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X. Wang
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ORAL 05 - Surgery (ID 97)
- Event: WCLC 2015
- Type: Oral Session
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:P. Van Schil, F.(. Kong
- Coordinates: 9/07/2015, 10:45 - 12:15, 201+203
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ORAL05.06 - Long-Term Survival after Lobectomy for Locally Advanced NSCLC between Improved Video-Assisted Thoracoscopic Lobectomy and Thoracotomy (ID 292)
10:45 - 12:15 | Author(s): X. Wang
- Abstract
- Presentation
Background:
Video-assisted thoracoscopic lobectomy(VATS) is preferred over thoracotomy for the treatment of early stage non-small cell lung cancer (NSCLC). However, little evidenceindicated its perioperative and oncologic outcomes for advanced-stage NSCLC and the result of VATS surgery may be overestimated since the majority of patients were stage I patients in previous studies. Therefore, we evaluate whether VATS lobectomy for locally advanced NSCLC could be performed safely and with acceptable short- and long-term outcomes when compared with standard thoracotomy on a well-balanced population from a multi-institutional database.
Methods:
Tumors that are greater than 5 cm in diameter, T3 or T4 tumors, tumors after neo-adjuvant treatment, and/or tumors with lymph node metastasis are defined to be locally advanced. By using a multi-institutional prospective database of high level comprehensive cancer hospitals, we analyzed locally advanced NSCLC patients who underwent lobectomy. VATS lobectomies were all performed by an improved technique, which had achieved proficiency that has been published previously. Using propensity-matched analysis based on preoperative variables, perioperative outcomes, oncologic efficacy and long-term survival were compared between VATS lobectomy and thoracotomy.
Results:
Matching based on propensity scores produced 125 patients in each group. Patient and tumor characteristics were similar. Conversion rate from VATS to thoracotomy is 9.6%. There were no intraoperative deaths and 1 perioperative death in each group. Postoperative outcomes like median operative time, blood loss and tube duration were similar between VATS and thoracotomy, Hospital length of stay was shorter after VATS than thoracotomy(10.4d vs 11.4d, p<0.01). VATS group had significant lower level of postoperative pain than thoracotomy group (p<0.01). The overall incidence of postoperative complications was 28.8% (36/125) and 36.0% (45/125)in the VATS group and in the thoracotomy group, respectively(p = 0.14).Similar number of lymph nodes (16.2vs 14.8, p= 0.148)and nodal stations (5.72 vs 5.66, p= 0.781) were removed by VATS and thoracotomy. Similar proportion of patients accepted postoperative chemotherapy (73.6% vs 72.0%, p= 0.776) , and completed similar cycles of postoperative chemotherapy (2.47 vs.2.35, p = 0.602) in the two groups. Median follow-up was 36.6 months. There were no significant differences in locoregional and distant recurrence patterns between the two groups. Disease-free survival(DFS) at 3-years were 50.1% and 47.3%, 5- years were 40.0% and 37.0% in the VATS and thoracotomy groups, respectively (p=0.878). Overall survival(OS) at 3-years were 75.0% and 68.9%, 5-years were 42.2% and 43.1% in the VATS and thoracotomy groups, respectively (p =0.551). Multivariate Cox regression analyses of DFS and OS confirmed the noninferiority of VATS, and showed that significant predictors of worse DFS and OS were advanced pathologic stage (HR,2.235; 95% CI,1.564 to 3.193; p<0.001), and without postoperative chemotherapy (HR,1.594; 95% CI,1.095 to 2.321; p=0.015).
Conclusion:
VATS lobectomy for locally advanced stage NSCLC can be performed safely, with shorter length of hospital stay, lower level of pain and showed similar long-term survivals compared to thoracotomy. With continued experience and optimized technique, VATS lobectomy can be performed in majority of cases without compromising the perioperative outcomes and oncologic efficacy. This work was supported by a funding named‘Beijing Municipal Science and Technology Project (D141100000214004)
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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
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.02-031 - Patient Outcomes following Curative-Intent Lung Resection among Non-Small Cell Lung Cancer (NSCLC) Patients in China (ID 2559)
09:30 - 17:00 | Author(s): X. Wang
- Abstract
Background:
Lung resection is a common treatment for patients with non-small cell lung cancer (NSCLC), particularly those with early stage disease. This study aimed to assess patient short-term outcomes following curative-intent lung resection among patients with NSCLC.
Methods:
Data were obtained from an NSCLC surgical outcome registry, which included patients from 13 tertiary hospitals in 11 provinces in 2013 and 2014. The surgery types include thoracotomy, video-assisted thoracic surgery (VATS), conversion from thoracotomy to VATS and mini-thoracotomy under VATS. Among all patients, 1,071 were followed up for at least 6 months. Post-surgery treatment pattern and patient outcomes (surgical complication rate and rates of survival, new metastasis and recurrent at the 6-month follow-up) were described; patient outcomes were compared among different tumor stages using Fisher’s exact test.
Results:
Among the 1,071 patients with ≥ 6-month follow up, the median age was 60 (range 26 to 84) years old and 68.3% were male. The most common types of cancer were adenocarcinoma (56.1%) and squamous cell carcinoma (38.3%). Based on the pathologic staging, 42.3% patients had stage I tumor; and stage II, III and IV tumor accounted for 27.5%, 27.8% and 2.4% of the patients, respectively. After surgery, 57.9% patients received further treatment: most of them received chemotherapy (78.3%), 1.2% received targeted therapy, 1.2% received radiation, 0.3% received re-operation, 7.2% received alternative medicine treatment. The overall post-surgery complication rate following surgeries was 6.0% and it did not vary significantly by stage (5.1%, 5.4%, 9.4% and 9.5% for stage I-IV, respectively; p=0.122). The overall survival rate at 6 months was 96.2% and it decreased substantially with increasing stage (98.3%, 95.4%, 92.2% and 85.7% for stage I-IV, respectively; p=0.0005). Recurrence rate was 1.5% for all patients and it was substantially higher among patients with stage IV cancer (2.2 %, 1.7%, 0.4% and 10.0% for stage I-IV, respectively; p=0.032). New metastasis occurred in 6.4% patients. Again, the rate varied significantly across different stages (4.9%, 4.2%, 10.0% and 25.0% for stage I-IV, respectively; p=0.001).
Conclusion:
Chemotherapy was the most commonly used treatment after surgery for NSCLC patients. Additionally, the NSCLC patients who underwent curative-intent lung resection surgeries had relatively high survival rate, low rates of recurrence and new metastasis at the 6-month follow up. As expected, prognosis became worse with increasing tumor stage.
