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  P1.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 949)

  • 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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    P1.17-18 - Treatment for Patients with T4 Superior Sulcus Non-Small Cell Lung Cancer: A Propensity-Matched Analysis of SEER Database (ID 12319)

    16:45 - 18:00  |  Author(s): Donglai Chen
    • Abstract
    • Slides

    Background
    

    Superior sulcus tumors (SSTs), a unique subgroup of locally advanced non–small-cell lung carcinoma (NSCLC), remain a great challenge for clinicians. T4 SSTs used to be a contraindication for operations, and the optimal treatment modality for T4 SS NSCLCs remains uncertain. The aim of our study is to evaluate the roles of surgical treatment and radiotherapy for patients with T4 SSTs.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We used the SEER database [1973-2015] to identify patients diagnosed with T4 stage SS NSCLC (according to 7th edition AJCC staging system) between 2004 and 2015, those with M1 disease were excluded. Propensity score matching with Kaplan-Meier and Cox proportional hazards model were performed to estimate prognosis.

    4c3880bb027f159e801041b1021e88e8 Result
    

    A total of 384 patients were included (mean 66.4±11.71 years-of-age). Among them, the majority was male (59.4%) with lesions located in the left lung (52.3%) and diagnosed with IIIB stage (56.6%). 47 patients underwent cancer-directed surgery, and radiotherapy was received by 66.9% of patients. Median overall survival (OS) and lung cancer specific survival (LCSS) was 12 and 17 months, and 5-year OS, LCSS was 15.8%, 25.4%, respectively. In the matched population, the median survival outcomes were better with receipt of surgery (OS: 51.3 vs 35.1 months; p=0.049 LCSS: 67.1 vs 36.3 months; p=0.003). Multivariate Cox analysis showed that age ≧ 66 years (hazard ratio [HR] = 1.639, 95% confidence interval [CI] 1.214-2.213, p=0.001), unmarried status (HR = 1.356, 95% CI 1.023-1.798, p=0.034), tumor sized ≧ 6.0 cm (HR = 1.694, 95% CI 1.263-2.273, p<0.001) were associated with inferior OS. Cancer-directed surgery (HR = 0.537, 95% CI 0.337-0.855, p=0.009) and radiotherapy (HR = 0.644, 95% CI 0.472-0.878, p=0.006) were independent protective factors for patients with T4 superior sulcus NSCLC. However, neither adjuvant nor neoadjuvant radiotherapy was independent prognostic factor for those received surgery (p>0.05). Conversely, in the subgroup analysis, favorable impacts of radiotherapy were observed for non-surgery patients (OS: HR = 0.58, 95% CI 0.42-0.79, p<0.001; LCSS: HR = 0.55, 95% CI 0.37-0.75, p<0.001).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Our study shows superior sulcus NSCLC patients with T4 stage have dismal prognosis. Surgical resection remains the optimal option for those with resectable disease. Moreover, for non-surgery tumors, the use of radiotherapy should be considered.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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