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MINI 32 - Topics in Localized Lung Cancer (ID 166)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
MINI32.04 - Clinico-Pathological Correlations and the Role of Brain MRI in Combined Clinical Staging for Resectable Lung Cancer (ID 2441)
18:30 - 20:00 | Author(s): F. Farrokhyar
In our model of Combined Clinical Staging (CCS) for lung cancer, patients with a Computerized Tomography (CT) scan of the chest that does not show distant metastases will then routinely undergo whole body Positron Emission Tomography (PET/CT) and Magnetic Resonance Imaging (MRI) of the brain prior to any therapeutic decision. We aim to determine the accuracy of CCS and the value of brain MRI in this population.
A prospective database was queried for all patients who underwent resection of lung cancer from 01/2012 to 06/2014. Demographics, wait times, clinical and pathological stage (7[th] edition AJCC/UICC), and costs of staging were collected. Krippendorff’s alpha was used to determine correlation between clinical and pathological stage.
Of 315 patients with primary lung cancer, 55.6% were female and the median age was 70 (27-87, Table 1). The mean time from initial CT scan to surgical treatment was 9.12 +/- 6.0 weeks. Krippendorff’s alpha between CCS and pathological stage was 0.193 (0.125 to 0.260, Table 2). When correlation was analyzed without consideration for sub-stages A and B, 49.8% (157/315) of patients were staged accurately, 39.7% (125/315) were over-staged, and 10.5% (33/315) were under-staged. Only 4.7% (15/315) of patients underwent surgery without appropriate neo-adjuvant systemic treatment. Preoperative brain MRI detected asymptomatic metastases in 4/315 patients (1.3%). At a median postoperative follow-up of 16 months (1-40), 7 additional patients developed symptomatic brain metastases, all of which had normal brain MRI preoperatively. The total cost of CCS was $416,924 over the study period, with $131,824 (31.6%) going towards brain MRI.
Table 1: Baseline descriptive data, N=315
Age Mean (SD) 69.80 (9.62) (Min: 27.34, Max: 86.61) Gender Female (%) 175 (55.6%) Male (%) 140 (44.4%) Weeks First Visit to Consent Mean (SD) 5.49 (8.15) (Min: 0, Max: 63) Weeks Consent to Surgery Mean (SD) 2.24 (2.07) (Min: 0, Max: 11) Weeks Initial CT to Surgery Mean (SD) 9.12 (6.01) (Min: 0, Max: 53) Weeks First Visit to Surgery Mean (SD) 8.00 (8.25) (Min: 0, Max: 64) Brain Metastases at Baseline (%) 4 (1.3%) Brain Metastases at Follow Up (%) 11 (3.5%)
Table 2: Frequency and agreement of CCS and pathological stage
Stage (N=315) Clinical Stage N (%) Pathological Stage N (%) Same Staging by Both (True Positives) 0 1 (0.3%) - - Stage IA 89 (28.3%) 103 (32.7%) 55 Stage IB 39 (12.4%) 82 (26.0) 19 Stage IIA 42 (13.3%) 47 (14.9%) 7 Stage IIB 32 (10.2%) 42 (13.3%) 12 Stage IIIA 78 (24.8%) 39 (12.4%) 16 Stage IIIB 21 (6.7%) 0 (0.0%) 0 Stage IV 13 (4.1%) 2 (0.6%) 2 Krippendorff's Alpha for level of agreement = 0.193 (0.125 to .260)
CCS is effective for patients with resectable lung cancer, with less than 5% of patients being under-staged in a way that denied them appropriate systemic treatment before surgery. Brain MRI is a low yield and high cost intervention in this population, and its routine use should be questioned.
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