Author of

• 25953

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  P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)

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

  • 27281

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    P2.16-26 - Lung Cancer Resection in Patients with Criteria for Lung Cancer Screening Provides Satisfactory Short Term Results (ID 12788)

    16:45 - 18:00  |  Author(s): Sophie Guinard
    • Abstract

    Background
    

    Criteria for lung cancer screening (LCS) include age 55-74 years old, a smoking history ≥ 30 pack-years with < 15 years smoking cessation. The lack of data regarding the operative risk for lung cancer resection (LCR) in patients with LCS criteria is a limit for national reimbursement of LCS in France. We aimed to determine whether the operative risk for LCR is increased in patients with LCS criteria.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We performed a retrospective analysis of consecutive LCR operated between October 2015 and October 2016 in a high volume tertiary center with routine minimally invasive thoracic surgery (videothoracoscopy). Among 241 patients who underwent a LCR, the study population were the 169 patients aged 55-74 years old. We compared the perioperative characteristics of patients with and without LCS criteria.

    4c3880bb027f159e801041b1021e88e8 Result
    

    LCS criteria were present in 92 patients out of 169. Preoperative and operative/postoperative data were reported in Tables 1 and 2, respectively. Despite an increased preoperative cardiovascular risk and a poorer respiratory function, patients with LCS criteria presented a similar postoperative morbidity, mortality and hospital readmission compared with patients without LCS criteria.

    Table 1: preoperative characteristics of patient aged 55-74 years old undergoing lung cancer resection. Comparison between patients with and without lung cancer screening (LCS) criteria. M: male; F: female; BMI: body mass index; CV: cardiovascular; EA: endarterectomy; ENT: ear nose and throat; NLR: neutrophil to lymphocyte ratio; CRP: C-reactive protein; FEV1: forced expiratory volume in 1 second. Quantitative data are expressed as mean ± standard deviation; qualitative data are expressed as n and %.

    All (n=169) With LCS criteria (n=92) Without LCS criteria (n=77) P Age (years) 64.7 ± 5.1 64.1 ± 4.5 65.4 ± 5.6 NS Sex (M/F) 100 / 69 65 / 27 35 / 42 0.002 BMI (kg/m2) 25.0 ± 4.8 24.3 ± 4.3 26.0 ± 5.2 0.023 Smoke habit Pack years 35.3 ± 22.0 48.0 ± 15.6 16.7 ± 15.7 <0.0001 CV events history 47 (27.8%) 34 (37.0%) 13 (16.9%) 0.006 Cardiac event 31 (18.3%) 22 (23.9%) 9 (11.7%) NS PAD 18 (10.7%) 15 (16.3%) 3 (3.9%) 0.019 Carotid EA 4 (2.4%) 4 (4.3%) 1 (1.3%) NS stroke 11 (6.5%) 5 (5.4%) 6 (7.8%) NS Aortic surgery 10 (5.9%) 8 (8.7%) 2 (2.6%) NS Cancer history 60 (35.5%) 35 (38.0%) 25 (32.5%) NS ENT 14 (8.3%) 12 (13.0%) 2 (2.6%) 0.022 Bladder 8 (4.7%) 8 (8.7%) 0 (0%) 0.008 Digestive tract 8 (4.7%) 4 (4.3%) 4 (5.2%) NS Breast 5 (3.0%) 2 (2.2%) 3 (3.9%) NS Lung 9 (5.3%) 4 (4.3%) 5 (6.5%) NS Other 25 (14.8%) 14 (15.2%) 11 (14.3%) NS Inflammation NLR 3.25 ± 2.27 3.41 ± 1.74 3.05 ± 2.78 NS CRP > 10 32 (18.9%) 20 (21.7%) 12 (15.6%) NS FEV1 87.5 ± 19.9 83.1 ± 20.4 92.9 ± 17.9 0.001

    Table 2: postoperative characteristics of patient aged 55-74 years old undergoing lung cancer resection. SSC: squamous cell carcinoma. Quantitative data are expressed as mean ± standard deviation but when specified; qualitative data are expressed as n and %.

    All (n=169) With LCS criteria (n=92) Without LCS criteria (n=77) P Infra lobar resection 19 (11.2%) 13 (14.1%) 6 (7.8%) NS Wedge resection 14 9 5 segmentectomy 5 4 1 Minimally invasive 13 9 4 Lobectomy 130 (76.9%) 72 (78.3%) 58 (75.3%) Minimally invasive 79 46 34 Bilobectomy 8 (4.7%) 1 (1.1%) 7 (9.1%) Totalisation pneumonectomy 2 (1.2%) 1 (1.1%) 1 (1.3%) Pneumonectomy 10 (5.9%) 5 (5.4%) 5 (6.5%) Pathology NS adenocarcinoma 113 (66.9%) 63 (68.5%) 50 (64.9%) SCC 38 (22.5%) 23 (25.0%) 15 (19.5%) others 18 (10.1%) 6 (6.5%) 12 (15.6%) Stage NS Stage I 85 (50.3%) 44 (47.8%) 41 (53.2%) Stage II 38 (22.5%) 25 (27.2%) 13 (16.9%) Stage III 41 (22.3%) 20 (21.7%) 21 (27.3%) Stage IV 5 (3.0%) 3 (3.3%) 2 (2.6%) 30-day Morbidity No morbidity 84 (49.7%) 42 (45.7%) 42 (54.5%) NS Medically treated 49 (29.0%) 28 (30.4%) 21 (27.3%) Clavien-Dindo I 1 1 0 Clavien-Dindo II 48 27 21 Requiring intervention 15 (8.9%) 14 (15.2%) 11 (14.1%) Clavien-Dindo IIIa 16 7 9 Clavien-Dindo IIIb 9 7 2 Requiring ICU 11 (6.5%) 8 (8.7%) 3 (3.9%) Clavien-Dindo IVa 8 6 2 Clavien-Dindo IVb 3 2 1 30 –days mortality 0 (0%) 0 (0%) 0 (0%) Clavien-Dindo V 0 0 0 Hospital stay duration (days) median (IQR) 7 (5 ; 11) 7 (5 ; 11) 6 (5 ; 10) NS 90-days hospital re-admission 4 (2.4%) 2 (2.2%) 2 (2.6%) NS

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    LCS program would allow us to achieve similar operative outcomes than patients without LCS criteria despite poorer respiratory function and increased cardiovascular risk.

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