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Cheryl Houston-Harris



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    MA06 - Challenges in the Treatment of Early Stage NSCLC (ID 124)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
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      MA06.01 - Mediastinal Lymph Node Dissection (MLND) v Systematic Sampling (SS) v Neither (NN) in Population-Based Cohort (Now Available) (ID 2974)

      13:30 - 15:00  |  Author(s): Cheryl Houston-Harris

      • Abstract
      • Presentation
      • Slides

      Background

      American College of Surgeons’ Oncology Group (ACOSOG) Z0030 revealed similar survival after MLND v SS for early-stage non-small cell lung cancer (NSCLC), but a recent meta-analysis of 1,980 patients in 5 randomized controlled trials from 1989-2007 suggested superior survival after MLND, raising doubts about Z0030 findings. We compared survival of patients with MLND v SS v NN in a population-based cohort.

      Method

      All resections for NSCLC in all institutions within 4 contiguous United States Hospital Referral Regions from 2009-2018 stratified by ACOSOG Z0030 nodal examination criteria into MLND (stations 2R,4R, 7, 8, 9 and 10R for right-side resections; 4L, 5, 6, 7, 8, 9, and 10L for left-sided), SS (minimum of 4R, 7, and 10R on the right and 5,6,7 and 10L on the left, but MLND definition not met), and NN (neither MLND nor SS ).

      Using appropriate statistical tests, we compared demographic and clinical characteristics, perioperative complication rates and survival, adjusting survival for extent of resection, histology, age, race, sex and insurance.

      Result

      2118 patients met Z0030 eligibility criteria (clinical T1/2,N0/non-hilar N1,M0): 15% had MLND, 15% SS, 69% NN. The distribution of age, race, insurance was similar, but 54% v 51% v 43% of MLND v SS v NN, were female (p=.0002). Use of preoperative PET-CT scans was similar (p=.5797), but invasive staging was used in 21% v 19% v 28% (p<.01), Although the distribution of clinical T,N and aggregate stage was similar (p>.05), 10% of the patients who met neither MLND nor SS criteria had no lymph nodes examined (pathologic NX). The median (interquartile range) number of mediastinal lymph nodes examined was 8(6-12), 5(4-8), 2 (0-5) (p<.001); hilar/intrapulmonary nodes 5(2-9), 6(3-10), 3(1-7) (p<.001). Postoperative complication rates were similar, including rates of cardiac arrhythmia, chylothorax and ICU re-admission. ICU length of stay (LOS) was 1(1-2) days in all groups, hospital LOS was 5(3-7), 5(3-8), 6(4-10) days. The 30-day mortality rate was 4% for all groups. Unadjusted hazard ratio (HR) was 0.80 (0.56-1.10, p=1.664) between MLND and SS; adjusted (a)HR 0.81 (0.58-1.138, p=0.2273). Survival of MLND and SS patients was significantly better than NN (Figure): aHR 0.62(0.48-0.81, p=0.0004) for MLND v NN; aHR 0.76 (0.60-0.98, p=0.0304) for SS v NN.

      figure acosog.png

      Conclusion

      ACOSOG systematic nodal dissection was achievable and safe in a ‘real-world,’ population-based cohort. SS was associated with similar survival to MLND in early-stage NSCLC, corroborating Z0030 findings. However, the majority of resections did not attain either criteria, with significantly worse survival.

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    P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.16-38 - Racial Disparities in Long-Term Survival After Surgical Resection in the US (Now Available) (ID 1968)

      09:45 - 18:00  |  Author(s): Cheryl Houston-Harris

      • Abstract
      • Slides

      Background

      Racial disparities exist in US lung cancer care, including delayed access, lower use of invasive procedures such as curative-intent surgery, and worse surgical outcomes in African-Americans compared to Caucasians. We investigated if racial disparities persist in non-small cell lung cancer (NSCLC) patients who received curative-intent resection in a population-based cohort.

      Method

      We examined all patients from a prospective population-based cohort who underwent curative-intent resections for lung cancer from 12 hospitals across 7 healthcare systems from 2009-2018. We compared overall survival (OS) by race and adjusted for age, sex, smoking status, family history, tumor histology, and clinical stage. We used Chi-square tests, Kaplan-Meier plots, and Cox proportional hazards modeling, reporting unadjusted and adjusted hazard ratios (aHR) with 95% confidence intervals.

      Result

      Of the 3,418 patients, 78% were Caucasian, 22% were African-American; 42% had Medicare,15% Medicaid, 39% commercial insurance, and 3% were uninsured. Caucasians were older (mean age 67.8 vs. 64.1; p=<0.0001). African-Americans were more likely to be active smokers (p=0.0017), have adenocarcinoma histology (p=0.0167), and less likely to be clinical stage I (p=0.0453). Median follow-up time in censored patients was 3.4 years. Overall, we found no differences in OS by race (unadjusted HR: 0.97 [0.88-1.08]; aHR: 0.998 [0.87-1.15]). However, stratified by insurance, we found significant differences (p=0.0251). Among patients with Medicaid insurance, African-Americans had significantly better OS (aHR: 0.73 [0.55-0.97]) than Caucasians but among patients with commercial insurance, African-Americans had significantly worse OS (aHR: 1.26 [1.02-1.57]).

      youmedicaid31_resize.jpg

      youcommercial31_resize.jpg

      Conclusion

      When all patients receive curative-intent surgical resection, racial disparities in NSCLC survival may be reduced, but differences in the impact of race on survival by type of insurance suggest residual and complex disparities in both access and quality of care. Further exploration of the interaction between race, socio-economic factors, and the mechanisms of lung cancer outcome disparities is warranted.

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