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T. Rong
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OA 03 - Mediastinal and Esophageal Tumor: Insight and New Treatment (ID 654)
- Event: WCLC 2017
- Type: Oral
- Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:M. Chida, Jhingook Kim
- Coordinates: 10/16/2017, 11:00 - 12:30, Room 311 + 312
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OA 03.07 - Developing Prognostic Nomogram and Evaluating Its Role in Personalized Adjuvant Chemotherapy for Patients with ESCC (ID 8649)
12:05 - 12:15 | Author(s): T. Rong
- Abstract
- Presentation
Background:
Nomogram has demonstrated its capability in individualized survival estimates. Some nomogram studies on esophageal squamous cell carcinoma (ESCC) have been reported, but accuracy of those nomograms is not high enough. Also, the role of ESCC nomogram in adjuvant chemotherapy remains unclear. Therefore, clinicopathological prognostic nomogram was developed and validated for patients with ESCC in this study. Its role in personalized adjuvant chemotherapy was investigated as well.
Method:
Data were retrieved about 1042 ESCC patients undergoing right transthoracic radical esophageactomy at Sun Yat-sen University Cancer Centre from January 1997 to December 2013. Of 1042 patients, 886 without adjuvant chemotherapy were divided into training set (Group A, n=590) and validation set (Group B, n=296) in a 2:1 ratio. Group C (the remaining 156 patients with adjuvant chemotherapy plus Group B, n=452) was used to evaluate the role of nomogram in personalized adjuvant chemotherapy. Cut-off points of continuous variables were established by X-tile. Survival and univariate analyses were calculated by Kaplan–Meier method. R software and "rms" package were used to perform Cox proportional hazard (CPH) regression model, plot nomogram, compute C-index, compare models, validate model, and plot calibration curve. The "survivalROC" package was used to plot time-dependent receiver operating curve (ROC).
Result:
The 1-, 3- and 5-year overall survival (OS) for the entire cohort was 88.3%, 64.5% and 54.8%, respectively. Univariate analyses were performed for 13 potential clinicopathological factors. Significant variables were analyzed for CPH regression model using R software and “rms” package. A prognostic nomogram including 8 factors (grade, location, T, N, resected negative nodes, length, gender, drinking history) was developed. C-index of the model was 0.739 (95% CI 0.719-0.759), higher than that of the 7[th] TNM staging system (0.696, 95% CI 0.676-0.716), p < 0.001. The calibration curve and time-dependent ROC showed this nomogram was superior to the 7[th] TNM staging system. The cut-off of prognostic score was 160, by which we grouped patients into low and high prognostic risk subgroup. In Group C, 209 patients belonged to high prognostic risk subgroup. Among them, patients receiving adjuvant chemotherapy had longer OS (p = 0.035). The remaining 243 patients belonged to low prognostic risk subgroup. Adjuvant chemotherapy didn’t improve OS (p = 0.799) in this subgroup.
Conclusion:
An accuracy clinicopathological prognostic nomogram was developed and validated for ESCC patients undergoing right transthoracic radical esophagectomy. The nomogram provided individual prediction of survival. Risk group stratification based on nomogram prognostic score successfully guided personalized adjuvant chemotherapy for ESCC patients.
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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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P2.05-018 - Video-Assisted Thoracoscopic Surgery vs Thoracotomy for Early-Stage Non-Small Cell Lung Cancer: Short-Term Outcomes of a Randomized Trial (ID 9974)
09:30 - 09:30 | Author(s): T. Rong
- Abstract
Background:
Video-assisted thoracoscopic surgery (VATS) has been rapidly gaining popularity worldwide in the treatment of early stage non–small cell lung cancer (NSCLC) because it is potentially less invasive. However, there has not been a large randomized controlled trial (RCT) to prove its superiority over thoracotomy. Therefore, a large multicenter RCT in China was designed and initialed in order to verify the role of VATS.
Method:
A non-inferiority phase 3 randomized controlled trial was undertaken at five tertiary centers in China. Patients aged 18-75 years who were diagnosed of clinically early-stage NSCLCs were randomized in a 1:1 ratio into VATS and thoracotomy groups. Radical lobectomy plus mediastinal lymph node dissection was the standard surgery as per protocol. The short-term outcomes including acute phase inflammatory reaction, performance status, postoperative pain, respiratory function and quality of life would be analyzed and reported in this article. Patients continue to be followed up for the primary endpoints (5-year overall and disease-free survival). This study is registered with the ClinicalTrials.gov, number NCT01102517.
Result:
Between January 2008 and March 2014, 508 patients were recruited and 481 were eligible for randomization. 236 patients were randomly assigned to the VATS group, while 245 to the thoracotomy group. Finally, 425 were eligible for analyses (215 and 210, respectively). For acute phase inflammatory reaction assessment, cytokines including IL-2、IL-4、IL-6、IL-10、TNF-α and IFN-γ were tested in different time points within 48 hours postoperatively. No significant difference was found between the 2 groups except IL-6 (P=0.0411). Patients who received VATS procedures had better daily Karnofsky performance status in the first week (P=0.0029). Visual analogue scale (VAS) was applied for pain assessment at the time points of postoperative day 1 to 7 and every 3 months within the first year. Our study showed VATS was superior to open procedures in pain control within the first week after surgery (P=0.0274). However, this benefit diminished within the year. Spirometry was tested at the time points of day 7, 1 and 3 months postoperatively. Both FEV1 and FVC were better preserved in VATS group throughout the time (P=0.0005). Finally, lung cancer symptom scale (LCSS) was used to evaluate the quality of life, and there was no significant difference demonstrated between the 2 groups within the first year after surgery.
Conclusion:
The short-term outcome of our trial has demonstrated that VATS may be superior to thoracotomy in the surgical treatment for NSCLC in terms of short-term performance status, pain control and respiratory function preservation.
