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S. Barnett
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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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P1.08-038 - VATS Sub-Lobar Anatomical Pulmonary Resections: Indications and Outcomes in Thoracic Oncological Practice (ID 5815)
14:30 - 14:30 | Author(s): S. Barnett
- Abstract
Background:
In patients with limited pulmonary reserve, sub-lobar anatomic pulmonary resection (SLAPR) may have reduced perioperative morbidity and mortality and additionally may better preserve long-term pulmonary function compared to lobectomy. SLAPR may also mitigate the oncological deficiencies of wedge resection. However, the safety and oncological efficacy of video assisted thoracoscopic surgical (VATS) SLAPR has not been well described. We therefore audited our recent experience of VATS SLAPR to evaluate: indications, safety, and oncological outcomes.
Methods:
We retrospectively reviewed a prospectively maintained database to identify all consecutive patients who underwent planned VATS SLAPR with curative intent. Demographics, co-morbidities, indications and treatment outcomes were retrieved, with supplemental chart review where necessary.
Results:
Seventy seven VATS SLAPRs were performed between December 2010 and May 2016. Median age of patients was 67 (44-83) years and 57% (44/77) were male. The majority (47/77; 61%) of SLAPRs were undertaken for resection of NSCLC. Indications for SLAPR in NSCLC patients included: inadequate pulmonary reserve (DLCO <60% or predicted post-operative DLCO <40%) in 21/47 (44%), excessive (≥2 major) comorbidities in 18/47 (38%), advanced age (≥75 years) in 13/47 (27%) or a combination of these factors precluding lobectomy. In patients with metastatic 22(28%) and benign 8(10%) nodules, indications included proximity to vascular structures or inability to palpate lesion precluding simple wedge resections. Superior segmentectomy (22/77; 28%) and lingula sparing left upper lobectomy (17/77; 22%) were the commonest SLAPRs performed. Seventy one (92%) were completed via VATS. Emergency conversion occurred in one case. Morbidity rate was 30% (23/77) and 30 day mortality rate was 2.5% (2/77). Pre-operative DLCO was not associated with post-operative pulmonary complication (P=0.7) or length of hospital stay (P=0.20). In the NSCLC sub group, all patients were clinically stage I; R0 resection was achieved in 100%. Median of 12(4-27) nodes were excised with a nodal upstaging rate of 25% (12/47) and pathological stage was I in 65%. Median disease free survival (DFS) was 40 months and median overall survival (OS) was not reached. Loco regional recurrence rate was zero. Pre-operative DLCO dichotomised using median did not correlate with OS (P=0.8) or DFS (P=0.29).
Conclusion:
A variety of VATS SLAPRs may be performed safely with acceptable morbidity and mortality in high risk patients. Complete microscopic resection and adequate nodal dissection can be achieved. Although larger studies and longer follow is needed, our findings suggest that VATS SLAPR achieves comparable oncological outcomes in high risk patients to formal lobectomy.
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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
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-047 - Association of FDG PET, Complete Pathological Response and Overall Survival in Patients with Pancoast Tumours Treated with Trimodality Therapy (ID 5331)
14:30 - 14:30 | Author(s): S. Barnett
- Abstract
Background:
Induction chermoradiotherapy (CRT) and surgical resection is considered standard care for treatment of node negative Pancoast tumours. However, not all patients benefit from this approach and there are no well-defined preoperative parameters to identify patients for whom addition of surgery may be unnecessary due to local control with CRT alone. We investigated wether baseline FDG positron emission tomography (PET) scan parameters or changes post induction may predict complete pathological response (pCR) to CRT and hence obviate the need for subsequent resection.
Methods:
We conducted a retrospective review of our prospectively maintained single institution database with supplemental chart review to evaluate: PET, histopathological, and clinical outcome parameters in consecutive patients undergoing curative intent trimodality treatment of Pancoast tumours from 2001 to 2015. Metabolic parameters based on the standardized uptake values (SUV) were calculated including SUV~max~ (maximum SUV value), SUV~PTL~ (peak tumour-to-liver ratio)~, ~and TGV (total glycolytic volume, mean SUV x tumour volume). Two pathologists independently reviewed specimens to assess percentage viable tumour in resected tumours.
Results:
Nineteen patients (10 Females), median age 61(42-75) yrs completed trimodality treatment with Cisplatin, Etoposide and 45Gy in the majority of cases. Histopathological was data available for all patients. Of the 19 patients baseline PET was available in 15 and post induction PET in 13. Baseline SUVmax < 9.4 was associated with pCR in 4/4 vs. 4/11 patients (p=0.03). A trend towards improved locoregional control with cPR did not reach significance. No PET measured parameter was associated with locoregional control. Baseline TGV > 441 was associated with reduced disease free survival (DFS) 5.7(0.7-10.5) vs. NR months (p=0.002), and overall survival (OS) 15.9(3.1-28.8) vs. NR months (p=0.04). No change in PET parameter measured post induction was associated with cPR, local recurrence, DFS or OS.
Conclusion:
In our series, low baseline SUV~max~ was associated with complete pathological response. If confirmed in a larger cohort, including multivariate analysis of other prognostic and predictive factors, this may allow patients at high perioperative risk to be better stratified to either definitive CRT or trimodality therapy. A larger series may be able to identify an association between metabolic response on FDG-PET and CPR, DFS or overall survival.
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P2.07 - Poster Session with Presenters Present (ID 468)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Nurses
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.07-008 - Victorian Comprehensive Cancer Centre Lung Cancer Clinical Audit: Collecting the UK National Lung Cancer Audit data from Hospitals in Australia (ID 4784)
14:30 - 14:30 | Author(s): S. Barnett
- Abstract
Background:
Clinical audit may improve best practice within health. The UK National Lung Cancer Audit (NLCA) collects data from UK hospitals about care of patients with thoracic cancers. We aimed to replicate collection of the NLCA data elements from hospitals caring for patients with thoracic cancers within the Victorian Comprehensive Cancer Centre (VCCC) and associated Western and Central Melbourne Integrated Cancer Service (WCMICS).
Methods:
Retrospective audit of patients newly-diagnosed with lung cancer or mesothelioma in 2013 at 6 major VCCC or WCMICS hospitals. The objectives were: to adopt/adapt the NLCA dataset for use in the Australian context; and analyze the findings using descriptive statistics to identify variations in care. Individual data items from the NLCA were tailored to the Australian context in consultation with an expert steering committee. Data was collected from existing datasets including the Victorian Cancer Registry, Victorian Admitted Episodes Dataset and individual hospital databases. Individual medical records were audited to collect missing data.
Results:
845 patients were diagnosed during 2013. Most were aged 65-80 (55%) and 62% were male. Most had non-small cell lung cancer (81%) with 9% small cell and 2% mesothelioma. Data completeness varied greatly between fields. Headline indicators of clinical care in the table below are compared to NLCA data. A significant area of concern identified was lack of access of many patients to a specialist lung cancer nurse.
Conclusion:
Lung cancer care at participating hospitals appeared to be comparable or better to many of the headline indicators of the NLCA. However, performing the audit retrospectively resulted in significant amounts of missing data for some fields. For future audits, prospective data collection should be harmonized across sites and correlated with survival outcomes. Initiatives to improve access to specialist lung cancer nurses are urgently needed.Benchmark VCCC/WCMICS (%) NLCA-2013 (%) Patients with histological diagnosis 810/845 (96%) (75%) Patients with CT before bronchoscopy 384/492 (78%) (91%) NSCLC patients receiving PET scan 544/748 (73%) (35%) Patients with stage documented 518/845 (61%) (93%) Patients discussed at multi-disciplinary meeting 585/845 (69%) (96%) Patients seen by lung cancer nurse specialist 110/845 (13%) (84%) Lung cancer nurse specialist present at diagnosis 0/845 (0%) (65%) Patients receiving active treatment 643/845 (76%) (60%) Patients treated with surgery 242/845 (29%) (15%) Patients treated with radiotherapy 370/669 (55%) (29%) Patients treated with chemotherapy 327/638 (51%) (70%) Patients seen by specialist palliative care 179/845 (21%) (30%)
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P3.03 - Poster Session with Presenters Present (ID 473)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.03-004 - Genome-Wide Copy Number Aberrations in Mesothelioma and Its Correlation with Tumour Microenvironment including PD-L1 Expression (ID 4506)
14:30 - 14:30 | Author(s): S. Barnett
- Abstract
Background:
Recent clinical studies have demonstrated positive correlation between tumour mutational burden and response to immune checkpoint inhibitors (CPI) in several malignancies. Although initial reports of some CPI in Malignant Mesothelioma (MM) have shown promise, the rate of somatic mutations in MM is known to be low and copy number aberrations (CNA) are the prominent genetic alterations. Using a large cohort of MM patients, we investigated CNA, PD-L1 expression and the surrounding immune infiltrates and correlated these parameters to clinicopathological features.
Methods:
Tissue microarrays (TMA) were constructed and stained with PD-L1 (E1L3N,CST, Massachusetts), CD4, CD8 and Foxp3 antibodies. PD-L1 positivity (PD-L1+) was defined as >5% membranous staining regardless of intensity and high positive as >50%. Genomic DNA was obtained from tumour cores of a representative subset (100 patients) and used for genome-wide copy number analysis. Percent genome aberrated (PGA) was computed for each sample as the total number of base pairs within altered regions, divided by the total number of base pairs in each region included in the array. Correlations of PGA, CNA profile and individual aberration (loss/gain) frequency with parameters including PD-L1 expression and survival were explored.
Results:
Amongst 329 patients evaluated, the median age was 67 years and most were male 274(83.2%). Epithelioid histology (N=203; 62.9%) was the commonest. PD-L1 positivity was seen in 41.7% with high positivity in 9.6%. PD-L1+ correlated with non–epitheloid histology (P=<0.0001) and increased infiltration with CD4, CD8 and FOXP3 lymphocytes. High PD-L1 expression correlated with worse prognosis (HR=2.37; 95%CI: 1.57-3.56; P=<0.0001) on univariate analysis but the effect was found to be time dependent. Neither PGA (P=0.57) nor CNA profile (P=0.76) were found to be associated with PD-L1 expression. After correction for multiple testing, no individual CNA count was significantly associated with PD-L1 status. Although epithelioid histology had higher PGA (P=0.04), high PGA was associated with poorer survival (HR=2.01; 95% CI: 1.24-3.26; P=0.004). This was also true when only epithelioid tumours (n=63) were considered.
Conclusion:
Increased genomic alterations in MM did not correlate with PD-L1 expression but was associated with poorer survival. High PD-L1 expression was associated with non-epithelioid MM, poor clinical outcome and increased immunological infiltrates.
