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Apichat Tantraworasin
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MA 18 - Global Tobacco Control and Epidemiology II (ID 676)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:H. Kawai, Christian Klaus Manegold
- Coordinates: 10/17/2017, 15:45 - 17:30, Room 511 + 512
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MA 18.07 - Disparity in Prognostic Factors After Pulmonary Resection in Non-Small Cell Lung Cancer Between Asian and White Patients (ID 10080)
16:25 - 16:30 | Presenting Author(s): Apichat Tantraworasin
- Abstract
- Presentation
Background:
Overall survival and in-hospital mortality in resectable non-small cell lung cancer (NSCLC) patients varies with race. Asian patients have a better overall survival compared with White and Black patients, however, the prognostic factors contributing to these differences are still under studied. The aim of this study was to identify race-specific prognostic factors of overall mortality and in-hospital mortality in resectable NSCLC patients.
Method:
Using the Surveillance, Epidemiology, and End Results Registry linked to Medicare claims between 1991-2010, 35,461 NSCLC patients who underwent pulmonary resection were extracted. Factors associated with in-hospital mortality and overall mortality stratified by Asian and White were analyzed by multivariable logistic regression analysis and multivariable cox regression analysis, respectively.
Result:
Factors associated with in-hospital mortality in Asian patients were age ≥ 80 years (adjusted odd ratios (OR~adj~)=5.8, 95% Confidence interval (CI)=1.59-21.23), stage III disease (OR~adj~=3.93, 95%CI=1.55-9.96), lower lobe lesion (OR~adj~=3.52, 95%CI=1.54-8.02), pneumonectomy (OR~adj~=11.12, 95%CI=2.61-47.34), postoperative pulmonary complication (OR~adj~=5.39, 95%CI=2.51-11.56), postoperative infections (OR~adj~=28.19, (95%CI=10.62-74.83), and intraoperative complication (OR~adj~=10.87, 95%CI=2.64-44.79). In White patients factors associated with in-hospital mortality were old age, male gender, higher comorbidity index, advanced stage, non-teaching hospital, lower hospital volume, pneumonectomy, preoperative radiotherapy, postoperative and intraoperative complications. Factors associated with overall mortality in Asian patients were age ≥ 80 years (HR~adj~=1.63, 95%CI=1.23-2.16), higher Elixhauser comorbidity index (HR~adj~=1.02, 95%CI=1.01-1.04), lower median income, stage (HR~adj~(95%CI) =1.89(1.41-2.54) for stage II, 2.19(1.69-2.83) for stage III, and 3.85(2.59-5.73) for stage IV versus stage I), non-teaching hospital, and receiving radiotherapy (HR~adj~=1.76,95%CI=1.35-2.30). In White patients, factors associated with overall mortality included old age, male gender, single status, higher comorbidity index and score, lower median income, higher stage, non-squamous cell carcinoma, higher tumor differentiation, location of tumor, lower hospital volume, pneumonectomy, no mediastinal lymph node dissection, and receiving chemotherapy or radiotherapy.
Conclusion:
Race specific differences in number and type of prognostic factors for in-hospital and overall mortality point at biological differences in the tumor as well as differences in treatment.
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OA 04 - Surgery from Minimal to Radical (ID 661)
- Event: WCLC 2017
- Type: Oral
- Track: Surgery
- Presentations: 1
- Moderators:J. Lee, A. Chang
- Coordinates: 10/16/2017, 15:45 - 17:30, Room 311 + 312
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OA 04.08 - Is Lobe-Specific Lymph Node Dissection in Clinical N0-1 Non-Small Cell Lung Cancer Adequate for Pathological Nodal Staging (ID 9714)
17:00 - 17:10 | Presenting Author(s): Apichat Tantraworasin
- Abstract
- Presentation
Background:
Lobe-specific lymph node dissection (L-SND) was proposed for clinical T1a-2b N0-1 non-small cell lung cancer (NSCLC), however, the benefit of this approach is still uncertain, especially for pathological nodal staging. In this study, we evaluated the percent detection of pN2 disease in L-SND and in systematic lymph node dissection (SLND).
Method:
From 2010 to 2016, 166 patients with cT1a-T2b N0-1 NSCLC underwent a lobectomy with SLND at Chiang Mai University Hospital. The pathologic results of the lymph nodes dissected in each station were extracted form medical records. Patients who underwent a SLND when then reclassified as L-SLN according to the site of the primary tumor; right upper lobe (station 2R-4R), left upper lobe (station 4L-6), and both lower lobes (station 7-9). Percent detection of pN2 disease was compared between L-SLN and SLND.
Result:
The rate of detection of pN2 in the SLND was higher than in the L-SLD, but the difference was not statistically significant (27.0 %versus 23.6%, p=0.474). The overall percent of cases upstaged to pN2 was only 4.4% after SLND; it was 4.4% in right upper lobe, 3.4 % in left lower lobe, 3.2 % in right lower lobe, and 1.9 % in left upper lobe (p=0.904). The pN2 disease detection agreement between L-SND and SLND was high (kappa=0.911 (95% CI; 0.784 - 0.957). Table 1 pathological N2 status in lobe-specific dissection and systematic lymph node dissectionLocation of primary tumor Clinical N0-1 status Pathologic N2 status (lobe-specific dissection) Pathologic N2 status (Systematic dissection) % upstaged to N2 disease Negative Positive Negative Positive Negative Positive RUL (n=67) 57 (85.1) 10 (14.9) 52 (77.6) 15 (22.4) 49 (73.1) 18 (26.9) 4.5 RLL (n=31) 29 (93.65) 2 (6.5) 24 (77.4) 7 (22.6) 23 (74.2) 8 (25.8) 3.2 LUL (n=51) 43(84.3) 8 (15.7) 37 (72.5) 14 (27.5) 36 (70.6) 15 (29.4) 1.9 LLL (n=29) 24 (82.8) 5 (17.2) 23 (79.3) 6 (20.7) 22 (75.9) 7 (24.1) 3.4
Conclusion:
These results suggest that lobe-specific lymph node dissection is as adequate as SLND for pathological N2 staging in clinically early stage NSCLC surgery. However, systematic lymph node dissection achieved a higher detection of pN2 disease. Further studies with a larger sample size are warranted to confirm these results.
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