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P. Levy
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P1.01 - Poster Session with Presenters Present (ID 453)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.01-030 - Factors Associated with Margin Positive Resections for Non-Small Cell Lung Cancer (NSCLC) in the Mid-South Region of the US (ID 5076)
14:30 - 14:30 | Author(s): P. Levy
- Abstract
Background:
Incomplete resection of NSCLC has a negative impact on survival. We evaluated risk factors associated with positive margins within a comparative observational population-based cohort study.
Methods:
We analyzed curative-intent resections from 2009-2016 from 4 contiguous Dartmouth Hospital Referral Regions in 3 US states. Statistical analyses were preformed using univariate and multiple logistic regression models.
Results:
Among the 2,275 NSCLC-resected patients, 52% were male, 78% white, 45% Medicare insured, and 36% privately insured, with a median age of 67 years. Factors associated with a higher margin positivity rate included male sex, large cell histology, undifferentiated tumor grade, neo-adjuvant therapy, clinical stage IIIA and IIIB, bilobectomy extent of resection, patients with abnormal diffusing capacity of the lungs for carbon monoxide (DLCO), use of bronchoscopic biopsy for diagnosis greater than 1 day before surgery, left lung resection, and tumor size >7cm (all p<0.15, Table 1). American Society of Anesthesiologists (ASA) score, prior lung cancer, smoking status, Charlson score, FEV1, PET/CT, brain scan, bone scan, mediastinoscopy, blood transfusion, and hospital were not associated with positive margins in univariate analyses (all p>0.15). Controlling for sex, histology, tumor grade, tumor size, neo-adjuvant therapy, clinical stage, extent of resection, DLCO, pre-operative bronchoscopic biopsy, and primary resection site in the multiple variable analysis, sex (p=0.0134), clinical stage (p<0.001), extent of resection(p=0.0461), DLCO (p=0.0431), and bronchoscopic biopsy (p=0.0029) were independently associated with risk for positive margins (Table 1).
Conclusion:
This detailed evaluation in a large regional cohort indicates patient-level characteristics are associated with positive surgical resection margins. Our recently published evaluation of the National Cancer Database also identified institutional factors that impact the rates of positive margins. Patient-level, surgeon-level, and institutional-level factors should be considered jointly to fully understand factors impacting margin positivity rates. Figure 1
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-020 - The Effect of Two Interventions on Attainment of Surgical Quality Measures in Resected Non-Small Cell Lung Cancer (NSCLC) (ID 5694)
14:30 - 14:30 | Author(s): P. Levy
- Abstract
Background:
Better pathologic staging improves early-stage NSCLC survival. We sought to measure the impact of complementary surgery (lymph node specimen collection kit) and pathology (a novel gross dissection method) interventions on attainment of guideline-recommended surgical staging quality.
Methods:
We analyzed curative-intent resections from 2004-2016 from 4 contiguous Dartmouth Hospital Referral Regions in 3 US states. Preoperatively-treated patients were excluded. Patients were categorized into groups based on whether a lymph node specimen collection kit was used during surgical resection, and whether a novel, anatomically-sound gross dissection method was used to retrieve intrapulmonary lymph nodes. Chi-squared tests were used to examine differences in demographic and disease characteristics and surgical quality parameters across implementation groups.
Results:
Of 2,094 patients, 1,492 received neither intervention; 152 received only the pathology intervention; 161 received only the surgery intervention; 289 had both (Table 1). Attainment of surgical quality guidelines significantly increased in ascending order of the pathology, kit, and combined interventions (Table 2). Figure 1 Figure 2
Conclusion:
The combined effect of two interventions to improve pathologic lymph node examination has a greater effect on attainment of a range of surgical quality parameters than either intervention alone.
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P1.08-027 - Evolution of Survival in a Regional Population-Based US Lung Cancer Resection Cohort (ID 6122)
14:30 - 14:30 | Author(s): P. Levy
- Abstract
Background:
Quality variances in surgical resection and pathology examination practice translate into survival disparity in patients with early stage lung cancer after curative-intent resection. We evaluated the survival patients from two eras in a US regional cohort.
Methods:
All curative-intent lung cancer resections in 11 US hospitals in 4 contiguous Dartmouth Hospital Referral Regions were analyzed for stage-stratified survival before and after an ongoing regional quality improvement campaign started in 2009. Overall and stage-stratified survival of patients with surgery in the 2004-2009 (pre-era) v 2010-2015 (post-era) were compared using the log-rank test and Cox proportional hazards models.
Results:
Of the total cohort of 3246 patients, 40.6% were in the earlier era, 59.4% in the later era. Demographic characteristics were similar between cohorts (Table 1). Preoperative PET/CT, brain MRI scans, bronchoscopy, and adjuvant therapy were more frequently used in the later era. Patients in the early era had an unadjusted hazard ratio (HR) of 1.22 (p=0.0006). After controlling for stage, tumor size, neoadjuvant therapy, comorbidity score, grade, extent of surgery, patients in the pre-era had a HR of 1.49 (p<0.0001). Figure 1Figure 2
Conclusion:
Survival has improved since introduction of a regional quality improvement campaign in a high lung cancer mortality region of the US.
