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Z.W. Fitch



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    P3.04 - Poster Session with Presenters Present (ID 474)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P3.04-013 - The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma (ID 6050)

      14:30 - 15:45  |  Author(s): Z.W. Fitch

      • Abstract
      • Slides

      Background:
      This study examined the association of extent of lung resection, pathologic nodal evaluation, and survival for patients with clinical stage I (cT1-2N0M0) adenocarcinoma with lepidic histology in the National Cancer Database (NCDB).

      Methods:
      The association between extent of surgical resection and long-term survival for patients in the NCDB between the years of 2003-2006 with clinical stage I lepidic adenocarcinoma who underwent lobectomy or sublobar resection was evaluated using Kaplan-Meier and Cox proportional hazards regression analyses.

      Results:
      Of the 1,991 patients with cT1-2N0M0 lepidic adenocarcinoma who met study criteria, 1,544 patients underwent lobectomy and 447 underwent sublobar resections. Patients treated with sublobar resection were older, more likely to be female, had higher Charlson/Deyo comorbidity scores, but had smaller tumors and lower T-status. Of patients treated with lobectomy, 6% (n=92) were upstaged due to positive nodal disease, with a median of 6 lymph nodes sampled (IQR: 3,10). In an analysis of the entire cohort, lobectomy was associated with a significant survival advantage over sublobar resection in univariate analysis (median survival 9.2 vs. 7.5 years, p=0.022; 5-year survival 70.5% vs. 67.8%) and following multivariable adjustment (hazard ratio [HR]: 0.81 [95% [CI]: 0.68-0.95], p=0.011), (Figure 1). However, lobectomy was no longer independently associated with improved survival when compared to sublobar resection (HR: 0.99 [95% CI: 0.77-1.27], p= 0.905) in a multivariable analysis of a subset of patients that compared only those patients who underwent sublobar resection that included lymph node sampling to patients treated with lobectomy. Figure 1



      Conclusion:
      Surgeons treating patients with stage I lung adenocarcinoma with lepidic features should cautiously utilize sublobar resection rather than lobectomy and must always perform adequate pathologic lymph node evaluation.

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    P3.07 - Poster Session with Presenters Present (ID 493)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Regional Aspects/Health Policy/Public Health
    • Presentations: 1
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      P3.07-012 - Disparities in Guideline-Concordant Treatment for Node-positive Non-Small Cell Lung Cancer Following Surgery (ID 4382)

      14:30 - 15:45  |  Author(s): Z.W. Fitch

      • Abstract

      Background:
      To examine guideline concordance across a national sample and to determine the relationship between socioeconomic factors, use of recommended post-operative therapy, and outcomes for patients with pN1 or pN2 non-small cell lung cancer (NSCLC).

      Methods:
      All margin-negative pT1-3 N1-2 M0 NSCLC treated with lobectomy or pneumonectomy without induction therapy in the National Cancer Data Base (NCDB) between 2006-2011 were included for analysis. Use of guideline-concordant adjuvant therapy, defined as chemotherapy for pN1 disease and chemoradiation therapy for pN2 disease, were examined regarding pathologic, demographic, and socioeconomic factors. Multivariable regression models were developed to estimate predictors of guideline adherence and outcomes. Survival was estimated using the Kaplan-Meier method.

      Results:
      A total of 9,300 patients were identified. Of these, 7,137 had pN1 disease and 2,163 had pN2 disease. Guideline-concordant adjuvant therapy was utilized in 4,477 (62.7%) pN1 patients and 646 (29.9%) pN2 patients. After multivariable adjustment, patient age (OR 0.59 per decade, 95% confidence interval [CI]: 0.56-0.63), uninsured status (OR 0.52, 95%CI:0.39-0.71), N2 disease (OR 0.21, 95%CI:0.18-0.23), pneumonectomy (OR 0.75, 95%CI:0.65-0.86), longer postoperative length of stay (OR 0.96/day, 95%CI:0.95-0.97) and unplanned readmission (OR 0.76, 95%CI:0.61-0.95) were associated with significantly worse guideline concordance, while higher education levels (OR 1.07 per quartile, 95%CI:1.01-1.14) and increasing T-stage (OR 1.08, 95%CI:1.01-1.16) were associated with significantly higher concordance. Overall, patients treated with guideline-concordant therapy had superior survival (5-year survival: 50.4 vs. 35.3%, p<0.001; Figure).Figure 1



      Conclusion:
      Socioeconomic factors, including lack of insurance, are associated with disparities in use of adjuvant therapy as recommended by National Comprehensive Cancer Network guidelines. These disparities have significant impact on patient outcomes. Future work should focus on improving access to appropriate adjuvant therapies among the uninsured and socioeconomically disadvantaged.