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Urshila Durani
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EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.15-08 - Association of Perioperative Chemotherapy with Survival in Thymic Malignancies (ID 1436)
08:00 - 18:00 | Author(s): Urshila Durani
- Abstract
Background
Patterns of perioperative chemotherapy utilization and its association with survival in thymic malignancies are largely unknown.
Method
We queried NCDB from years 2004-2014 and identified 3,788 patients with non-metastatic thymic carcinoma (TC) and thymoma who received surgery. We compared patients who received perioperative chemotherapy to those who didn't and used a Cox proportional hazards model to determine predictors of mortality.
Result
764 patients (20%) received chemotherapy: 287(38%) neoadjuvant (NAC), 347(45%) adjuvant (AC), and 130(17%) unspecified. 184(24%) had TC; the rest had thymoma. Patients who didn’t receive chemotherapy (N=3024) had older age (median 62 vs 47, P<0.01) and earlier stage (51% versus 24% stage I-IIA, P<0.01). In multivariable analysis, patients who received AC versus no chemotherapy had a similar overall survival(OS); however, NAC predicted a worse OS. For separate thymoma and TC subsets, median OS did not differ between those who received AC and those who didn’t in either group. AC did not improve OS for patients with R1/R2 margins (114 months, 95%CI 94-NR vs 131 months, 95%CI 118-NR)
Characteristic
Hazard ratio for mortality (95% confidence interval) 1
Age
1.03 (1.03-1.04)
Thymoma vs. TC
0.50 (0.43-0.58)
Charlson-Deyo score>0
1.40 (1.21-1.63)
Chemotherapy
None
Adjuvant
Neoadjuvant
Unclassified
1
1.13 (0.89-1.44)
1.77 (1.37-2.27)
1.60 (1.16-2.19)
Masaoka-Koga Stage
I-IIA
IIB
III
Unknown/other
1
1.08 (0.88-1.34)
1.59 (1.34-1.90)
2.71 (2.01-3.65)
Radiation
0.78 (0.67-0.91)
Positive margin
1.55 (1.33-1.81)
1Model included sex, academic center, insurance, and race/ethnicity
Conclusion
Chemotherapy in the perioperative setting was not associated with improved OS in either TC or thymoma. Prospective controlled studies are needed to determine the role of perioperative chemotherapy in thymic malignancies.
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P1.06 - Mesothelioma (ID 169)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.06-02 - National Trends in Outcomes in Patients with Malignant Pleural Mesothelioma (ID 1944)
09:45 - 18:00 | Author(s): Urshila Durani
- Abstract
Background
Malignant pleural mesothelioma is an aggressive tumor and is often incurable. We aim to identify national practice patterns and trends in survival in patients with mesothelioma.
Method
We queried National Cancer Database from years 2004-2014 to identify adult mesothelioma cases. We collected baseline characteristics were collected and analyzed treatment patterns and survival trends. Multivariable Cox regression models were applied to identify factors associated with survival.
Result
Of 11,372 patients 4354 (38%) had epithelioid histology, 1431 (12%) sarcomatoid, 880 (0.7%) biphasic, and 4707 (41%) unspecified. 20% were stage IA, 22% stage IB, 2% stage II, 1% stage IIIA, 31% stage IIIV, and 23% were stage IV. Sarcomatoid histology was associated with worst overall survival (HR 2.2) while epithelioid histology had best survival (referent). Chemotherapy alone was the most common treatment modality (36%). Combined treatment with surgery, radiation, and chemotherapy was associated with best overall survival (HR 0.45) followed by chemotherapy combined with surgery. However, 1 year and 5-year OS remain low at 41.2% and 6.5% respectively. There has been no clinically significant improvement in overall survival from 2004 to 2014.
Multivariate Cox Regression
Variable
Level
HR (95% CI)
Age
Unit=1
1.018 (1.015-1.020)
Academic
No vs Yes
1.171 (1.124-1.221)
Charlson Score
1 vs 0
1.104 (1.053-1.158)
2 vs 0
1.201 (1.109-1.300)
>=3 vs 0
1.460 (1.279-1.666)
Histology
Biphasic vs Sarcomatoid
0.737 (0.675-0.805)
Epithelioid vs Sarcomatoid
0.460 (0.432-0.491)
NOS vs Sarcomatoid
0.552 (0.518-0.587)
Sex
Female vs Male
0.817 (0.779-0.857)
Year
Unit=1
0.984 (0.977-0.990)
Insurance
Medicaid vs Private
1.193 (1.043-1.364)
Medicare vs Private
0.993 (0.940-1.048)
Other/None/Unknown vs Private
1.038 (0.938-1.148)
Stage
IB vs IA
1.156 (1.088-1.228)
II vs IA
1.229 (1.056-1.431)
IIIA vs IA
1.442 (1.164-1.788)
IIIB vs IA
1.459 (1.379-1.544)
IV vs IA
1.801 (1.695-1.913)
Treatment
Chemo vs None
0.613 (0.584-0.643)
Chemo, Radiation, & Surgery vs None
0.450 (0.396-0.512)
Chome & Surgery vs None
0.468 (0.436-0.504)
Other vs None
0.737 (0.682-0.796)
Surgery vs None
0.694 (0.638-0.756)
Conclusion
Survival outcomes in mesothelioma remain poor. There is a need for more clinical trials using combinatorial approaches to improve outcomes in mesothelioma.
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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
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.12-11 - Exploring Sex Differences in Small Cell Lung Cancer: Is This a Hormonal Issue? (ID 605)
09:45 - 18:00 | Author(s): Urshila Durani
- Abstract
Background
Small cell lung cancer (SCLC) accounts for about 10% to 15% of lung cancers among women and men. Though heavily associated with smoking, its incidence in women is rapidly increasing despite a decline in cigarette exposure. Given the changing demographics of SCLC and hormonal factors associated with other forms of lung cancer, we studied differences between sexes in SCLC.
Method
Utilizing the National Cancer Database, we identified all incident SCLC cases from 2004 to 2014. Patients were classified as limited (LS) or extensive stage (ES). Women were stratified by menopausal status (≥55 years = postmenopausal). Kaplan-Meier method and Cox regression were used for overall survival (OS) and multivariable analysis.
Result
161,978 patients were identified. No significant sociodemographic differences were observed between sexes. The majority of patients were non-Hispanic whites (89.1%), followed by non-Hispanic blacks (7.5%). Men were more likely to be diagnosed with ES disease than women (63% vs. 56%). Both sexes initiated treatment within a similar time frame from diagnosis (chemotherapy, median 18 days, IQR 8-32). Women had better median OS compared to men in both LS (15.2 vs. 12.7 months, HR: 0.85, 95% CI 0.83-0.86, p < 0.0001) and ES (6.4 vs. 5.7 months, HR: 0.88, 95% CI 0.87-0.90, p < 0.0001). No racial or ethnic disparities in OS were observed, overall and when examined within sex and disease stage groups. Differences between sexes in OS were also observed when comparing patients within the same racial/ethnic group (women having better OS). When divided by menopausal status, postmenopausal women with LS and ES had worse OS than premenopausal women (14.7 vs. 22 months, HR: 1.50, 95% CI 1.44-1.56; 6.1 vs. 9.8 months, HR: 1.41, 95% CI: 1.37-1.46, respectively). We also observed worse OS in older men when divided by age (<55 years and ≥55 years). In multivariable analysis, older age, postmenopausal status, and Medicaid as primary insurance were associated with worse OS for both LS and ES.
Conclusion
In this large cohort, women with SCLC had better OS compared to men. Post-menopausal women had worse OS compared to pre-menopausal women. Since older men had a similar trend of worse survival compared to younger men, age might exert a more significant influence on survival than hormonal status in SCLC. Further studies with data on sexual hormone levels are necessary to better understand their role in women with SCLC.
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P2.12 - Small Cell Lung Cancer/NET (ID 180)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.12-24 - Underutilization of Surgery for Localized Small Cell Lung Cancer: A Nationwide Analysis (ID 832)
10:15 - 18:15 | Author(s): Urshila Durani
- Abstract
Background
Although surgery has been recommended in node-negative localized small-cell lung cancer (SCLC), utilization has been low (<10%) in the past. Here, we evaluate treatment patterns and outcomes of surgery in localized SCLC over the last decade to determine if routine practice follows the growing literature in support of surgery in localized SCLC.
Method
We queried years 2006-2014 of the National Cancer Database, a hospital dataset capturing 70% of incident cancers in the United States, to identify adults with Stage IA to IIA (T1-T2N0M0) SCLC who underwent treatment. Temporal practice patterns and multivariable survival outcomes were assessed.
Result
In the cohort of 5877 patients, 2892 (49%) received chemoradiation, 1300 (22%) received surgery with radiation or chemotherapy, 639 (11%) received chemotherapy alone, 628 (11%) received surgery alone, and 418 (7%) received radiation alone. Amongst patients receiving surgery, 1277 (66%) received a lobectomy or pneumonectomy. Likelihood of receiving surgery in combination with radiation or chemotherapy was higher in later years of diagnosis (15% in 2006 vs 25% in 2014, p<0.001). Stage IA was more prevalent in the group that received surgery alone (77%) or surgery with chemotherapy or radiation (75%) compared to chemoradiation (45%), chemotherapy (49%), and radiation (63%).
Median overall survival was most favorable for surgery with chemotherapy or radiation (51.8 months) followed by surgery alone (33.2 months) compared to chemotherapy + radiation (26.2 months), radiation alone (17.8 months), and chemotherapy alone (11.8 months)(p<0.001). In a multivariable Cox model (Table), surgery with chemotherapy and/or radiation was associated with decreased mortality versus chemoradiation (hazard ratio=0.6, P<0.001).
Hazard ratio
95% CI
Treatment
Chemoradiation
Chemotherapy alone
Radiation alone
Surgery alone
Surgery + chemotherapy or radiation
Ref
2.1
1.4
0.9
0.6
1.9-2.3
1.2-1.6
0.7-0.9
0.6-0.7
Female sex
0.8
0.8-0.9
Stage
IA
IB
IIA
Ref
1.1
1.2
1-1.2
1.1-1.3
*Model also included age, insurance, median income quartile, Charlson comorbidity score, region, and race (not shown)
Conclusion
Utilization of surgery in localized SCLC remains low, despite its association with improved survival. Future clinical trials may be needed to establish the best therapeutic strategy for these patients.
