Virtual Library

Start Your Search

Mohamed Kamel



Author of

  • +

    OA06 - Early Stage Lung Cancer: Outcomes and Interventions (ID 902)

    • Event: WCLC 2018
    • Type: Oral Abstract Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 13:30 - 15:00, Room 202 BD
    • +

      OA06.07 - Predictors and Consequences of Refusing Surgery for Clinical Stage I NSCLC: A National Cancer Database Analysis (ID 13865)

      14:35 - 14:45  |  Author(s): Mohamed Kamel

      • Abstract
      • Presentation

      Background

      Given perceived morbidity of lung cancer surgery, patients may instead pursue other treatment options, particularly in the current era of shared decision-making. We sought to determine predictors of refusal of surgery for clinical stage I non-small cell lung cancer (NSCLC) patients and to determine associated outcomes.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The NCDB (2004-2014) was queried for clinical stage I NSCLC patients who underwent or were recommended to undergo surgery. A unique field in the NCDB allows identification of those patients who were recommended to have surgery, but refused. We only included cases in which surgery was refused “by the patient, patient’s family member or guardian”. We excluded patients with multiple primary tumors, unknown treatment modality/sequence, those who did not undergo recommended surgery for unknown reasons, and those initially not recommended to have surgery. Survival was compared using log rank test in Kaplan Meier curves. Logistic regression was performed to identify predictors of refusing surgery.

      4c3880bb027f159e801041b1021e88e8 Result

      We identified 118,0217 patients undergoing surgery and 3,210 (2.6%) who were recommended, but refused surgery. By multivariate analysis older age (HR=1.09, CI=1.08-1.09), non-white race (HR=2.18, CI=1.97-2.42), low income (HR=1.28,CI=1.16-1.41), lack of insurance (HR=2.62,CI=1.89-3.62), squamous histology (HR=1.40,CI=1.29-1.53), and larger tumor size (HR=1.57,CI=1.42-1.73) predicted refusal of surgery.Patients refusing surgery were treated with chemoradiation (n=249, 7.8%), radiation or chemotherapy alone (n=1,568, 48.8%), or no treatment (n=1393, 43.4%). Median survival was worse for patients who refused any treatment versus those who received other treatment modalities (19.8 vs 42.2 months, P<0.001). Among those patients refusing surgery who were treated with radiation, we identified 758 patients (23.6%) who received stereotactic body radiation therapy (SBRT). The proportion of patients who refused surgery and received SBRT increased over time, from 3.8% in 2004-2006, to 17% in 2007-2009, to 31.1% in 2010-2012, and to 37.9% in 2013-2014. Patients receiving SBRT had improved survival compared to other patients refusing surgery (47.9 vs. 25.2 months, p<0.001), although survival in the SBRT group was inferior to patients undergoing surgery as recommended (47.9 vs. 82.8 months, p<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Although patients may be reluctant to undergo surgery for early stage NSCLC, refusal of surgery when recommended comes at the expense of decreased survival. Socioeconomic factors may be associated with refusal of surgery. The use of SBRT is an effective and increasingly used alternative in these patients, which improves survival compared to no treatment but which is still not equivalent to surgery in this unmatched, retrospective cohort.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Information from this presentation has been removed upon request of the author.

      Information from this presentation has been removed upon request of the author.

  • +

    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: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P1.16-49 - Treatment of NSCLC Patients with Clinical N1 Disease: Is There an Advantage to Neoadjuvant Therapy? (ID 14106)

      16:45 - 18:00  |  Author(s): Mohamed Kamel

      • Abstract
      • Slides

      Background

      Treatment options for clinical N1 patients with non-small cell lung cancer (NSCLC) include neoadjuvant therapy and surgery, surgery with adjuvant therapy, or definitive chemoradiation (dCRT). We sought to evaluate the rates of use of each strategy and associated outcomes in patients in the National Cancer Database (NCDB).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The NCDB (2004-2014) was reviewed for patients with clinical N1 NSCLC, excluding those with multiple primary tumors, unknown treatment modality/sequence, and clinical M1 disease. Overall survival (OS) of different treatment modalities was compared using log rank test in Kaplan Meier curves. Logistic and Cox regressions were performed to identify predictors of OS among cN1 cohorts respectively.

      4c3880bb027f159e801041b1021e88e8 Result

      We identified 14,934 cN1 patients undergoing curative treatment. Median age was 67 (IQR 59-73) and median tumor size 4.5 cm (IQR 3-6.4). This included 1,040 patients (7%) undergoing neoadjuvant therapy followed by surgery, 4,398 patients (29.4%) undergoing surgery +/- adjuvant therapy, and 9,496 patients (63.6%) undergoing dCRT. Predictors of neoadjuvant therapy were age (OR=0.96,CI=0.95-0.96), white race (OR=1.54,CI=1.23-1.93), year of diagnosis (OR=0.92,CI=0.90-0.94), Charlson Comorbidity Index (CCI)<2 (OR=1.282,CI=1.004-1.637), adenocarcinoma (OR=1.30,CI=1.12-1.51), larger tumor size (OR=1.002,CI=1.001-1.003, and private insurance (OR=1.51, CI=1.29-1.77). Superior OS was achieved following neoadjuvant therapy and surgery (median-OS=42.1±3.4 months) compared to surgery ± adjuvant therapy (38.4±1.5 months, p=0.002). dCRT was associated with the worst survival (18.9± 0.30 months). By MVA, predictors of poor survival in the cohort were older age (HR=1.015,CI=1.012-1.018), male gender (HR=1.20,CI=1.13-1.26), lack of insurance (HR=1.26,CI=1.08-1.46), higher comorbidities (CCI=2, HR=1.29, CI=1.19-1.40), larger tumors (HR=1.002, CI=1.001-1.002), and the use of dCRT (HR=1.75,CI=1.58-1.95).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Neoadjuvant therapy followed by surgery is associated with superior survival compared to upfront surgery +/- adjuvant therapy in this large cohort of patients. dCRT, although used most commonly in patients with cN1 disease, demonstrates the worst survival rates.

      cn1 km os.png

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active 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 or select "Add to Cart" and proceed to checkout.