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S.I. Park



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    ORAL 34 - Quality/Survival/Prognosis in Localized Lung Cancer (ID 153)

    • Event: WCLC 2015
    • Type: Oral Session
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      ORAL34.03 - Prognostic Factors in Early Stage NSCLC: Analysis of the Placebo Group in the MAGRIT Study (ID 24)

      16:45 - 18:15  |  Author(s): S.I. Park

      • Abstract
      • Presentation
      • Slides

      Background:
      The MAGRIT study was a worldwide, multicenter, phase-3 double-blind, randomized trial evaluating efficacy of the MAGE-A3 Cancer Immunotherapeutic in resected non-small cell lung cancer (NSCLC) (www.clinicaltrials.gov NCT00480025). We examined baseline patient and disease characteristics associated with overall survival (OS) and disease-free survival (DFS) among patients assigned to placebo.

      Methods:
      Study participants were ≥18 years, with histologically proven, MAGE-A3-positive stage IB, II or IIIA NSCLC (AJCC 6.0). Participants had undergone complete anatomical resection of the tumor (lobectomy or pneumectomy) with mediastinal lymph node (LN) dissection or sampling according to standard of care. Up to four cycles of platinum-based adjuvant chemotherapy were allowed. Cox regression models were used to explore characteristics that could predict DFS and OS. Factors statistically significant in univariate analysis (p<0.05) were included in multivariate models using a stepwise approach (p<0.05 to enter/remain in the model).

      Results:
      There were 757 placebo patients in the total treated population; median age 63 years, 76% male, 53% with squamous cell carcinoma (SCC), 34% with adenocarcinoma, 98% with performance status 0-1, 52% had received adjuvant chemotherapy.In univariate analyses, SCC, lower N-category and earlier disease stage were associated with improved DFS. Lower N-category, earlier stage and smaller tumor size were associated with improved OS. In multivariate analysis, N-category (HR 1.34, 95%CI [1.16-1.55]) and histological type (HR for SCC vs non-SCC 0.64, 95%CI [0.51-0.81]) remained significant for DFS. N-category (HR 1.47, 95%CI [1.21-1.79]) and tumor size (HR by unit increase 1.08, 95%CI [1.01-1.15]) did so for OS. No association was found between DFS or OS and age, gender, race, region, baseline performance status, quantitative MAGE-A3 expression, chemotherapy administration or type of chemotherapy, smoking status or type of LN sampling (minimal/systematic). Among patients with SCC, univariate analysis identified increased number of chemotherapy cycles and operative technique (pneumectomy) as associated with improved DFS (p<0.05). Only operative technique remained in the multivariate model. When including N-category (p<0.10 in univariate analysis) in the multivariate model, N-category and number of chemotherapy cycles were also selected. Lower N-category and smaller tumor size were significantly associated with improved OS, in univariate and multivariate analyses. Among patients with non-SCC, univariate analysis identified younger age, being female, lower N-category and earlier disease stage with improved DFS, and lower N-category, earlier disease stage and region (East Asia) with improved OS. N-category and gender, and N-category and region remained significant in the multivariate analysis for DFS and OS, respectively.

      Conclusion:
      This is the first prognostic factor analysis in resected NSCLC performed on data from a large, prospective randomized study. It highlighted that in terms of DFS, SCC patients have a better prognosis than non-SCC patients. N-category plays a major role in determining prognosis. Operative technique (pneumectomy), number of chemotherapy cycles (SCC) and gender (non-SCC) are also associated with outcome. Variables predictive for OS are N-category and tumor size (all) and region (non-SCC). These results confirm retrospective studies done within the context of TNM classification, but add that histopathology subtype is a strong determinant for DFS in resected NSCLC.

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    P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P3.01-045 - Short-Term Outcomes of Stage IV Non-Small Cell Lung Cancer with Brain Metastasis (ID 2701)

      09:30 - 17:00  |  Author(s): S.I. Park

      • Abstract

      Background:
      Patients who had non-small cell lung cancer with brain metastasis at the initial diagnosis had poor prognosis and quality of life. We reviewed patients who had undergone lung resection and brain surgery. We also analyzed the characteristics of the patients and the factors affecting survival and recurrence.

      Methods:
      Between 2007 and 2012, 25 consecutive patients who had undergone lung resection and brain surgery because of non-small cell lung cancer with brain metastasis were retrospectively evaluated in a single-center. The non-small cell lung cancer subtype was adenocarcinoma in 23 patients, squamous cell carcinoma in 1 patient, and adenosquamous cell carcinoma in 1 patient. Twenty patients underwent Gamma Knife radiosurgery. Nodal stage was stage 0 in 9 patients, stage 1 in 9 patients, and stage 2 in 7 patients.

      Results:
      The median survival time after lung resection was 36.8 months. The 1-, 2-, and 3-year survival rates after lung resection were 95.8%, 79.2%, and 54.2%, respectively, and the 1-, 2-, and 3-year disease-free survival rates were 95.8%, 82.9%, and 64.2%, respectively. There were no local recurrences. Brain surgery methods did not affect disease-free survival (p=0.201) or overall survival (p=0.567). Nodal stage also did not affect disease-free survival (p=0.519) or overall survival (p=0.645).

      Conclusion:
      Even in cases of stage IV non-small cell lung cancer with brain metastasis, assertive lung resection and brain surgery bring improvements of survival and recurrence to patients. Brain surgery methods do not affect survival or recurrence. Therefore, Gamma Knife radiosurgery is a good choice for quality of life for patients.