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B.C. Tong
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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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MINI20.04 - Right-Sided vs Left-Sided Pneumonectomy after Induction Therapy for Non-Small Cell Lung Cancer (ID 3064)
17:00 - 17:05 | Author(s): B.C. Tong
- Abstract
- Presentation
Background:
A right-sided pneumonectomy after induction therapy for non-small cell lung cancer (NSCLC) has been shown to be associated with significant perioperative risk. We examined the impact of laterality on long-term survival using the National Cancer Data Base (NCDB).
Methods:
Perioperative and long-term outcomes of patients who underwent pneumonectomy following induction chemotherapy ± radiation from 2003-2011 in the NCDB were evaluated using Kaplan-Meier method, multivariable logistic regression analysis and multivariable Cox proportional hazards modeling.
Results:
During the study period, 1,652 patients met inclusion criteria, of whom 740 (45%) underwent right-sided pneumonectomies. Right-sided patients were more likely to have adenocarcinomas, cN2 disease and lower co-morbidity scores (Table). The 30-day mortality rate was higher for right-sided procedures in univariable (11% [84/740] vs 4% [39/912], p<0.001) and multivariable (OR 9.1 [1.8-50.0], p<0.01) analysis. However, 5-year overall survival between right and left pneumonectomy were not significantly different (figure) after a median follow up of 30.2 months. Right-sided procedure also did not impact overall survival in multivariable analysis (hazard ratio (HR), 1.41 [95% CI: 0.87-2.27], p=0.16), while increasing age (HR, 1.02 [95% CI: 1.01-1.03]), Charlson co-morbidity Score of 2 (HR, 1.42 [95% CI: 1.04-1.93]), adenosquamous histology (HR, 1.72 [95% CI: 1.18-2.51]), cN1 status (HR, 1.27 [95% CI: 1.02-1.58]), cN2 status (HR, 1.38 [95% CI: 1.14-1.66]), cN3 status (HR, 1.84 [95% CI: 1.19-2.83]), cM1 status (HR, 2.04 [95% CI: 1.42-2.92]) and incomplete resection (HR, 1.45 [95% CI: 1.14-1.84]) all predicted worse survival. Figure 1Table: Baseline characteristics.
There were no significant differences between the groups with regards to sex, race, facility type, and clinical T and M status.Variable Right-sided (n=740) Left-sided (n=912) p Induction chemoradiation 461 (62%) 584 (64%) 0.47 Age (median, IQR) 59 (52-66) 60 (52-67) 0.07 Charlson/Deyo Comorbidity Score 0.02 0 518 (70%) 610 (66%) 1 190 (26%) 243 (27%) 2 32 (4%) 68 (7%) Histology 0.02 Adenocarcinoma 227 (37%) 243 (32%) Squamous 310 (50%) 450 (59%) Large cell 28 (5%) 19 (2%) Adenosquamous 20 (3%) 21 (3%) Neuroendocrine/carcinoid 4 (1%) 7 (1%) BAC 28 (5%) 23 (3%) Clinical N < 0.01 0 190 (27%) 269 (31%) 1 134 (19%) 187 (21%) 2 368 (52%) 381 (44%) 3 16 (2%) 34 (4%)
Conclusion:
In this population analysis, right-sided pneumonectomy after induction therapy was associated with a significantly higher perioperative but not worse long-term mortality compared to a left-sided procedure. These findings can be used in the risk/benefit analysis when considering patients for pneumonectomy following induction therapy.
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MINI 37 - SCLC Therapy (ID 165)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:D. Ettinger, G.R. Simon
- Coordinates: 9/09/2015, 18:30 - 20:00, 605+607
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MINI37.03 - Survival after Surgery for pN1 and pN2 Small Cell Lung Cancer: A Comparison with Surgical Treatment of Non-Small Cell Lung Cancer (ID 3100)
18:40 - 18:45 | Author(s): B.C. Tong
- Abstract
- Presentation
Background:
With the advent of modern chemotherapy and radiotherapy, we hypothesize that patients who undergo surgery followed by adjuvant therapy for locally advanced small cell lung cancer (SCLC) may have significantly better long-term survival compared to historical data suggesting 2-year overall survival of 4-20% for patients undergoing surgery for SCLC.
Methods:
Prospectively-collected perioperative outcomes and survival data of patients with pathologic T1-3, N1 and (limited) N2 SCLC and non-small cell lung cancer (NSCLC) who underwent complete resection with adjuvant chemotherapy ± radiation and no induction therapy were reviewed from the US National Cancer Data Base from 2003-2011 using Kaplan-Meier method and propensity-score matching. Groups were matched for common prognostic co-variates including year of diagnosis, age, sex, race, education, insurance status, facility type, distance from facility, Charlson/Deyo co-morbidity score, T and N status, tumor size, and tumor location. These prospective data were acquired by certified tumor registrars and include over 70% of cancer diagnoses annually in the U.S.
Results:
During the study period, 369 and 12,152 patients underwent complete resection for pathologic T1-3 N1-2 M0 SCLC and pT1-3 N1-2 M0 NSCLC, respectively. Median follow-up time was 43 months. Five-year overall survival was 37% for SCLC pN1 patients and 26% for SCLC pN2 patients (Table). Matched patients with pN1/N2 NSCLC had better 5-year survival compared to patients with pN1/N2 SCLC (Table and Figure). Figure 1 Figure 2
Conclusion:
SCLC T1-3 N1-2 patients who undergo complete resection followed by adjuvant chemotherapy ± radiation have 5-year survival greater than 26%. Compared to NSCLC, SCLC patients with N1/N2 disease have worse survival; however, the differences in survival between NSCLC and SCLC patients with N1/N2 disease are much smaller than previously reported. These results support a re-evaluation of the role of surgery in multimodality therapy for locally advanced small cell lung cancer.
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ORAL 10 - SCLC (ID 98)
- Event: WCLC 2015
- Type: Oral Session
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:C. Faivre-Finn, P. Lara Jr.
- Coordinates: 9/07/2015, 10:45 - 12:15, 605+607
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ORAL10.06 - Long-Term Survival after Surgery for Pathologic N1 and N2 Small Cell Lung Cancer: A Comparison with Nonoperative Management (ID 3089)
11:59 - 12:10 | Author(s): B.C. Tong
- Abstract
- Presentation
Background:
With the advent of modern chemotherapy, patients previously thought to have unresectable small cell lung cancer (SCLC) may have tumors amenable to surgery. This study was undertaken to test the hypothesis of whether surgery, in the setting of modern adjuvant therapies, offers a survival advantage among patients with node-positive SCLC.
Methods:
Overall survival (OS) of patients with pT1-2 pN1-2 M0 SCLC who underwent non-operative management (chemotherapy ± radiation) vs surgery (with adjuvant chemotherapy ± radiation) in the National Cancer Data Base (NCDB) from 2003-2011 was assessed using propensity-score-matched analysis. Groups were matched for common prognostic co-variates (year of diagnosis, age, sex, race, insurance status, facility type, distance from facility, Charlson/Deyo co-morbidity score, pathologic T and N status, and tumor location). NCDB data is prospectively collected by certified tumor registrars and include over 70% of cancer cases diagnosed annually in the U.S.
Results:
Of 1,071 patients who met inclusion criteria, 359 (33.5%) patients underwent surgery with adjuvant chemotherapy ± radiation and 712 (66.5%) underwent non-operative management. After propensity-score matching, 11 covariates were balanced between the surgery (n=231) and non-operative (n=231) groups. Surgery was associated with a significantly higher OS than non-operative management (5-year OS 28.1% vs 18.3, log-rank p<0.01) (Figure 1). To minimize treatment selection bias due to comorbidities, we limited the propensity-matched analysis to patients with no comorbidities; surgery remained significantly associated with a higher OS than non-operative management (5-year OS 32.1% vs 21.8%, log-rank p<0.01) (Figure 2). Figure 1 Figure 2
Conclusion:
In a propensity-matched analysis of a national population-based cancer database, surgery followed by adjuvant chemotherapy ± radiation for SCLC pT1-3 pN1-2 patients had improved outcomes when compared to non-operative medical treatment. These results support an increased role of surgery in multimodality therapy for more advanced limited-stage small cell lung cancer.
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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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ORAL35.02 - Wedge Resection vs Segmentectomy for Patients with T1A N0 Non-Small Cell Lung Cancer (ID 3208)
16:56 - 17:07 | Author(s): B.C. Tong
- Abstract
- Presentation
Background:
A previous study of the Society of Thoracic Surgeons database showed that non-anatomic resection had lower perioperative morbidity than segmentectomy for non-small cell lung cancer (NSCLC); however the study lacked long term outcomes. We tested the hypothesis that segmentectomy for stage T1a N0 NSCLC had better long-term survival than wedge resection using the U.S. National Cancer Data Base (NCDB).
Methods:
Perioperative outcomes and overall survival (OS) of patients with clinical T1a N0 NSCLC who underwent wedge resection or segmentectomy in the NCDB from 2003-2011 were assessed using propensity-score-matched analysis. Groups were matched for common prognostic covariates (year of diagnosis, race, sex, age, education, income, insurance status, facility type, distance from facility, Charlson/Deyo comorbidity score, tumor size and location). Additional propensity-matched analyses were performed on patients with tumors ≤ 1 cm, patients with no comorbidities, and patients with pathologic T1a pN0 disease.
Results:
Of 40,058 clinical stage T1a N0 NSCLC patients, wedge resection and segmentectomy were performed in 7,517 (19%) and 1,268 (3%) patients, respectively. After matching, all baseline covariates, including comorbidity scores, were balanced between the wedge (n=1,231) and segmentectomy (n=1,231) groups. There were no significant differences between wedge and segmentectomy regarding 30-day mortality (1.6% [n=20] vs 1.5% [n=18], p=0.94). However, wedge was associated with significantly lower long-term survival than segmentectomy (Figure 1); this finding remained consistent even in a propensity-matched analysis of patients with tumors ≤ 1 cm (5 year OS: 56.8% [wedge] vs 78.2% [segmentectomy], log-rank p<0.01). To minimize treatment selection bias due to comorbidities, a propensity-matched analysis was also performed between wedge (n=509) and segmentectomy (n=509) for patients without comorbidities; wedge resection was associated with worse survival when compared with segmentectomy (5 year OS: 65.5% vs 69.5%, log-rank p<0.01). An additional propensity-matched analyses demonstrated that wedge (n=1,099) was associated with worse survival when compared with segmentectomy (n=1,099) for patients with pathologic T1a pN0 disease (5 year OS: 56.8% vs 65.5%, log-rank p<0.01).Figure 1
Conclusion:
In an analysis of a population-based dataset, a large proportion of patients was found to have received wedge resection for stage T1a N0 NSCLC. Segmentectomy for T1a N0 NSCLC had similar 30-day mortality but improved long-term survival when compared to wedge resection, even for patients with very small tumors ≤ 1 cm, for patients with no comorbidities and for patients with pathologic T1a pN0 disease.
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P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.03-021 - Impact of Radiation on Recurrence Patterns and Survival for Patients Undergoing Lobectomy for Stage IIIA-pN2 Non-Small Cell Lung Cancer (ID 2425)
09:30 - 09:30 | Author(s): B.C. Tong
- Abstract
Background:
There is controversy regarding the optimal multimodality treatment strategy for stage IIIA-pN2 non-small cell lung cancer (NSCLC). This study evaluated the impact of induction and adjuvant radiation on locoregional and distant recurrence and survival when induction chemotherapy and surgery is used.
Methods:
Cancer recurrence and survival of 113 consecutive patients who were treated with lobectomy after induction chemotherapy ± radiation for pathologically staged IIIA-N2 NSCLC between 1995 and 2012 at a single institution were evaluated using Kaplan-Meier, logistic regression, and Cox proportional hazard analysis.
Results:
Induction radiation was used in 58 (51%) patients and adjuvant radiation was used in 29 (26%) patients (Table 1). For the entire cohort (n=113), median survival was 30.1 months (95% CI, 22.0 to 56.4). Five-year overall and recurrence-free survivals were 39.0% (95% CI, 29.1 to 48.7) and 28.2% (95% CI, 18.0 to 39.2), respectively. Recurrent disease occurred in 62 (55%) patients after a median (IQR) time of 11.5 months (4.3, 18.7) after surgery. First recurrence site was locoregional only (n=19), distant only (n=34), and locoregional and distant (n=9) (Table 1). In multivariable analysis, induction radiation was associated with decreased likelihood of developing locoregional recurrence (odds ratio (OR), 0.17; 95% CI: 0.04-0.90; p=0.04) but not improved survival (hazard ratio [HR], 1.47; 95% CI: 0.71-3.03; p=0.04) while adjuvant radiation was not associated with decreased likelihood of developing locoregional recurrence (OR, 0.48; 95% CI: 0.07-3.37; p=0.46) but was associated with improved survival (HR, 0.20; 95% CI: 0.04-0.91; p=0.04) (Table 2). Figure 1 Figure 2
Conclusion:
A significant number of recurrences in stage IIIA-pN2 NSCLC patients who undergo induction therapy followed by lobectomy are locoregional recurrences. Use of radiation was associated with improved local control only in the induction setting and may be optimal in terms of survival when given in the adjuvant rather than induction setting.
