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Masayuki Chida
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MA01 - Early Stage Lung Cancer: Questions and Controversies (ID 894)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 10:30 - 12:00, Room 202 BD
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MA01.06 - Evaluation of Safety and Efficacy in Surgical Treatment for Octogenarian Lung Cancer Patients by Multicenter Prospective Study: JACS1303 (ID 13117)
11:05 - 11:10 | Author(s): Masayuki Chida
- Abstract
- Presentation
Background
The percentage of octogenarian lung cancer patients have increased on the background of the aging of Japan’s demographics. Although some retrospective studies reported clinicopathological scoring systems for predicting postoperative complications and survival outcomes for elderly lung cancer patients, optimized scoring systems remain controversial. This study (JACS1303) aims to evaluate the clinical factors to develop a comprehensive operative risk scoring (RS) system for octogenarian patients with lung cancer.
a9ded1e5ce5d75814730bb4caaf49419 Method
JACS conducted a nationwide multicenter prospective cohort and enrolled a total of 1,019 octogenarians with medically operable lung cancer. Details of the clinical factors, comorbidities, and comprehensive geriatric assessment were recorded for 895 patients to develop a comprehensive risk scoring (RS) system capable of predicting severe complications.
4c3880bb027f159e801041b1021e88e8 Result
Operative (30 days) and hospital mortality rates were 1.0% and 1.6%, respectively. Complications were observed in 308 (34%) patients, of whom 81 (8.4%) had grade 3–4 severe complications. Pneumonia was the most common severe complication, observed in 27 (3.0%) patients. The following five predictive factors: gender, comprehensive geriatric assessment (CGA)75: memory, Simplified Comorbidity Score (SCS): diabetes mellitus, Alb, and %VC were identified as independent predictive factors for severe postoperative complications (odds ratio = 2.73, 1.86, 1.54, 1.66, and 1.61, respectively) through univariate and multivariate analyses. A 5-fold cross validation was performed as an internal validation to reconfirm these five predictive factors (average AUC: 0.70). We developed a simplified RS system as follows: RS = 3 (Gender: male) + 2 (CGA75: memory: yes) + 2 (Alb: <3.8 ng/ml) + 1 (%VC: ≤90) + 1 (SCS: Diabetes mellitus: yes).
8eea62084ca7e541d918e823422bd82e Conclusion
The current study shows that octogenarians can be successfully treated for lung cancer with surgical resection with an acceptable rate of severe complications and mortality. We propose a simplified RS system to predict severe complications in octogenarian patients with medically operative lung cancer.
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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P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.15-21 - Post Resection Lung Cancer Surveillance: Comparisons of Practice Between STS, ESTS and JACS Members (ID 12202)
16:45 - 18:00 | Author(s): Masayuki Chida
- Abstract
Background
We recently investigated contemporary practice in post-resection lung cancer surveillance, between the Society of Thoracic Surgeons (STS) and the European Society of Thoracic Surgeons (ESTS) updating a published STS survey and showed a wide variance of practice.
In order to understand better the role of socio-demographics on this divergence, we aim to compare these patterns to those of members of the Japanese Association for Chest Surgery(JACS) as well as surveillance attitudes across these regions.
a9ded1e5ce5d75814730bb4caaf49419 Method
A survey identical to the one conducted in 1995 among STS members was administered via mail or electronically to members of the STS, ESTS and JACS requesting responses from those treating NSCLC. Goodness of fit tests were used to compare profiles of respondents and attitudes toward testing between groups. Multivariable logistic regression was performed to examine for predictors of guideline concordant surveillance with CT.
4c3880bb027f159e801041b1021e88e8 Result
A total of 2978 STS member (response rate 7.8%, n=234), 1450 ESTS members (response rate 8.4%, n=122) and 272 JACS (response rate 40,8%, n=111) members were surveyed. All three societies reported similar use of history and physical examination for asymptomatic patients (75%vs78%vs73%p=0.52). Rate of guideline-recommended surveillance CT was reported highest among ESTS respondents for stage I patients (22% ESTS, 3% STS and 6% JACS members, p<0.01). However, both JACS and ESTS respondents reported higher rates of use of non-guidelines-recommended tests compared to STS respondents which persisted on adjusted analyses. In particular, JACS and ESTS respondents reported significantly higher use of brain MRI (JACS AOR 13.85 [7.46-25.73] ESTS AOR 2.81 [1.59-4.99], p<0.01), Bone Scan (ESTS AOR 3.00 [1.68-5.36] JACS AOR 5.69 [3.21-10.08], p<0.01) and bronchoscopy for post-resection surveillance (JACS AOR 3.51 [1.99-6.20] ESTS AOR 3.25 [1.83-5.79], p<0.01) compared to STS respondents. Regarding attitudes towards surveillance, more JACS and ESTS members either “agree” or “strongly agree” that routine testing for NSCLC recurrence results in potentially curative treatment (ESTS:86%, STS:70%, JACS:90% p<0.01). Similarly, JACS and ESTS respondents believe that surveillance would identify a curable second primary NSCLC (ESTS:94%, STS:84%, JACS:100% p<0.01) and that current literature documents definitive survival benefits from routine follow-up testing (ESTS:57%, STS:30%, JACS:62% p<0.01).
8eea62084ca7e541d918e823422bd82e Conclusion
The Japanese attitude towards surveillance is similar to that of ESTS members potentially highlighting significant differences between European and Asian surgeons compared to STS members and may be the underpinnings of routine use of non-guideline concordant surveillance. These differences clearly highlight the need of better prospective studies and joint recommendations to standardize practice globally.
6f8b794f3246b0c1e1780bb4d4d5dc53
