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Ronald Go



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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): Ronald Go

      • Abstract
      • Slides

      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

      tc_surv_plot_stages_chemo_thymic_carcinoma.jpg

      tc_surv_plot_stages_chemo_thymoma.jpg

      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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    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): Ronald Go

      • 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)

      sclung_surv_bytrt_figure1_040919.jpg

      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.