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P. Yang
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P1.05 - Early Stage NSCLC (ID 691)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.05-016 - The Prognosticator in Synchronous Multiple Primary Lung Cancer: A Comprehensive Analysis of 438 Cases (ID 9473)
09:30 - 09:30 | Author(s): P. Yang
- Abstract
Background:
Synchronous multiple primary lung cancers (sMPLC) demonstrate good outcome if metastatic disease was absent. However, the prognostic factors vary across published reports.
Method:
Patients who met Martini & Melamed criteria of sMPLC were included for this study. Patients with small cell lung cancer, carcinoid tumor, neuroendocrine, incomplete resection or insufficient follow-up were excluded. Overall survival (OS) was estimated using the Kaplan-Meier method, cause-specific mortality analysis was performed with competing risks analysis; factors associated with survival outcome were evaluated using log-rank test and Cox proportional hazards models. Propensity score was taken to match the variables between sMPLC and sPLC with a ratio of 1:4.
Result:
A total of 438 patients met inclusion criteria for the study. The mean follow-up time was 6.3 years (1-22.9), with a 5-year OS rate of 59.48%. Squamous cell carcinoma (SQC) was a sole histology in 50 patients (Pure SQC group); SQC with other cell type in 59 patients (SQC-other group); no SQC in 329 patients (Non-SQC group). The 5-year OS rate of pure SQC group, SQC-other groups and Non-SQC group were 44.7%, 33.0% and 66.8% (p<0. 001) in univariate analyses. In multivariable analyses the SQC present as an independent poor predictor, the hazard ratio (HR) for pure SQC group was 1.39 (95% CI, 0.97-2.0, P=0.004) and SQC-other group was 1.82, (95% CI, 1.27-2.61, P=0.004) compared to Non-SQC group. Pure SQC group and SQC-other group were both with poorer survival than Non-SQC group in cause-specific mortality analysis. The sublobe resection (n=233) and pneumonectomy (n=14) shows worse outcome than pure lobectomy (n=174) with 5-year OS rate were 53.8%, 45.9% and 70.5%. The HR for sublobe resection and pneumonectomy in multivariate analyses were 1.41 (95% CI, 1.07-1.89, P=0.002) and 1.91 (95% CI, 1.0-3.7). The outcome of surgical T1-4N0M0 sMPLC with solo cell type (n=339) was worse than well-matched sPLC (n=1356), with a 5-year OS rate were 65% and 68.2% (P=0.05); the 5-year OS rate of sMPLC with different cell type and well-matched sPLC (cell type match to more aggressive one) were similar (41.7 vs. 52.7, P=0.36). The other significant prognostic factors include sex, age, highest tumor stage, highest lymph node stage and smoke status.
Conclusion:
The presence of SQC in sMPLC represents the poor outcome; The sublobe resection and pneumonectomy decease the survival of sMPLC patients; For those surgical T1-4N0M0 patients, the outcome was similar with well-matched sPLC; Studies with bigger size were needed to further confirm the findings.
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P3.03 - Chemotherapy/Targeted Therapy (ID 719)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.03-029 - ROS1 Alterations in Lung Adenocarcinoma: The Prognostic Role of Rearrangement and Copy Number Variation (ID 10400)
09:30 - 09:30 | Author(s): P. Yang
- Abstract
Background:
ROS1 rearrangements define a distinct molecular subset of lung adenocarcinoma and patients (pts) experience significant improvements with oncogene-directed therapies. Break-apart/Split Fluorescence in situ hybridization (FISH) is a commonly used detection method for rearranged genes as well as the copy number variation (CNV). Based upon FISH, we aimed to thoroughly evaluate the prognostic role of ROS1 alterations in lung adenocarcinoma.
Method:
Between 1997 and 2016, 634 pts with complete FISH test data were enrolled and followed for outcome research. According to ratios of separated signals, ROS1 rearrangement status were dichotomized into positive and negative. Due to combinative patterns of the signals, positive ones were divided into typical (separation), atypical (single 3' signal) and rare patterns (single 5' signal), and CNV were divided into normal, amplification and deletion.
Result:
ROS1 rearrangement was present in 24 (3.8%) pts, including 17 (2.7%) typical or atypical patterns and 7 (1.1%) rare patterns. ROS1 rearranged pts confer sensitivity to treatment with ALK/ROS1/MET inhibitor crizotinib as the overall response rate (ORR: CR+PR) is 37.5% and the overall disease control rate (DCR: CR+PR+SD) is 75.0%; for 1st line therapy, these rates are 50.0% and 83.3%, respectively. However, the ORR and DCR were dramatically decreased in 2nd or 3rd line therapy as 25.0% and 25.0%. Overall survival rates differ among three kinds of rearranged patterns; rare pattern pts tend to have the worst prognosis. Multivariate Cox regression analysis indicated that ROS1 rearrangement (hazard ratio [HR], 0.49) was significantly associated with improved overall survival (OS) while disease free survival (DFS) was equivocal (HR=0.66; p=0.22), and CNV was not an independent prognostic factor for both OS and DFS. ROS1-negative pts had worse fatigue and lung cancer symptoms than positive ones, while CNV did not predict recent QOL. Younger age (<60 years), female gender, non-smoker and advanced stage (IIIb-IV) were significant indicators for ROS1 rearrangement.
Conclusion:
ROS1 rearrangement confers favor OS and QOL in lung adenocarcinoma pts and crizotinib induced preferable clinical remission, while CNV showed no exact implications, which might only act as an minor aspect of genetic heterogeneity in tumor cells. Therefore, our results highlight the importance of screening for ROS1 rearrangement in pts with lung adenocarcinoma, which should help to prolong pts’ survival time and maintain or improve QOL.
