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Paula Antonia Ugalde
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WS04 - Staging Workshop Part 1: IASLC Database Challenges and Application (ID 105)
- Event: WCLC 2019
- Type: Workshop
- Track: Staging
- Presentations: 6
- Now Available
- Moderators:Paula Antonia Ugalde, Maria Teresa Tsukazan
- Coordinates: 9/09/2019, 14:00 - 15:30, San Francisco (2009)
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WS04.01 - Challenges of Data Entry in IASLC Database (Now Available) (ID 3678)
14:00 - 15:30 | Presenting Author(s): Brigitte Fournier
- Abstract
- Presentation
Abstract
Challenges of data entry in IASLC Database
Session :
Staging Workshop Part 1: IASLC Database Challenges and Application
Our experience with the registry of the patients at IUCPQ- University Laval QuebecFrom 2015, IASLC submitted to the Union for International Cancer ControI (UICC) & to the American Joint Committee on Cancer (AJCC) recommendations for the 8th Edition for the Staging of Lung Cancer. Those recommendations issued from a retrospective data collection of patients (94,708) diagnosed with lung cancer around the world between 1999 and 2010 were accepted by UICC and AJCC in 2017.1-2-3 Since the Staging and Prognostic Factors Committee of IASLC has entered in the next phase of the project designed to inform the 9th forthcoming TNM edition. Volunteer site participants were invited to submit data on patients diagnosed with lung cancer between January 1, 2011, and December 31, 2019.4
IUCPQ has officially started the collaboration to the Lung Cancer Staging Project in June 2018. So far, we have entered over 1 000 patients in the database. Accesses to Patients’ Medical Chart and to the Electronic Data Base (EDB) are the main tools used to participate to this project. Our growing experience at IUCPQ with IASLC database demonstrates that a strategy to access medical charts, a multidisciplinary team work and constant review of the data are key points to ensure the quality of the data collection. This presentation will describe our experience with the registry of the patients in the Electronic Data Capture system.
1 Rami-Porta, R., Bolejack, V., Crowley, J., Ball, D., Kim, J., Lyons, G. et al. (2015).The IASLC Lung Cancer Staging Project Proposals for Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. Journal of Thoracic Oncology Vol. 10 No.990-1003
http://DOI:10.1097/JTO.00000000000005592 Goldstraw, P., Chansky, K., Crowley, J., Rami-Porta,R., Asamura, H., Eberhardt, E.E., et al.(2015). The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. Journal of Thoracic Oncology Vol.11 No. 1:39-51. http://dx.doi.org/10.1016/j.jtho.2015.09.000
3 Detterbeck, F.C., Francklin,W.,A., Nicholson,A.G., Girard,N., Arenberg,D.,A., Travis, W.D., et al. (2016). The IASLC Lung Cancer Staging Project: Background Data and Proposed Criteria to Distinguish Separate Primary Lung Cancer from Metastatic Foci in Patients with Two Lung Tumors in the Forthcoming Eighth Edition of the TNM Classification fir Lung Cancer. Journal of Thoracic Oncology Vol 11 No.5:651-665
http://dx.doi.org/10.1016/j.tho.2016.01.0254 Giroux, J.,Van Schil, P., Asamura, H., Rami-Porta, R., Chansky, K., Crowley et al. (2018). The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. Journal of Thoracic Oncology Vol.13 No. 6:801-809. https://doi.org/10.1016/j.jtho.2018.02.012
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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WS04.02 - Challenges in Imaging Evaluation to Enter Data in the IASLC Database (Now Available) (ID 3679)
14:00 - 15:30 | Presenting Author(s): Helmut Prosch
- Abstract
- Presentation
Abstract
Soon after the publication of the proposals for the 8thedition of the TNM staging system, the International Association for the Study of Lung Cancer (IASLC) opened a new database for data collection for the next iteration of the lung cancer staging system (1).
The database contains more than 450 fields, which address data on patient characteristics, baseline laboratory values, as well as the results of pulmonary function, imaging, and pathological tests. As the database collects the data about lung cancer newly diagnosed between January 1, 2011, and December 31, 2019, the data entered might be predominantly retrospectively collected in some centers.
From an imaging perspective, this might lead to a number of problems. First, at least some of the elements required by the database might not be mentioned in the radiological reports. This may necessitate a re-evaluation of the imaging studies by an experienced radiologist, which might not be possible in all centers. Furthermore, the levels of training of the radiologists and reporting across different countries may be variable and thus introduce some degree of imprecision into the quality of the data.
As an example, in T staging, particular attention has to be paid to thorough measurements to ensure that the largest diameter in the axial, coronal, or sagittal plane is measured (2). Caution should also be taken not to overdiagnose additional pulmonary nodules as metastases. In N staging, particular attention has to be paid to the lymph node atlas-mining, particularly the well-known pitfall in the correct assignment of lymph nodes at levels 4 and 10 (3-5).
Furthermore, the quality of imaging and the availability of more advanced/expensive imaging techniques may also vary from country to country. As an example, the availabilities of PET/CT and/or MRI are not homogenous all over the globe. However, if PET/CT is not performed routinely in operable patients, as many as 20% of unexpected distant metastases might be missed (6).
Future staging projects should specifically address these issues in order to further improve the the quality of data necessary to improve the next iteration of the staging system.
1. Giroux DJ, Van Schil P, Asamura H, Rami-Porta R, Chansky K, Crowley JJ, et al. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. J Thorac Oncol. 2018;13(6):801-9.
2. Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al. The IASLC Lung Cancer Staging Project: Proposals for Coding T Categories for Subsolid Nodules and Assessment of Tumor Size in Part-Solid Tumors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol. 2016.
3. El-Sherief AH, Lau CT, Obuchowski NA, Mehta AC, Rice TW, Blackstone EH. Cross-Disciplinary Analysis of Lymph Node Classification in Lung Cancer on CT Scanning. Chest. 2017;151(4):776-85.
4. El-Sherief AH, Lau CT, Wu CC, Drake RL, Abbott GF, Rice TW. International association for the study of lung cancer (IASLC) lymph node map: radiologic review with CT illustration. Radiographics. 2014;34(6):1680-91.
5. Aviram G, Revel MP. Misclassification of Lymph Nodes in Lung Cancer Staging: Can We Improve? Chest. 2017;151(4):733-4.
6. Fischer B, Lassen U, Mortensen J, Larsen S, Loft A, Bertelsen A, et al. Preoperative Staging of Lung Cancer with Combined PET-CT. N Engl J Med. 2009;361(1):32-9.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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WS04.03 - How to Adjust Pathology Evaluation According to IASLC Database (Now Available) (ID 3680)
14:00 - 15:30 | Presenting Author(s): Philippe Joubert
- Abstract
- Presentation
Abstract
How to Adjust Pathology Evaluation According to IASLC Database
In 2016 the 8th edition of the TNM by the International Association for the Study of Lung Cancer (IASLC) refined the definition of early-stage lung cancer by further subdividing the T1 and T2 descriptors according to 1 cm size cut-offs. In addition, in nonmucinous adenocarcinoma (AC) with a lepidic component only the size of the invasive component defines the T descriptor rather than the total size of the lesion. These modifications not only led to a better prognostication of surgical adenocarcinoma patients, but they also emphasize the importance to accurately assess (grossly and microscopically) and report the histological patterns of adenocarcinoma. In addition, although the number of metastatic lymph nodes was not integrated in the N descriptor, its relevance has been demonstrated and will be addressed in the upcoming edition.
The purpose of this presentation is to review the key elements of a pathology report when evaluating a pulmonary carcinoma, and to discuss the challenges encountered in pathology for the development of the upcoming edition of the TNM.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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WS04.04 - Institutional Benefits of Adherence to IASLC Database (Now Available) (ID 3681)
14:00 - 15:30 | Presenting Author(s): Catherine Labbe
- Abstract
- Presentation
Abstract
The International Association for the Study of Lung Cancer (IASLC) Lung Cancer Staging Project, through an electronic data capture system, is a global effort to study and improve the current and future lung cancer staging system. In 2016, the 8thedition of the TNM was developed with the participation of 35 centres from 16 countries. In 2018, the Heart and Lung Institute in Quebec City, Canada, started to collect and send data for the upcoming 9thedition of the TNM classification.
The purpose of this presentation is to review and discuss the potential institutional benefits of adherence to the IASLC electronic database, namely the comprehension by all participating centers of the role and the importance of the database, the organization of an interdisciplinary group to ensure that the entire clinical pathway of lung cancer patients is evidence-based, the standardisation of radiology and pathology reports, and the improvement in rates of lobe-specific systematic nodal dissection for all lung resections.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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WS04.05 - Developing the IASLC Lung Cancer Staging Database and Recommendations for the 9th Edition (Now Available) (ID 3682)
14:00 - 15:30 | Presenting Author(s): Dorothy Jane Giroux | Author(s): Hisao Asamura, Paula Antonia Ugalde
- Abstract
- Presentation
Abstract
Developing the IASLC lung cancer staging database and recommendations for the 9th edition
Background
Since the turn of the century, the international database of the IASLC Staging Project has served as the foundation for evidence-based recommendations for revisions to the TNM classification system for lung cancer. These recommendations were adopted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), establishing the IASLC Staging Project as a global resource for lung cancer staging research. The project is currently midway through its third iteration of data collection, which was begun in 2017 and includes lung cancer cases diagnosed from 2011 through 2019, with follow-up for survival through 2021. The preferred mechanism for data collection is direct, online entry into a central database administered by Cancer Research and Biostatistics (CRAB) in Seattle, Washington.
Discussion
The data fields in the lung cancer database are extensive, having been revised in 20171 by the IASLC Staging and Prognostic Factors Committee (SPFC) to address specific research questions framed by each of its 15 subcommittees, such as the impact of direct extension into specific anatomic sites on survival, the relative effects of location vs size of involved nodes, or the importance of the size of distant metastases relative to the number of lesions and distant sites. The committee will consider the prognostic value of these anatomic parameters independently and in the context of non-anatomic factors such as sex, comorbidity, laboratory values that correlate with survival, or molecular markers. Existing institutional databases and large registries have traditionally been used to supplement the data contributed using the online system; however, these external sources rarely contain sufficient detail to address all of the committee’s stated objectives.2
The SPFC is chaired by Hisao Asamura, MD, and has separate subcommittees for T, N, M, ground glass opacities and adenocarcinoma in situ, neuroendocrine tumors, stage groupings, lymph node chart, validation and methodology, prognostic factors, R factor (completeness of resection), radiology and imaging, multiple pulmonary nodules, molecular markers, and data quality, as well as a steering committee that provides oversight. SPFC members are expected to demonstrate leadership and promote participation in the project, as well as develop and evaluate proposals for change. The current SPFC membership reflects the diverse geographic representation in the database used to support the most recent (8th edition) recommendations.
As of 5 June 2019, over 3,000 patients from 14 countries have been enrolled directly in the online system. Larger databases designed to be compatible with the project have also been transferred from Japan and the United States.
In the newly redesigned IASLC web site (www.iaslc.org), new participants can sign up online to contribute data by choosing the IASLC Staging Project page under the Research & Education heading. Following the publication of the core recommendations for the 9th edition of TNM, the web site may also be used to submit research proposals for secondary use of the data. Secondary use may be restricted according to agreements with individual sites in some cases. All proposals will be reviewed by the steering committee according to published guidelines.3
Conclusion
In the context of shifting paradigms and rapid advancements in treatments, diagnostics, and molecular technologies, the SPFC is tasked with evaluating and improving TNM staging on a global scale. To this end, we aim to engage a wide variety of research partners and to increase participation in previously underrepresented regions such as Egypt and India, where the first sites from each of these countries have recently been recruited. The collection of a large and comprehensive database will be pivotal to the SPFC’s ability to provide data-informed, universally applicable, and balanced recommendations that will be used world-wide by physicians, researchers, and patients. As we continue to prepare for upcoming analysis of the 9th edition database, the IASLC membership is encouraged to participate through the contribution of data and engagement with the SPFC and its mission. This global effort to improve the TNM staging criteria presents a unique opportunity to collaborate in international public health research.
References
Giroux DJ, Schil PV, Asamura H, et al. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. J Thorac Oncol 2018;13:801-809.
Rami-Porta R, Bolejack V, Giroux D, et al. The IASLC Lung Cancer Staging Project: The New Database to Inform the Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2014;9:1618-1624.
Goldstraw P, Rami-Porta, R, and Crowley J. We Probably Have the Answer: Now What is the Question? J Thorac Oncol 2009;4:939-940.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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WS04.06 - Case Discussion (Now Available) (ID 3683)
14:00 - 15:30 | Presenting Author(s): Paula Antonia Ugalde
- Abstract
- Presentation
Abstract
In this presentation we will present how we access a Patient Medical Record to include a case in the IASLC database. Through a precise strategy we collect patient's data and include in the Electronic Data Base.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
Author of
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OA10 - Sophisticated TNM Staging System for Lung Cancer (ID 136)
- Event: WCLC 2019
- Type: Oral Session
- Track: Staging
- Presentations: 1
- Now Available
- Moderators:Ke-Neng Chen, Pedro Lopez De Castro
- Coordinates: 9/09/2019, 14:00 - 15:30, Toronto (1985)
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OA10.09 - Clifton F. Mountain Lectureship Award for Staging (Now Available) (ID 3900)
14:00 - 15:30 | Presenting Author(s): Paula Antonia Ugalde
- Abstract
- Presentation
Abstract not provided
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.18 - Treatment of Locoregional Disease - NSCLC (ID 190)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.18-17 - Survival After Adjuvant Chemotherapy in Completely Resected N1 Non-Small Cell Lung Cancer (Now Available) (ID 368)
09:45 - 18:00 | Author(s): Paula Antonia Ugalde
- Abstract
Background
Upfront surgery is the standard of care for patients with clinical stage I or II non-small cell lung cancer (NSCLC), but the relapse rate remains high, and 5-year survival is unsatisfactory. Randomized controlled trials, including the International Adjuvant Lung Cancer trial published in 2014, showed that adjuvant chemotherapy (ACT) after surgery increased overall survival at 5 years. However, ACT is seldom well tolerated, and often patients do not complete treatment. The goal of this study was to analyze the effects of adjuvant therapy in patients with N1 disease to better understand the effectiveness of ACT in a real-world surgery series.
Method
This is a retrospective study from a prospectively maintained database at our institution. Patient with NSCLC were included in the study if they underwent surgery with complete resection (R0) from January 2006 to December 2017 and had pathological N1 NSCLC.
Result
We identified 207 patients with pN1 NSCLC; their mean age was 64.5 ± 8.9 years. Most (71.2%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 0. Eight patients (3.9%) were never-smokers. Over 50% of the patients had a video-assisted thoracoscopic surgery (VATS) lobectomy. Mean tumor size was 31.6 ± 15.4 mm, and most tumors (70.5%) were adenocarcinomas. Although 139 patients (65.7%) underwent ACT using the BR.10 chemotherapy regimen, only 59 patients (42.4%) completed all cycles of the treatment. Five years after surgery, overall survival was 55±4%, and disease-free survival was 39.3±4%. There was no statistically significant difference in disease-free survival between the patients who received ACT and those who did not (median 4.0 vs 2.8 years, hazard ratio [HR] = 0.74 (95% confidence interval, 0.49, 1.11), p = 0.1463), but there was a trend toward improved overall survival in patients who underwent ACT (median 8.6 vs 5.0 years, HR = 0.66 (0.41, 1.05), p = 0.0763). (Figure 1)
Conclusion
Adjuvant chemotherapy was completed in only 42% of patients in this single-center, retrospective study. No statistically significant differences in disease-free survival or overall survival as a result of ACT were observed, likely a result of the small cohort. This study highlights the difficulties patients encounter in completing ACT, and the need for alternative ACT regimens to improve survival in patients with pN1 NSCLC after surgery.
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WS04 - Staging Workshop Part 1: IASLC Database Challenges and Application (ID 105)
- Event: WCLC 2019
- Type: Workshop
- Track: Staging
- Presentations: 2
- Now Available
- Moderators:Paula Antonia Ugalde, Maria Teresa Tsukazan
- Coordinates: 9/09/2019, 14:00 - 15:30, San Francisco (2009)
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WS04.05 - Developing the IASLC Lung Cancer Staging Database and Recommendations for the 9th Edition (Now Available) (ID 3682)
14:00 - 15:30 | Author(s): Paula Antonia Ugalde
- Abstract
- Presentation
Abstract
Developing the IASLC lung cancer staging database and recommendations for the 9th edition
Background
Since the turn of the century, the international database of the IASLC Staging Project has served as the foundation for evidence-based recommendations for revisions to the TNM classification system for lung cancer. These recommendations were adopted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), establishing the IASLC Staging Project as a global resource for lung cancer staging research. The project is currently midway through its third iteration of data collection, which was begun in 2017 and includes lung cancer cases diagnosed from 2011 through 2019, with follow-up for survival through 2021. The preferred mechanism for data collection is direct, online entry into a central database administered by Cancer Research and Biostatistics (CRAB) in Seattle, Washington.
Discussion
The data fields in the lung cancer database are extensive, having been revised in 20171 by the IASLC Staging and Prognostic Factors Committee (SPFC) to address specific research questions framed by each of its 15 subcommittees, such as the impact of direct extension into specific anatomic sites on survival, the relative effects of location vs size of involved nodes, or the importance of the size of distant metastases relative to the number of lesions and distant sites. The committee will consider the prognostic value of these anatomic parameters independently and in the context of non-anatomic factors such as sex, comorbidity, laboratory values that correlate with survival, or molecular markers. Existing institutional databases and large registries have traditionally been used to supplement the data contributed using the online system; however, these external sources rarely contain sufficient detail to address all of the committee’s stated objectives.2
The SPFC is chaired by Hisao Asamura, MD, and has separate subcommittees for T, N, M, ground glass opacities and adenocarcinoma in situ, neuroendocrine tumors, stage groupings, lymph node chart, validation and methodology, prognostic factors, R factor (completeness of resection), radiology and imaging, multiple pulmonary nodules, molecular markers, and data quality, as well as a steering committee that provides oversight. SPFC members are expected to demonstrate leadership and promote participation in the project, as well as develop and evaluate proposals for change. The current SPFC membership reflects the diverse geographic representation in the database used to support the most recent (8th edition) recommendations.
As of 5 June 2019, over 3,000 patients from 14 countries have been enrolled directly in the online system. Larger databases designed to be compatible with the project have also been transferred from Japan and the United States.
In the newly redesigned IASLC web site (www.iaslc.org), new participants can sign up online to contribute data by choosing the IASLC Staging Project page under the Research & Education heading. Following the publication of the core recommendations for the 9th edition of TNM, the web site may also be used to submit research proposals for secondary use of the data. Secondary use may be restricted according to agreements with individual sites in some cases. All proposals will be reviewed by the steering committee according to published guidelines.3
Conclusion
In the context of shifting paradigms and rapid advancements in treatments, diagnostics, and molecular technologies, the SPFC is tasked with evaluating and improving TNM staging on a global scale. To this end, we aim to engage a wide variety of research partners and to increase participation in previously underrepresented regions such as Egypt and India, where the first sites from each of these countries have recently been recruited. The collection of a large and comprehensive database will be pivotal to the SPFC’s ability to provide data-informed, universally applicable, and balanced recommendations that will be used world-wide by physicians, researchers, and patients. As we continue to prepare for upcoming analysis of the 9th edition database, the IASLC membership is encouraged to participate through the contribution of data and engagement with the SPFC and its mission. This global effort to improve the TNM staging criteria presents a unique opportunity to collaborate in international public health research.
References
Giroux DJ, Schil PV, Asamura H, et al. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. J Thorac Oncol 2018;13:801-809.
Rami-Porta R, Bolejack V, Giroux D, et al. The IASLC Lung Cancer Staging Project: The New Database to Inform the Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2014;9:1618-1624.
Goldstraw P, Rami-Porta, R, and Crowley J. We Probably Have the Answer: Now What is the Question? J Thorac Oncol 2009;4:939-940.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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WS04.06 - Case Discussion (Now Available) (ID 3683)
14:00 - 15:30 | Presenting Author(s): Paula Antonia Ugalde
- Abstract
- Presentation
Abstract
In this presentation we will present how we access a Patient Medical Record to include a case in the IASLC database. Through a precise strategy we collect patient's data and include in the Electronic Data Base.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
