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Yu-Sheng Lee



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    MA25 - Oligometastasis: Defining, Treating, and Evaluating (ID 929)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 13:30 - 15:00, Room 203 BD
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      MA25.05 - Characteristics & Survival of Resected Stage IV Non-Small Cell Lung Cancer (NSCLC) in the Mid-South Quality of Surgical Resection Cohort (ID 13381)

      14:00 - 14:05  |  Author(s): Yu-Sheng Lee

      • Abstract
      • Presentation
      • Slides

      Background

      Surgical resection is potentially curative in subsets of oligometastatic NSCLC. We evaluated the characteristics and survival of resected stage IV NSCLC in a population-based cohort.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Patients were included who had curative-intent resections from 11 hospitals in 4 contiguous Dartmouth Hospital Referral Regions in the mid-Southern USA from 2009-2018. Statistical analyses were performed using univariate and multiple Cox regression models.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 3092 resections, 96 (3.1%) were stage IV: 38 M1a, 54 M1b, and 4 M1c. Of the M1a patients, 1 had a pleural effusion, 37 had a contralateral lung nodule. The most common sites of extrathoracic metastasis were bone (13 (13.5%)), and brain (25 (26%)). Other extrathoracic sites were distant lymph nodes, liver, adrenals, thyroid, pancreas, colon, soft tissue, and esophagus.

      Stage IV patients had a younger median age (63 vs 67 (p<0.0001)), less Medicare coverage but more Medicaid or Commercial insurance (p=0.0248), fewer comorbid conditions (p=0.0096), higher cT (p<0.0001), and higher-grade tumors (p=0.0002).

      58% (22) of M1a patients did not receive treatment to the site of metastatic disease, compared to 72% (39) and 75% (3) of M1b and M1c, respectively (p=0.0086).

      For patients with bone metastases, median/5 year survival was 1.28 years/0%, compared to 5.16 years/51% for all other metastatic sites and 6.39 years/56% for non-stage IV NSCLC (p=0.0058) (Figure 1). In fully adjusted models, survival for Stage IV patients without bone metastasis did not differ significantly from Stage I-III patients (HR: 1.3, p=0.15). However, Stage IV patients with bone metastasis had significantly worse survival (HR:3.2, p=0.0006).

      image001.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      Bone metastasis connotes a very poor prognosis in patients with oligometastatic NSCLC, but survival of patients with other sites of metastasis was remarkably good in this highly selected group of patients from a population-based multi-institutional cohort.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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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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      P1.16-46 - A Population-Based Validation Study of the Proposed ‘R-Factor’ Classification in a Lung Cancer-Endemic Region of the US. (ID 13985)

      16:45 - 18:00  |  Author(s): Yu-Sheng Lee

      • Abstract
      • Slides

      Background

      The IASLC has proposed a definition of completeness of surgical resection beyond margin status. We sought to validate the proposed classification in a US cohort, and evaluated the impact of a lymph node (LN) specimen collection kit on resection status.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The population-based Mid-South Quality of Surgical Resection cohort includes >95% of lung cancer resections in 4 contiguous US Dartmouth Hospital Referral Regions from 2009-2018. Resections were classified as Complete (R0), Uncertain (R[un]), or Incomplete (R1-R2) based on the proposed classifications. We evaluated overall survival (OS) using the Kaplan-Meier method and proportional hazards models. Adjusted models included age, sex, histology, extent of resection, pTNM categories, and co-morbidities. A subset of resections used a LN specimen collection kit.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 3,099 resections, 18% were R0, 76% R(un), and 6% R1-R2. 5-year OS was 69%/54%/35% for R0/R(un)/R1-R2 (p<0.0001, Figure 1A). Compared to R0, the increased hazard of death for R(un)/R1-R2 was 1.6/3.0 overall, 1.5/2.3 in node negative patients, 1.7/3.1 in node positive patients, and 1.5/1.9 in fully adjusted models (all p<0.0001).

      Of 2,351 R(un) resections, the highest mediastinal LN positive increased the hazard of death 1.6 times (vs. negative, p=0.0008). However, 626 (27%) had no mediastinal LN examined (MLE). R(un) resections with 0 MLE had 1.2 times the hazard of death compared to R(un) with >1 MLE (p=0.0212, Figure 1B).

      Use of the LN kit intervention resulted in R0 in 40% of cases, compared to 6% without the kit (p<0.0001). Kit cases had improved OS across the entire cohort (p=0.0002), but when restricted to R0 patients, OS did not differ based on kit use (p=0.96).

      figure 1 5-3-18 final.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      The proposed ‘R-factor’ classifications are prognostic. R(un) rates were high, but significantly lower in cases where a LN collection kit was used. Further delineation of R(un) cases based on MLE should be considered.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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