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Shannon Mary Otsuka
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P1.17 - Treatment of Early Stage/Localized Disease (ID 188)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.17-30 - Sex and Age-Associated Survival Following Resected Early Stage Non-Small Cell Lung Cancer (Now Available) (ID 1452)
09:45 - 18:00 | Author(s): Shannon Mary Otsuka
- Abstract
Background
Background: Non-small cell lung cancer (NSCLC) is the most common malignant tumour, and a leading cause of mortality worldwide. Rising rates of NSCLC have been observed among females, but nonetheless females also are often observed to possess better prognosis across all stages of disease. We aimed to assess the impact of biological sex along with age at diagnosis on the outcome of NSCLC patients with resected early-stage disease.
Method
A 15-year population-based retrospective analysis was conducted on de novo early stage (AJCC 7th edition, Stage I or II) patients between 1999-2014, whose primary tumor was surgically resected. Demographic, clinical characteristics, treatment modalities and outcome data were extracted from the institutional Glans-Look Lung Cancer Database, and univariate analysis, including Kaplan-Meier survival, alongside multivariate Cox regression was performed to compare outcomes by sex and determine prognostic factors associated with survival.
Result
872 early-stage resected NSCLC patients were identified. Median age at diagnosis 65.9 years (IQR: 59.1-72.6), 56% female, 76% ‘ever’ smokers, 68% Stage I, 91% oncologic resection (9% wedge resection). Median overall survival (mOS) for all early-stage resected cases was 93 months (95% CI: 81.9 – 105.4) with a 5-year survival rate of 62.5%. Females exhibited superior survival outcomes to males (105.4 months vs. 77.5 months, log-rank p=0.002), as did those < 75 years at diagnosis compared to those ≥ 75 years (103.9 vs. 76.2 months, log-rank p <0.001). Best and worst survival outcome was observed in females under age 75, and males over age 75, respectively (mOS 114.3 vs. 64.5 months; 5-year survival: 67.9% vs. 50.5%). No difference in rate of recurrence (overall) or rate of metastatic recurrence between males and females was identified (39% vs. 36%, p=0.214; 19% vs. 16%, p=0.591). After controlling for confounding variables, a reduced risk of mortality was found for females (HR: 0.8, p=0.016), age under 75 years at diagnosis (HR: 0.6, p < 0.001) and stage I presentation (HR: 0.6, p< 0.001).
Conclusion
Females experience significantly longer mOS, in particularly females under the age of 75 years at diagnosis. After adjusting for confounding factors, we found significantly reduced mortality risk for females aged under 75 years at diagnosis, and Stage I disease. Despite possessing the poorest outcomes among this cohort, males ≥ 75 years still possessed a 5-year survival rate of 50%, suggesting that surgical resection is a highly effective treatment option for suitable NSCLC patients, regardless of age.
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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
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.16-12 - Treatment Uptake and Outcomes of Elderly Stage III NSCLC Patients: A 15-Year Retrospective Real-World Study (Now Available) (ID 1438)
10:15 - 18:15 | Author(s): Shannon Mary Otsuka
- Abstract
Background
Incidence of non-small cell lung cancer (NSCLC) is highly correlated with age; the age-specific incidence rate of NSCLC in individuals ≥ 75 is nearly double that of patients < 70. Further, nearly one-third of patients diagnosed with NSCLC present with locally advanced (Stage III) disease. This represents an anatomically heterogeneous, frequently non-resectable tumour for which contemporary practice guidelines, based on two decades of clinical trials, recommend concurrent chemoradiotherapy (cCRT) to maximize both local tumor control and survival. Underrepresentation of elderly patients in clinical trials requires the use of real-world populations to assess whether current recommendations and trial-derived survival outcomes are also applicable to this significant and growing age group.
Method
A 15-year population-based retrospective analysis of patients with de novo Stage III (AJCC 7th edition) NSCLC diagnosed between 1999-2014 was conducted. Demographic, clinical characteristics, treatment and outcome data were extracted from the institutional Glans-Look Lung Cancer Database. We defined elderly patients as those ≥ 75 years at diagnosis, and investigated the treatment intent, type, uptake and outcomes among elderly and non-elderly patients.
Result
We identified 1040 patients with a Stage III diagnosis. 333 (32%) were elderly. Treatment patterns differed significantly between elderly patients and non-elderly patients: elderly patients were less significantly likely to receive any form of active treatment (82% vs. 58%), particularly curative-intent treatment (41% vs. 14%), and no elderly patients underwent surgical resection. Median overall survival (mOS) favoured non-elderly patients (13.2 vs. 9.7 months, log-rank p <0.001.) Among elderly patients, receipt of curative-intent treatment was associated with significant improvement in mOS (17.4 months vs. 9.3 months for no active treatment/observation, vs. 8.5 months for palliative-intent treatment, p < 0.001). When receiving curative-intent treatment, specifically cCRT, survival outcomes of elderly patients were not significantly different from those of younger patients (24.5 vs. 21.3 months, p=0.81), and had comparable 5-year survival rates (15.9% and 12.2% respectively).
Conclusion
This real-world population reveals that elderly patients are less likely to receive any, and particularly, curative-intent treatment for their NSCLC diagnosis when compared with a younger cohort. When deemed suitable for a curative-intent regiment of cCRT, elderly patients show comparable outcomes to younger cohorts. This finding reinforces the current guideline recommendations that cCRT is associated with best outcome for non-resectable, locally-advanced NSCLC, even among elderly patients. Further, it supports the critical need for more tolerable and effective treatments for this presentation of disease to improve feasibility of curative-intent treatment for all, but in particular, elderly patients.
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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
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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): Shannon Mary Otsuka
- 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 7th 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.
