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Y. Liu



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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
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      P1.01-035 - Trends, Patterns of Treatment and Outcomes in Non-Small Cell Lung Cancer (NSCLC) as a Second Primary: A National Cancer Data Base (NCDB) Analysis (ID 6185)

      14:30 - 14:30  |  Author(s): Y. Liu

      • Abstract

      Background:
      The prevalence of NSCLC as a second primary tumor has been increasing over the past decades, though very little data are available in the literature. We analyzed the NCDB, an oncology outcomes database administered by the American College of Surgeons and the American Cancer Society, to study the outcomes and patterns of treatment of patients (pts) diagnosed with NSCLC as a second or subsequent primary (SP).

      Methods:
      The NCDB was queried from 2004 to 2012 for NSCLC pts. Pts diagnosed with NSCLC as SP were compared with pts with de novo (DN) NSCLC as defined by sequence number in the database. Univariate (UV) and multivariable analyses (MV) with overall survival (OS) were conducted by Cox proportional hazards model. Kaplan-Meier plots were produced to compare the survival curves by subgroups along with log-rank p-values.

      Results:
      A total of 207,518 pts in SP and 697,709 pts in DN groups were included in the analysis, which accounted for 22% and 74% of all NSCLC pts respectively. Pt characteristics (SP/DN %): median age 72/68, male 53/53, white 89/84, stage IV 28/41, treated at academic centers 33/32, government insured 72/57, mean tumor size (cm) 3.5/4.4. An increasing trend in incidence of SP was observed (19.5% in 2004 to 24% in 2012) vs. a decreasing trend in DN (75.6% in 2004 to 73% in 2012). About 12% in SP and 15% in DN received chemotherapy as part of their treatment. Surgery was performed in 39% of SP group vs. 28% in DN. Radiation was given to 43% of the pts in DN vs. 36% in SP. On UV and MV analysis, SP was associated with better survival than DN (HRs 0.84 and 0.93 respectively; p<0.001). The SP group had higher 5-year OS (23% vs. 19.6%, p<0.001) and a higher median survival (17 vs. 11.5 months) compared to DN. On stratifying by stage, DN had inferior survival in stage IV pts (HR 1.12, p<0.001) compared to SP but better survival in stage I and II pts (HRs 0.86 and 0.93, p<0.001). No difference in OS was seen in stage III pts (HR 1.01, p= 0.4).

      Conclusion:
      The incidence of second primary has increased over the past decade. Second primary NSCLC is diagnosed at an earlier stage, smaller tumor size, and is associated with a better survival, compared to de novo NSCLC.

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    P2.02 - Poster Session with Presenters Present (ID 462)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Locally Advanced NSCLC
    • Presentations: 1
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      P2.02-015 - Guideline Concordant Care is Associated with Better Survival for Patients with Stage III Non-Small Cell Lung Cancer (ID 5103)

      14:30 - 14:30  |  Author(s): Y. Liu

      • Abstract

      Background:
      Current evidence-based guideline-concordant care (GCC) is administration of platinum-based chemotherapy during thoracic radiotherapy (TRT) for locally advanced non-small cell lung cancer (NSCLC) patients with good performance status. This study evaluates factors associated with lack of GCC.

      Methods:
      Patients (pts) with unresected stage IIIA/IIIB NSCLC diagnosed from 2005 – 2013 and Charlson-Deyo Score 0 were identified from the National Cancer Data Base (NCDB). Primary outcomes measured were receipt of GCC, defined by administration of chemotherapy with TRT commencing within 2 weeks of each other and minimum TRT dose of 60 Gy, and overall survival (OS). Multivariable logistic regression (MLR) modeling was performed to identify variables associated with non-GCC. Cox proportional hazard modeling was utilized to examine OS.

      Results:
      Patient characteristics (n=37,809) included: mean age 67.8 years; 55% male; 13% African American; 3.4% Hispanic, 3.6% ‘other’ race/ethnicity; 66% government-insured; mean tumor size 5.0 cm; 38% adenocarcinoma; 32% squamous cell carcinoma (SCC); 30% large cell/other histology. In total, 28% of pts received GCC. On MLR analysis, Hispanic pts were more likely to receive non-GCC (OR=1.34, p <0.001) compared to non-Hispanic pts. Uninsured pts were more likely to receive non-GCC (OR=1.57, p<0.001) compared to privately-insured pts. Patients treated in the western, southern, or northeastern U.S. were more likely to receive non-GCC (OR= 1.43, 1.45, 1.21, all p values <0.001) compared to pts treated in the Midwest. Adenocarcinoma and large-cell/other histological types were more likely to receive non-GCC (OR= 1.71, 1.39, both p<0.001) compared to SCC. For every one-year increase in age or 50-mile increase in distance to treatment facility, patients had a 4% or 3% increased odds of not receiving GCC (OR=1.04, 1.03; p<0.001, p = 0.003, respectively). On hazard modeling, those receiving non-GCC had higher death rates compared to those receiving GCC (HR=1.42, p<0.001). Survival rates were lower for Hispanics receiving non-GCC versus GCC (HR=1.24, p=0.034). Other groups with lower OS for non-GCC versus GCC included: the uninsured (HR=1.61, p<0.001), treatment in the western, southern, or northeastern US (HRs= 1.56, 1.40, 1.33, respectively, p<0.001), adenocarcinomas and large cell/other histologies (both HR=1.40, p<0.001).

      Conclusion:
      Socioeconomic factors, including Hispanic ethnicity, lack of insurance, geographic location, and distance from treatment facility are associated with receipt of non-GCC. Patient and disease specific factors including increasing age and adenocarcinoma histology are also associated with non-GCC. Future interventions could target these groups to improve provision of GCC.