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Thomas K. Varghese
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
- Coordinates: 9/26/2018, 10:30 - 12:00, Room 105
MA23.07 - Defining the Role of Adjuvant Therapy for Early Stage Large Cell Neuroendocrine Lung Cancer (ID 12814)
11:10 - 11:15 | Author(s): Thomas K. Varghese
Large cell neuroendocrine lung cancer (LC-NEC) is a rare, high-grade neuroendocrine tumor. Patterns of adjuvant treatment after surgical resection have not been well defined.a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with a pathologic diagnosis of LC-NEC were identified in the National Cancer Database 2004-2014. Patient demographics, tumor and treatment characteristics were examined. Survival differences in patients receiving chemotherapy were evaluated using Kaplan-Meier curves, and multivariate hierarchical Cox models were constructed to evaluate the impact of patient, histologic, tumor, treatment and hospital characteristics on overall survival (OS). A conditional landmark of 90-day postoperative survival was used to address immortal time bias and propensity-matching was used to address imbalance in covariates between groups.4c3880bb027f159e801041b1021e88e8 Result
1,793 patients were identified with pathologically stage I LC-NEC, of which 482 (26.9%) received adjuvant chemotherapy. Use of adjuvant chemotherapy remained similar across the study period. Patients receiving adjuvant chemo were younger, less comorbid and more likely to have T2 tumors. Significantly longer survival was observed with the receipt of adjuvant chemotherapy (5-year OS 59.2% vs. 45.3%), which persisted after adjustment in multivariable Cox models (HR 0.69, 95%CI0.58 – 0.82, p<0.0001). Adjuvant chemotherapy was associated with longer survival in patients with tumors 2-3cm (60.4% vs. 41.8%; HR 0.64, 95%CI 0.46-0.89, p<0.0001), and T2 tumors (59.8% vs. 42.1%; HR 0.63, 95%CI 0.50-0.81, p<0.0001), but no differences were observed for LC-NEC patients with tumor size <2cm. Adjuvant chest radiotherapy was not associated with improved survival. T-stage specific propensity-matching confirmed these findings, however the association between survival and adjuvant chemotherapy for patients with tumors 2-3cm was no longer significant.
In this national study of LC-NEC, adjuvant chemotherapy was associated with significantly longer survival in Stage I tumors greater than 2cm. Adjuvant radiation was not associated with survival. A randomized trial of stage T2-4N0 LCNEC is needed to clarify the role of adjuvant chemotherapy in this population.6f8b794f3246b0c1e1780bb4d4d5dc53
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