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Rickie P Voland
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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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MA23.05 - Post-Operative Radiation Improves Overall Survival in Patients with Node-Positive Non-Small Cell Lung Cancer Undergoing Sublobar Resections (ID 14350)
11:00 - 11:05 | Author(s): Rickie P Voland
- Abstract
- Presentation
Background
The incidence and prognosis associated with patients undergoing sub-lobar resections and having positive lymph nodes(PLN) has been rarely studied. Our investigation will retrospectively review this topic.
a9ded1e5ce5d75814730bb4caaf49419 Method
The National Cancer Database(NCDB) was queried during the years 2004-2014 to assess patients undergoing sub-lobar resection (wedge, segmentectomy, and sub-lobar-NOS, N = 38,599) and specifically the patients with PLN (N = 5484). Patients were excluded who had any pre-op chemotherapy and/or radiation, had follow-up of less than 3 months, had stage IV disease or >1 tumor nodule. Multi-variable modeling(MVA) was used to determine factors for overall survival (OS). Propensity score matching(PSM) was used to determine pre-operative risk factors for PLN in patients having at least one node examined(N=22712) (matched by median number of nodes examined) and to assess the role of radiation in those patients with node positive disease (matched by age, sex, stage, chemotherapy, and number of nodes positive).
4c3880bb027f159e801041b1021e88e8 Result
The incidence of PLN decreased progressively during our study from 17.9% in 2004 to 9.4% in 2014 (N1 8.3-5.0% and N2 9.6-4.4%). A lower risk of PLN was noted for squamous cell carcinomas, bronchoalveolar (minimally invasive) adenocarcinomas, and right upper lobe locations; but the risk increased with age, tumor size and clinical stage. In the node positive group, MVA demonstrated that OS was worse with males, older ages, non-Hispanic Whites (compared to Asian and Hispanic Whites), lowest income quartile, Charlson co-morbidity > 0, grade, tumor size, number of positive nodes, positive surgical margins, length of stay, and not receiving chemotherapy or radiation. PSM demonstrated that radiation increased OS in patients having PLN regardless of margin status or N level involvement.
8eea62084ca7e541d918e823422bd82e Conclusion
The incidence of node positive sub-lobar resections has decreased during the years of our study, but still can be found in nearly 10%. In both MVA and PSM, post-operative radiation improves OS.
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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P3.09 - Pathology (Not CME Accredited Session) (ID 975)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.09-07 - Immunohistochemical Expression of Programmed Death-Ligand 1 in Diabetic Patients vs Non-Diabetics with Non-Small Cell Lung Cancer (ID 14142)
12:00 - 13:30 | Author(s): Rickie P Voland
- Abstract
Background
Immunohistochemical (IHC) expression of programmed death-ligand 1 (PD-L1) serves as a predictive biomarker to select a subgroup of patients who may benefit from immunotherapy. Diabetes mellitus type 2 (DM2) has been shown to be present in approximately 20-25% of lung cancer patients and adversely affects lung cancer outcome. Yet, there are no established studies which investigate potential differences in PD-L1 expression in this group of patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
To investigate expression of PD-L1 in DM2 patients compared to non-DM2 patients, we assembled a retrospective cohort of 79 surgically-resected NSCLC cases (39-adenocarcinoma, 40-squamous cell carcinoma) without previous malignancies or pre-operative radiation. Clinical data were obtained by chart review. Patients with DM2 had Hb1Ac levels of 7.5-7.7. Histologic slides were methodically reviewed. PD-L1 (DAKO 22C3) immunohistochemistry was performed on slides with the maximum amount of viable tumor. Tumor positive score (TPS) was evaluated based on IASLC guidelines as follows: 0: no staining; 1: <1%; 2: 1-49%; and 3: >50%. Immunoreactivity was compared using Chi-square and Fisher’s exact tests.
4c3880bb027f159e801041b1021e88e8 Result
Of the 79 cases of NSCLC, 40 (50.6%) were patients with DM2, and consisted of 20 (50%) adenocarcinoma, and 20 (50%) squamous cell carcinoma. Non-DM2 patients showed a relatively equal TPS distribution from 0 to more than 50%; however, DM2 group largely showed TPS of less than 50% (P=0.0319 Chi-square test); (P=0.0347 Fisher's Exact test); (Table 1). No significant difference was observed between the two groups in terms of overall survival, local recurrence, metastasis, peritumoral inflammation, and necrosis.
8eea62084ca7e541d918e823422bd82e Conclusion
DM2 patients were less likely to have PD-L1 >50%, and therefore they may be less likely to respond to PD-L1 inhibition alone in the adjuvant setting. These findings are in accordance with the literature that supports a worse prognosis, tendency for co-morbidities, and known immunologic defects for DM2 patients with NSCLC.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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P3.16-45 - The Rates and Survival of Surgically-Resected Second Primary Lung Cancers in Patients Undergoing Resection of an Initial Primary Lung Cancer. (ID 13543)
12:00 - 13:30 | Author(s): Rickie P Voland
- Abstract
Background
The Lung Cancer Screening Trial demonstrated improved overall survival (OS) and lung cancer specific survival (LCSS), likely due to finding early-stage non-small cell lung cancer(NSCLC). Patients with a past history of lung cancer were excluded from this trial. The purpose of our investigation is to suggest whether long-term surveillance strategies (4 years after surgical resection of the initial lung cancer(1LC)) would be beneficial in NSCLC patients by assessing the rates of second lung cancers(2LC) and the OS/LCSS in 1LC as compared to 2LCs when treated surgically.
a9ded1e5ce5d75814730bb4caaf49419 Method
The SEER13/18 database was retrospectively reviewed for years 1998-2013. The 1LC population(N=58,758) consisted of all patients with Stage I-III (AJCC 6th) NSCLC undergoing a definitive resection, while the 2LC population (N= 384) consisted of 1LC patients who developed a 2LC > 48 months after 1LC. Log-rank tests were used to determine the OS/LCSS differences between the 1LC and 2LC in the entire surgical group(EG) and in those having an early-stage tumors (ESR, tumors <4cm with no node involvement). Joinpoint analysis was used to assess changes in rates of 2LCs in comparison to all other second cancers after resection of a 1LC.
4c3880bb027f159e801041b1021e88e8 Result
Median follow-up in the 1LC and SLC populations was 76 and 46 months. The rate of 2LCs was significantly less than all other second cancers until 2001 when the incidence of 2LCs increased sharply and became significantly greater than all other second cancers in females starting in year 2005 and in men starting in year 2010. OS/LCSS, adjusted for propensity score by using inverse probability weighting, demonstrated similar OS, but worse LCSS for 2LCs in the EG, but similar OS/LCSSs in the ESR group. Unlike the 1LC group, OS in the 2LC group was not dependent upon T/N stage, age, resection type, and race. OS in the 1LC and 2LC decreased with divorce, positive nodes, and poor differentiation.
8eea62084ca7e541d918e823422bd82e Conclusion
Because the rate of 2LCs are increasing and because the OS/LCSS of the 1LC and 2LC are similar in early-stage lesions, we feel that continued surveillance of patients in order to find early-stage disease may be beneficial.
6f8b794f3246b0c1e1780bb4d4d5dc53
