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OA 15 - Diagnostic Radiology, Staging and Screening for Lung Cancer II (ID 684)
- Event: WCLC 2017
- Type: Oral
- Track: Radiology/Staging/Screening
- Presentations: 1
OA 15.08 - Thoroughness of Staging and the Outcomes of Surgical Resection Outcomes in Potentially Curable Non-Small Cell Lung Cancer (NSCLC) (ID 10059)
14:30 - 16:15 | Author(s): B. Wolf
Substantial variation exists in the processes of care for potentially curable NSCLC. We examined the impact of thoroughness of staging for patients undergoing NSCLC surgery in a large, heterogeneous population within a lung cancer endemic region of the US.
We evaluated all surgically resected patients in the Mid-South Quality of Surgical Resection (MS-QSR) cohort from 2009-2017. MS-QSR is a population-based cohort including all curative-intent NSCLC resections at 11 hospitals in the mid-south US. Patients were classified into 8 groups based on use (Yes/No) of the following staging modalities: PET/CT, pre-operative invasive staging, operative mediastinal nodal examination (MLE). We compared stage distribution, adjuvant therapy, and overall survival outcomes across groups using the chi-square test and adjusted Proportional Hazards Models.
The 2,370 patients had a median age of 67 years, were 53% male. The racial distribution was: 70% White, 25% Black, 5% Other. Clinical N-stage was similar between the 8 groups. We found statistically significant differences in pathologic stage distribution, adjuvant therapy usage, and overall survival across the 8 groups (Table 1). Patients who received PET/CT, invasive staging, and MLE (Group 1) had significantly higher pathologic N-stage distribution compared to the other groups due to substantial nodal upstaging. Group 1 had 76% eligibility and 31% use of adjuvant chemotherapy compared to 51% and 8% in the Group 8 (No PET/CT, No Invasive Staging, No MLE). Use and eligibility for adjuvant radiation therapy was also highest in Group 1. There was an overall difference in survival across the groups (p-value=0.0019) which remained significant after adjusting for age, sex, race, histology, and path stage (p-value=0.0013). After adjustment, Group 8 had a 14% increased hazard of death compared with Group 1. Figure 1
A less thorough approach to staging may lead to less nodal upstaging and less eligibility for adjuvant therapy, which could have implications for long term survival.
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P2.16 - Surgery (ID 717)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
P2.16-019 - Improving Survival with a Lymph Node (LN) Collection Kit for Non-Small Cell Lung Cancer (NSCLC) Resections (ID 10000)
09:30 - 16:00 | Author(s): B. Wolf
Poor pathologic nodal staging impairs overall survival (OS) after curative-intent surgical resection of NSCLC. We implemented a LN collection kit and previously demonstrated how it improves pathologic nodal staging. We now report its survival impact.
Using a prospective step-wedge design, kits were implemented for curative-intent surgical resections from 2009-2017 in 11 hospitals within 4 contiguous US Dartmouth Hospital Referral Regions. OS was analyzed with the Kaplan-Meier method. Crude (HR) and adjusted (aHR) hazard ratios with 95% confidence intervals (CI) are presented from Proportional Hazards Models adjusted for clustering by surgeon. Covariates in adjusted models include: age, sex, histology, tumor grade, extent of resection, T and M categories, and number of comorbidities.
The LN kit was used in 734 of 2,547 (29%) resections. All demographic and clinical characteristics, including age, sex, race, health insurance coverage and preoperative stage distribution were similar between kit and non-kit cases. Aggregate 1, 3, 5-year OS: 89%, 74%, 66%(kit) vs. 83%, 65%, 53% (non-kit) (p< 0.0001, Fig.1). Clinical stage stratification (kit v non-), 5-year OS: I, 68% vs. 58%, (p-value=0.0038); II, 68% vs. 40%, (p=0.0045); III, 57% vs. 42%, (p=0.0412). Pathologic stage stratification (kit v non-) 5-year OS: I, 72% vs. 59% (p=0.0082), II, 60% vs. 44% (p=0.0403); III, 48% vs. 36%, p =0.0179). For both clinical and pathologic Stage IV, survival did not differ. Kit cases had a 30% lower hazard of death compared to non-kit cases: HR 0.67 (CI[0.55,0.80], p<0.0001) and aHR: 0.70 (CI[0.54,0.92], p<0.0001). Results remained statistically significant after multiple sensitivity analyses excluding sub-lobar resections, 60-day mortality, non-adopting surgeons, and excluding the 48 months of retrospective baseline control data (aHR: 0.28 to 0.73). Operating time, perioperative complication rates, and duration of hospitalization were similar between groups. Figure 1
Intraoperative specimen collection with a LN kit improves long-term NSCLC survival.