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L. Du



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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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      P1.05-047 - Early Mortality in Patients with Non-Small Cell Lung Cancer Undergoing Adjuvant Chemotherapy (ID 5523)

      14:30 - 15:45  |  Author(s): L. Du

      • Abstract

      Background:
      Although adjuvant chemotherapy improves survival in patients with completely resected non-small-cell lung cancer (NSCLC) compared to surgery alone, it is also associated with potentially disabling or lethal adverse events. Since there is limited information on the early mortality among patients undergoing adjuvant chemotherapy, we used the National Cancer Data Base (NCDB) to calculate the percentage of deaths within the first 6 months from starting chemotherapy.

      Methods:
      The NCDB was queried for patients aged 18 or older, diagnosed with stage IB to IIIA NSCLC (AJCC 7[th] edition) from 2004 to 2012, who underwent surgery with negative margins followed by multi-agent chemotherapy, starting within 120 days from the surgical resection. Patients who received radiation therapy were excluded. Age groups were divided into <50, 51-60, 61-70, 71-80 and >80 years. Early mortality from months 1 to 6 were calculated and multivariate logistic regression was performed to identify clinical variables independently associated with mortality at six months from the date of initiation of adjuvant chemotherapy.

      Results:
      A total of 19,791 patients met the eligibility criteria. The median age was 65 (range 19-89). The percentage of deaths at 1, 2, 3, 4, 5 and 6 months were 0.6%, 1.3%, 1.9%, 2.6%, 3.3% and 4.2% respectively. The percentages of death at 6 months for each age group from < 50 years to > 80 years were 2.7%, 3.2%, 4.1%, 5.3% and 7.8% respectively. Factors independently associated with increased 6-month mortality included increased age, male gender, higher Charlson-Deyo co-morbidity score (CDCS), type of surgery, length of stay (LoS) > 6 days and 30-day readmission (Table).

      Conclusion:
      There is a high risk for early mortality among patients undergoing adjuvant chemotherapy for NSCLC, particularly in patients older than 70, with high co-morbidity score and a more complicated post-operative period.

      Table. Multivariable analysis
      Variable OR (95% CI) P-value
      Age
      ≤ 50 Reference Reference
      51-60 1.08 (0.74-1.60) 0.68
      61-70 1.33 (0.91-1.95) 0.15
      71-80 1.59 (1.06-2.38) 0.03
      > 80 2.27 (1.29-3.98) 0.004
      Gender
      Male Reference Reference
      Female 0.70 (0.59-0.82) < 0.001
      CDCS
      0 Reference Reference
      1 1.13 (0.95-1.34) 0.15
      2 1.58 (1.26-1.98) < 0.001
      Surgery
      Sub-lobar Reference Reference
      Lobectomy 0.72 (0.53-0.97) 0.03
      Pneumonectomy 0.97 (0.68-1.39) 0.87
      Stage
      IB Reference Reference
      II 1.29 (1.04-1.59) 0.02
      IIIA 2.28 (1.81-2.87) < 0.001
      LoS
      ≤ 6 days Reference Reference
      > 6 days 1.24 (1.06-1.46) 0.008
      30-day readmission
      No Reference Reference
      Yes 1.54 (1.20-1.99) 0.001