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Witold Rzyman
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P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- 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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P2.01-81 - Treatment of Superior Sulcus Tumor: A Twelve-Year Single-Center Experience (ID 14144)
16:45 - 18:00 | Presenting Author(s): Witold Rzyman
- Abstract
Background
Superior sulcus tumor (SST), also known as Pancoast tumor, occurs in up to 5% of all non-small cell lung cancer patients. Owing to its proximity to vital thoracic structures, SST remains one of the biggest challenges of thoracic surgery. The results of the Southwest Oncology Group Trial 9416, in which SST patients were subjected to induction chemoradiation followed by surgical resection, established a widely accepted standard-of-care. Data on the efficacy of this approach outside of clinical trial setting are scarce. We present long-term outcomes in a large group of patients with SST who underwent surgery with or without preoperative treatment (PT) in a single tertiary referral center.
a9ded1e5ce5d75814730bb4caaf49419 Method
Study group included 76 consecutive patients treated between February 2006 and June 2017. All patients had histologically-proven and radiologically-defined T3-T4 N0-N1 M0 superior sulcus non-small cell lung cancer. Study group included 50 men (66%) and 26 women (34%) with a mean age of 56 years (range, 41-81 years). Squamous cell lung cancer constituted 55% of the population.
4c3880bb027f159e801041b1021e88e8 Result
Fifty-four patients (71%) underwent PT, 44 of whom received radiochemotherapy (58%), 4 radiotherapy (5%) and 6 chemotherapy (8%), and 22 (29%) were managed with surgery alone. All patients selected to PT underwent subsequent pulmonary surgery including lung and chest wall en bloc resection, and complete lymphadenectomy. In the entire group 71 lobectomies (93%), 3 segmentectomies (4%) and 2 pneumonectomies (3%) were performed. Surgery in patients managed with PT included 52 lobar resections (96%) and 2 pneumonectomies (4%). Complete or near complete pathologic response following PT was achieved in 67% of operated patients. In the entire group resection was complete (R0) in 62 patients (82%). Overall 30-day and 90-day mortality in the entire treatment group was 2.6% and 6.6%, respectively. Overall 3-year and 5-year survival probabilities were 44% (95% CI: 32%–56%) and 38% (95% CI: 26%–50%) respectively. A non-significantly higher 3-year survival probability was recorded in patients, who underwent PT compared to those managed with surgery alone (50% vs. 36%, respectively; log-rank p=0.27).
8eea62084ca7e541d918e823422bd82e Conclusion
Real-world treatment outcomes in SST patients amenable to surgery are similar to those obtained in the general population of lung cancer patients. PT may increase long-term survival rate and is associated with low perioperative mortality, which justifies its routine application.
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P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)
- 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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P2.11-16 - Comparison of Two Lung Cancer Screening Programs in One Medical Center - Does Experience of the Screening Team and Indications Affect the Results? (ID 12965)
16:45 - 18:00 | Author(s): Witold Rzyman
- Abstract
Background
Onset of lung cancer (LC) screening programs in Europe is expected in near future in form of stepwise process. Yet, several issues need improvement. We compared two screening programs performed in Gdańsk, Poland by one multidisciplinary team in over 14,000 individuals – Pomeranian Pilot Lung Cancer Screening Program (PPP) and Moltest Bis (MB). We assessed how do the indications and learning curve affect results.
a9ded1e5ce5d75814730bb4caaf49419 Method
Between 2009-2011, 8,649 healthy volunteers (aged 50-75, >20 pack-years) were recruited to PPP. Between 2016-2017, 5,534 healthy volunteers (aged 50-79, >30 pack-years) entered MB. Early MB results are presented as it will be closed in May 2018. Positive computed tomography’s (LDCT) result in the first round led to secondary screening. Three rounds of LDCT screening in PPP and two rounds in MB were performed in suspected lung nodules. All positive results were assessed by this same multidisciplinary team.
4c3880bb027f159e801041b1021e88e8 Result
Detection rates of lung nodules requiring follow-up were 34.7% of PPP and 17.6% of MB subjects (p<0.0001). LC was diagnosed in 107 (1.24%) PPP and 105 (1.90%) MB participants (p=0.0016). Three hundred (3.5%) PPP and 199 (3.6%) MB patients were referred for further diagnostic work-up (p=0.6890). Yet, more MB patients were sent for diagnostic work-up after first screening round - 85.9% vs 75.7% in PPP (p=0.0050). Fine needle aspiration biopsy was more often positive among LC subjects in MB (84.7% vs 54.0% in PPP; p=0.0002). Surgical resection was performed in 125 (1.5%) PPP and 80 (1.5%) MB patients (p=0.7385), with 19.2% and 15.0% of futile interventions, respectively. Lobectomies or segmentectomies were performed in 84.0% and 90.0% of LC patients in PPP and MB, respectively (p=0.2160). MB patients more often underwent video-assisted thoracoscopic resections – 73.0% vs 24.0% in PPP (p<0.0001). Complication rates were comparable in both programs – 11.2% in PPP vs 17.1% in MB (p=0.0560). Majority of subjects with non-small cell lung cancer (NSCLC) had stage I or II – 86.4% in PPP and 83.4% in MB (p=0.442). Rate of stage I NSCLC within surgical group was higher in MB (86.0% vs 79.0% in PPP; p<0.001).
8eea62084ca7e541d918e823422bd82e Conclusion
Narrower inclusion criteria (>30 pack-years) and increased upper age limit (79 years) led to higher detection rate and number of operated early stage NSCLC patients. Experience gained in PPP has resulted in reduction of number of nodules requiring follow-up but not reduction of “unnecessary” diagnostic work up and surgical treatment. Minimally invasive surgery was applied significantly more often with broader experience.
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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P3.16-31 - Younger Patients Operated for Lung Cancer Have Better Overall Survival (ID 13891)
12:00 - 13:30 | Author(s): Witold Rzyman
- Abstract
Background
Median age of patients diagnosed with lung cancer is 63 years. Incidence of lung cancer in population of patients younger than 50 years of age is relatively low. The aim of this study was to compare the clinical outcomes of patients with early lung cancer onset (ELCO, onset before the age of 50) and late lung cancer onset (LLCO, onset after the age of 50).
a9ded1e5ce5d75814730bb4caaf49419 Method
We have retrospectively analyzed the prospectively collected data of 1517 patients with Lung cancer treated in a Thoracic Surgery Department in the years 2007-2015. Patients were divided into two groups, group I - 78 patients with ELCO and group II - 1439 patients with LLCO. We have compared overall survival in unmatched and matched population. In order to reduce potential selection bias being a result of different histology and different rate of concomitant diseases we performed a propensity-score matched analysis (based on exact matching – by sex, pTNM, type of operation, pathological diagnosis and Charlson Comorbidity Index). The latter analysis was performed in 65 ELCO patients with 453 LLCO patients.
4c3880bb027f159e801041b1021e88e8 Result
In the unmatched population we found no differences in gender, pTNM and type of surgery performed. Younger patients were also more likely to have typical carcinoid (23.1% vs 2.6%, p<0.05, OR 11.06 95%CI 5.695-21.360) and mucoepidermoid tumours (2.6% vs 0.3%, p<0.05, OR 7.547 95%CI 0.997-44.708), whereas the older patients were more likely to have squamous cell lung carcinoma (39.7% vs 23.1%, p<0.05, OR 0.455 95%CI 0.256-0.799). Older patients were more likely to be smokers (82% vs 59%, p<0.05 OR 0.316, 95%CI 0.192-0.519). Median Charlson Comorbidity Index in younger population was 0 and in the older population was 1 (p<0.05). Five-year survival in EOLC group was 71.9% vs. 58.7% in LLCO (p=0.008).
The propensity score-matched analysis with exact method, comparing sex, pTNM, type of operation, pathological diagnosis and Charlson Comorbidity Index, showed that younger patients had better survival rates compared to older patients (p<0.001 HR=0.559, 95%CI 0.360-0.865). Five-year survival in patients with ELCO was 77.6% comparing to 61.5% in LLCO patients (p=0.011).
8eea62084ca7e541d918e823422bd82e Conclusion
Patients with early lung cancer onset have higher five-year survival after surgical treatment compared to patients with late lung cancer onset irrespectively of histology.
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