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C.I. Henschke
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HOD 02 - Highlights of the Previous Day: Biology, Pathology, Molecular Testing, Prevention, Tobacco Control, Screening and Early Detection (ID 241)
- Event: WCLC 2015
- Type: Highlights of the Day
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 07:00 - 08:00, Four Seasons Ballroom F3+F4
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HOD02.03 - Screening, Early Detection (ID 3397)
07:00 - 08:00 | Author(s): C.I. Henschke
- Abstract
- Presentation
Abstract not provided
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MINI 19 - Surgical Topics in Localized NSCLC (ID 138)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:D. Jablons, B. Stiles
- Coordinates: 9/08/2015, 16:45 - 18:15, 605+607
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MINI19.14 - Survival After Sub-Lobar Resection for Early Stage Lung Cancer: Methodological Obstacles in Comparing the Efficacy to Lobectomy (ID 1583)
16:45 - 18:15 | Author(s): C.I. Henschke
- Abstract
- Presentation
Background:
Surgery is the treatment of choice for early stage lung cancer (LC). While lobectomy (L) is the historic standard, whether long term outcomes of sub-lobar resection (SL) are comparable is still under debate. The only randomized trial was conducted 20 years ago; 5 subsequent meta-analyses showed inconclusive or conflicting results. We present a comprehensive review of the literature on 5 year-survival after SL compared to L for early stage LC.
Methods:
A priori inclusion criteria were: 1) observational studies, 2) L compared to SL for early stage LC, 3) at least CT staging, 4) 5-year survival reported. A Medline search through January 2015 resulted in 32 studies, representing 24 distinct datasets. The absolute difference in 5-year survival was calculated and plotted for each study.
Results:
There were 4,702 cases treated with L, 2,323 treated with SL. Of 20 studies reporting the reason for SL, 11 indicated that SL was performed because of comorbidities, or impaired cardiopulmonary function. Among all 24 studies, 4 showed no difference in 5-year survival, 13 favored L, and 7 favored SL (Figure 1). Of the two studies using propensity scores, one favored L and the other SL. No meta-estimate could be calculated due to high statistical heterogeneity. Of 21 studies reporting recurrence rate (Figure 2), 11 favored L and 10 favored SL. Figure 1
Conclusion:
Studies comparing 5-year survival rates of SL to L are heterogeneous, and traditional meta-analytic summary estimates of survival and recurrence could not be calculated. SL survival is often similar to L survival, despite the fact that SL is performed in patients with comorbidities or impaired cardiopulmonary function. New approaches to comparing L to SL survival are needed.
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MINI 36 - Imaging and Diagnostic Workup (ID 163)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Screening and Early Detection
- Presentations: 1
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MINI36.11 - Pre-Operative Fine Needle Aspiration (FNA) for Diagnosis of Suspected Early Stage Lung Cancer Reduces Non-Malignant Resection Rate (ID 2124)
18:30 - 20:00 | Author(s): C.I. Henschke
- Abstract
- Presentation
Background:
Rates of resection of non-malignant lung nodules suspected pre-operatively to be lung cancer vary widely and are reported to be as high as 40%. Commonly used modalities in the pre-operative workup of new lung nodules suspicious for lung cancer include positron emission tomography (PET), bronchoscopy, and computed tomography (CT)-guided fine needle aspiration (FNA). We evaluated the non-malignant resection rate (NMRR) and the frequency of benign resections among patients with pre-operative FNA in our lung cancer center.
Methods:
The study population was identified using databases of the Mount Sinai Departments of Thoracic Surgery and Radiology. Eligible patients included those with a CT-guided FNA and/or surgical resection performed during the 12-month period between July 2013 – July 2014 for known or suspected first primary early stage lung cancer presenting with a lung nodule or mass. Cases were included if patients were >18 years of age with no history of cancer treated within 5 years. Patient data were abstracted from the electronic medical records.
Results:
A total of 283 nodules from 264 patients met inclusion criteria. Of these, FNA was performed in 217 (77%) of the 264 patients, with 131 results (60%) categorized as malignant. Similarly, 228 nodules (81%) were PET imaged, and 141 (62%) of these were positive (Standard Uptake Value >2). Sensitivity and specificity of FNA and PET for diagnosis are reported in Table 1. Post-FNA pneumothorax requiring a chest tube occurred in 11/193 FNAs performed at Mount Sinai (6%). Of 208 surgically resected nodules, 27 cases (13.0%) had a non-malignant diagnosis on pathologic examination. The non-malignant resection rate (NMRR) ranged from 0% to 39% by different surgeons and did not correlate with surgical case volume. Among the 142 resections preceded by FNA, 11 (7.7%) were found to have non-malignant pathology. In contrast, among the remaining 66 resections without a pre-operative FNA, 16 (24.2%) were benign (OR 3.81, 95%CI 1.52-9.69; p = 0.001). Figure 1
Conclusion:
In this single center retrospective analysis, the overall NMRR was lower than in previously published reports. Furthermore, the NMRR was significantly lower in thoracic operations preceded by a CT-guided FNA compared with those without a pre-operative FNA. Diagnostic accuracy of FNA in this cohort of patients at moderate to high risk for lung cancer is higher than that of PET, with an acceptably low complication rate. These findings suggest that pre-operative diagnostic confirmation by FNA results in a low rate of non-malignant resection.
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ORAL 35 - Surgical Approaches in Localized Lung Cancer (ID 155)
- Event: WCLC 2015
- Type: Oral Session
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:M. de Perrot, J. Mitchell
- Coordinates: 9/09/2015, 16:45 - 18:15, 601+603
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ORAL35.05 - The Role of Surgical Mediastinal Resection in CT Screen-Detected Lung Cancer Patients (ID 960)
16:45 - 18:15 | Author(s): C.I. Henschke
- Abstract
- Presentation
Background:
Comparison of long-term survival of patients with clinical Stage I non-small-cell lung cancer (NSCLC) with and without mediastinal lymph node resection (MLNR) in the International Early Lung Cancer Action Program, a large prospective cohort in a low-dose CT screening program.
Methods:
All instances of thoracic surgery for first solitary primary non-small-cell lung cancer prompted by low-dose CT screening, performed under an IRB approved common protocol at each of the participating institutions since 1992 to 2014, are included. Follow-up time was calculated from diagnosis to death from lung cancer, last contact, or December 31, 2014, whichever came first. Univariate logistic regression analysis of the demographic, CT, and surgical findings for those with and without MLNR was performed. Kaplan-Meier (K-M) survival rates and Cox regression analysis was performed using all significant univariate variables.
Results:
The 10-year Kaplan-Meier (K-M) NSCLC-specific survival rate for the 225 patients manifesting as a subsolid nodule was 100%, regardless of whether they had MLNR (N = 169) or not (N = 56). For the 373 NSCLC patients manifesting as a solid nodule, for those who had MLNR (N = 285) and those who did not (N = 88), the K-M NSCLC-survival rate was not significantly different (86 % vs. 93%, P = 0.23). The rate was 95% vs. 96% (P = 0.86) for those whose pathologic tumor diameter was <= 10 mm; 83% vs. 94% (P = 0.19) for 11-20 mm, and 79% vs. 86% (P = 0.67) for 21-20 mm. Cox regression analysis comparing MLNR with no MLNR showed that survival rates were not significantly different (P = 0.33), but significantly survival decreased when the tumor diameter was above 20 mm (HR= 5.1, 95% CI: 1.6-15.7).
Conclusion:
Lymph node evaluation is not necessary for resection of subsolid nodules in patients with screen-detected lung cancer.
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P1.06 - Poster Session/ Screening and Early Detection (ID 218)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.06-014 - Impact of Surgery for Stage I Non-Small Cell Lung Cancer on Quality of Life (ID 1586)
09:30 - 17:00 | Author(s): C.I. Henschke
- Abstract
Background:
The literature is mixed regarding the impact of lung cancer surgery on physical and mental health quality of life (QoL)[1-4]. Some studies have found an improvement in QoL post surgery[1] while others have indicated a decrease in various aspects of QoL[2,3]. Further, the impact on QoL is often dependent on numerous factors such as type of surgery. The current study aims to assess the impact of surgery on both physical and mental health QoL in screening-diagnosed patients with early stage lung cancer, an under-studied population.
Methods:
SF-12 QoL indicators were collected from 86 participants (40 women, 46 men) at baseline CT screening and one-year follow up post-surgery for clinical stage IA non-small cell lung cancer. 69 had lobectomy and 17 had sublobar resection. Average time of follow up was 12 months since surgery (SD: 1.5 months; range: 9-15 months post surgery). Univariate and multivariate analyses were performed to examine the difference in physical (PHC) and mental (MHC) health component scores of the SF-12 before and after surgery using the Wilcoxon signed rank and Mann Whitney tests.
Results:SF-12 Quality of Life Scores Pre and Post Surgery
There was no significant change in PHC post-surgery (Wilcoxon signed rank test, S=-216, p=0.32), but MHC significantly improved from baseline to post-surgery (S=527, P=0.01). Mean MHC was significantly higher among males as compared to females at both baseline (Chi-square=3.95, p=.047) and post-surgery (Chi-square=4.23, p=.039) and after controlling for age, ethnicity, and education, while no differences in PHC was observed. Further, there was an improvement in PCS score post-surgery among participants who underwent limited resection while a decrease in PCS score was observed among those who underwent lobectomy. The change in PCS score was significantly different between type of surgery (t=-2.01, p=0.048). After controlling for demographics, the difference was borderline significant (F=3.62, p=0.06).ALL M(SD) MALE M(SD) FEMALE M(SD) LIMITED RESECTION M(SD) LOBECTOMY M(SD) PHC Baseline (Pre-Surgery) 49.4(6.8) 49.8(5.8) 49.0(7.8) 47.8 (7.8) 49.8(6.5) Post-Surgery 48.7(7.1) 48.5(7.7) 49.0(6.4) 50.3(6.3) 48.3(7.2) Difference (Post-Pre) -0.7(7.6) -1.3(7.5) 0.0(7.6) 2.5*(6.0) -1.5(7.7) MHC Baseline (Pre-Surgery) 53.7(8.6) 55.5(7.6) 51.7(9.3) 52.3(13.4) 54.0(7.1) Post-SurgerY 55.8(8.2) 57.3(8.1) 54.1(8.2) 55.7(6.3) 55.8(8.7) Difference (Post-Pre) 2.0*(9.6) 1.7*(8.5) 2.4*(10.9) 2.9(10.7) 1.8(9.4) *p<.05
Conclusion:
Surgery for early stage lung cancer was associated with an increase in mental health QoL one year after surgery, however, physical health QoL was not affected by surgery overall, but it did marginally improve among participants who underwent limited resection as compared to lobectomy. Further, although mental health QoL improved for both males and females, females had lower mental health QoL as compared to males at both time points. Current study findings have implications for lung cancer health professionals regarding how to most effectively present the possible impacts of surgery on the QoL of this subset of patients in which disease has not yet significantly progressed.
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P3.06 - Poster Session/ Screening and Early Detection (ID 220)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.06-019 - Lung Cancer Deaths in the NLST Attributed to Nonsolid Nodules (ID 3022)
09:30 - 17:00 | Author(s): C.I. Henschke
- Abstract
Background:
There has been increasing awareness of the more indolent course of cancers manifesting in nonsolid nodules, especially among those where the nodule is solitary or dominant. There have been reports of virtually 100% cure rates upon resection and most recently, the recommendation from the ACR in their Lung-RADS screening guidelines is for those nonsolid nodules less than 2 centimeters to be followed by annual screening without additional evaluation. In order to further evaluate the aggressiveness of these types of cancers in the screening setting, we determined how frequently they were the cause of death (COD) within the NLST.
Methods:
We searched the NLST database to identify all participants who had a diagnosis of lung cancer after a positive result on CT screening and whose death was attributed to lung cancer by the NLST endpoint verification process. Among them, 28 participants had at least one nonsolid nodule identified on CT in a screening round. Among these, all cases where the nonsolid nodule could not identified in the study year the cancer was first identified (cancyr) or in the location of the confirmed lung cancer were excluded. All images associated with the remaining 8 cases were downloaded from The Cancer Imaging Archive (TCIA) using the NLST Query Tool and reviewed by three radiologists (DY, DX, MH) to assess nodule consistency and location.
Results:
Among the 8 cases reviewed by the radiologists, only 5 cases had at least one nonsolid nodule. The remaining three cases had no CT evidence of a non-solid nodule (Table 1). Among the 5 cases with nonsolid nodules, 2 cases had another large solid nodule (average diameter of 54.5mm and 15 mm) in the same lobe which was the probable lung cancer that was the cause of death. In another case, the nodule was less than 5 mm in diameter and stable for 3 years, and in another the cause of death was small cell carcinoma which is not known to manifest as a nonsolid cancer. One case manifested on baseline scan with multiple nonsolid and part-solid nodules which all grew on successive annual scans. Table 1. Lung cancer deaths with non-solid nodules in NLST database
*ns-nonsolid; ps-part-solidCase Any NS nodules Size of largest NS Multiple/solitary Stage/Cell-type Comments 128534 Y 29 x 19 Solitary NS Solitary solid IIIA/Squamous cell Large solid nodule (57 x 52) 134088 Y 27 x 20 Multiple NS Multiple solid IV/Small-cell 212718 Y 26 x 26 Multiple NS Multiple PS IV/BAC Cancer reported in all lobes 116279 Y 5 x 4 Solitary NS IV/Carcinoma NOS NS nodule appears stable over 3 years 126576 Y Multiple NS Solitary solid IA/Adeno-mixed Growing solid nodule, 15 mm 117025 N Multiple solid IV/Adeno NOS 208792 N Solitary solid IIIA/Squamous cell 218307 N Solitary solid IIIA/Squamous cell
Conclusion:
It seems unlikely that within the NLST, there were cases of lung cancer specific death that were attributable to cancers manifesting as a solitary or dominant nonsolid nodule. This lends further support that lung cancers manifesting as nonsolid nodules have an indolent course.
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PRC 02 - Press Conference 2 (ID 197)
- Event: WCLC 2015
- Type: Press Conference
- Track: Other
- Presentations: 1
- Moderators:J.R. Jett
- Coordinates: 9/07/2015, 09:45 - 10:45, 108+110+112
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PRC02.01 - Daily Theme: Lung Cancer Prevention & Screening - Dr. Claudia Henschke, Professor of Radiology and Head of Lung and Cardiac Screening Program at Mount Sinai Medical Center, New York (ID 3619)
09:45 - 10:45 | Author(s): C.I. Henschke
- Abstract
- Presentation
Abstract not provided
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