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Sara Moore
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P2.05 - Early Stage NSCLC (ID 706)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.05-003 - Stage by Stage Comparison of Radiotherapy versus Surgery in NSCLC: The Influence of Prognostic Factors on Survival Outcome (ID 8261)
09:30 - 09:30 | Presenting Author(s): Sara Moore
- Abstract
Background:
Curative intent therapy of stage I-III NSCLC may include surgical resection or definitive radiotherapy. Primary management with surgery or radiotherapy may be influenced by patient and disease characteristics. We sought to perform a stage by stage comparison of patients receiving surgery or radical radiation therapy as their curative treatment, and explore the impact of known prognostic factors on outcome.
Method:
A retrospective review was completed of all patients with stage I-III NSCLC referred to the BC Cancer Agency from 2005-2012. Cases were filtered to identify those receiving curative intent therapy including surgery, radiotherapy, and combined chemo-radiation. Information was collected on known prognostic and predictive factors. The primary outcome measure was overall survival.
Result:
A total of 3873 patients were referred. Of these, 1744 (45%) received curative therapy (713 surgery, 1031 radiotherapy); 592 (34%) presented with stage I disease, 386 (22%) with stage II, and 766 (44%) with stage III. At the time of analysis, 1199 (69%) patients had died. Median overall survival in stage-matched cohorts was significantly shorter in the radiotherapy group compared to the surgery group (stage I 34.9 mo vs 44.8 mo, p=0.003, stage II 27.6 mo vs 42.7 mo, p=0.014, stage III 26.5 mo vs 38.7 mo, p=0.001). However, in a multivariable analysis incorporating age, sex, weight loss, smoking history, and ECOG status, the survival difference between radiotherapy and surgery disappeared for stage I and II disease and persisted for stage III.Univariate and multivariate analysis of prognostic factors and treatment group on survival
Stage I Stage II Stage III UVA HR p-value MVA HR p-value UVA HR p-value MVA HR p-value UVA HR p-value MVA HR p-value Age at diagnosis 1.03 <0.001 1.03 <0.001 1.03 <0.001 1.03 <0.001 1.02 <0.001 1.02 0.002 Male vs female 1.31 0.01 1.24 0.04 1.30 0.04 1.12 0.39 1.14 0.11 1.00 0.99 Weight loss 5-10% vs <5% >10% vs <5% 2.01 1.40 <0.001 0.11 1.96 1.15 <0.001 0.51 0.96 1.44 0.81 0.06 0.87 1.18 0.46 0.39 1.33 1.56 0.02 0.001 1.35 1.28 0.02 0.08 Smoking status Former vs never Current vs never 1.78 1.65 0.01 0.04 1.58 1.72 0.06 0.03 2.39 2.73 0.02 0.006 1.85 2.62 0.10 0.01 1.64 1.60 0.003 0.004 1.44 1.32 0.03 0.10 ECOG >=2 vs 0-1 1.39 0.002 1.18 0.14 1.45 0.007 1.31 0.05 2.06 <0.001 1.98 <0.001 Radiotherapy vs surgery 1.36 0.003 1.09 0.44 1.37 0.02 1.27 0.07 1.41 0.001 1.36 0.004
Conclusion:
In stage I and II NSCLC, the performance of radical radiotherapy and surgery were comparable after controlling for known prognostic factors. Superior survival was observed with surgery in stage III disease however; this may be related to disease characteristics. Surgery and radiotherapy are both viable options for curative intent treatment and selection of the primary modality may relate to underlying patient and disease characteristics.
