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Ajita Naik



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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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      MA06.03 - 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): Ajita Naik

      • Abstract
      • Presentation
      • Slides

      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.

      pfttable.png

      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): Ajita Naik

      • Abstract
      • Slides

      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).

      carcinoidtable.png

      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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