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Paulo Manuel Pêgo Fernandes
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P1.10 - Prevention and Tobacco Control (ID 175)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Prevention and Tobacco Control
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.10-10 - Social Vulnerability and Survival in Lung Cancer in Emerging Country (Now Available) (ID 2335)
09:45 - 18:00 | Author(s): Paulo Manuel Pêgo Fernandes
- Abstract
Background
The association between lung cancer and socioeconomic conditions has been reported more frequently in the last years. Demographical and epidemiological characteristics have changed over time, and these changes are observed mainly in big metropolitan areas of emerging countries with high inequalities scores. Our objective was to analyze the impact of social vulnerability in lung cancer survival in a big urban area of an emerging country.
Method
We retrieved data from a local cancer database (RHC) including sociodemographic (Paulista Index of social vulnerability-IPVS and educational level), clinical (tumor characteristics, treatment) and survival data. We used median and interquartile range to show the descriptive results, frequencies and proportions to categorical variables. The survival curve was calculated by Kaplan-Meier and Log-rank.
Result
8631 patients were diagnosed with lung cancer between 2000 to 2013 and registered in the RHC database. In our population we found a predominance of men (61%), mean age 63 years (SD±11.4), and 52.5% of them were living in areas with low social vulnerability (Index 2). The most frequent histological type was adenocarcinoma (39%), and most patients were at clinical stage IV at diagnosis (56%); 31.4% received chemotherapy and 24.5%, chemotherapy+radiotherapy as a definitive treatment. The mean time from diagnosis to definitive treatment was 44 days (SD±93). The overall survival was 10 months (4-23). When adjusted for clinical stage, the probability of survival was better for patients living in areas of low social vulnerability (p<0.000) and for those who had completed >12 years of schooling (p<0.000).
Conclusion
Social vulnerability and years of schooling are directly related with survival in lung cancer, even when adjusted for clinical stage. Our results highlight the impact of inequality in health outcomes.
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P2.13 - Staging (ID 315)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Staging
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.13-09 - The Impact of the 8th Edition of IASLC Staging in Patients Who Underwent Surgical Treatment of Lung Cancer (Now Available) (ID 2329)
10:15 - 18:15 | Author(s): Paulo Manuel Pêgo Fernandes
- Abstract
Background
TNM cancer staging main function is to unify the language of patient´s evaluation. It is supposed to be a global initiative, however participation of latin american patients in the IASLC database is limited and the performance of staging in such a population is unknown.Our study aims to describe the performance of TNM 7th and 8th editions in predicting survival of patients with lung cancer who underwent surgical treatment in a latin american country.
Method
This is a retrospective study conducted in a Oncologic hospital of São Paulo, Brazil. We selected the patients who underwent surgical treatment of lung cancer between January 2011 and December 2015. Clinical data was obtained from the institutional database including exactly the same variables as the IASLC database. Patients were classified according to the TNM clinical and pathological staging system, both in 7th and 8th editions. Then we performed a survival analysis in 36 months according to each classification using the Kaplan–Meier method. A Cox regression was made with the clinical and pathological staging as variables, in order to determine which classification was more precise in risk prediction.
Result
The mean age was 63,9 (±11.6), female predominance (53%), and strong association with current or former smoking (74%). The most common histological type was invasive adenocarcinoma (54%) followed by squamous cell carcinoma (22%). Both TNM classifications stratified risk adequately as demonstrated in Image 1.
According to the Cox regression, TNM 8th edition had a better performance in survival prediction.
Clinical 7th ed (LL=-329.14095; LR=6.29) versus Clinical 8th ed (LL=-25.91923; LR=12.73). Pathological 7th ed (LL=-318.82608; LR=26.92) versus Pathological 8th ed (LL=-315.19067; LR=34.19).
Conclusion
TNM 7th and 8th editions predicted adequately survival in patients of a Latin American country, suggesting that these classifications are generalizable for such a population. 8th edition had a better performance when compared to 7th edition.
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P2.13-10 - Lymph Node Upstaging Evaluation After Robotic Resection for NSCLC in Brazil (Now Available) (ID 934)
10:15 - 18:15 | Author(s): Paulo Manuel Pêgo Fernandes
- Abstract
Background
An adequate lymph node staging plays a key role in the management of Non-Small Cell Lung Cancer (NSCLC) having great value in determining the necessity for adjuvant therapy. Inasmuch as the development of surgical robotic devices and robotic lobectomy is prominent, it is important to study if the robotic approach is capable of yielding the same or better lymph node staging as open or video assisted technique(VATS).The prevalence of nodal upstaging has been used as an adequate evaluation of the completeness of lymphadenectomy. The aim of this study was to determine the prevalence of lymph node upstaging in patients treated for NSCLC using robotic approach during the initial adoption of this method in Brazil.
Method
It was a descriptive analysis with retrospective collection of data from patients submitted to treatment for NSCLC with curative intention using robotic technique in different centers in Brazil. All data regarding demographics in addition to clinical and pathological details about nodal staging were collected. Patients with incomplete records about staging were excluded.
Result
We included 172 patients operated on from January 2015 to March 2019 . The average age was 65.7 years, 87 were female and 85 male. The most frequent histologic types were adenocarcinoma with 131(75.7%) cases , carcinoid tumors with 22(12.7%) cases followed by 17(9.8%) squamous carcinomas , 2 (1.1%) large cell carcinomas and 1 (0.5%) adenosquamous carcinoma. One of the patients had 2 tumors with different histotypes (large cell carcinoma and adenocarcinoma). The most frequent stage was IA both in clinical (118,68.6%) and pathological (114, 66.2%) and the average tumor size was 20mm. There was upstaging in 34 (19.7%) cases and down staging in 30( 17.4 %) cases. Lobectomy was the most frequent type of resection with 140 cases. On average 11.9 lymph nodes were resected and 5.8 node categories were addressed. Nodal upstaging occurred in 17 cases (9.8%) of which 8(4.6%) were N1-2 upstaging 6(3.4%) N0-1 upstaging and 3(1.7%) N1-2 upstaging. The incidence of nodal upstaging found was comparable with others studies.
Conclusion
In our experience , the treatment for NSCLC using the robotic approach was able to perform an adequate lymphadenectomy with prevalence rate comparable to previous data in literature.
