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Nicholas Mayne
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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): Nicholas Mayne
- 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.
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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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
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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): Nicholas Mayne
- 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.
6f8b794f3246b0c1e1780bb4d4d5dc53
