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Jonas Nilsson
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P1.06 - Epidemiology/Primary Prevention/Tobacco Control and Cessation (ID 692)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.06-002 - The Role of Comorbidity in the Management and Prognosis in Nonsmall Cell Lung Cancer: A Population-Based Study (ID 7921)
09:30 - 09:30 | Presenting Author(s): Jonas Nilsson
- Abstract
Background:
Coexisting disease constitutes a challenge for the provision of optimal cancer care. The influence of comorbidity on lung cancer management and prognosis remains incompletely understood. We assessed the influence of comorbidity on treatment intensity and prognosis in a population-based setting in patients with nonsmall cell lung cancer.
Method:
Our study was based on information available in Lung Cancer Data Base Sweden (LcBaSe), a database generated by record linkage between the National Lung Cancer Register (NLCR) and several other population-based registers in Sweden. The NLCR includes data on clinical characteristics on 95% of all patients with lung cancer in Sweden since 2002. Comorbidity was assessed using the Charlson Comorbidity Index. Logistic regression and time to event analysis was used to address the association between comorbidity and treatment and prognosis.
Result:
In adjusted analyses encompassing 19,587 patients with a NSCLC diagnosis and WHO Performance Status 0-2 between 2002 and 2011, those with stage-IA-IIB disease and severe comorbidity were less likely to be offered surgery (OR: 0.45; 95% CI: 0.36-0.57). In late-stage disease (IIIB-IV), severe comorbidity was also associated with lower chemotherapy treatment intensity (OR: 0.76; 95% CI: 0.65-0.89). In patients with early, but not late-stage disease, severe comorbidity in adjusted analyses was associated with an increased all-cause mortality, while lung cancer-specific mortality was largely unaffected by comorbidity burden.
Conclusion:
Comorbidity contributes to the poor prognosis in NSCLC patients. Routinely published lung cancer survival statistics not considering coexisting disease conveys a too pessimistic picture of prognosis. Optimized management of comorbid conditions pre- and post-NSCLC-specific treatment is likely to improve outcomes.
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P1.14 - Radiotherapy (ID 700)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.14-008 - Elevated Platelet Levels Affect Prognosis in Patients with NSCLC Treated with Curatively Intended Chemoradiotherapy (ID 7528)
09:30 - 09:30 | Author(s): Jonas Nilsson
- Abstract
Background:
For inoperable stage III NSCLC, chemoradiotherapy is the standard of care. However, this treatment is associated with significant side effects and only offers a small chance of cure. Having adequate prognostic information at the start of treatment is essential in order to select the most appropriate treatment strategy for each individual patient. This study investigates the prognostic value of pre-treatment platelet (Plt) levels in this treatment setting.
Method:
Data were collected retrospectively from two phase II trials conducted from 2002 to 2007 in Sweden with patients treated with chemoradiotherapy for stage IIIA-IIIB NSCLC. Clinical and laboratory data at enrollment were collected for all patients and studied in relation to overall survival using Kaplan-Meier product-limit estimates and a multivariate Cox regression model. An optimal prognostic cut-off point for Plt was estimated by using a stepwise log-rank testing of survival comparing patients with a Plt count below and above every Plt count in the dataset. The cut-off point was defined as the Plt count that gave the lowest p-value using the log-rank test.
Result:
Patients with thrombocytosis (defined as Plt > 350 x 10[9]/L) had a shorter median overall survival than patients with normal Plt (≤ 350 x 10[9]/L) at baseline (14.5 and 23.7 months, respectively), which was statistically significant (p=0.0025). This significant association was retained in a multivariate model where other laboratory and clinical factors, such as performance status, were included. The optimal prognostic cut-off point for platelet levels in this patient material was estimated at Plt = 610. Figure 1
Conclusion:
In stage III NSCLC treated with curatively intended chemoradiotherapy, elevated platelet levels showed to be an independent prognostic marker for shorter overall survival. Further research is needed to establish the role of platelet levels and appropriate cut-off limits when making treatment decisions in this clinical setting.
