Virtual Library
Start Your Search
Esther Fevrier
Author of
-
+
P1.11 - Screening and Early Detection (ID 177)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
-
+
P1.11-28 - Lung Cancer: Susceptibility and Survival Differences for Women and Men (ID 2416)
09:45 - 18:00 | Author(s): Esther Fevrier
- Abstract
Background
To determine the lung cancer susceptibility to tobacco carcinogens and survival after diagnosis of lung cancer for women and men in the International Early Lung Cancer Program (I-ELCAP).
Method
We used the prospective I-ELCAP cohort of asymptomatic men and women to identify all who were 40 years and older, had smoked at least 5 pack-years, and had low-dose CT screening in I-ELCAP between 1992 and 2018 at participating institutions in two continents, North America or Europe. Logistic regression models were used to calculate the odds ratio (OR) for lung cancer in women compared to men, adjusting for age, smoking history, and location. To account for time from baseline to lung cancer diagnosis, hazard ratio (HR) using Cox proportional hazards models were calculated for lung-cancer-specific mortality in women and men, conditioned on age, smoking history, disease stage, histology, whether resection was performed, and continent (NA or Europe). Interaction between sex and location was also evaluated.
Result
Of the 23,438 women, 18,451 were in North America, 4987 in Europe. Of the 31,365 men, 18,451 in North America, 22,812 in Europe. Lung cancer was diagnosed in 475 women and 509 men; in NA, frequency was significantly higher in women (2.2% vs. 1.5%, p<0.0001) while in Europe, it was significantly lower (1.4% vs. 2.0%, p =0.007). As the interaction between sex and continent was significant (p<0.0001), separate multiple logistic regression analyses were performed which showed sex to be a significant independent predictor of lung cancer in North America (ORwomen=1.7, 95% CI:1.4-2.0), but not in Europe (ORwomen=0.8, 95% CI: 0.6-1.1).
Median follow-up time of the 742 and 242 lung cancer patients in North America and Europe was 89.8 months and 67.0 months, respectively. Lung cancer deaths occurred less frequently in women than in men in North America [NA: 47/406 (11.6%) vs. 59/336 (17.6%)] and in Europe [3/69 (4.4%) vs. 17/173 (9.8%)]. In North America, the risk of death was significantly lower for women (unadjusted HRwomen = 0.6, 95% CI: 0.4-0.9), but no longer significant when adjusted for other covariates. In Europe, unadjusted HRwomen = 0.44 (95% CI: 0.13-1.50) was not significant.
Conclusion
Women appear to have an increased susceptibility to tobacco carcinogens in NA but not in Europe. In both continents, however, rates of fatal outcome from lung cancer were slightly, but not significantly lower for women.
-
+
P1.13 - Staging (ID 181)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Staging
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
-
+
P1.13-01 - The Importance of Staging of Lung Cancers, 30 mm or Less, Separately for Subsolid and Solid Nodules (ID 1413)
09:45 - 18:00 | Author(s): Esther Fevrier
- Abstract
Background
To determine pathologic results on non-small-cell lung cancers (NSCLCs), 30 mm or less in maximum diameter, separately by tumor consistency (solid, subsolid) on CT scans as we had shown that long-term survival was significantly different by tumor consistency and by type of parenchymal invasion.
Method
We reviewed all patients enrolled in the Initiative for Early Lung Cancer Research on Treatment (IELCART), a prospective cohort study of patients with first primary T1a-T1c NSCLC between 2016 and 2018 who had surgical resection. Short-axis diameter of N1-N3 lymph node on CT and SUVmax uptake on FDG-PET, if performed, were documented with values ≥ 2.5 defined as PET positive. Pathology reports were reviewed for N1-N3 lymph nodes (LNs) metastases and parenchymal invasion.
Result
Among 347 patients, 280 (80.7%) and 67 (19.3%) had solid and subsolid NSCLCs, respectively; all subsolid NSCLCs were adenocarcinoma. There was FDG-PET uptake in 253 (93.3%) with solid NSCLCs and in 55 (91.7%) with subsolid NSCLCs.None of the 67 subsolid NSCLCs had N1 or N2 LN metastases (Table 1). Among the 280 solid NSCLCs, none of the 42 NSCLCs≤ 10 mm had N1 or N2 metastases, while 5 of the 238 solid NSCLCs greater than 10 mm had N2 and 14 had N1 LN metastases. None of the N2 LNs were positive on FDG-PET and only 4(28.6%) of the 14 N1 LNs were positive on FDG-PET.
Angiolymphatic invasion was most frequently, followed by pleural and major vascular invasion (Table 1). For solid NSCLCs, invasion increased with increasing tumor diameter.
Conclusion
No N1-N3 LN metastases were identified in solid NSCLCs ≤ 10 mm; none in subsolid NSCLCs ≤ 30 mm. None with N2 LN metastases were positive on FDG-PET. This suggests that for NSCLCs, 30 mm or less, clinical staging be based on solely tumor size. For pathologic staging, we recommend differentiating staging classification by tumor consistency in line with the latest recommendations for pathologic assessment.
-
+
P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
-
+
P2.16-03 - IELCART Quality of Life in the First Year After Surgery for Stage IA Lung Cancer Patients: Preliminary Results (ID 1409)
10:15 - 18:15 | Presenting Author(s): Esther Fevrier
- Abstract
Background
To compare quality of life (QoL) after lobectomy (L) and sublobar resection (SLR) within the first postoperative year among patients undergoing video-assisted thoracoscopic surgery.
Method
We used a prospective cohort of Stage I lung cancer patients from the Initiative for Early Lung Cancer Research on Treatment (IELCART). QoL used three validated instruments: SF-12 physical (PCS) and mental health (MCS), FACT-L lung cancer symptoms, and PHQ-4 for anxiety and depression. The QoL scores were measured before surgery, and within 4, 6, and 12 months after surgery. For each QoL measure, a piece-wise linear mixed effects model was used to estimate changes in average scores and test for differences between L and SLR patients within 2 months post-surgery and from 2 to 12 months. Social support was also assessed at baseline using the MOS survey.
Result
Of the 160 patients, 58 (36.3%) had L and 102 (63.7%) SLR. After adjustment for demographics, BMI, pack-years of smoking, and comorbidities, mean QoL and social support scores at baseline did not differ between L and SLR patients. The post-operative rates of change are given in Table 1. L showed significant decreases in PCS (p = .01) and anxiety scores (p = .0001) within 2 months post-surgery and significant improvement from 2 to 12 months in PCS (p = .005) and FACT-L QoL scores (p = .01). SLR anxiety scores decreased (p = .004) within the first two months post-surgery; PCS did not change significantly within the first two months but improved significantly (p = .02) from 2 to 12 months. Other measures were stable across the year after surgery. No significant differences between L and SLR were detected in the post-operative rates of change.
Conclusion
Mental health, anxiety, and depression scores either improved or remained stable. Decreases in physical health persisted 2 months postoperatively, but thereafter improved significantly. Implications for intervention include provision of preoperative counseling about anticipated changes in physical function after surgery, and post-op interventions aimed at improving physical function.
