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Fernando Conrado Abrao
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P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.16-18 - Pleural Malignant Effusion. Is it Possible to Predict Recurrence After Palliative Pleural Procedure? (ID 1832)
09:45 - 18:00 | Presenting Author(s): Fernando Conrado Abrao
- Abstract
Background
Malignant pleural effusion (MPE) accounts for several hospital admissions. MPE recurs rapidly in a considerable number of patients. Since MPE is associated with poor survival, a detailed prognosis may help to recognize patients with at higher risk of recurrence, aiming to individualize treatment strategies. However, there have been few studies that evaluated factors, including systemic therapy, associated with MPE recurrence. The aim of this study was to recognize risk factors of recurrence in symptomatic patients only, who required a pleural approach.
Method
A prospectively assembled database was analyzed to search for patients with symptomatic MPE. The obtained data included basic demographics, primary tumor site, performance status, neutrophil/lymphocyte ratio (NLR) and platelets/lymphocyte ratio. Metastatic sites were also evaluated, which was defined as presence of any numbers of metastasis at each organ.
Regarding the postoperative period, we analyzed pleural effusion recurrence, the palliative approach used, in addition to the biochemical profile of pleural fluid. Pleural thickening and pulmonary infiltrate were also described. Systemic treatment was evaluated. Patients were classified into three groups at MPE diagnosis: systemic treatment-naïve patients, patients who received first-line systemic treatment and patients receiving second-line systemic treatment or further therapy.
The quantitative variables without definite cutoff points were submitted to the ROC (Receiver Operating Characteristic) curve, using a sub-sample of 50% of the recorded cases. Cutoff points were defined as the ones with sensitivity and specificity values >0.80. Univariate and multiple Cox regression models were used to evaluate the risk of recurrence (HR) and their respective 95% confidence intervals (95%CI).
Result
Of the 288 analyzed patients, the most frequent main procedure was pleurodesis (43.1%). Disease recurrence occurred in 58 patients (20.1%). Recurrence-free survival was 73.3% at 12 months. Patients submitted to the pleurodesis procedure had a longer recurrence-free survival of 84.6%, with HR = 0.33 (95%CI = 0.17 - 0.63) when compared to patients who underwent the pleural drainage. Regarding the chemotherapy lines of treatment, Cox univariate analysis showed that the risk of recurrence for those submitted to the 1st line of palliative CT was HR = 3.19 (95% CI = 1.32 - 7.70) and for the 2nd line of palliative CT, HR = 7.32 (95% CI = 3.34 - 16.07) when compared to the systemic treatment-naïve patients.
The independent factors for recurrence-free survival were procedure and chemotherapy lines. Patients who were submitted to pleurodesis had a protective factor for recurrence, with an HR = 0.34 (95% CI = 0.15 - 0.74, p = 0.007). On the other hand, patients submitted to the 1st and 2nd line of palliative CT had, respectively, an HR risk = 2.81 (95% CI = 1.10-7.28, p = 0.034) and HR = 3.23 (95% CI = 1.33 - 7.84, p = 0.010).
Conclusion
Patients receiving the first or second line of systemic treatment have a higher risk of MPE recurrence when compared to patients who underwent MPE treatment before starting the systemic treatment. The definitive treatment of MPE, such as pleurodesis, was associated with a lower risk of MPE recurrence.
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P2.17 - Treatment of Early Stage/Localized Disease (ID 189)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-13 - Thoracoscore Fails to Predict In-Hospital Mortality Following Elective Surgery in a Brazilian Lung Cancer Cohort (Now Available) (ID 1973)
10:15 - 18:15 | Author(s): Fernando Conrado Abrao
- Abstract
Background
According to SEER database only 40% of patients with lung cancer present localized or regional disease at diagnosis. The cornerstone of treatment of potentially resectable lung cancer is surgical removal of the tumor and it is important to estimate the loss of lung function after resection. The risk of in-hospital death can be estimated by some a scores system such as Thoracoscore. The aim of this study is to evaluate the applicability of this risk assessment model for in-hospital mortality in a Brazilian cohort of patients submitted to surgical resection.
Method
This is a prospective analysis of patients who underwent lung resection for lung cancer in two thoracic surgery centers in Brazil between January 2015 to December 2018. Patients were included if they were 18yo or older, had a histologically proven diagnosis of lung cancer. Tumor staging was done according the seventh edition of the AJCC classification. Data on prognostic factors such as histology, gender, performance status, comorbidities and type of treatment were collected. Thoracoscore was calculated based on the following variables: age, sex, American Society of Anaesthesiologists' class (ASA), performance status classification, dyspnea score, priority of surgery, procedure class, diagnosis group and comorbidities score. A receiver operating characteristic analysis determined the ability of the thoracoscore to predict in-hospital mortality and it would be considered acceptable if AUC > 0.7; significance test for AUC was performed using Chi-square test. Proportion of events was compared between groups according to the Cochran-Armitage linear trend test to evaluate the calibration of Thoracoscore. All P-values were 2-sided. Results were considered significant if p < 0.05. Statistical analyses were performed using SAS version 9.4.
Result
166 patients were included in the study. Median age was 62 years, 48,8% were male, 57.8% had adenocarcinoma, 71.7% had one or two comorbidities, 40.3%, 36.1%, 19.2% and 3.6% were respectively clinical stage I, II, III and IV, 71% and 13.3% underwent respectively lobectomy/bilobectomy and pneumectomy, 79.5% were ASA ≤2, 100% had ECOG ≤2, elective surgery and dyspnea score ≤2. The observed in-hospital mortality was 13 patients (7.8%). We attributed our mortality to high rate of stage III lung cancer patients and we also included stage IV patients who underwent to palliative surgery. Mean thoracoscore was 3.92 (SD ± 1.41) and the mean predicted in-hospital mortality using thoracoscore was 1.81%. The AUC for thoracoscore was 0.579. When this area was compared with the area of 0.50 (absent discrimination), no significant difference was observed (p = 0.3642). Thoracoscore was divided into three risk groups: low (0–3), moderate (3.1–5) and high (≥5.1). The score was not able to differentiate the mortality among the groups (p = 0.30).
Conclusion
Our results corroborate the non-validation of Thoracoescore in a Brazilian population of patients with lung cancer. Additional studies are needed for the development of more accurate mortality risk scores in this population.
