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Mark Berry
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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): Mark Berry
- 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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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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P1.16-50 - 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): Mark Berry
- 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
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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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P2.15-06 - Examination of Optimal Timing of Post-Surgical Surveillance for Early Stage Lung Cancer Patients and Association with Outcomes (ID 13119)
16:45 - 18:00 | Author(s): Mark Berry
- Abstract
Background
Guidelines for post-operative surveillance for NSCLC are variable. Historically, surgeons have used a one-size fits all approach, such that surveillance guidelines incorporate few important prognostic indicators for recurrence and survival. Recent NCCN guidelines recommend surveillance CT every 6 months for both stage I and II patients. This is in contrast to the recent IFCT-0302 Trial suggesting that CT scans every 6 months are not useful within the first 2 years following surgery. The goal of this study was to determine optimal timing for detection of recurrence by CT scan and the association between surveillance CT and overall survival.
a9ded1e5ce5d75814730bb4caaf49419 Method
This was a retrospective, single institution series of patients undergoing surgical resection (2008-2012) with stage I or II disease (AJCC 7thedition) with at least 6 months of follow-up. Guideline adherence was defined as receipt of CT every 6 months for the first two years and annually thereafter.
4c3880bb027f159e801041b1021e88e8 Result
The cohort consisted of 162 patients (80% stage I 20% stage II) with median follow-up 57 months. Recurrence occurred in 27.5% of patients at a median of 29.5 months following surgery. The rate of adherence to guideline recommended surveillance ranged 61%-76.3%with the majority of all CT scans done for surveillance purposes (87%-98%). The percentage of CT scans with suspicious findings was relatively stable over time (30-35%), however, the rate of CT scans with recurrence was variable, peaking at 2-3 years following surgery. For those detected on CT scan, stage I recurrences peaked at 25-36 months whereas stage II peaked at 19-24 months.
Timing of recurrences differed significantly based on stage with 81% of recurrences occurring > 24 months following surgery for Stage I patients compared to 41% of a Stage II patients. (p<0.01) Overall, higher rates of surveillance CT were associated with a reduced risk of death (HR 0.14 [95% CI 0.06-0.36] p<0.01).
8eea62084ca7e541d918e823422bd82e Conclusion
The majority of CT imaging performed within 5 years following surgery was done for surveillance purposes rather than symptoms. The timing of recurrence differs significantly based on stage such that few stage I patients have recurrences within 2 years following surgical resection. Additionally, rates of recurrence detected by surveillance CT scans performed less than 24 months following surgery is lower for stage I patients.These results should be examined within a larger cohort with longer longitudinal follow-up as timing of CT surveillance based on peak recurrence rates has the potential to eliminate unnecessary testing and expense for healthcare systems.
6f8b794f3246b0c1e1780bb4d4d5dc53
