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Florentino Hernando-Trancho

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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: 12
    • 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  |  Presenting Author(s): Meredith Ray  |  Author(s): Nicholas Faris, Carrie Fehnel, Cheryl Houston-Harris, Olawale Akinbobola, Philip Ojeabulu, Matthew P Smeltzer, Ray Osarogiagbon

      • 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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      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  |  Presenting Author(s): David E. Gerber  |  Author(s): Mitchell Von Itzstein, Rong Lu, Yang Xie

      • 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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      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  |  Presenting Author(s): Brendon M Stiles  |  Author(s): Adam N Sholi, Mohamed K Kamel, Abu Nasar, Ajita Naik, Sebron Harrison, Benjamin Lee, Jeffrey L Port, Nasser K Altorki

      • 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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      MA06.04 - Discussant - MA06.01, MA06.02, MA06.03 (Now Available) (ID 3736)

      13:30 - 15:00  |  Presenting Author(s): Daniel J Boffa

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MA06.05 - Predictive Performance of Quantitative Metabolic Metrics of FDG-PET/CT on Survival and the Effect of Adjuvant Chemotherapy in Lung Cancer (Now Available) (ID 1294)

      13:30 - 15:00  |  Presenting Author(s): Yojiro Makino  |  Author(s): Yoshihisa Shimada, Sachio Maehara, Hagiwara Masaru, Masatoshi Kakihana, Naohiro Kajiwara, Tatsuo Ohira, Norihiko Ikeda

      • Abstract
      • Presentation
      • Slides

      Background

      Growing evidence suggests metabolic metrics of tumors, maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on FDG-PET/CT, reflect the malignancy of early-staged lung cancer. We aimed to investigate the role of metabolic metrics in predicting prognosis and response to adjuvant chemotherapy in pathological stage I (the 7th Edition of TNM Staging of Lung Cancer) lung adenocarcinoma (p-I Ad).

      Method

      The study included 452 patients with p-I Ad who underwent FDG-PET/CT followed by complete resection between July 2012 and December 2017. In this study, MTV is defined as the total tumor volume with an SUV > 2.5 while TLG is calculated as mean of SUV x MTV. The three metabolic metrics measured by a three-dimensional workstation and clinico-pathological factors were analyzed to identify the factors associated with unfavorable overall survival (OS) and recurrence-free survival (RFS). We assessed whether the metabolic metrics were associated with response to oral adjuvant chemotherapy with uracil-tegafur (AC with UFT) in patients with p-I Ad amenable to the treatment.

      Result

      All the three metabolic metrics were significantly correlated with unfavorable OS and RFS on univariate analyses (SUVmax; p=0.047 / p<0.001, MTV2.5; p=0.003 / p<0.001, TLG2.5; p=0.005 / p<0.001). On multivariate analyses, smoking status (p=0.043), the value of serum CEA (p < 0.001), and SUVmax (p=0.001) were independent determinants for poorer RFS while gender (p=0.013) and MTV2.5 (p=0.028) were independent significant factors for unfavorable OS. The receiver operating characteristic areas under the curves for SUVmax, MTV2.5, and TLG2.5 relevant to recurrence were 0.901, 0.849, and 0.872, respectively. Among 239 patients who fitted the criteria of AC with UFT (p-IA > 2cm or p-IB), 80 patients (33.4%) received the treatment (250 mg of tegafur per square meter of body-surface area per day). Although the administration of AC with UFT did not significantly affect RFS and OS (p=0.411 and 0.753), patients with TLG2.5 > 12.8, which value corresponded to the cut-off level, who were not given AC with UFT exhibited worse RFS than those who received the treatment (5-year RFS rate of 72.1% vs. 92.7%; p=0.041).figure.png

      Conclusion

      Metabolic metrics on FDG-PET/CT such as SUVmax, MTV, and TLG enable us to estimate survival outcomes and the effectiveness of AC with UFT in patients with p-I Ad. Patients with metabolically active tumors should be considered high risk, and this information can be useful for the selection of appropriate therapeutic strategy including AC with UFT.

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      MA06.06 - A Phase III Study of Adjuvant Chemotherapy in Patients with Completely Resected, Node-Negative Non-Small Cell Lung Cancer  (Now Available) (ID 285)

      13:30 - 15:00  |  Presenting Author(s): Hideo Kunitoh  |  Author(s): Hiroyuki Sakurai, Masahiro Tsuboi, Masashi Wakabayashi, Morihito Okada, Kenji Suzuki, Norihiko Ikeda, Makoto Takahama, Mitsuhiro Takenoyama, Yasuhisa Ohde, Katsuo Yoshiya, Isao Matsumoto, Motohiro Yamashita, Takashi Marutsuka, Hiroshi Date, Toru Hasumi, Yoshinori Yamashita, Norihito Okumura, Shun-ichi Watanabe, Hisao Asamura

      • Abstract
      • Presentation
      • Slides

      Background

      Post-operative UFT (tegafur/uracil) has been shown to prolong survival of Japanese patients with completely resected, p-stage I (T1> 2 cm) non-small cell lung cancer (NSCLC). This trial, the Japan Clinical Oncology Group (JCOG) 0707, aimed at estimating the efficacy of S-1 (tegafur/gimeracil/oteracil) compared to UFT as adjuvant therapy in this population.

      Method

      Eligible patients had received complete resection with lymph node dissection for p-stage I (T1-2N0M0, T1> 2 cm, by 5thEdition UICC TNM) NSCLC, within 56 days of enrollment. Patients were randomized to receive: oral UFT 250mg/m2/day for 2 years (Arm A), or oral S-1 80mg/m2/day for 2 weeks and 1 week rest, for 1 year (Arm B). The initial primary endpoint was overall survival (OS). Based upon the monitoring in Jun. 2013, which showed the combined OS of the 2 arms better than expected (4-year OS of 91.6% vs. presumed 5-year OS of 70-76.5%), it was judged to be underpowered. The study protocol was amended so that the primary endpoint is relapse-free survival (RFS). With the calculated sample size of 960, this study would detect the superiority of Arm B over Arm A with power 80% and one-sided type I error of 0.05, assuming the 5-year RFS of 75% in Arm A and the hazard ratio of 0.75.

      Result

      From Nov. 2008 to Dec. 2013, 963 patients were enrolled (Arm A : 482, Arm B : 481): median age 66 (range: 33 to 80), male 58%, adenocarcinoma 80%, p-T1/T2 46%/54%. Only 2 received pneumonectomy. >Grade 3 toxicities (hematologic/nonhematologic) were observed in 15.9 (1.5/14.7) % in Arm A, and in 14.9 (3.6/12.1) % in Arm B, respectively. 60.0% of the patients in Arm A and 54.7% of them in Arm B completed the protocol treatment (p=0.10). There were 4 cases of deaths during protocol treatment, probably of cardio-vascular origin, with 1 in Arm A and 3 in Arm B. At the data cut-off of Dec. 2018, the hazard ratio (HR, Arm B vs. Arm A) of RFS was 1.06 (95% confidence interval (C.I.): 0.82-1.36), showing no superiority of S-1 over UFT. The HR of OS was 1.10 (95% C.I.: 0.81-1.50). The 5-year RFS/OS rates were 79.4%/88.8% in Arm A and 79.5%/89.7% in Arm B, respectively. Pre-specified subset analyses for gender, age, smoking, stage, tumor side, lymph node dissection area, pleural invasion and histology revealed no remarkable results; S-1 arm was not superior to UFT arm in each analysis. Of the 77 and 85 OS events for Arm A/Arm B, 45 each (58%/53%, respectively) were due to the NSCLC. During the follow-up period, secondary malignancy was observed in 85 (17.8%) and 84 (17.8%) in Arm A and Arm B, respectively.

      Conclusion

      Post-operative adjuvant therapy with oral S-1 was not superior to that with UFT in stage I (T>2 cm) NSCLC after complete resection. UFT remains standard in this population. Future investigation should incorporate identification of high-risk population for recurrence, since survival of each arm was so good with substantial number of OS events due to other causes of deaths in this trial.

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      MA06.07 - E1505: Adjuvant Chemotherapy +/- Bevacizumab for Early Stage NSCLC: Updated Chemotherapy Subset Analysis (Now Available) (ID 2885)

      13:30 - 15:00  |  Presenting Author(s): Heather A Wakelee  |  Author(s): Suzanne E Dahlberg, Steven M Keller, William J Tester, Seena C Aisner, Jan M. Rothman, Jyoti D Patel, Robert Delaune, Sean R McDermott, Atif Shafqat, Roman Perez-Soler, Andrew E Chapman, Samer S Kasbari, Anne M Traynor, Tracey L Evans, Leora Horn, Stephen L Graziano, David R Gandara, Alex A Adjei, Charles A Butts, Natasha B Leighl, Suresh S Ramalingam, Joan H Schiller

      • Abstract
      • Presentation
      • Slides

      Background

      Adjuvant chemotherapy (chemo) for resected early stage NSCLC provides modest survival benefit with limited comparison data between regimens. From this trial we previously reported that adding bevacizumab (B) to adjuvant chemo failed to improve either disease free survival (DFS) or overall survival (OS). Here we update outcomes by chemotherapy regimen with an additional 30 months of follow-up.

      Method

      Enrolled patients with resected early stage NSCLC, stratified by stage, histology, sex, and chemo option, were randomized 1:1 to chemo alone or with B (15 mg/kg every 3 weeks for up to 1 year). Chemo consisted of a planned 4 cycles of every 3 week cisplatin with either vinorelbine (V), docetaxel (D), gemcitabine (G) or pemetrexed (P).

      Result

      From July 2007 to September 2013, 1501 patients were enrolled with this distribution of chemo: V 25.0%, D 22.9%, G 18.9% and P 33.2%. P was added in 2009 and restricted to non-squamous (NSq) pts. Chemo regimen was chosen (not randomized). Arms were well balanced for known prognostic factors; 28% had Sq histology. Median f/up per chemo group is: V 83.5 months(m); D 89.9m; G 87.8m; P 71.9m. In pooled analysis DFS differed by histology ranging from 29.9m(G)-43.5m(V) for NSq and 59.4m(V)-77.3m(G) for Sq. OS also differed by histology ranging from 80m(D)-98.8m(P) for NSq and 98m(G)-119m(V) for Sq. A non-significant decline in both DFS and OS was seen when B was added to D or V regimens, regardless of histology. Conversely, the addition of B to P improved both DFS (HR 0.74, p= .00994) and OS (HR 0.65, p= .00368). We thus compared outcomes across non-B regimens and though numerical differences were seen in median DFS and OS, these failed to reach statistical significance. Toxicity details were presented previously.

      Conclusion

      B did not improve OS when added to adjuvant chemo for patients with surgically resected early stage NSCLC, though variable DFS and OS outcomes by chemotherapy regimen have emerged with longer-term follow-up. These include a significant positive improvement in DFS and OS with B combined with P and trends of worse outcomes when B was added to other regimens. Ongoing molecular analysis of samples will hopefully elucidate the etiology of these differences.

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      MA06.08 - Discussant - MA06.05, MA06.06, MA06.07 (Now Available) (ID 3737)

      13:30 - 15:00  |  Presenting Author(s): Jordi Remon

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MA06.09 - Timing of Driver Mutation Development and the Genetic Evolution of Semi-Solid Lung Nodules into Early NSCLC (Now Available) (ID 2980)

      13:30 - 15:00  |  Presenting Author(s): Gavitt A Woodard  |  Author(s): Vivianne Ding, Il-Jin Kim, Kirk Jones, Gordon Chavez, Greg Haro, Johannes Kratz, Michael J. Mann, Julia Rotow, Collin M Blakely, David M Jablons

      • Abstract
      • Presentation
      • Slides

      Background

      The genetic changes that drive the appearance of a ground glass opacity and subsequent development of an invasive solid component within a semi-solid lesion (SSL) are not well understood. Biomarkers that predict the transition to invasive cancer are needed to determine when ground glass lesions will evolve into invasive cancer.

      Method

      From a prospective database 65 patients with surgically resected SSL between 2011-2018 were identified. Clinical characteristics and disease free survival was compared between SSL and 155 stage I adenocarcinomas resected during the same time period. Paraffin tissue blocks were obtained from 22 of the SSL and areas of normal lung (NL) ground glass (GG) and solid (S) tumor were identified and microdissected separately from within the same lesion. Next generation sequencing (NGS) was performed on DNA extracted from 19 nineteen matched GG and S samples on twenty-five common lung cancer driver mutations. Affymetrix microarray of over 48,000 transcripts was performed on S, GG, and NL samples from eight patients with SSL.

      Result

      No patients with a resected SSL has recurred to date with significant differences in 5-year disease free survival verses stage I adenocarcinomas from the same time period (100% vs 80.9%, log-rank p-value 0.007). Driver mutations in the solid component of SSL were EGFR mutation (43%; L858R 26% and exon 19 deletion 11%), KRAS mutation (21%), and no mutation identified (42%). All driver mutations present in S component of SSL were also identified in GG regions of the same lesion with very similar gene expression profiles. Only 32 transcripts were significantly different between GG and S areas of the same tumor. The greatest difference observed between GG and S portions of the same tumor was significantly higher expression of secreted phosphoprotein 1 (SPP1) in the invasive solid portion suggesting that SPP1 may serve as a biomarker of invasive potential.

      Conclusion

      This is the first study to examine the systems genetics of mutations and gene expression from the microenvironments of solid and ground glass areas within the same tumor. Mutations are present in the ground glass portion of a semi-solid tumor suggesting early development of driver mutations. Increased expression of SPP1 emerged as the most promising biomarker of invasive potential of a semi-solid lesion. In other studies SPP1 has been shown to correlate with poor prognosis and is a biomarker that warrants further study.

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      MA06.10 - Stereotactic Ablative Radiotherapy in the Management of Synchronous Early Stage Non-Small Cell Lung Cancers (Now Available) (ID 1924)

      13:30 - 15:00  |  Presenting Author(s): Zeina Ayoub  |  Author(s): Eric D Brooks, James W Welsh, Aileen Chen, Saumil Gandhi, John Victor Heymach, Ara A Vaporciyan, Joe Y Chang

      • Abstract
      • Presentation
      • Slides

      Background

      The aim of the study is to evaluate the efficacy and patterns of failure of early stage synchronous non-small cell lung cancer (NSCLC) treated with stereotactic ablative radiotherapy (SABR).

      Method

      Patients with synchronous NSCLC who received SABR (50 grays in 4 fractions or 70 grays in 10 fractions) to at least one lesion were reviewed. Synchronous lesions were defined as multiple ipsilateral or contralateral intrapulmonary lesions diagnosed within 6 months.

      Result

      Out of a total of 912 patients treated with SABR for early stage NSCLC between 2005 and 2015, 82 (9%) had synchronous disease. The median age was 70 years and 34 (41.5 %) patients were males. The median diameter was 2.1 cm (Interquartile range (IQR) 1.6-3 cm) for index lesions and 1.5 cm (IQR 1.1-2.2 cm) for second lesions. At a median follow-up time of 58 months, the 1, 3 and 5-year progression-free survival (PFS) rates were 85.4%, 47.3% and 28.5%, respectively; the corresponding overall survival rates were 95.1%, 66.9% and 52.4% and the 1, 3 and 5-year local recurrence (LR)-free survival rates were 97.3%, 79.6% and 70.8%, respectively. Among the 39 (47.6%) patients with disease progression, intralobal LR was the first site of failure in 15 (18.3%) patients, with a total of 19 local recurrences out of 169 (11.2%) thoracic lesions. Isolated regional recurrence occurred in 3 (3.7%) patients, and distant failure in 221 (25.6%) patients. On multivariate analysis, factors associated with improved PFS were an improved ECOG PS score (HR 10.786; 95% CI 2.845-40.902; p-value <0.001), DLCO (HR 0.947; 95% CI 0.903-0.994; p-value 0.026) and an index lesion pathology of adenocarcinoma (HR 0.167; 95% CI 0.033-0.841; p-value 0.030). Only the ECOG PS score maintained significance (HR 6.165; 95% CI 2.081-18.263; p-value 0.001) on multivariate analysis for OS. No association was found between the use of chemotherapy as part of the initial management strategy and survival outcomes. Similarly, no difference in outcomes was observed whether all lesions were treated with SABR compared to SABR and other modalities.

      Conclusion

      SABR achieves promising long-term survival and tumor control rates and may be a potential curative treatment for synchronous early stage NSCLC. Our data indicates that patients presenting with synchronous NSCLC lesions can be approached as having two separate primary lung tumors, and be offered definitive local therapy with aims of cure.

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      MA06.12 - Discussant - MA06.09, MA06.10, MA06.11 (Now Available) (ID 3738)

      13:30 - 15:00  |  Presenting Author(s): Samina Park

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MA06.13 - Tsuguo Naruke Lectureship Award for Surgery (Now Available) (ID 3901)

      13:30 - 15:00  |  Presenting Author(s): Raja Flores

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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Author of

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    EP1.03 - Biology (ID 193)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Biology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.03-21 - Circulating Tumor Cells Isolation Is Not a Useful Prognostic Tool for Non-Small Cell Lung Cancer Patients Candidates to Surgical Treatment (ID 1271)

      08:00 - 18:00  |  Author(s): Florentino Hernando-Trancho

      • Abstract
      • Slides

      Background

      It is well known that prognostic stratification according to TNM classification of non-small cell lung cancer (NSCLC) patients is somehow imprecise as there exist notable differences among patients endorsed in the same staging. Because of this it is mandatory to find complementary tools to reach a more accurate classification in order to the best selection of treatments for every patient. The presence of circulating tumor cells (CTC) in periferic blood samples has showed worse prognosis in other primary tumors. The aim of this study is analyzing the impact of CTC on disease free survival (DFS) and overall survival (OS).

      Method

      Periferic blood samples from 28 patients diagnosed with NSCLC in early stages candidates for surgical treatment were obtained. Study period was from June 2011 to October 2013. Blood samples were obtained at least at three different moments: before surgery (S1), one year after the operation (S2) and the last one 2 years after the operation (S3). Blood samples were analyzed by CellSearch method.

      Probability of survival was calculated following the Kaplan-Meier method; differences in survival were examined by the Long-Rank test.

      Result

      Median OS was 34 months and DFS was 11 months. There was no statistically significant differences among patients with or without CTC in S1, S2 and/or S3. When CTC were present, no relationship was observed between the variations in the number of CTCs among the different blood samples and the OS and DFS.

      Conclusion

      In our study, the presence of CTCs in any of the blood samples obtained during the follow-up showed no relationship with OS and DFS. The same results were observed in relation to variations of CTCs' count.

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    EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)

    • Event: WCLC 2019
    • Type: E-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, 08:00 - 18:00, Exhibit Hall
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      EP1.16-08 - Behobiamediopulmon: Putting Face and Running Shoes on Patients with Lung Cancer (Now Available) (ID 765)

      08:00 - 18:00  |  Author(s): Florentino Hernando-Trancho

      • Abstract
      • Slides

      Background

      As lung cancer is one of the most lethal in Europe, it has little presence in the media and social networks. To change this dynamic, a campaign to support lung cancer patients using the hashtag #behobiamediopulmon was planned, where the final event was the participation of patients with lung cancer in the most famous half-marathon in Spain: Behobia-San Sebastián.

      Method

      Joining forces between the Spanish Association of Lung Cancer Victims (AEACAP), the organization of the Behobia-San Sebastian and the local government of Gipuzkoa; And with the support of the main scientific societies that treat this pathology (SECT: Spanish Society of Thoracic Surgery, SEPAR: Spanish Society of Pneumology and Thoracic Surgery, SEOM: Spanish Society of Medical Oncology and SEOR: Spanish Society of Radiation Theraphy), it was decided to carry out a campaign of visibility of lung cancer patients.

      Result

      During 2018 different actions were carried out: solidary running training (300 participants), children´s race (180 children), charity market, online sale of shirts, creation of a specific song (the protagonists of the videoclip were four patients), production of a documentary-film about lung cancer (presented at a round table with the participation of the daughter of Johan Cruyff). Broadcast of the videoclip in the football matches that Real Sociedad and SD Eibar played at home until the day of the race. In the Behobia-San Sebastian, 3 patients operated on for lung cancer at Donostia Universitary Hospital runned accompanied by 300 people (among them stand out soccer players like Xabi Prieto and Xabi Alonso; musicians of La Oreja de Van Gogh, the journalist Juan-Ramon Lucas or Susila Cruyff).

      Impact achieved: 3 different national newscast spoke about #behobiamediopulmon, 10 times in regional newscast, 18 radio interviews and 14 newspaper interviews. In YouTube 800,000 reproductions of the song “Sólo si lo hacemos juntos”, 1300 reproductions of the documentary-film #datupaso, Instagram profile (@behobiamediopulmon) with 1000 followers, Prize to the charitable cause with the highest collection in the Behobia-San Sebastian 5000€, solidarity training fund 6600€.

      Conclusion

      By joining forces it is possible to perform an action that provides visibility to patients with lung cancer. Joining sport and health, we are able to create a very positive message that reaches to the newly diagnosticated patients, inspiring confidence and life expectancy. The race represents the metaphor of their situation, where patients try to reach the goal, with their ups and downs along the way, accompanied by family, friends and health personnel.

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    MA08 - Pawing the Way to Improve Outcomes in Stage III NSCLC (ID 127)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
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      MA08.11 - SLCG SCAT Trial: Surgical Audit to Lymph Node Assessment Based on IASLC Recommendations (Now Available) (ID 2252)

      15:15 - 16:45  |  Author(s): Florentino Hernando-Trancho

      • Abstract
      • Presentation
      • Slides

      Background

      The Spanish Lung Cancer Group (SLCG) developed a multicenter trial in which completely resected pathological N positive NSCLC patients received different schemes of adjuvance based on level of tumoral BRCA expression (SCAT trial). We assess here surgical topics, with an in-depth analysis of quality of lymphadenectomy based on IASLC recommendations, evaluating their effect on survival.

      Method

      Phase-III SLCG-SCAT trial included patients with completely resected (R0) NSCLC with pathological hilar and/or ipsilateral mediastinal lymph node (LN) involvement. Patients from SLCG-SCAT trial in which complete pathologic report with information about mediastinal lymph node dissection was available (including number of lymph nodes assessed and involved by tumor in each hilar and mediastinal region), were included for our study. We also analyzed data about estimated overall survival (OS) and disease-free survival (DFS). All patients underwent surgical resection in high-volume departments of thoracic surgery.

      Result

      Lymph node assessment

      From the whole series (451 patients), in 33.7%, 17.7% and 49.9% of cases, regions 7, 10 and 11 respectively were not assessed. No lymph nodes were biopsied from region 8, 9 and 12 in 80%, 61.9% and 91.1% of cases, respectively. Region 10 was that with the higher number of lymph nodes resected (medium 4.64). From them, 27.9% were involved by tumor. Median assessed mediastinal regions was 4. In 21.1% of patients, lymph nodes from only one or two regions were obtained. In most of the patients (91.8%), one or two N1 regions were assessed. From 272 patients with N1 (no N2) involvement, 15.4% had no N2 regions biopsied, 20.2% had one N2 region evaluated and only 39.7% had three or more N2 regions assessed. On the other hand, from 179 patients with positive N2, 8.9% had no N1 regions biopsied and 54.7% had one. From 409 patients with at least one N2 lymph node resected, 120 (29.3%) shown the highest region involved. Number of mediastinal regions assessed and affected, and number of lymph nodes resected and affected were significantly higher in patients with N1 plus N2 disease than those with isolated N1 or N2 involvement.

      Survival

      Median follow-up was 52.3 months. Five-year OS was 55.7% (CI95% 50.8%-60.3%). Differences were found on OS regarding type of lymph node involvement (N1, N2 or both) (p=0.002). Five-year OS was 61.7% (CI95%:55.4%-67.4%), 51.5% (CI95%:39.2%-62.4%) and 42.3% (CI95%:32.1-52.2%) for patients with N1, N2 and N1+N2 disease, respectively. No differences were found in survival regarding total number of N1 or N2 regions evaluated. Both number of regions involved and number of lymph nodes with tumor were significantly related to worse prognosis.

      Conclusion

      International recommendations for surgical lymph node assessment in NSCLC were not deemed for the design of the trial and were not followed in a high proportion of cases. Patterns of N1 and N2 involvement shown to impact prognosis. The design of trials assessing surgical series of patients undergoing complete resection requires the control of surgical procedures in order to avoid recruitment biases.

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    MA16 - Prioritizing Use of Technology to Improve Survival of Lung Cancer Subgroups and Outcomes with Chemotherapy and Surgery (ID 142)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      MA16.07 - Implementation of a Smartphone App to Face Postoperative Period in Patients with NSCLC Undergoing Lung Resection Surgery (Now Available) (ID 1028)

      15:45 - 17:15  |  Author(s): Florentino Hernando-Trancho

      • Abstract
      • Presentation
      • Slides

      Background

      Preoperative patient education and counseling helps to set expectations about surgical procedure and to prepare for it. Thoracic surgery procedures are related to postoperative complications and strategies to reduce them begin prior to surgery. Lung expansion maneuvers, the importance of early ambulation and pain control are best taught before the procedure. The aim of this prospective study was to implement the use of a smartphone application in a cohort of patients undergoing lung resection surgery and describe their feedback results.

      Method

      We created a Smartphone application as a multidisciplinary tool including: peri-operative medical advice (stop smoking, mouth health, early mobilization and pain control) (Fig1), ten chest physical exercises (with animated images) and programmable Smartphone daily notifications. Complete information to download, set up and interaction with the software was given to patients. A Multiple-Choice-Question survey was applied to patients at the moment of hospital discharge in order to evaluate their experience. This prospective and observational study included clinical data and results of surveys applied.

      image1 (3).png

      Result

      A total of 68 patients interacted with the application before surgery and answered the survey after the procedure. Median age was 66.5 years and 67.6% were males. Of them, 51 patients (75%) considered the content “very compressible”. 54 patients (79.4%) considered “positive” the contribution of the application to face the postoperative period. Additionally, 31 patients (45.6%) deemed “appropriate” the quantity of time and physical effort needed to complete the interaction with the tool and reach the goals.

      Conclusion

      This is the first smartphone application created by thoracic surgeons to improve patient´s education and helps them to prepare for surgery. This new technological tool was successfully implemented in our thoracic surgery department. For patients, it is easy to download, setup and contents comprehensible information that contributes to face positively the postoperative period with an adequate physical effort and quantity of time.

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    P1.03 - Biology (ID 161)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Biology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.03-45 - Circulating Tumor Cells' Clearance in Blood Samples After Chemotherapy: A Good Prognostic Factor for OS in Advanced NSCLC (ID 1277)

      09:45 - 18:00  |  Author(s): Florentino Hernando-Trancho

      • Abstract
      • Slides

      Background

      The poor prognosis of patients diagnosed with non-small cell lung cancer (NSCLC) patients in advanced stages requires a close monitoring of treatment´s response in order to plan early changes when necessary. The presence of circulating tumor cells (CTC) in periferic blood samples has showed worse prognosis in different tumors.

      The aim of the study is analyzing the relationship between the presence of CTCs in periferic blood samples and overall survival (OS) and progression-free interval (PFS) in advanced stages of NSCLC patients.

      Method

      Periferic blood samples were obtained from 25 patients diagnosed with NSCLC in advanced stages from April of 2010 to January of 2013 suitable for chemotherapy treatments. One blood sample was taken before treatment (S1) and the other one, after one cycle of chemotherapy (S2). Blood samples were analyzed by CellSearch method.

      Probability of survival was calculated following the Kaplan-Meier method; differences in survival were examined by the Long-Rank test.

      Result

      Median OS and PFS were 10 months and 6 months respectively.

      OS was 6 months in patients with isolation of CTC in S1 vs 11 months in those with no isolation of CTC; no statistical differences (p=0.978).

      OS was longer in those patients in whom there was no isolation of CTC in S2 compared to those in whom CTC were isolated (19 months vs 5 months; p=0.006). Contrary to this, no difference was observed considering PFS with a median of 6.5 months in patients without CTCs in their S2 and 6 months with CTCs present.

      untitled.jpg

      Conclusion

      In our study, patients with CTC´s isolation in S2 had a worse prognostic, median of 14 months OS, compared to those in whom there were no CTC isolation.

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    P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

    • 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: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-42 - The Use of a Smartphone Application Improves Postoperative Outcomes in Patients Undergoing Lung Cancer Resection (Now Available) (ID 1462)

      10:15 - 18:15  |  Author(s): Florentino Hernando-Trancho

      • Abstract
      • Slides

      Background

      For early stages of lung cancer, complete surgical resection with curative intent for patients who are surgical candidates remains the most effective treatment. However, thoracic surgery procedures are related to postoperative pulmonary complications which increase the morbidity and mortality. Preoperative pulmonary rehabilitation programs improve postoperative outcomes. This study aims to evaluate the role of a smartphone application to improve pulmonary rehabilitation in a group patients scheduled for lung cancer resection.

      Method

      A Smartphone application containing peri-operative medical advice (stop smoking, mouth health, early mobilization and pain control) and ten chest physical exercises (aerobic exercise, inspiratory muscle strength and secretion mobilization technique) was created. This prospective and no randomized study was developed between January 2017 and December 2018. All patients scheduled for surgery were asked to participate. A group of 68 patients used and interacted with the software before and after the surgery. The control group (114 patients) received classical information and education by the Department of Physical Medicine and Rehabilitation. Clinical-pathological variables, incidence of postoperative pulmonary complications, duration of chest drainage, length of hospital stay and 30 days mortality rate were recorded and analyzed.

      Result

      Postoperative pulmonary complications were developed 17.6% in the intervention group and 33.3% in the control group (P=0.02). The length of hospital stay was shorter in the intervention group (median 3±4.09d vs. 5±6.87d P=0.001). No differences were found in duration of chest drainage or 30 day mortality compared with control group.

      Conclusion

      This new technological resource created by thoracic surgeons demonstrates that preoperative rehabilitation program and patient education improve postoperative outcomes in patients undergoing lung cancer resection, decreasing the incidence of postoperative pulmonary complications and length of hospital stay.

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