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M.F. Berry
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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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P1.08-033 - Effect of EGFR Mutations on Survival in Patients following Surgical Resection of Lung Adenocarcinoma (ID 4938)
14:30 - 14:30 | Author(s): M.F. Berry
- Abstract
Background:
While numerous trials have evaluated the effects of EGFR mutations on survival in patients undergoing treatment with tyrosine kinase inhibitors (TKIs), research on the influence of EGFR mutations in patients undergoing surgical resection as their primary intervention is limited and conflicting. We hypothesized that patients with resectable EGFR-mutant tumors have a better postoperative prognosis than those with wild-type (WT) tumors, as EGFR-mutant tumors often include an in-situ component that portends an improved prognosis. We further hypothesized that the two most common EGFR mutations may impact post-resection prognosis differentially.
Methods:
We carried out a single-center, retrospective study evaluating the influence of EGFR mutation status on progression-free (PFS) and overall survival (OS) after resection, adjusting for tumor stage and ethnicity. Kaplan-Meier plots and Cox proportional hazard models were used to generate crude and adjusted hazard ratios.
Results:
249 patients underwent lung adenocarcinoma resection and had mutational analysis and ≥1 year of follow-up at our institution between 2008-2015. These resections included 200 lobectomies, 12 segmentectomies, and 32 wedge resections. Ninety-three (37.3%) patients had EGFR-mutant tumors. Relative to WT tumors, EGFR-mutant tumors were more likely to exhibit well-differentiated (44.0% vs 29.0%, p=0.009) or lepidic (61.3% vs 36.5%, p <0.0001) histology, and trended towards presenting as pathologic stage IA/IB (p=0.082). EGFR mutation improved crude OS (HR 0.39, 95% CI 0.159-0.931, p=0.034), but this difference became nonsignificant when adjusted for tumor stage and ethnicity (OS HR 0.549, 95% CI 0.200-1.508, p=0.245). PFS did not differ between mutant and WT cohorts (adjusted HR 0.94, 95% CI 0.550-1.603, p=0.817). In comparing L858R and Exon 19, neither PFS (adjusted HR 0.91, 95% CI 0.350-2.379, p=0.851) nor OS (HR 0.88, HR 0.160-4.790, p=0.879) significantly differed. Lastly, sublobar resection did not interact with EGFR mutation presence to affect PFS (interaction p-value=0.735) or OS (interaction p-value=0.771).
Conclusion:
Patients with EGFR-mutant adenocarcinomas exhibit improved crude post-resection OS vs. those with WT tumors, but this difference disappears after adjustment for tumor stage and ethnicity. These findings appear attributable to EGFR-mutant tumors presenting at earlier stages. We hypothesize that this occurs because lepidic tumors spend a longer phase in stage I before developing a more aggressive phenotype. Our finding that EGFR mutation status does not interact with resection extent (sublobar vs. ≥ lobar) suggests that mutation status should not affect surgical planning prior to resection.
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-013 - The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma (ID 6050)
14:30 - 14:30 | Author(s): M.F. Berry
- Abstract
Background:
This study examined the association of extent of lung resection, pathologic nodal evaluation, and survival for patients with clinical stage I (cT1-2N0M0) adenocarcinoma with lepidic histology in the National Cancer Database (NCDB).
Methods:
The association between extent of surgical resection and long-term survival for patients in the NCDB between the years of 2003-2006 with clinical stage I lepidic adenocarcinoma who underwent lobectomy or sublobar resection was evaluated using Kaplan-Meier and Cox proportional hazards regression analyses.
Results:
Of the 1,991 patients with cT1-2N0M0 lepidic adenocarcinoma who met study criteria, 1,544 patients underwent lobectomy and 447 underwent sublobar resections. Patients treated with sublobar resection were older, more likely to be female, had higher Charlson/Deyo comorbidity scores, but had smaller tumors and lower T-status. Of patients treated with lobectomy, 6% (n=92) were upstaged due to positive nodal disease, with a median of 6 lymph nodes sampled (IQR: 3,10). In an analysis of the entire cohort, lobectomy was associated with a significant survival advantage over sublobar resection in univariate analysis (median survival 9.2 vs. 7.5 years, p=0.022; 5-year survival 70.5% vs. 67.8%) and following multivariable adjustment (hazard ratio [HR]: 0.81 [95% [CI]: 0.68-0.95], p=0.011), (Figure 1). However, lobectomy was no longer independently associated with improved survival when compared to sublobar resection (HR: 0.99 [95% CI: 0.77-1.27], p= 0.905) in a multivariable analysis of a subset of patients that compared only those patients who underwent sublobar resection that included lymph node sampling to patients treated with lobectomy. Figure 1
Conclusion:
Surgeons treating patients with stage I lung adenocarcinoma with lepidic features should cautiously utilize sublobar resection rather than lobectomy and must always perform adequate pathologic lymph node evaluation.
