Author of

• 31628

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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

  • 31664

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    P1.16-33 - From a Systematic Review to Real World Evidence: Integrating Gender as a Clinical Risk Factor in NSCLC  (ID 2730)

    09:45 - 18:00  |  Author(s): Noor Asaad Alsaadoun
    • Abstract

    Background
    

    Gender-based disparities in NSCLC experience have been widely discussed in the literature. The recognition of gender as a confounder in clinical practice remains uncertain. Confirming its impact on prognosis encourages personalized interventions in an effort to improve survival for NSCLC patients. Since best prevention programs are derived from findings established from multiple-evidence based analysis, the influence of gender on the observed disparities in NSCLC was explored using worldwide evidence and single institute experience. A systematic review was initially carried out to synthesize the evidence on a global scale to confirm the influence of gender-discrepancies in NSCLC incidence rates. Findings were compared and contrasted using a single cancer institute to highlight potential trends related to the different data.

    Method
    

    We identified relevant articles published in English using Medline between 1996 and 2016. Pooled standardized-incidence data was analyzed using a semi-parametric longitudinal regression model to estimate changes in NSCLC incidence as a function of time, histology and gender. A heat map was also designed to illustrate the global trend of NSCLC captured in the published articles. Findings of this review were evaluated to confirm the influence of gender on NSCLC trends and outcomes using a single center record. A retrospective analysis was performed using the Glans-Look Database (GLD) for patients diagnosed between 1999 and 2015. The Kaplan-Meier estimator of cumulative survival was conducted to analyze treatment outcomes of patients using SPSS and R. Statistical significance was set at 95% confidence level (p < 0.05).

    Result
    

    Our systematic review demonstrated gender-based disparities over time, and the main effect of gender on incidence rates is significant (p=0.01). Visualizing global trends of NSCLC’s histology confirm that women are prone to develop ADC. GLD data verifies the influence of gender, where women were more prone to develop ADC (49%), and the relative changes of its rate over 15 years increased significantly compared to men (58% vs 32%, P<0.02). Survival rates were also predisposed by gender, where female ADC mOS exceeded that of males in overall comparisons (17.6 vs. 12.2, p=0.047).

    Conclusion
    

    Our findings serve as a basis to resolve the inherent controversies in the research, and highlight the importance of gender as a clinical risk factor. Therefore, it is important to include gender as a prognostic tool to improve screening programs and promote tailored therapies for better outcomes. Biological, social, or a combination of factors could also influence the differences observed and warrant further investigation.

• 31865

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  P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Treatment of Locoregional Disease - NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

  • 31869

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    P2.18-04 - Improved Outcome in Female Stage III NSCLC Diagnoses Is Driven by Non-Curative Intent Treatment, and Adenocarcinoma Histology (ID 2113)

    10:15 - 18:15  |  Author(s): Noor Asaad Alsaadoun
    • Abstract

    Background
    

    Biological sex disparities in incidence, molecular alterations and outcome in NSCLC have been well documented in the literature; however, there are no sex-based approaches to diagnosis and treatment in lung cancer. Recognising differences in therapeutic outcome and survival between the biological sexes could help inform clinical research and further personalized interventions in an effort to improve survival for NSCLC patients.

    Method
    

    Using the Glans-Look Lung Research (GLR) database, a retrospective analysis was undertaken for Stage III (AJCC 7^th edition) NSCLC patients diagnosed between 1999 and 2014. Demographic, clinical, treatment and outcome data were extracted to assess sex-based differences in histology, treatment uptake and survival. Univariate methods, including Kaplan-Meier survival analysis were performed to compare outcomes by sex, histology and treatment-intent.

    Result
    

    1040 Stage III NSCLC were identified, median age 69.6 years (IQR 61.3-76.8), 57.9% female, 89.1% ‘ever’ smokers, 34% adenocarcinoma (ADC), 36% squamous cell carcinoma (SCC), 20% ‘other’, 10% unknown. Among female patients ADC is more prevalent (42% vs. 28%, p<0.001), while in SCC patients are more likely to be males (44% vs. 26%, p < 0.001). Males were more likely to receive palliative-intent treatment (44% vs. 37%), while females more likely to receive best supportive care (BSC) (31% vs. 22%), p=0.006. Median overall survival (mOS) for the entire stage III cohort favoured females (14.1 vs. 10.7 months, p=0.001). This trend was also observed across different treatment categories, where female survival significantly exceeded that of males: curative-intent (25.5 vs. 18 months, p=0.035), palliative-intent (9.5 vs. 8.0 months, p = 0.025) and BSC (11.2 vs. 7.2 months, p=0.014). Although no differences in treatment patterns were seen between males and females within ADC or SCC, sex-based disparities in survival were also present within the ADC histology: female ADC mOS exceeded that of males, in overall comparisons (17.6 vs. 12.2 months, p=0.047), within palliative-intent treatment (15.1 vs. 8.0, p=0.008) and BSE (13.2 vs. 3.4, p=0.005), but not in curative-intent combined modality chemo-radiation (26.8 vs. 21.7 months, p =0.972). No differences in mOS, either overall or by treatment category were observed in SCC.

    Conclusion
    

    Higher mOS among females in stage III NSCLC appears to be driven by both the ADC histology and non-curative-intent treatments. Sex-based differences in outcomes should be assessed more deeply as prognostic variable in patients with NSCLC.