Author of

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  P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall

  • 27228

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    P2.15-06 - Examination of Optimal Timing of Post-Surgical Surveillance for Early Stage Lung Cancer Patients and Association with Outcomes (ID 13119)

    16:45 - 18:00  |  Author(s): Natalie Lui
    • Abstract

    Background
    

    Guidelines for post-operative surveillance for NSCLC are variable. Historically, surgeons have used a one-size fits all approach, such that surveillance guidelines incorporate few important prognostic indicators for recurrence and survival. Recent NCCN guidelines recommend surveillance CT every 6 months for both stage I and II patients. This is in contrast to the recent IFCT-0302 Trial suggesting that CT scans every 6 months are not useful within the first 2 years following surgery. The goal of this study was to determine optimal timing for detection of recurrence by CT scan and the association between surveillance CT and overall survival.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    This was a retrospective, single institution series of patients undergoing surgical resection (2008-2012) with stage I or II disease (AJCC 7^thedition) with at least 6 months of follow-up. Guideline adherence was defined as receipt of CT every 6 months for the first two years and annually thereafter.

    4c3880bb027f159e801041b1021e88e8 Result
    

    The cohort consisted of 162 patients (80% stage I 20% stage II) with median follow-up 57 months. Recurrence occurred in 27.5% of patients at a median of 29.5 months following surgery. The rate of adherence to guideline recommended surveillance ranged 61%-76.3%with the majority of all CT scans done for surveillance purposes (87%-98%). The percentage of CT scans with suspicious findings was relatively stable over time (30-35%), however, the rate of CT scans with recurrence was variable, peaking at 2-3 years following surgery. For those detected on CT scan, stage I recurrences peaked at 25-36 months whereas stage II peaked at 19-24 months.

    Timing of recurrences differed significantly based on stage with 81% of recurrences occurring > 24 months following surgery for Stage I patients compared to 41% of a Stage II patients. (p<0.01) Overall, higher rates of surveillance CT were associated with a reduced risk of death (HR 0.14 [95% CI 0.06-0.36] p<0.01).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    The majority of CT imaging performed within 5 years following surgery was done for surveillance purposes rather than symptoms. The timing of recurrence differs significantly based on stage such that few stage I patients have recurrences within 2 years following surgical resection. Additionally, rates of recurrence detected by surveillance CT scans performed less than 24 months following surgery is lower for stage I patients.These results should be examined within a larger cohort with longer longitudinal follow-up as timing of CT surveillance based on peak recurrence rates has the potential to eliminate unnecessary testing and expense for healthcare systems.

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