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E. Taioli



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    P1.01 - Poster Session with Presenters Present (ID 453)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Epidemiology/Tobacco Control and Cessation/Prevention
    • Presentations: 1
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      P1.01-029 - Personal and Hospital Factors Associated with Limited Surgical Resection, In-Hospital Mortality and Complications in New York State (ID 5359)

      14:30 - 15:45  |  Author(s): E. Taioli

      • Abstract
      • Slides

      Background:
      Lung cancer represents 13.4% of all newly diagnosed US cancers and 27.1% of all cancer deaths. Early stage lung cancer is generally treated with surgical resection. Many patient- and hospital-level factors influence the selection of appropriate surgical procedures and their outcome. We identified patient- and hospital-level characteristics influencing the type of lung cancer surgical approach utilized in New York State and assessed in-hospital complications and mortality.

      Methods:
      Patients were selected from the Statewide Planning and Research Cooperative System, SPARCS (1995-2012) based on ICD-9-CM codes of diagnosis (162 and 165) and procedures (32.0-32.9). Surgery was categorized into: limited resection (LR: 32.2-32.3), lobectomy (L: 32.4), and pneumonectomy (P: 32.5-32.6). Statistical analyses were performed in SAS v9.4 and ArcMap v10.3.1.

      Results:
      There were 36,460 patients (age 60-75 years); 56% underwent L, 37% LR, and 7% P. LR patients were more likely to be older (OR~adj~ 1.01, 95%CI [1.01-1.02]), female (OR~adj~ 1.10 [1.06-1.15]), Black (OR~adj~ 1.24 [1.15-1.34]), with comorbidities (OR~adj~ 1.10 [1.04-1.16]) than L patients. Opposite trends were observed among P patients, except for race. Over time, the odds of P decreased, while those of LR significantly increased (OR~adj~ 1.22 [1.16-1.29] for years 2007-2012 vs 1995-2000). Teaching hospitals were less likely to perform LR over L (OR~adj~ 0.82 [0.75-0.88]), while the opposite was true for hospitals with larger surgery volumes (OR~adj~ 1.07[1.03-1.11]). In-hospital complications were significantly less after LR than L (OR~adj~ 0.66 [0.62-0.69]), while in-hospital mortality was similar (OR~adj~ 0.93 [0.84-1.03]). In-hospital mortality was directly associated with age, length of stay, urgent/emergency admission, and inversely associated with female gender, private insurance, and surgery volumes. Figure 1



      Conclusion:
      There is a growing trend towards LR, which is still more likely to be performed in older patients with co-morbidities. In-hospital outcomes were affected by patients’ clinical and personal characteristics, and were better after LR than L or P.

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    P1.05 - Poster Session with Presenters Present (ID 457)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P1.05-071 - A Review of Quality of Life Measures Used in Lung Cancer Surgical Outcomes (ID 6175)

      14:30 - 15:45  |  Author(s): E. Taioli

      • Abstract

      Background:
      With the increased life expectancy following surgery for early stage non-small-cell lung cancer (NSCLC), concern about the quality of life (QoL) of patients after surgery has gained attention. Previous QoL studies were limited by small sample size, inclusion of late-stage cancers and non-surgical treatments. This review summarized the existing literature on QoL in early stage lung cancer patients who underwent surgical treatment.

      Methods:
      PubMed and PsycINFO were searched for articles published between 1995 (year of the last published meta-analysis) and March 21, 2016. All English articles reported on quality of life for Stage I NSCLC were included. Data extraction was performed by two independent reviewers using pre-specified criteria.

      Results:
      Ten articles from nine studies were identified. Of the nine studies, four reported on the SF-36, one on the SF-12, one on the EORTC QLQ-C30, one on POMS-TMD, one on EQ-5D, and one on SGRQ. One study reported only on pre-surgical QoL, six only on post-surgical QoL and two studies reported on both pre- and post- surgical QoL. Timing for the administration of post-surgical QoL survey varied, from time at discharge to up to six years post-surgery. Two studies included only NSCLC patients with COPD. Due to the heterogeneity of these studies, comparison between studies and traditional meta-analysis were not possible.

      Conclusion:
      The literature on QoL in Stage I NSCLC patients is very sparse. As CT screening for lung cancer becomes more widespread with a consequent shift from late to early stage NSCLC, additional research is needed to explore the impact of different NSCLC surgical approaches on QoL.

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    P3.03 - Poster Session with Presenters Present (ID 473)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      P3.03-031 - Definitive Radiation Therapy is Associated with Improved Survival in Non-Metastatic Malignant Pleural Mesothelioma (ID 4458)

      14:30 - 15:45  |  Author(s): E. Taioli

      • Abstract

      Background:
      To analyze rates of definitive radiation therapy (RT) utilization for malignant pleural mesothelioma (MPM) and evaluate the association between RT and overall survival (OS).

      Methods:
      The National Cancer Data Base (NCDB) was queried to identify patients with non-metastatic MPM diagnosed between 2004 and 2013. Definitive RT was defined as receipt of 40-65 Gy of external beam radiation therapy to the chest wall, lungs, or pleura. Multivariate logistic regression was performed to identify predictors of RT receipt. OS was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to identify predictors of mortality. Propensity score matching was performed to verify the effect of definitive RT on OS.

      Results:
      Among 14,090 MPM patients, 3.6% received RT. Younger age, lower co-morbidity score, private insurance, surgical resection, and receipt of chemotherapy were associated with increased RT utilization. Patients who received RT had higher crude 2 and 5-year OS rates (33.9% and 12.6%, respectively) compared to patients who did not (19.5% and 5.3%, respectively; p<0.001). On multivariable analysis and propensity matched analysis, definitive RT was associated with improved survival (adjusted hazard ratio [adj HR] 0.78, 95% CI 0.70-0.87) and (adj HR 0.77, 95% CI 0.67-0.89), respectively. Compared to no therapy, surgery and RT (adj HR 0.41, 95% CI 0.31-0.54) and trimodality therapy (adj HR 0.47, 95% CI 0.40-0.55) were associated with the best survival.

      Comparison of Overall Survival According to Definitive RT
      2-yr rate 95% CI 5-yr rate 95% CI p Adjusted HR 95% CI
      No RT 19.5% 18.8-20.3 5.3% 4.9-5.8 <0.001 1.00 Ref
      RT 33.9% 29.4-38.4 12.6% 9.4-16.3 <0.001 0.78 0.70-0.87


      Conclusion:
      The rate of definitive RT utilization for non-metastatic MPM has remained low over the past decade. Patients who received RT had improved OS, suggesting a role for increased utilization, particularly with the advancement in RT techniques. Combined modality therapy was associated with a greater improvement in survival than any single modality treatment.