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K.D. Jones
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OA19 - Translational Research in Early Stage NSCLC (ID 402)
- Event: WCLC 2016
- Type: Oral Session
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:G. Heller, G. Goss
- Coordinates: 12/07/2016, 11:00 - 12:30, Schubert 3
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OA19.06 - Adjuvant Chemotherapy Decisions Based on Molecular Risk Status Improves Outcomes in Early Stage, Non-Small Cell Lung Cancer (ID 5321)
11:55 - 12:05 | Author(s): K.D. Jones
- Abstract
- Presentation
Background:
A clinically certified, 14-gene quantitative PCR expression assay has been found to assess mortality risk more accurately than clinicopathologic criteria in early-stage, non-squamous, non-small cell lung cancer (NSCLC). Clinically validated molecular stratification may provide a more informative approach to identify early stage NSCLC patients who are most likely to benefit from chemotherapy than current National Comprehensive Cancer Network (NCCN) high-risk clinicopathologic features.
Methods:
Prospective molecular risk-stratification by the 14-gene quantitative PCR expression assay was performed on 91 consecutive patients with stage I-IIA non-squamous NSCLC after complete surgical resection at a single institution. Information from molecular risk profiling was used in conjunction with pathologic stage and NCCN criteria to make adjuvant chemotherapy recommendations. Fisher’s exact test was used to compare recurrence rates, and Kaplan-Meier analysis and log-rank tests were used to evaluate differences in disease free survival.
Results:
Median age was 69 years, 57% were female and median follow up was 23±2 months. Among all patients, 33 (36%) met NCCN high-risk criteria for adjuvant chemotherapy and 27 (30%) were molecular high risk. Recommendations for adjuvant chemotherapy were discordant in 18 (55%) of NCCN high-risk patients and in 12 (44%) who were molecular high-risk. Twelve (44%) of molecular high-risk patients agreed to receive adjuvant chemotherapy. Whereas recurrence was observed in 33% of molecular high-risk patients who did not receive adjuvant chemotherapy, none of the molecular high-risk patients who underwent chemotherapy recurred (log-rank p=0.001).
Conclusion:
This prospective single-institution study demonstrates the clinical utility of molecular testing of early-stage NSCLC to supplement pathologic stage and NCCN guidelines in making adjuvant chemotherapy recommendations. Molecular risk scores better differentiated prospective recurrence rates than did NCCN risk criteria. This study provides preliminary evidence that molecular testing followed by adjuvant chemotherapy in molecularly high-risk patients may prevent a significant number of recurrences and improve outcomes.
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P2.04 - Poster Session with Presenters Present (ID 466)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-039 - Long-Term Risk of Recurrence in Benign Pleural Solitary Fibrous Tumors: A Single Institution Review (ID 5782)
14:30 - 14:30 | Author(s): K.D. Jones
- Abstract
Background:
Solitary fibrous tumor (SFT) is a rare tumor of submesothelial origin that can occur in the abdomen, extremities, trunk, head, neck and pleura. Pleural SFTs are defined as benign or malignant based on the number of mitoses and the presence of pleomorphism, hemorrhage, or necrosis. There is limited data in the literature regarding the recurrence risk of benign pleural SFT and the need for long-term follow up in these patients.
Methods:
A single institution retrospective chart review was performed on all surgically resected primary pleural SFTs between 1992 and 2015. Preoperative clinical information, pathologic tumor characteristics, and long-term recurrence and survival data were collected.
Results:
There were 29 primary pleural SFTs resected between 1992 and 2015. Patients had a mean age of 60 years and there were 16 men (55%) and 13 women (45%). Fourteen (48%) presented with symptoms, including two patients with paraneoplastic syndromes, and the other 15 tumors (52%) were found incidentally on imaging. There were six giant SFTs defined as size greater than 15 cm, with two of six giant SFTs undergoing preoperative embolization to aid surgical resection. Otherwise, there were no neoadjuvant or adjuvant treatments in any patient. There was no perioperative 30-day mortality (0%). Mean follow up time was 77 months, during which 4 (14%) patients recurred and 21 of 29 patients (72%) were alive at last follow up. Three of the 8 deaths occurred in patients with recurrent disease. Among the 19 benign pleural SFTs, 2 (11%) recurred at 5 and 9 years postoperatively and 2 of the 6 malignant SFTs (33%) recurred at 4 and 15 years postoperatively. Margin status was known in 25 cases, of which 21 (84%) were negative and 4 (16%) were positive. There were no recurrences in patients with known negative margins.
Conclusion:
This study represents one of the largest contemporary single institution reviews of outcomes of pleural SFT. While benign pleural SFTs were less likely to recur than malignant pleural SFTs, benign pleural SFTs with positive or unknown margin status remain at risk for recurrence up to a decade following resection and require ongoing long-term follow up and surveillance imaging.
