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L. Smith



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    MINI 10 - ALK and EGFR (ID 105)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Biology, Pathology, and Molecular Testing
    • Presentations: 1
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      MINI10.14 - Brain Metastasis at Diagnosis and EGFR Mutational Status in Non-Small Cell Lung Cancer (ID 431)

      18:00 - 18:05  |  Author(s): L. Smith

      • Abstract
      • Presentation
      • Slides

      Background:
      Prior studies have indicated higher epidermal growth factor receptor (EGFR) mutation rate in non-small cell lung cancer (NSCLC) patients (pts) with brain metastases; however, these studies did not adjust for the effects of potential confounding variables.

      Methods:
      This was a retrospective study of NSCLC pts diagnosed between 2007-2014 at the University of Nebraska Medical Center, USA and Tata Memorial Hospital, India. After excluding 87 pts due to missing data, a total of 1522 pts were included. Univariate analysis (Chi-square or Fisher’s exact tests) and multivariate logistic regression were used to determine any association between EGFR status and clinical factors.

      Results:
      EGFR mutations were more common in females than males (38% vs. 24%, p<.0001), Asians than Caucasians (31% vs. 13%, p<.0001), non-smokers than smokers (40% vs. 14%, p<.0001), alcohol non-consumers than consumers (32% vs. 15%, p<.0001), adenocarcinoma than other histologies (32% vs. 10%, p<.0001) and in pts with brain metastasis than extracranial metastases or no metastasis (39% vs. 29% vs. 15%, p<.0001). The type of EGFR mutation (exon 19 vs. 21) did not correlate with the presence of brain metastasis. Multivariate analysis demonstrated a higher likelihood of an EGFR mutation among Asians vs. Whites/other ethnic groups (odds ratio, OR 2.1, p=0.015), non-smokers vs. smokers (OR 2.8, p<0.0001), alcohol non-consumers vs. consumers (OR 1.6, p=0.022) and adenocarcinoma vs. other histologies (OR 3.1, p<0.0001). Pts with brain metastasis were 1.9 times more likely to have an EFGR mutation than pts with extracranial metastasis (p=0.0002). Pts with brain metastasis were 1.8 times more likely to have an EFGR mutation (p=0.0002) compared to those without. The distribution of EGFR mutations was similar between pts with brain metastasis vs. non-metastatic disease (p=0.86) and pts with extracranial metastasis vs. non-metastatic disease (p=0.44).

      Conclusion:
      Our study is the largest study to demonstrate almost two-fold higher likelihood of an EFGR mutation among newly diagnosed NSCLC pts with brain metastases vs. those without. Studies of prophylactic cranial irradiation in pts with earlier stages of EGFR mutation positive NSCLC may be warranted.

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    P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      P2.02-029 - Pre-Operative Pulmonary Function Tests (PFT) and Outcomes from Stage I and II Non-Small Cell Lung Cancer (NSCLC) Treated with Surgery (ID 2385)

      09:30 - 09:30  |  Author(s): L. Smith

      • Abstract
      • Slides

      Background:
      Pre-operative PFTs predict operative morbidity and mortality after resection in lung cancer. However, the impact of pre-operative PFT on overall survival (OS) in surgically resected stage I and II NSCLC is relatively less studied.

      Methods:
      This is a retrospective study of 149 patients who underwent surgical resection as first-line treatment for stage I and II NSCLC at a single center between 2003 and 2014. PFTs (FEV1, DLCO, both absolute values and percentage of predicted values were categorized into quartiles The Kaplan-Meier method and Cox regression analysis were used to determine whether PFTs predicted for OS. The t-test was used to compare the risk of post-op complications and length of stay greater than 10 days based on the results of PFTs and multivariate logistic regression was used for predictive modeling. P-value<0.05 was considered statistically significant.

      Results:
      The median age of the cohort was 68 years. The cohort was predominantly male (98.6%), current or ex-smokers (98%), with stage I NSCLC (82.76%). The majority of patients underwent a lobectomy (n=121, 81.21%). The predominant tumor histology was adenocarcinoma (n=70, 47%) followed by squamous cell carcinoma (n=61, 41%). The median follow-up of surviving patients was 53.2 months. Although DLCO was found to be a significant predictor of OS (HR: 0.93, 95% CI, 0.87-0.99; p=0.03), this was no longer significant on multivariate analysis. While PFTs did not predict for post-operative complications, worse PFTS were significant predictors of length of stay >10 days. Table 1. PFTs and Outcome:

      Multivariate model for of LOS > 10 days Odds Ratio(95% CI, p-value)
      FEV1 0.34(0.16-0.76,p=0.0087)
      FEV1 (percentage predicted) 0.96(0.94-0.99,p=0.0033)
      DLCO 0.78(0.68-0.90,p=0.0004)
      DLCO (percentage predicted) 0.96(0.94-0.99,p=0.0060)
      OS=Overall Survival, LOS= Length of stay, ULN= Upper Limit of Normal *PFT as continuous variables

      Conclusion:
      Preoperative PFTs did not predict for survival from resected early stage NSCLC, but did predict for longer hospital stays following surgery.

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