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D.N. Ranney



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    MINI 20 - Surgery (ID 137)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      MINI20.04 - Right-Sided vs Left-Sided Pneumonectomy after Induction Therapy for Non-Small Cell Lung Cancer (ID 3064)

      16:45 - 18:15  |  Author(s): D.N. Ranney

      • Abstract
      • Presentation
      • Slides

      Background:
      A right-sided pneumonectomy after induction therapy for non-small cell lung cancer (NSCLC) has been shown to be associated with significant perioperative risk. We examined the impact of laterality on long-term survival using the National Cancer Data Base (NCDB).

      Methods:
      Perioperative and long-term outcomes of patients who underwent pneumonectomy following induction chemotherapy ± radiation from 2003-2011 in the NCDB were evaluated using Kaplan-Meier method, multivariable logistic regression analysis and multivariable Cox proportional hazards modeling.

      Results:
      During the study period, 1,652 patients met inclusion criteria, of whom 740 (45%) underwent right-sided pneumonectomies. Right-sided patients were more likely to have adenocarcinomas, cN2 disease and lower co-morbidity scores (Table). The 30-day mortality rate was higher for right-sided procedures in univariable (11% [84/740] vs 4% [39/912], p<0.001) and multivariable (OR 9.1 [1.8-50.0], p<0.01) analysis. However, 5-year overall survival between right and left pneumonectomy were not significantly different (figure) after a median follow up of 30.2 months. Right-sided procedure also did not impact overall survival in multivariable analysis (hazard ratio (HR), 1.41 [95% CI: 0.87-2.27], p=0.16), while increasing age (HR, 1.02 [95% CI: 1.01-1.03]), Charlson co-morbidity Score of 2 (HR, 1.42 [95% CI: 1.04-1.93]), adenosquamous histology (HR, 1.72 [95% CI: 1.18-2.51]), cN1 status (HR, 1.27 [95% CI: 1.02-1.58]), cN2 status (HR, 1.38 [95% CI: 1.14-1.66]), cN3 status (HR, 1.84 [95% CI: 1.19-2.83]), cM1 status (HR, 2.04 [95% CI: 1.42-2.92]) and incomplete resection (HR, 1.45 [95% CI: 1.14-1.84]) all predicted worse survival. Figure 1

      Table: Baseline characteristics.
      Variable Right-sided (n=740) Left-sided (n=912) p
      Induction chemoradiation 461 (62%) 584 (64%) 0.47
      Age (median, IQR) 59 (52-66) 60 (52-67) 0.07
      Charlson/Deyo Comorbidity Score 0.02
      0 518 (70%) 610 (66%)
      1 190 (26%) 243 (27%)
      2 32 (4%) 68 (7%)
      Histology 0.02
      Adenocarcinoma 227 (37%) 243 (32%)
      Squamous 310 (50%) 450 (59%)
      Large cell 28 (5%) 19 (2%)
      Adenosquamous 20 (3%) 21 (3%)
      Neuroendocrine/carcinoid 4 (1%) 7 (1%)
      BAC 28 (5%) 23 (3%)
      Clinical N < 0.01
      0 190 (27%) 269 (31%)
      1 134 (19%) 187 (21%)
      2 368 (52%) 381 (44%)
      3 16 (2%) 34 (4%)
      There were no significant differences between the groups with regards to sex, race, facility type, and clinical T and M status.



      Conclusion:
      In this population analysis, right-sided pneumonectomy after induction therapy was associated with a significantly higher perioperative but not worse long-term mortality compared to a left-sided procedure. These findings can be used in the risk/benefit analysis when considering patients for pneumonectomy following induction therapy.

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