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Rong Lu



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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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      MA06.02 - NSCLC Surgery Outcomes Between Facility Types and Association with Guideline Directed Surgical Quality of Care Metrics  (Now Available) (ID 2245)

      13:30 - 15:00  |  Author(s): Rong Lu

      • Abstract
      • Presentation
      • Slides

      Background

      Non-small cell lung cancer (NSCLC) treatment outcomes differ between facility types. Surgical outcome differences may be related to modifiable factors and likelihood of receiving guideline centered care, which could be improved with new policy initiatives. We therefore analyzed the National Cancer Database (NCDB), to determine the variables related to different outcomes between facility types.

      Method

      The NCDB is a cancer registry curated by the Commission on Cancer that captures demographic and clinical data for an estimated 80% of NSCLC patients in the United States. A retrospective analysis of the NCDB was performed from 2004-2013 for Stage 1, 2 and 3a NSCLC patients treated with surgery. We compared overall survival between academic comprehensive cancer programs (ACAD) and community cancer programs (CCP) and four surgical quality metrics; lobectomy or greater vs sublobectomy, positive vs negative margin status, whether regional lymph node (LN) surgery was performed and number of nodes removed (less that 10 or equal to or greater than 10), in addition to 16 other demographic and clinical variables known to affect NSCLC survival. Kaplan-Meier estimates, log-rank test, multivariate Cox proportional hazard models and propensity score matching were used to evaluate survival differences while adjusting the effects of covariates. Quality of matching was checked using Wilcoxon rank sign test, chi-square test, and multivariate logistic regression models.

      Result

      The total cohort was 75,976 patients. After propensity matching for clinical and demographic variables, median overall survival (OS) for Stage 1, 2 and 3a was 76, 51 and 36 months for ACAD and 67, 43 and 32 months for CCP respectively (p<0.002 for all). Overall, selection of lobectomy or greater was the same between facility types (p=0.645), but ACAD were more likely to have negative margins (92.3% vs 89.8%, p<0.00001), perform LN dissection (89.5% vs 84.3%%, p<0.00001) and remove greater than 10 LN (37.4% vs 23.1%%, p<0.00001). After contrast matching for the surgical quality metrics, OS for Stage 1, 2 and 3a was 73, 49 and 34 months for ACAD and 67, 43 and 32 months at CCP respectively, with a non-significant P value for Stage 3a sub-cohort. Analysis revealed that the four key surgical quality measures explained 38% of the OS difference in median survival (p<0.00001).

      Conclusion

      In this large cohort of Stage 1, 2 and 3a NSCLC patients treated surgically, OS was higher at ACAD compared to CCP, which was in part explained by differences in surgical quality metrics. In the era of discussions of nationalized healthcare, policymakers will need to consider the differential treatment outcomes at different centers and consider consolidating treatment for NSCLC at high performing centers or improving the quality care measures of low performing centers.

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    P1.04 - Immuno-oncology (ID 164)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.04-71 - Tumor Burden Is Not Associated with Efficacy of Immune Checkpoint Inhibitors in Advanced Lung Cancer (ID 2454)

      09:45 - 18:00  |  Author(s): Rong Lu

      • Abstract

      Background

      Tumor bulk has long been cited as an impediment to efficacy of certain immunotherapeutic agents, such as vaccines. However, the association between tumor burden and efficacy of immune checkpoint inhibitors (ICI) is unknown.

      Method

      We prospectively enrolled patients with diverse cancer types treated with immune checkpoint inhibitors on a registry trial. Demographic, disease, and treatment data were collected on patients with advanced non-small lung cancer (NSCLC). Imaging studies (predominantly computed tomography) were reviewed, and tumor dimensions were recorded according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Associations between tumor number and dimensions, and radiographic response, progression-free survival (PFS), and overall survival (OS) were determined using log-rank tests, cox proportional-hazard regression, and logistic regression.

      Result

      Eighty-nine patients treated with ICI (without concurrent or sequential chemotherapy or radiation therapy) were included in the analysis. Median baseline sum of largest diameters (BSLD) was 6 cm; median baseline largest single diameter was 3 cm; median number for both target and non-target lesions was 2. There was no significant difference between cases with BSLD ≤6 cm and >6 cm for response rate (OR=1.06; P=0.94) (Figure 1), PFS (HR 0.99; 95% CI, 0.60-1.64; P=0.97), or OS (HR 0.99; 95% CI, 0.59-1.68; P=0.98) (Figure 2). No significant differences were observed for these endpoints when cases were considered according to largest single diameter, number of target lesions, or number of non-target lesions.wclc -- tumor burden figure 1.jpgwclc -- tumor burden figure 2.jpg

      Conclusion

      Although tumor burden was considered a potential mediator of efficacy of vaccines and other early immunotherapies, it does not appear to impact outcomes from ICI.