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C. Schieman
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MINI 32 - Topics in Localized Lung Cancer (ID 166)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:D. Boffa, T. D'Amico
- Coordinates: 9/09/2015, 18:30 - 20:00, 201+203
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MINI32.04 - Clinico-Pathological Correlations and the Role of Brain MRI in Combined Clinical Staging for Resectable Lung Cancer (ID 2441)
18:45 - 18:50 | Author(s): C. Schieman
- Abstract
Background:
In our model of Combined Clinical Staging (CCS) for lung cancer, patients with a Computerized Tomography (CT) scan of the chest that does not show distant metastases will then routinely undergo whole body Positron Emission Tomography (PET/CT) and Magnetic Resonance Imaging (MRI) of the brain prior to any therapeutic decision. We aim to determine the accuracy of CCS and the value of brain MRI in this population.
Methods:
A prospective database was queried for all patients who underwent resection of lung cancer from 01/2012 to 06/2014. Demographics, wait times, clinical and pathological stage (7[th] edition AJCC/UICC), and costs of staging were collected. Krippendorff’s alpha was used to determine correlation between clinical and pathological stage.
Results:
Of 315 patients with primary lung cancer, 55.6% were female and the median age was 70 (27-87, Table 1). The mean time from initial CT scan to surgical treatment was 9.12 +/- 6.0 weeks. Krippendorff’s alpha between CCS and pathological stage was 0.193 (0.125 to 0.260, Table 2). When correlation was analyzed without consideration for sub-stages A and B, 49.8% (157/315) of patients were staged accurately, 39.7% (125/315) were over-staged, and 10.5% (33/315) were under-staged. Only 4.7% (15/315) of patients underwent surgery without appropriate neo-adjuvant systemic treatment. Preoperative brain MRI detected asymptomatic metastases in 4/315 patients (1.3%). At a median postoperative follow-up of 16 months (1-40), 7 additional patients developed symptomatic brain metastases, all of which had normal brain MRI preoperatively. The total cost of CCS was $416,924 over the study period, with $131,824 (31.6%) going towards brain MRI.Table 1: Baseline descriptive data, N=315
Age Mean (SD) 69.80 (9.62) (Min: 27.34, Max: 86.61) Gender Female (%) 175 (55.6%) Male (%) 140 (44.4%) Weeks First Visit to Consent Mean (SD) 5.49 (8.15) (Min: 0, Max: 63) Weeks Consent to Surgery Mean (SD) 2.24 (2.07) (Min: 0, Max: 11) Weeks Initial CT to Surgery Mean (SD) 9.12 (6.01) (Min: 0, Max: 53) Weeks First Visit to Surgery Mean (SD) 8.00 (8.25) (Min: 0, Max: 64) Brain Metastases at Baseline (%) 4 (1.3%) Brain Metastases at Follow Up (%) 11 (3.5%) Table 2: Frequency and agreement of CCS and pathological stage
Stage (N=315) Clinical Stage N (%) Pathological Stage N (%) Same Staging by Both (True Positives) 0 1 (0.3%) - - Stage IA 89 (28.3%) 103 (32.7%) 55 Stage IB 39 (12.4%) 82 (26.0) 19 Stage IIA 42 (13.3%) 47 (14.9%) 7 Stage IIB 32 (10.2%) 42 (13.3%) 12 Stage IIIA 78 (24.8%) 39 (12.4%) 16 Stage IIIB 21 (6.7%) 0 (0.0%) 0 Stage IV 13 (4.1%) 2 (0.6%) 2 Krippendorff's Alpha for level of agreement = 0.193 (0.125 to .260)
Conclusion:
CCS is effective for patients with resectable lung cancer, with less than 5% of patients being under-staged in a way that denied them appropriate systemic treatment before surgery. Brain MRI is a low yield and high cost intervention in this population, and its routine use should be questioned.
