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Thomas A. D'Amico
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MA12 - Mesothelioma Surgery and Novel Targets for Prognosis and Therapy (ID 913)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 10:30 - 12:00, Room 202 BD
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MA12.03 - The Impact of Malignant Pleural Mesothelioma Histology on the Use of Surgery and Survival in a Population-Based Analysis (ID 14406)
10:40 - 10:45 | Author(s): Thomas A. D'Amico
- Abstract
- Presentation
Background
Histologic subtype for malignant pleural mesothelioma (MPM) is known to be an important determinant of both treatment and survival. This study aimed to quantify the impact of MPM histology on the use of surgery and survival in a population-based analysis.
a9ded1e5ce5d75814730bb4caaf49419 Method
Overall survival (OS) of patients with stage I-III epithelioid, sarcomatoid, and biphasic MPM in the National Cancer Database from 2004 to 2015 was evaluated using Kaplan-Meier survival analysis and multivariable Cox proportional hazard models.
4c3880bb027f159e801041b1021e88e8 Result
Of the 3,346 patients who met inclusion criteria, the histologic subtype was epithelioid in 2,326 patients (70%), biphasic in 482 patients (14%), and sarcomatoid in 538 patients (16%). Median survival was 16.2 [95% CI: 15.3 – 17.2] months in the epithelioid group, 10.9 [95% CI: 9.8 – 11.9] months in the biphasic group, and 5.3 [95% CI: 4.7 – 6.0] months in the sarcomatoid group (p<0.001). Cancer-directed surgery was utilized more often in epithelioid (31%, n=718) and biphasic patients (38%, n=181) compared to sarcomatoid patients (17%, n=91) (p<0.001). Among patients who underwent surgery, median survival was significantly better for epithelioid (22.6 [95% CI: 21.2 – 24.8] months) and biphasic (14.7 [95% CI: 12.6 – 17.3] months) histologies compared to sarcomatoid histology (7.7 [95% CI: 6.4 – 8.6] months) (p<0.001). Surgery was associated with better survival in multivariable analysis for epithelioid (HR 0.81; [95% CI: 0.72 – 0.93], p=0.002) and biphasic histologies (HR 0.69; [95% CI: 0.53 – 0.89], p=0.004), but not for sarcomatoid type mesothelioma (HR 0.87; [95% CI: 0.65 – 1.16, p=0.34). Further, the absolute difference in median survival between surgical and non-surgical therapy was more clinically significant for the epithelioid (22.6 vs 15.8 months; p <0.001 and biphasic (14.7 vs 10.4 months; p=0.001) patients compared to the sarcomatoid (7.7 vs 7.2 months; p=0.13).
8eea62084ca7e541d918e823422bd82e Conclusion
In this U.S. national analysis of patients with malignant pleural mesothelioma, surgery was most commonly used for epithelioid and biphasic histologies and was associated with a median survival of nearly 2 years and over 1 year, respectively. However, surgery was also used in almost 1 in 5 patients with sarcomatoid mesothelioma but was associated with a median survival of less than 8 months. These results suggest that the specific mesothelioma histology should be firmly established before surgery, and it is reasonable to aggressively treat select patients with epitheloid and biphasic mesothelioma with surgery, but that surgery should not be performed for most patients with sarcomatoid mesothelioma.
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MA23 - Early Stage Lung Cancer: Present and Future (ID 926)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 10:30 - 12:00, Room 105
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MA23.09 - Minimally Invasive Approaches Do Not Compromise Outcomes for Pneumonectomy, a Comparison Utilizing the National Cancer Database (ID 12073)
11:30 - 11:35 | Author(s): Thomas A. D'Amico
- Abstract
- Presentation
Background
Minimally invasive approaches are increasingly being used for the conduct of complex surgical procedures. Whether the benefits of minimally invasive approaches compared to thoracotomy for sublobar and lobar lung resection for nonsmall cell lung carcinoma are realized for patients undergoing pneumonectomy is not clear.
a9ded1e5ce5d75814730bb4caaf49419 Method
The National Cancer Database was queried for patients who underwent pneumonectomy for NSCLC from 2010-2014. Those who underwent resection by a minimally invasive approach (MIS) were compared with those who were done by thoracotomy (Open) in an intent-to-treat analysis. Associations between potential covariates and treatment were analyzed using the Pearson Chi-square test for categorical variables and Wilcoxon Rank Sum test for continuous variables. Univariable and multivariable logistic models and proportional hazards model were used to assess the effect of surgical approach on 30 day and 90 day mortality and overall survival. Relative prognosis was summarized using odds ratios (OR) and hazards ratios (HR) estimates and 95% confidence limits.
4c3880bb027f159e801041b1021e88e8 Result
A total of 4,938 patients underwent pneumonectomy during the study period, of which 755 (15.3%) were completed by minimally invasive approaches (MIS). No difference was noted in 30 and 90-day mortality rates for MIS compared to Open approaches (6.8% and 12.3% vs 6.7% and 11.9% respectively, p = 0.9 and 0.86). Tumor histology and stage characteristics were similar between the two groups. Mean lymph nodes examined was higher in the MIS group compared to Open (17.1± 0.4 vs 16.1 ± 0.2, p=0.034). Surgical approach was not associated with any difference in perioperative mortality with univariable or multivariable analysis. MIS was associated with improved overall survival on univariable analysis, but this was not evident with multivariable analysis.
8eea62084ca7e541d918e823422bd82e Conclusion
Pneumonectomy performed by minimally invasive approaches does not compromise perioperative mortality or long term outcomes. Further investigation into the impact of minimally invasive approaches on perioperative outcomes for whole lung resection is warranted.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MTE24 - Multiple Lung Nodules; Resect, Radiate or Watch? (Ticketed Session) (ID 834)
- Event: WCLC 2018
- Type: Meet the Expert Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 07:00 - 08:00, Room 203 BD
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MTE24.01 - Surgery vs SABR for Early NSCLC (ID 11589)
07:00 - 07:30 | Presenting Author(s): Thomas A. D'Amico
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.16-39 - A Nomogram for Predicting Survival Of TNM8 Stage I Non-Small Cell Lung Cancer Patients to Tailor Potential Chemotherapy Candidates (ID 12463)
16:45 - 18:00 | Author(s): Thomas A. D'Amico
- Abstract
Background
The 8th TNM stage I non–small-cell lung cancer (NSCLC) patients are not considered as candidates for adjuvant chemotherapy (ad-Chemo). This study aimed to develop a nomogram for predicting cancer specific survival (CSS) of these patients and identifying those who might benefit from ad-Chemo.
a9ded1e5ce5d75814730bb4caaf49419 Method
NSCLC cases between 1998 and 2013 were extracted from the SEER database and randomly divided into training and validation cohorts. We identified and integrated the recurrence-associated factors to build a nomogram. We determined the cut-off for the high-risk group by matching the nomogram-predicted 5-year CSS with that of the current 4-5 cm stage IIA cases. The difference in benefit from chemotherapy between risk groups was examined using both SEER and NCDB cohort.
4c3880bb027f159e801041b1021e88e8 Result
A total of 30,475 patients with stage I were included for analysis. Six independent prognostic factors were identified and integrated into the model. The calibration curves showed good agreement. The C-index of the nomogram was higher than that of the staging system (IA1, IA2, IA3, IB) (training set, 0.59 vs. 0.56, P < 0.01; validation set, 0.62 vs. 0.57, P < 0.01). Specifically, 26.9% stage IB patients (8.1% of all stage I) were categorized into the high-risk group (score>29) and had inferior CSS compared with stage IIA patients. In addition, chemotherapy was associated with significantly better OS (HR, 0.739; P = 0.047) than no-chemotherapy in the high-risk group.
8eea62084ca7e541d918e823422bd82e Conclusion
We established a practical and economical nomogram to predict CSS for 8th edition stage I NSCLC, and identified a subset of patients at relatively high risk for recurrence who might benefit from ad-Chemo.
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P1.16-50 - The Role of Adjuvant Therapy for Patients with Early Stage Large Cell Neuroendocrine Lung Cancer: A National Analysis (ID 13077)
16:45 - 18:00 | Author(s): Thomas A. D'Amico
- Abstract
Background
Although large cell neuroendocrine lung cancer (LCNEC) generally has a worse prognosis than other non-small cell lung cancer histologies, data regarding the role of adjuvant therapy in completely resected stage I LCNEC are extremely limited and current guidelines do not routinely recommend adjuvant therapy. This U.S. National Cancer Data Base (NCDB) analysis was performed to improve the evidence guiding decision-making regarding postoperative therapy for early stage LCNEC.
a9ded1e5ce5d75814730bb4caaf49419 Method
Overall survival of patients with pathologic T1-2aN0 LCNEC who underwent resection in the NCDB from 2003 to 2015 was evaluated using Kaplan-Meier and multivariable Cox proportional hazard analysis. Patients who died within 30 days of surgery were excluded. These prospective data were acquired by certified tumor registrars, and include over 80% of cancer diagnoses annually in the U.S.
4c3880bb027f159e801041b1021e88e8 Result
Of the 5,177 patients who met study criteria, adjuvant therapy was given to 31% of patients (n=1585): 20% received chemotherapy (n=1039), 8% chemoradiation (n=400), and 3% radiation (n=146). In stage IA LCNEC, adjuvant chemotherapy was associated with improved survival when compared to no adjuvant therapy in unadjusted analysis (five-year survival 55% vs. 53%; p=0.03) but not after multivariable adjustment (hazard ratio [HR] 0.81; 95% CI 0.64 to 1.02). Of note, adjuvant chemoradiation (HR 1.66; 95% CI 1.11 to 2.48) and adjuvant radiation (HR 1.55; 95% CI 1.06 to 2.25) were associated with worse survival when compared to no adjuvant therapy. In stage IB LCNEC, adjuvant chemotherapy was associated with improved survival when compared with no adjuvant therapy in both univariate (five-year survival 60% vs. 43%; p<0.0001; Figure) and multivariable (HR 0.65; 95% CI 0.48 to 0.88) analyses.
8eea62084ca7e541d918e823422bd82e Conclusion
In this NCDB study of resected stage I LCNEC, adjuvant chemotherapy was associated with improved survival after resection of stage IB but not stage IA LCNEC.
6f8b794f3246b0c1e1780bb4d4d5dc53
