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Chi-Fu Jeffrey Jeffrey Yang
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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
- Moderators:Seiki Hasegawa, Enrico Ruffini, Angel Artal
- Coordinates: 9/08/2019, 13:30 - 15:00, Melbourne (1991)
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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 | Presenting Author(s): Chi-Fu Jeffrey Jeffrey Yang
- Abstract
- Presentation
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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MA08 - Pawing the Way to Improve Outcomes in Stage III NSCLC (ID 127)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:Simon Ekman, Helena A Yu
- Coordinates: 9/08/2019, 15:15 - 16:45, Tokyo (1982)
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MA08.05 - A Multi-Center Analysis of Right vs Left-Sided Pneumonectomy Following Induction Therapy (Now Available) (ID 1178)
15:15 - 16:45 | Presenting Author(s): Chi-Fu Jeffrey Jeffrey Yang
- Abstract
- Presentation
Background
Previous single-center studies of pneumonectomy following induction therapy for non-small-cell lung cancer (NSCLC) have found a significant perioperative risk associated with right-sided pneumonectomy. We examined the impact of laterality on long-term survival after induction therapy followed by pneumonectomy in a multi-institutional analysis.
Method
Perioperative and long-term outcomes of patients with NSCLC who underwent pneumonectomy following induction chemotherapy with or without radiation from 2000-2016 across 3 institutions were evaluated using multivariable logistic regression, Cox proportional hazards modeling and propensity score-matched analysis. Patients who underwent a completion pneumonectomy or who had M1 disease were excluded from the analysis.
Result
During the study period, 172 patients (right n = 78 [45%], left n = 94 [55%]) met inclusion criteria. Right-sided pneumonectomy was associated with a similar perioperative complication rate (38% [30/78] vs 27% [25/94], p=0.10), and 30-day (13% [10/78] vs 9% [8/94], p=0.36) and 90-day mortality (23% [18/78] vs 13% [12/94], p=0.08) when compared to left-sided pneumonectomy. In multivariable analysis, right-sided pneumonectomy was not found to be a predictor of higher perioperative complications (OR 0.85 [95% CI: 0.33-2.14], p=0.73) or 30-day (OR 2.06 [95% CI: 0.44-9.69], p=0.36) and 90-day mortality (OR 2.06 [95% CI: 0.54-7.88], p=0.29). Overall survival between right and left pneumonectomy was not significantly different in unadjusted (5-year survival 30% [95% CI: 19%-41%] vs 29% [95% CI: 20%-39%], log-rank p=0.77 [Figure]) or multivariable analysis (adjusted hazard ratio, 1.05 [95% CI: 0.63-1.76], p = 0.84). A propensity score-matched analysis of 108 patients balancing baseline characteristics—including pulmonary function, tumor size and stage—was also performed, and found no significant differences in perioperative complication rates (46% [25/54] vs 48% [26/54], p=0.85), 30-day (17% [9/54] vs 7% [4/54], p=0.14) and 90-day mortality (26% [14/54] vs 13% [7/54], p=0.09) between right versus left pneumonectomy, respectively. Overall survival was not significantly different between right- and left-sided pneumonectomy (5-year survival 33% [95% CI: 20%-47%] vs 28% [95% CI: 16%-41%], log-rank p=0.98).
Conclusion
In this multi-center analysis, right-sided pneumonectomy after induction therapy was not associated with significantly higher perioperative mortality rates or worse long-term survival when compared to a left-sided pneumonectomy.
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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): Chi-Fu Jeffrey Jeffrey Yang
- 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
