoracic Surgeons, and the Japanese multicenter database. This paper retrospectively analyzes survival data from a large-sample multicenter database in China.
Methods:
The Chinese Alliance for Research of Thymoma (ChART), established in June 2012 in China, constructed a retrospective database of patients with thymic epithelial tumors. This database enrolled 1,930 patients, including 369 with thymic carcinoma. In this study, we analyzed clinical, pathologic and treatment imformation, measured long-term survival rates, and identified relevant prognostic factors.
Results:
Among 369 thymic carcinoma underwented radical intended surgery, 211 underwent R0 resection; 34, R1 resection; and 84, R2 resection. The 3-, 5-, and 10-year survival rates were 78.3%, 67.1%, and 47.9%, respectively. The survival rates of the patients at different Masaoka-Koga stages were significantly different (P ＜ 0.001). The survival rate of the patients who underwent complete resection (R0) was significantly higher than that with incomplete resection (R1/R2)（P < 0.001）. Postoperative chemotherapy did not significantly affect patient survival (P = 0.873). Postoperative radiotherapy significantly improved the overall survival not only of the patients with R1/R2 resection but also of those with stage III/IV disease who underwent R0 resection. Multivariate analyses showed that R0 resection, Masaoka-Koga stage and postoperative radiotherapy were major prognostic factors of overall and disease-free survival. Figure 1
Conclusion:
Surgery remains the primary treatment for thymic carcinoma. R0 resection was the main factor of prognosis. For patients with stage III/IV disease who had undergone R0 resection and all the patients who had undergone R1+R2 resection, postoperative radiotherapy should be administered.
