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H.D. Harper



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    P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      P1.03-013 - Clinical Characteristics and Survival in Stage IIIA NSCLC Patients Treated with Neoadjuvant Chemotherapy and Surgery (ID 1020)

      09:30 - 17:00  |  Author(s): H.D. Harper

      • Abstract

      Background:
      The role of surgery in the management of stage IIIA non-small cell lung cancer (NSCLC) is controversial, with several studies reporting mixed results regarding the benefit of surgery in this group of patients. This study aimed to analyze the clinical characteristics and prognostic factors in stage IIIA patients treated with neoadjuvant chemotherapy followed by surgery.

      Methods:
      We reviewed the medical records of all patients diagnosed with stage IIIA NSCLC at our institution from 2000 to 2012. Tissue diagnosis and PET-Scan at our institution were required. Median follow up was 36 months. Cox regression model was used for multivariate analysis.

      Results:
      A total of 275 stage IIIA patients were identified, and 84 of those patients were treated with induction chemotherapy followed by surgery. Median age at diagnosis was 65 years (range: 42-82). There were more males than females (68% vs. 32%). 64% of the tumors were located in the upper, 24% lower and 12% middle lobe. Adenocarcinoma was the most prevalent histologic subtype (69%) followed by squamous cell (24%). 57% were poorly differentiated tumors. All patients received cisplatin based chemotherapy; response to induction therapy was: CR 0%, PR 55%, and SD 44%. Median time from induction chemotherapy to surgery was 80 days (range: 15-126). About surgery: 69% were lobectomies, 26% pneumonectomies and 5% wedge resections. Post-operatively, microscopic residual tumor was found in 8% of the patients. Pneumonectomies had a higher post-operatively mortality when compared with lobectomies (5% vs 2%). 50% of the patients received post-surgical radiation. Median overall survival was 19.5 months (95%CI: 14.5-26.7) and when comparing these patients with stage IIIA patients that received chemoradiation alone, a survival benefit was observed (19.5 months vs. 15.8 months). Recurrence was observed in 26% of the patients (64% had local and 36% distal recurrence). Patients that did not receive radiation had a higher risk of recurrence. Male gender (OR: 0.33, p<0.002), age>65 (OR: 2.61, p<0.03) tumor size >4cm (OR: 3.10, p<0.01) and partial response with induction therapy (OR. 0.69, p<0.005) were significant predictors of survival in this group of patients.

      Conclusion:
      In our cohort, we observed that patients who underwent induction chemotherapy followed by surgery had a higher overall median survival than patients treated with chemoradiation alone. Gender, age, tumor size and response to induction therapy were independent and significant predictors of survival in these patients. Adding radiation therapy to the regimen was associated with a lower recurrence rate. Further research is needed to identify the optimal management of stage IIIA NSCLC as well as the effect of other clinical characteristics on survival.

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    P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P2.01-038 - Prognostic Factors for Brain Metastasis in Non-Small Cell Lung Cancer (ID 430)

      09:30 - 17:00  |  Author(s): H.D. Harper

      • Abstract

      Background:
      Non-Small Cell Lung Cancer (NSCLC) patients tend to develop brain metastasis (BM) early in the course of the disease, usually within 2 years of diagnosis. BM are an important cause of morbidity and mortality, the study of prognostic factors for its development are invaluable in implementing measures to prevent or decrease the incidence of BM. The aim of this study was to evaluate the prognostic value of certain clinical characteristics in the development of BM in NSCLC patients.

      Methods:
      We retrospectively analyzed all patients diagnosed with NSCLC at our institution between 2000 and 2013. Demographics, tumor characteristics and metastatic patterns were studied. Median follow up was 45 months. Cox regression was used for multivariate analysis.

      Results:
      A total of 1062 patients were studied. Of these, 172 (16%) had BM at the time of analysis, with 61 (35%) patients having BM at diagnosis. Median age was 68 years (range, 18-91); median time from diagnosis to BM was 259 days. There were more females than males (64% vs. 36%, p < 0.0001). About NSCLC characteristics, patients with BM were more likely to have upper lobe tumors than all other tumor locations combined (63% vs. 37%, p < 0.0001). 32% of the lung tumors were 5-7cm in diameter and adenocarcinoma represented 68% of all the histologic subtypes. In regards to other distant metastases: 34% of the patients had bone metastasis, 23% adrenal and 17% hepatic. BM were most commonly located in the frontal (41%), parietal (17%) and occipital (14%) lobes. There was a significant survival difference between Stage IV patients with and without BM; patients with BM survived 6.1 months compared with 11.9 months in those without BM (p < 0.0001). In univariate analysis, female sex, histologic grade, upper lobe tumors and high LDH levels were associated with BM. Age < 65 years (HR: 0.60, 95%CI: 0.37-0.95, p < 0.03), T3-4 tumors (HR: 3.4, 95%CI: 2.04-5.64, p < 0.0001), adrenal metastasis (HR: 5.2 95%CI: 2.5-10.7, p < 0.0001) and liver metastasis (HR: 8.6, 95%CI: 4.3-17.2, p < 0.0001) were independent risk factors for the development BM.

      Conclusion:
      The results of this study pose female sex, tumor histologic grade, tumor location, and LDH levels as important prognosticators of future BM. In addition, younger age, T3-4 tumors, and the presence of adrenal/liver metastases are noted as independent risk factors for BM development. With this information, criteria for the selection of patients as suitable candidates for intra-cranial irradiation, periodic brain imaging studies, and close outpatient follow-up may aid in further prevention of BM, early identification, and timely management.

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    P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      P3.02-001 - Factors Affecting Tumor Recurrence in Early Stage Non-Small Cell Lung Cancer (ID 459)

      09:30 - 17:00  |  Author(s): H.D. Harper

      • Abstract

      Background:
      For early stage non-small cell lung cancer (NSCLC) surgery is potentially the only curative treatment. However, a proportion of lung cancer patients develop recurrence, even after complete resection. The factors affecting recurrence in these patients are largely unknown. This study aimed to identify the predictive factors for recurrence in patients with stage I/II NSCLC.

      Methods:
      We retrospectively reviewed all patients diagnosed with stage I/II NSCLC at our institution from 2000 to 2013. Initial diagnosis at our institution and a minimum follow up of 36 months were required. Cox regression model was used for multivariate analysis.

      Results:
      A total of 673 patients with stage I/II were identified, of those 175 (26%) developed local or distant recurrence, with a median time to recurrence of 18 months. Median age was 74 (range: 44-96 years), 56% were current or former smokers. Patients were more likely to have upper lobe tumors than all other tumor locations combined (58% vs 42%), adenocarcinoma was the most prevalent histologic subtype (53%) and 47% had poorly differentiated or anaplastic tumors. 152 patients (87%) received surgery with lobectomy being the most common procedure followed by wedge resection. 24% received chemotherapy and 7% radiation. Median overall survival was 26 months (95%CI: 17.2-34.5). Patients with squamous cell carcinoma had a shorter median time to recurrence when compared with adenocarcinomas (13.2 months vs. 19.7 months) (p<0.02). Smoking history (HR: 1.98, 95%CI: 1.62-2.82, p<0.007), central tumor location (HR: 1.24, 95%CI: 1.09-1.56, p<0.01), squamous subtype (HR: 1.46, 95%CI: 1.22-1.84, p<0.002) , high histologic grade (HR: 2.76, 95%CI: 1.34-5.97, p<0.01) and lymphovascular invasion (HR: 4.3, 95%CI: 3.32-5.00, p<0.001) were independent predictors of recurrence by multivariate analysis. Poorly differentiated tumors were associated with a higher frequency of distant recurrence when compared with well differentiated tumors (OR: 2.7 vs. 1.2). In 43% of the patients with recurrence lung cancer was the primary cause of death.

      Conclusion:
      In our cohort, we observed that patients with lymphovascular invasion have the highest recurrence risk followed by high histologic grade tumors with the former having a direct correlation with distant metastasis. Patients with these risk factors may benefit from close surveillance after surgical resection, adjuvant therapy and aggressive management of local recurrence.