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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)
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): Abu Nasar
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.
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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