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Vignesh Raman



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    MA05 - Update on Clinical Trials and Treatments (ID 123)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Mesothelioma
    • Presentations: 1
    • Now Available
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      MA05.03 - Impact of Time to Surgery on Outcomes in Patients Undergoing Outright Resection for Malignant Pleural Mesothelioma (Now Available) (ID 648)

      13:30 - 15:00  |  Author(s): Vignesh Raman

      • Abstract
      • Presentation
      • Slides

      Background

      We hypothesized that a longer interval to surgery would be associated with worse overall survival for patients with malignant pleural mesothelioma (MPM).

      Method

      The National Cancer Database (NCDB) for patients with cT1-3N0-1M0 MPM who underwent surgery without induction therapy. Patients with interval of <1 or >180 days were excluded. Patients were grouped into quartiles based on distribution of time intervals to surgery: Q1 (1-30 days), Q2 (31-50 days), Q3 (51-80 days), and Q4 (>80 days). The primary outcome was overall survival. Secondary outcomes were upstaging to pN2 and margin-positive (>R0) resection rate. Survival was estimated using the Kaplan-Meier and Cox Proportional Hazards methods. Nodal upstaging and >R0 resection rates were modeled with multivariable logistic regression.

      Result

      A total of 812 patients met study criteria. The median interval from diagnosis to surgery was 52 days. The unadjusted median survival for Q1, 2, 3, and 4 was 16, 19, 20, and 27 months, respectively (log-rank p=0.004). In multivariable analysis, increased time to surgery was not associated with worse overall survival (Table 1), and Q4 (>80 days) was independently associated with improved survival compared to Q1. When modeled as a continuous variable, an increased time to surgery was associated with a small but clinically insignificant increase in survival (AHR 0.997; 95%CI 0.995-0.999; p=0.005). In a multivariable regression of factors predicting pathologic upstaging to N2, increased time to surgery was significantly associated with upstaging (adjusted odds ratio [AOR] for Q4 compared to Q1: 2.26; 95%CI 1.04-5.28). In a separate regression of >R0 resection, an increased interval to surgery was not associated with margin-positive resection (AOR 0.70; 95%CI 0.41-1.21).

      Conclusion

      An increasing interval from diagnosis to definitive surgery for MPM was not associated with worse overall survival or margin-positive resection, but was associated with higher likelihood of pathologic nodal upstaging in this analysis.

      Variable

      Adjusted HR

      95% CI

      P value

      Interval (ref:Q1)

      Q2

      Q3

      Q4

      1.07

      0.96

      0.74

      0.84-1.36

      0.76-1.22

      0.58-0.95

      0.61

      0.75

      0.02

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    P2.06 - Mesothelioma (ID 170)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Mesothelioma
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.06-03 - Timing of Surgery After Induction Therapy for Malignant Pleural Mesothelioma: A National Analysis  (ID 649)

      10:15 - 18:15  |  Author(s): Vignesh Raman

      • Abstract

      Background

      The safe window to offer surgery following induction chemotherapy for malignant pleural mesothelioma (MPM) is unknown.

      Method

      The National Cancer Database (NCDB) was queried for patients with cT1-3N0-1M0 MPM undergoing induction chemotherapy followed by definitive surgery. Patients with induction radiation, missing survival data, and time to surgery <1 or >180 days were excluded. Patients were stratified into quartiles based on time from chemotherapy to surgery: Q1 (<85 days), Q2 (85-100 days), Q3 (101-120 days), and Q4 (>120 days). The primary outcome was overall survival, and secondary outcomes were pN2 disease and margin-positive (>R0) resection. Survival was modeled with Kaplan-Meier and Cox Proportional Hazards, and upstaging and >R0 resection with multivariable logistic regression.

      Result

      A total of 205 patients were included, with a median time from induction therapy to surgery of 104 days. There was no difference in unadjusted median survival between the groups: 23 (Q1), 25 (Q2), 25 (Q3), and 20 (Q4) months (log-rank p=0.92). In multivariable regression, increasing time to surgery was not associated with survival examined by quartile (Table) or as a continuous variable (adjusted hazard ratio [AHR] 1.00; 95% confidence interval [CI] 0.99-1.01). Increasing time to surgery was also not associated with increased pathologic upstaging to N2 (adjusted odds ratio [AOR] for Q4 vs. Q1: 1.22; 95%CI 0.33-4.65). In a multivariable regression, increased time from chemotherapy to surgery was not associated with >R0 resection (AOR 0.81; 95%CI 0.23-2.87 for Q4 vs. Q1).

      Conclusion

      Increased time from induction therapy to surgery for MPM was not associated with worse survival, nodal upstaging, or margin-positive resection in this study. Patients with MPM can be safely offered surgery even three months after induction chemotherapy.

      Variable

      Adjusted HR

      95% CI

      P value

      Interval (ref:Q1)

      Q2

      Q3

      Q4

      0.83

      0.92

      1.08

      0.49-1.40

      0.55-1.53

      0.61-1.92

      0.49

      0.74

      0.79