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Arthur Vieira



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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
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      P2.05-019 - Overall Survival (OS) of Pathological T1N0 Non-Small Cell Lung Cancer (NSCLC) After Resection. (ID 10294)

      09:30 - 09:30  |  Author(s): Arthur Vieira

      • Abstract

      Background:
      Complete surgical resection is the standard treatment of stage I NSCLC. The aim of the current study was to evaluate overall survival of T1N0 NSCLC after complete resection.

      Method:
      The Institut de Cardiologie et Pneumologie de Quebec Biobank was queried for all patients with pathological T1N0M0 NSCLC who underwent complete (R0) surgical resection between November 1999 and February 2017. Survival was examined using the Kaplan-Meier method with log rank analysis. Significance was set at p≤0.05.

      Result:
      We identified 1071 eligible patients, 624 (58%) were female with mean age of 64±9y, 763 (71%) were adenocarcinoma and 183 (17%) were squamous cell carcinoma. Regarding surgical modality, 285 (27%) patients underwent sublobar resection, 772 (72%) lobectomy or bilobectomy and 14 (1%) pneumonectomy. The 30-day mortality of the cohort was 0.3% (3 patients). During 17 years of follow-up, a total of 253 (24%) patients died; of these events, 160 (63%) were cancer-related. Median OS of the cohort was 12.8y (CI 11.2 – 14.2). When comparing lobar versus sublobar resection, median OS was 12.8y and 8.7y respectively (HR 1.92; CI 1.45-2.55, p=<0.0001) (Figure 1). Figure 1: Overall survival according to type of resection Figure 1



      Conclusion:
      In our institutional database study, median OS after complete resection of T1N0 NSCLC was 12.8y. Patient undergoing lobectomy had a survival advantage over patients who had sublobar resection. Until more definitive data confirms our findings, patients with T1N0M0 disease should be treated with lobectomy.

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    P3.01 - Advanced NSCLC (ID 621)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 2
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      P3.01-080 - Overall Survival (OS) of Pathological N2 Non-Small Cell Lung Cancer (NSCLC) After Surgical Resection (ID 10316)

      09:30 - 09:30  |  Author(s): Arthur Vieira

      • Abstract

      Background:
      Despite complete pre-operative staging, incidental N2 disease is still found during surgical resection of NSCLC. Proceeding with resection versus aborting the operation to treat with definitive chemotherapy and radiotherapy is controversial. The aim of the current study was to evaluate survival of pathological N2 disease after complete resection.

      Method:
      The Institut de Cardiologie et Pneumologie de Quebec Biobank was queried for all patients with pathological N2 NSCLC who underwent complete (R0) surgical resection either by lobectomy, bilobectomy or pneumonectomy between January 2000 and February 2017. Survival was examined using the Kaplan-Meier method with log rank analysis. Significance was set at p≤0.05.

      Result:
      We identified 224 eligible patients; 119 (53%) were male, mean age was 63±9, there were 143 (64%) adenocarcinoma and 60 (27%) squamous cell carcinoma. Regarding surgical modality, 156 (70%) patients underwent lobectomy or bilobectomy and 68 (30%) pneumonectomy. The 30-day mortality of the cohort was 3% (5 pneumonectomy and 2 lobectomy). During 17 years of follow-up, 142 (63%) patients died, including 87 (61%) in the lobectomy/bilobectomy group and 55 (39%) in the pneumonectomy group. Among all deaths, 105 (74%) were cancer-related. Median OS of the entire cohort was 2.6 y (CI 1.9-4.4). In the univariate analysis cox model, median OS was shorter for pneumonectomy than lobectomy/bilobectomy (2,1 years [1,6-2,6) vs 4,4 years [2,2-5,8]), HR 1.54 (CI 1.09 – 2.16, p=0.01; figure 1). However, when only considering cancer-related deaths, the difference was not statistically significant (p=0.95). Figure 1: Overall survival of pathological N2 according to type of resection. Figure 1



      Conclusion:
      In our institutional database study, median OS after surgical resection of N2 NSCLC was 2.6y. Pneumonectomy is indicated as cancer cure treatment however, major efforts should be made to decrease peri-operative morbidity and mortality.

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      P3.01-081 - Overall Survival (OS) of Locally Advanced Non-Small Cell Lung Cancer (NSCLC) After Negative Invasive Mediastinal Staging (ID 10318)

      09:30 - 09:30  |  Presenting Author(s): Arthur Vieira

      • Abstract
      • Slides

      Background:
      According to current guidelines, invasive pre-operative staging should be performed with endoscopic ultrasound in NSCLC in suspected N2 disease. Due to its higher negative predictive value, in case of PET positive, CT enlarged mediastinal lymph nodes or central tumors, mediastinoscopy remains indicated when EBUS staging is negative. The aim of the current study was to evaluate OS of patients with locally advanced NSCLC who underwent surgical resection after negative EBUS and mediastinoscopy.

      Method:
      The Institut de Cardiologie et Pneumologie de Quebec Biobank was queried for all patients with high probability of N2 disease or central tumors with negative EBUS and mediastinoscopy that underwent complete surgical resection (R0) between March 2009 and February 2017. Survival was examined using the Kaplan-Meier method with log rank analysis. Significance was set at p≤0.05.

      Result:
      We identified 88 eligible patients (Table 1); 56 (64%) were male, mean age was 65±9 and 50% of the cases were adenocarcinoma. Regarding surgical modality, 1 (1%) patient underwent sublobar resection, 65 (74%) lobectomy or bilobectomy and 22 (25%) pneumonectomy. Among these, there were 11 (13%) pathological N2 cases. There was no 30-day mortality. During 8 years of follow-up, 30 patients died, including 20 (31%) in the lobectomy/bilobectomy group compared to 9 (41%) in the pneumonectomy group. We then identified 16 (80%) cancer-related deaths in the lobectomy/bilobectomy and 7 (78%) in the pneumonectomy group. Median OS of the entire cohort was 5.7 years, with no difference between groups (HR 1.29, CI 0.58-2.87, p=0.53). Table 1: Demographics of Locally advanced NSCLC Cohort

      Characteristic Lobectomy/Bilobectomy (n=65) N(%) Pneumonectomy (n=22) N(%) Total (87) N (%) p value
      Sex Male Female 44 (68) 21 (32) 11 (50) 11 (50) 55 (63) 32 (37) 0.200
      Histology Squamous Adenocarcinoma Other 21 (32) 34 (53) 10 (15) 10 (45.5) 10 (45.5) 2 (1) 31 (36) 44 (50) 12 (14) 0.549
      Mean age (years) 65.8 ± 8.2 63.4 ± 6.8 65.4 ± 8.1 0.216
      Pathological stage IA IB IIA IIB IIIA IIIB 10 (15) 13 (20) 12 (18) 10 (15) 19 (30) 1 (2) 0 4 (18) 3 (14) 9 (40) 5 (23) 1 (5) 10 (11) 17 (20) 15 (17) 19 (22) 24 (28) 2 (2) 0.075


      Conclusion:
      In our institutional database, patients locally advanced NSCLC had 13% incidence of pathological N2 disease and the OS was 5.7y. Our data supports surgical complete resection either by lobectomy or pneumonectomy in this group of patients with locally advanced disease.

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