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T.J. Szczęsny
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-058 - Cost-Effectiveness of CT Screening in the Early Detection of Lung Cancer (ID 5862)
14:30 - 14:30 | Author(s): T.J. Szczęsny
- Abstract
Background:
Screening using computerized tomography of the chest for an early detection of lung cancer has been performed worldwide since decades, but only two years ago, after proving in a prospective randomized study that it prolongs survival of the study population, it received the recommendation of scientific societies. However, the issue of cost-effectiveness of this screening remains open.
Methods:
A review of several cost-effectiveness analyses of lung cancer screening with low-dose CT available in the literature was performed. We also conducted our own cost-effectiveness analysis on the basis of epidemiological data and data from the National Health Fund concerning the type, number and cost of medical procedures reimbursed for lung cancer patients.
Results:
The results of cost-effectiveness analyses carried out in different countries are equivocal and depend mainly on the inclusion and exclusion criteria, methods of analysis and prices of medical procedures. More recent analyses, performed in different countries, indicate high profitability of this screening. In our study, the cost of early detection of one lung cancer using CT scan is comparable to the cost of a detection of one breast cancer using mammography and is about 3,400 Euro. The incremental cost-effectiveness ratio (ICER) in our analysis is about 1180 Euro / life year gained.
Conclusion:
As the widely accepted limit of cost-effectiveness is three times the gross national product per capita / life year gained, lung cancer screening with low-dose CT in Poland should be considered highly cost-effective. In future screening programs, high cost-effectiveness can be achieved by strict adherence to inclusion and exclusion criteria. To ensure this, screening should be performed either as prospective observatory non-randomized clinical trials or in dedicated screening centers. To ensure low level of false positive and false negative results, radiologists in screening centers should be equipped with software for measuring and monitoring the volume of pulmonary nodules.
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-039 - Systematic Review and Updated Meta-Analysis of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Lung Cancer (ID 4951)
14:30 - 14:30 | Author(s): T.J. Szczęsny
- Abstract
Background:
Uniportal video-assisted thoracoscopic surgery (VATS) is a challenging surgical procedure that poses substantial technical difficulties compared to multiportal VATS but has been associated with favorable outcomes in studies reported to date.
Methods:
On-line databases were screened until June 2016. Meta-analysis aimed to compare clinical outcomes of uniportal and multiportal VATS lobectomy for patients with lung cancer. Endpoints assessed included perioperative mortality, operative time and blood loss; length of hospital stay; duration of postoperative drainage; rates of conversion to open thoracotomy; number of harvested lymph nodes and overall morbidity. Risk Ratios (RR)/Mean Difference (MD) and corresponding 95% Confidence Intervals (95%CIs) served as primary statistics.
Results:
Twelve studies were included (among them 1 randomized trial) that enrolled N=2,476 patients. There was no difference in the 30-day mortality: (N=2,476); RR (95%CIs) 0.32 (0.03-3.01); p=0.32; Event rates: 0.10% (1/1,021) vs 0.07% (1/1,455); no difference were demonstrated for conversion-to-thoracotomy: 0.91 (0.48-1.73); p=0.77; similarly there were no differences in regard to operative times: MD (95%CIs): 3.50 ([-12.35]-19.34) min; p=0.67 and blood loss: -2.15 ([-17.13]-12.83) ml; p=0.78. There was no statistically significant difference between number of harvested lymph nodes: 18.4±6.6 vs 19.4±8.5; MD (95%CIs): -0.34 ([-1.39]-0.70) node; p=0.52. Uniportal VATS was associated with significantly shorter duration of chest tube drainage: -0.61 ([-0.99]-[-0.23]) days; p=0.002 (Figure 1A); and length of hospital stay: -0.58 ([-0.77]-[-0.40]) days; p<0.001 (Figure 1B). Overall morbidity was significantly reduced with uniportal VATS as well: RR (95%CIs) 0.77 (0.63-0.95); p=0.01. Figure 1 Figure 1. Individual and summary point estimates. Uniportal vs multiportal VATS. Length of hospital stay (A) and duration of chest tube drainage (B).
Conclusion:
Uniportal VATS is at least as safe and effective as multiportal VATS for patients with lung cancer. Whether clear postoperative benefits with uniportal VATS further translate into reduction of clinical endpoints and potentially improved survival remains to be confirmed in adequately powered randomized trial.
