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Adam N Sholi
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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
- Moderators:Florentino Hernando-Trancho, Ayten Kayi Cangir
- Coordinates: 9/08/2019, 13:30 - 15:00, Colorado Springs (1994)
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MA06.03 - Poor Pulmonary Function Does Not Define “Medical Inoperability”: Short and Long Term Results of a Matched Lung Cancer Cohort (Now Available) (ID 2846)
13:30 - 15:00 | Author(s): Adam N Sholi
- Abstract
- Presentation
Background
Patients with suboptimal pulmonary function tests (PFTs) are often denied surgery for NSCLC. However, there is no consensus definition of compromised lung function. This study compared morbidity and survival following surgery in patients with preoperative %predicted FEV1or DLCO <50% (Low-Group) versus those with both values >50%(High-Group).
Method
A prospectively-maintained database was reviewed for patients undergoing surgery for NSCLC between 1990–2019. Propensity matching (1:2) was performed based on age, gender, histology, pathologic stage, and comorbidity index. Overall survival (OS) was estimated using Kaplan-Meier analysis and multivariable analysis identified predictors of survival.
Result
Among 2982 patients with PFT data, 372(12.5%) had FEV1or DLCO <50%. We matched 321 patients with FEV1or DLCO <50% to 637 patients with both PFTs >50%. No significant differences were observed in perioperative complications(Table) or 30-day mortality between Low and High groups (0.3% vs. 0.6%, p=0.668). The Low group more frequently underwent sublobar resection (41% vs. 22%, p<0.001). Median follow-up was 41 months, and median, 3-, and 5-year OS for the Low and High groups was 118 vs.148 months, 79% vs. 82%, and 70% vs. 74%, respectively (p=0.003). Patients with both FEV1and DLCO <50% (n=44) had a median survival of 109 months and 3- and 5-year OS of 77% and 71%. Multivariable analysis identified advanced age (HR=1.03, CI 1.01–1.05), higher clinical stage (HR=1.85, CI 1.22–2.82), and earlier year of surgery (HR=1.06, CI 1.01–1.12) as predictors of poor survival, but not FEV1or DLCO <50% (p=0.672). Among the Low group only, advanced age (HR=1.05, CI 1.02–1.07) and sublobar resection (HR=1.60, CI 1.04–2.45) predicted worse OS.
Conclusion
Patients with decreased lung function have comparable perioperative outcomes to patients with normal lung function and experience excellent long-term survival. “Medical inoperability” should therefore be determined by surgeons and not by pulmonary function alone.
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P1.12 - Small Cell Lung Cancer/NET (ID 179)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.12-02 - Nationwide Assessment of the Role of Adjuvant Systemic Therapy in High-Risk Lung Carcinoids (Now Available) (ID 2745)
09:45 - 18:00 | Author(s): Adam N Sholi
- Abstract
Background
Carcinoid tumors are often considered indolent tumors. However, a subset of patients develop recurrence after resection, and some even develop disseminated disease. To date, little data exists regarding the role of adjuvant therapy in high-risk carcinoid patients. We sought to assess whether adjuvant systemic therapy provides survival benefit for patients with these tumors.
Method
The National Cancer Database was queried for patients undergoing resection for carcinoids (2004–2014). Adjusted mortality hazard ratios (aHR) (adjusted for age, gender and stage) were estimated for typical vs. atypical carcinoids and also for node negative vs. node positive atypical carcinoids. Patients with node positive atypical carcinoids were divided into two groups; adjuvant chemotherapy vs. no adjuvant chemotherapy. Balance between the two groups was obtained by propensity matching (controlling for age, gender, comorbidity, pStage, and number of positive nodes).
Result
21820 patients had carcinoid tumors (19560 typical, and 2260 atypical). Carcinoids had a lower mortality (aHR 0.35, CI:0.31-0.39) compared to adenocarcinoma (reference) and squamous cell carcinoma (aHR 1.17, CI:1.14-1.20). Among patients with carcinoid tumors, atypical carcinoids had higher mortality compared to typical carcinoids (aHR 2.16 CI:1.55-3). Among atypical carcinoids only, those with node positive disease had worse survival (aHR 2.42 CI:1.63-3.58). Patients with atypical carcinoids who had lymph node positive disease were propensity matched (1:1, caliper 0.1, n=250) to those who received adjuvant chemotherapy and those who had no adjuvant therapy (Table). There was no difference in 5-year survival between the two groups (67% vs 62%, P=0.67).
Conclusion
Patients with node positive, atypical carcinoid tumors, have a significantly reduced survival compared to other carcinoid patients. However, adjuvant therapy did not confer an improvement in outcome. Novel adjuvant treatments are required for these higher risk patients.
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P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-06 - Trends and Outcomes of Minimally Invasive Approaches for Lung Cancer Resection After Induction Therapy in the United States (Now Available) (ID 2793)
10:15 - 18:15 | Author(s): Adam N Sholi
- Abstract
Background
Lung resection following induction-therapy (IT) is technically challenging. To date, a paucity of national data exists on the feasibility of minimally invasive surgical (MIS) approaches in this setting. We assessed national trends and outcomes associated with MIS following IT, compared to open approach.
Method
The National Cancer Database was queried for NSCLC patients undergoing resection following IT (2010-2016). Trends in MIS utilization were assessed using Mantel-Haenszel test. Propensity-matching (MIS vs. open) was performed (1:1-Caliper 0.2), controlling for age, gender, comorbidity, clinical stage, and histology. Perioperative outcomes and survival were compared between the matched groups.
Result
Lung resection following IT was performed in 11287 patients. The utilization of MIS approaches increased from 19% in 2010 to 41% in 2016 (Mantel-Haenszel, P<0.001). The number of hospitals performing at least one MIS increased from 166 in 2010 to 305 in 2016. Compared to the traditional open approach, MIS approaches were used more frequently in patients with higher annual-income (>$63000, 37%vs.33%,P<0.001), and in patients treated in academic hospitals (54%vs.47%,P<0.001). The open approach was used more in males (54%vs.49%, P<0001), and in patients with larger tumor size (4.4cm vs. 3.8cm, P<0.001)(Table).
In propensity-matched groups, there were no differences in 30-day readmission (3% vs. 4%,P=0.513), or 30-/90-day mortality between the two approaches (3%vs.4%,P=0.145; 6%vs.7%,P=0.685). However, MIS was associated with a shorter median length of stay (5vs.6 days,P<0.001). 5-year overall survival (OS) was slightly better in the open group (45% vs.39%,P=0.002). However, on multivariable analysis, surgical approach was not associated with OS (open approach: HR:0.99, 95%CI:0.91-1.09).
Conclusion
National use of minimally-invasive surgery following induction therapy increased significantly over the study period. The current study shows that using MIS after induction therapy is feasible and safe, and is associated with a shorter hospital stay compared to open approach, yet without compromising perioperative outcomes or survival.
