Virtual Library

 x 
My Library Virtual Library FAQ

Start Your Search

D.N. Ranney



Author of

  • +

    MINI 20 - Surgery (ID 137)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
    • +

      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): D.N. Ranney

      • Abstract
      • Presentation
      • Slides

      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 1

      Table: Baseline characteristics.
      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%)
      There were no significant differences between the groups with regards to sex, race, facility type, and clinical T and M status.



      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.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.