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Y. Lee
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P1.05 - Poster Session with Presenters Present (ID 457)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-044 - The Impact of IASLC 8th Edition Updates for T-Classification for Lung Cancer in a US Population-Based Surgical Resection Cohort (ID 6241)
14:30 - 14:30 | Author(s): Y. Lee
- Abstract
Background:
Accurate staging of non-small cell lung cancer (NSCLC) is vital for prognostication and treatment selection. We evaluated the impact of the 8[th] Edition TNM (8E) T-classification in a US regional NSCLC resection database.
Methods:
Curative-intent NSCLC resections from 11 hospitals in 4 contiguous Dartmouth Hospital Referral Regions within 3 US states from 2009-2016 were re-staged based on 8E T-categorization. Survival analyses were conducted using the Kaplan-Meier method and proportional hazards models with adjusted hazard ratios (aHR) controlling for age, histology, grade, pN-category, and comorbidities. M1 patients and those who received neoadjuvant therapy were excluded.
Results:
The 2245 patients had a median age of 65, were 48% female, 78% white, 21% black. The 961 pT1 (8E) distribution was 10% pT1a, 52% pT1b, and 39% pT1c. The 793 pT2 (8E) patients were 82% pT2a and 18% pT2b. Of the 318 patients with pT3 (8E), 134 (42%) were pT2b based on the 7[th] Edition TNM (7E); of the 152 with pT4 (8E), 107 (70%) were pT3 based on 7E. There was no survival difference between pT1a and pT1b (p=0.83); pT1c had worse survival than pT1b (p<0.01; Figure 1a). Of the 145 patients previously classified as pT2b by 7E, 134 (92%) were upstaged to pT3. They had similar survival to those classified as pT3 in 7E (p=0.75). Of the 296 patients previously classified as pT3, 107 (36%) were upstaged to pT4. The upstaged patients had worse survival than 7E pT3 patients who were not upstaged, although not statistically significant (aHR:1.32, Figure 1b). Adjusted models confirm an increasing trend in the hazard of death with increasing stage, with the exception of pT1b. (aHR: pT1a=1.00, pT1b=0.89, pT1c=1.15, pT2a=1.38, pT2b=1.54, pT3=1.86, pT4=2.44). Figure 1
Conclusion:
This analysis independently corroborates the 8E re-classification for late stage patients in the US. However, we found no survival differentiation between tumors less than 2cm.
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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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P1.08-021 - Predictors of Post-Operative Mortality in Non-Small Cell Lung Cancer (NSCLC) in a High Mortality Region of the US (ID 4447)
14:30 - 14:30 | Author(s): Y. Lee
- Abstract
Background:
Surgical resection is recommended for most patients with early-stage NSCLC. High postoperative mortality risk diminishes the benefit of curative-intent surgery. We examined factors associated with mortality within 120 days of curative-intent resection in a population-based cohort.
Methods:
We examined all NSCLC patients with curative-intent resections from 2009-2016 in all 11 hospitals in 4 US Dartmouth Referral Regions. We evaluated patient demographics, disease characteristics, pre-operative evaluation, treatment, and perioperative complications to identify risk factors for 30-, 60-, 90-, and 120-day mortality using logistic regression models.
Results:
The 2,258 patients’ median age was 67, 48% were female; 78% were White, 21% Black. The 30-, 60-, 90-, and 120-day post-operative mortality rates were 4%, 6%, 8%, and 9%. After adjusting for all other factors, American Society of Anesthesiologists score (ASA) (p=0.0405), prior lung cancer (p=0.0406), and Charlson comorbidity score (p=0.0163) were associated with 30-day mortality. Adjusted models for 120-day mortality indicate associations with age (p=0.0001), tumor size (p=0.0012), intra-operative blood loss (p=0.0150), hospital (p=0.0065), ASA (p=0.0035), prior lung cancer (p=0.0466), and Charlson score (p=0.0064) (Table 1). Patients >75 years old had 1.5 times the odds of 120-day mortality compared with those <49. A Charlson score >=3 (vs. 0) conferred 2.7 times the odds of 120-day mortality. On average, each 1 cm increase in tumor size increased the odds of 120-day mortality by 12%. Patients with all three risk factors (age >75, Charlson score >=3, tumor >4cm) had 26.5% 120-day mortality. Although 17.5% of pneumonectomy patients died within 120 days, extent or duration of surgery were not significant after adjusting for other factors.N (total=2258) 30-Day Mortality 120-Day Mortality % % Age < 49 101 3 7.9 50-64 730 2.6 4.3 65-74 937 4.7 9.9 75+ 490 6.1 13.1 p=0.1954 p=0.0001 Tumor Size(mean) 2258 3.6 3.9 p=0.1834 p=0.0012 Surgery Type Lobectomy/Wedge 1696 3.5 7.8 Pneumonectomy 143 9.1 17.5 Bilobectomy 126 6.4 11.9 Segmentectomy/Wedge 293 5.5 7.9 p=0.4359 p=0.6029 Previous Lung Cancer No 2166 4 8.3 Yes 92 10.9 17.4 p=0.0406 p=0.0466 Charlson Comorbidity 0 455 1.8 4.2 1-2 1132 3.8 8.2 ≥3 671 6.7 12.5 p=0.0163 p=0.0064 Blood loss(surgical) 0-500cc 2048 4 7.8 501-1000cc 136 6.6 16.9 >1000cc 74 8.1 18.9 p=0.4842 p=0.015
Conclusion:
Age, ASA, Charlson score, and tumor size are important risk factors for post-operative mortality. Inter-hospital disparity suggests an opportunity for institution-level corrective interventions. Patients with the combination of age >75, Charlson score >=3, and advanced T-category had a high rate of post-operative mortality.
