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J. Glanzman
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MINI 20 - Surgery (ID 137)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:G. Veronesi, R. Flores
- Coordinates: 9/08/2015, 16:45 - 18:15, 201+203
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MINI20.01 - Do Secondary Lung Cancers Have the Same Disease-Specific Survival and Overall Survival as Primary Lung Cancers? (ID 2686)
16:45 - 16:50 | Author(s): J. Glanzman
- Abstract
- Presentation
Background:
The risk of recurrent lung cancer decreases markedly after 4 years. It is unknown whether frequent surveillance after this time period would be beneficial in order to diagnose and treat secondary lung cancers. The purpose of investigation is to assess whether there is an increasing frequency of second lung cancers and whether the first primary reduces Overall Survival(OS)/Lung Cancer Specific Survival(LCSS) as compared to similar patients presenting with their first lung cancer (new primary, NP).
Methods:
The SEER databases were used to investigate incidence (1973-2010) and OS/LCSS (1998-2010) of secondary lung cancer. Incidence was examined by frequency and trend analyses. A SP population was chosen who was originally treated for Stage I-III NSCLC and developed a new primary at least four years after diagnosis of their original primary lung cancer (N=1,699). The OS/LCSS of their SP NSCLC were compared to patients presenting with a new primary (NP) NSCLC. OS/LCSS in NP and SP were analyzed by Kaplan-Meier estimation, multivariate proportional hazards modeling and log-rank tests in the overall group and in a favorable sub-group (stage I, < 4cm).
Results:
The annual incidence rates per 100,000 persons for SP NSCLC has increased almost 5 fold in last three decades (2.5 in 1973; 12 in 2010; p<0.001), more so in male patients. OS and LCSS in SP were higher than NP in the log rank tests (p<0.001). In the subgroup of NP and SP who had favorable tumor characteristics, OS/LCSS was significantly different between NP and SP (P=0.0032; P=0.0015), but did not remain so after accounting for treatment, tumor factors, and patient characteristics (HR=0.983, p=0.8493; HR=1.154, p=0.1770). Rates of OS and LCSS improved significantly with increasingly aggressive treatment in the SP group. Patient and tumor characteristics of the first primary NSCLC were not signantly linked to mortality.
Conclusion:
Patients presenting with a second primary lung cancer had a similar or better OS/LCSS as compared to patients presenting with a new primary lung cancer. The SP population also benefitted from increasingly aggressive treatment. Continued surveillance for new primary lung cancers after 4 years may be beneficial to lung cancer survivors.
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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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P1.08-038 - The Effect of the WHO Histologic Classification on Thymic Specific Survival and Overall Survival (ID 2616)
09:30 - 09:30 | Author(s): J. Glanzman
- Abstract
Background:
In 1999 the World Health Organization published a histologic classification system for thymoma that divided it into 5 categories (A, AB, B1-B3). We investigated the effect that this classification has on outcomes and determined if there was a role for radiotherapy in patients undergoing resection.
Methods:
The SEER database was used to retrospectively analyze thymomas from 2000-2011. Only those patients having first primary thymic neoplasia and undergoing resection were included in the analysis. Overall survival (OS) and thymic-specific survival(TSS) were evaluated by Kaplan-Meier Methods. Propensity Score was used to determine the role of radiotherapy.
Results:
1047 patients had median follow-up of 53 months. In patients not receiving radiation (N=428), multivariate analysis found that worse OS was associated with older age, unmarried status, advanced stage, and partial resection. Better TSS was associated with white race and early stage. Histologic classification did not have any effect on OS or TSS. In patients with stage I and II disease (N=541), the 5-year OS and cumulative incidence rates of thymic death were 87.5% and 3.0%. In 483 stage III/IVA patients, propensity match of 153 patients treated with or without radiation demonstrated that radiation was associated with a significantly better OS (HR=0.400, p= 0.001) and TSS (HR=0.473, p=0.034), and that the effect of radiation did not depend upon histologic subtype. Selection factors for radiation included younger age and tumor size. Radiation was not associated with an increase in cardiopulmonary deaths or deaths due to second malignancies. Only 36.6% of patients had any lymph nodes explored, and 12.0% were positive. WHO Histology B3 was most likely to have involved lymph nodes (20%), while histology A (0%) and B2 (2%) were least likely. 125 (11.9%) patients have developed secondary malignancies.
Conclusion:
Radiation may be beneficial for surgically-resected advanced-stage thymoma. Neither OS or TSS was affected nodal involvement or histology. The lack of correlation of histology with outcomes may demonstrate that the current histologic system is not predictive of outcomes or that it does not translate to the broad spectrum of pathologists in SEER registry areas.
