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D. Morris
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MINI 04 - Clinical Care of Lung Cancer (ID 102)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:L. Gaspar, V. Westeel
- Coordinates: 9/07/2015, 16:45 - 18:15, Mile High Ballroom 2c-3c
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MINI04.11 - Incidence of Brain Metastasis in Non-Small Cell Lung Cancer Over Eleven Years at a Single Canadian Institution (ID 1585)
17:45 - 17:50 | Author(s): D. Morris
- Abstract
- Presentation
Background:
The highest percentage of metastasis to the brain exists among non-small cell lung cancer (NSCLC) patients. The exact incidence of brain metastasis (BM) in NSCLC is unknown, but current literature suggests that incidence for this cohort is increasing as cancer patients live longer. To date, only a single Canadian study reporting BM occurrence in lung cancer patients is available. A key limitation to this study is the method of incidence reporting, as number of cases, rather than number of cases as a percentage among lung cancer population. Reliable estimates of BM in NSCLC patients are necessary to further improve patient care and resource allocation.
Methods:
The Alberta Cancer Registry dataset was used to identify all NSCLC patients living in southern Alberta who are consulted at the Tom Baker Cancer Centre, Calgary, Alberta, Canada between 1999 and 2010. These patients were registered and their charts were reviewed for an institutional lung cancer database (Glans-Look Database). NSCLC patients were categorized into two groups: (i) having BM at diagnosis or (ii) developing BM between diagnosis and death. Patient characteristics were compared to the database NSCLC cohort and all metastatic cases. The number of BM cases was reported for each group per year. Incidence was calculated as a percentage of the NSCLC and metastatic disease cases, where applicable. Linear trend testing was performed.
Results:
A total of 5297 NSCLC patients were consulted. The percentage of BM at diagnosis in the cohort was 11% in 1999 and 8% in 2010 (linear trend test p-value=0.010). These numbers were 26% in 1999 and 15% in 2010 (p=0.010) in the metastatic cohort. The percentage of BM developed by death in the NSCLC cohort was 20% in 1999 and 13% in 2010 (p=0.010). These numbers were 44% in 1999 and 26% in 2010 (p=0.009) in the metastatic cohort (Figure 1). Out of 2501 non-metastatic NSCLC patients, 46% developed BM by death in 1999 compared to 62% in 2010 (p=0.14).
Conclusion:
Although the absolute number of NSCLC patients with BM at diagnosis has increased between 1999 and 2010, the incidence, reported as a percentage of the all NSCLC cases, is decreasing. Similar trends were not observed for non-metastatic patients. As a future step, a pre-specified multivariable analyses will be conducted to examine effects of age, gender, histology, smoking, and treatment on rates of BM in NSCLC.Figure 1
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ORAL 23 - Prevention and Cancer Risk (ID 121)
- Event: WCLC 2015
- Type: Oral Session
- Track: Prevention and Tobacco Control
- Presentations: 1
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ORAL23.06 - Radon Gas Exposure and Lung Cancer in a Cohort of Lung Cancer Patients Who Never Smoked (ID 2859)
11:39 - 11:50 | Author(s): D. Morris
- Abstract
- Presentation
Background:
Radon is a naturally occurring radioactive gas produced by the breakdown of uranium and uranium progeny in soil and rocks. This colourless and odourless gas moves easily through bedrock and foundations to accumulate within homes (basements) and buildings. Once inhaled, radon gas can decay to solid radionucleotides that deposit within tissue of the airways and lungs and continue to emit alpha particle radiation over the course of >25 years. Exposure to radon gas is thought to be a major epidemiological risk for the development of lung cancer in people who have never smoked, but the precise relationship between exposure and molecular alterations associated with lung cancer are poorly described. In order to explore the relationship between domestic radon gas levels and lung cancer incidence in never-smokers, we set out to identify a cohort of Alberta lung cancer patients who have never smoked and measure radon gas levels of in their homes.
Methods:
The Glans-Look Database, comprised of clinicopathological and outcome data for over 5000 patients with non-small cell lung cancer (NSCLC) consulted at the Tom Baker Cancer Centre between 1999 and 2010, was searched for patients who had developed NSCLC but never smoked. Follow-up information was obtained to determine if the patients or their family members still lived at the address provided at diagnosis. Initial letters of contact were sent explaining the study. Patients and their family members will be notified by mail of the levels of radon gas in their homes, and how best to mitigate levels if high. Radon concentration was examined as a continuous variable and as a dichotomous variable, using the cut point value of 200 Bq/m[3] suggested by Health Canada guidelines. Statistical analysis of data utilizes Cox proportional hazard regression models to examine the independent effects of radon exposure on patient outcome, utilizing IBM SPSS Statistical Package version 19. The model addresses the possible confounding variables of exposure to second hand smoke, type and age of dwelling, family history of lung cancer, profession and hours spent within the home.
Results:
A cohort of 317 patients was identified, 189 of whom met study criteria requirement. As of March 2015, 42 patients or their family members agreed to participate in this study. 30 long term testing radon monitors have been placed in the homes where patients lived for at least five years before developing NSCLC. These monitors are being collected by the study team by: all will be retrieved by June 30, 2015, three months after initial placement.
Conclusion:
This study will contribute significantly to our understanding of residential radon gas exposure in NSCLC, and in the short term, alert patients and their families to potential risk of high level radon gas exposure. In the longer term, as this will be the first study of its type in Alberta, the findings may be seminal in forming the basis of a health program for improved testing for radon gas in the home and educating the public with respect to the dangers of radon gas exposure.
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P3.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 235)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.04-073 - CXCR4 Expression Is Associated with Poor Survival in Early, Resected NSCLC (ID 3081)
09:30 - 09:30 | Author(s): D. Morris
- Abstract
Background:
CXCR4, a G protein coupled chemokine receptor, and its ligand, stromal cell derived factor-1 (SDF-1), play a critical role in organ specific tumor metastasis. In vitro, CXCR4 expression has been shown to correlate with migration, invasion and adhesion in various cancer cell lines including lung, breast and colon, among others. In clinical studies, patients whose tumors exhibit high CXCR4 expression tend to have a poorer clinical outcome. We previously demonstrated that high expression of CXCR4 by quantitative IHC in a cohort of 170 stage IV NSCLC specimens was associated with significantly decreased overall survival, particularly in the female patients. We subsequently investigated whether CXCR4 also conferred a poorer prognosis in our early stage NSCLC patients with resected disease, to validate our previous findings.
Methods:
After ethical approval was obtained, demographic details, clinical variables and outcome data were gathered on patients diagnosed at the Tom Baker Cancer Centre (TBCC) from 2003 to 2006. Formalin-fixed paraffin embedded tumor specimens were obtained from those patients diagnosed with resected stage I, II or III NSCLC and tissue micro arrays (TMAs) were generated. CXCR4 expression in NSCLC cells was analyzed by immunohistochemistry using anti CXCR4 mAb and the HistoRx PM-2000 platform, then correlated with clinical outcome. Statistical analysis was performed using the Kaplan-Meier method, multivariate analysis and a multi-state model to account for the competing risks of disease free and overall survival.
Results:
Of 1502 patients diagnosed with NSCLC at the TBCC in 2003-2006, 166 had resected (pneumonectomy, lobectomy or wedge resection) stage I (63%), II (30.7%) or III (9.6%) disease. 37.3% of the patients received adjuvant treatment (combined chemoradiotherapy or radical radiotherapy alone) after their surgery. 46.4% of the patients were still alive at the time of analysis. The mean CXCR4 AQUA scores were significantly lower for the early stage patients than those obtained for the advanced stage IV patients (1715.90 vs 2512.44 p< 0.0001). High CXCR4 expression was associated with worse overall survival (p = 0.026) but had no significant effect on disease free survival after resection (p = 0.376). Subgroup analysis showed no significant differences between genders in the association between high CXCR4 expression and clinical outcome.
Conclusion:
CXCR4 is expressed in early stage resected NSCLC tumors and appears to increase significantly from stage I-III to stage IV NSCLC. High CXCR4 expression is associated with significantly poorer overall survival in early stage resected patients, validating our previous findings in stage IV NSCLC using the same method. CXCR4 does not seem to be associated with disease free survival in this cohort of patients, nor does there seem to be any association between gender and the effect of CXCR4 on poor outcome unlike that seen in our stage IV NSCLC patients.
