Virtual Library
Start Your Search
Brendon Stiles
Author of
-
+
P08 - Early Stage/Localized Disease - Epidemiology (ID 117)
- Event: WCLC 2020
- Type: Posters
- Track: Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
-
+
P08.04 - Progress in Early Stage Lung Cancer Among Economically Disadvantaged Patients (ID 1948)
00:00 - 00:00 | Presenting Author(s): Brendon Stiles
- Abstract
Introduction
Low socioeconomic status is a risk factor for poor outcomes in several diseases, including non-small cell lung cancer (NSCLC). Patients with the lowest income may be slower to seek treatment, are more likely to be undertreated, and have historically had worse survival for early stage NSCLC. We sought to determine whether early stage NSCLC outcomes have improved over time in low income patients.
Methods
The National Cancer Database (NCDB, 2004-2014) was queried for patients with primary clinical stage I-II NSCLC. Patients were divided by income into quartiles (Q1 <$38,000; Q2 $38,000-$47,999; Q3 $48,000-$62,999; Q4 ³$63,000) and those from the lowest quartile were analyzed among four time periods (T1-T4). Mann Whitney, Kruskal Wallis and Chi (X2) tests were used. Survival was compared using log rank test in Kaplan Meier curves. Cox regression was performed to identify predictors of overall survival (OS).
Results
We identified 242,575 patients, among whom 47,437 patients (49.7% female) were in the lowest income quartile with a median age of 69 years. Approximately 23% of patients were black and 65% were from metropolitan areas. Most patients were clinical stage I (75%), with adenocarcinoma (43%) the most common histology. Final pathologic stages (in surgically resected patients) were similar over the time periods studied. The proportion of patients on Medicaid increased slightly while those on private insurance decreased (p<0.001). Over time, patients were more likely to undergo surgery (57.9% in T4 vs. 52.0% in T1) and less likely to get no treatment (15.1% in T1 vs. 12.3% in T4) or chemoradiation (11.7% vs. 8%, p<0.001). Both 30-day (2.8% vs. 2.1%, p=0.032) and 90-day (5.3% vs. 3.9%, p=0.004) mortality decreased from T1 to T4, as did rates of 30-day readmission (4.9% vs. 3.3%, p<0.001). Both 1-year (74.2% vs. 82.8%, p<0.001) and 2-year (57.8% vs. 68.3%, p<0.001) overall survival increased steadily from T1 to T4. Among low income patients, predictors of decreased mortality were female gender (HR 0.746, CI 0.719-0.774), stage I disease (HR 0.686, CI 0.657-0.717), treatment at an academic center (HR 0.926, CI 0.891-0.963), private insurance (HR 0.842, CI 0.800-0.886), surgical treatment (HR 0.487, CI 0.462-0.513), and later year of diagnosis (HR 0.812, CI 0.749-0.881).
Conclusion
Efforts have been made to address disparities in lung cancer care. Encouragingly, we found that over the decade studied, short term mortality and hospital readmission decreased and that short term survival improved in low income patients. In addition to later year of diagnosis, treatment at academic centers, surgical treatment, and having private insurance each seem to improve outcomes in economically disadvantaged patients.
-
+
P37 - Pathology - Biomarker Testing (ID 107)
- Event: WCLC 2020
- Type: Posters
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
-
+
P37.04 - EGFR Mutations in US Hispanics with Lung Adenocarcinoma are Common and Portend a Worse Prognosis (ID 3187)
00:00 - 00:00 | Author(s): Brendon Stiles
- Abstract
Introduction
Activating mutations in Epidermal growth factor receptor (EGFR) occur in approximately 15% White, 40-50% of Asian and 15% of Black patients with lung adenocarcinoma. However, its prevalence in the nearly 60 million U.S. Hispanics has not been well characterized. Herein we evaluate EGFR mutation frequency in U.S. Hispanic patients with lung adenocarcinoma at an academic institute serving a large multi-ethnic area.
Methods
We queried our prospective database (2015-19) for lung adenocarcinoma patients who underwent resection and had routine mutational analysis by a targeted gene panel. We identified 768 patients and were able to stratify 668 patients by self-identified race/ethnicity. We compared demographics (chi-square) and survival (Kaplan-Meier).
Results
668 patients representing White, Hispanic, Asian and Black patients were identified. 200/668 patients had an activating EGFR mutation. Hispanic patients displayed a higher frequency of EGFR mutations than Whites (35% vs. 20%, p=0.013) Table 1. Hispanic patients were less likely to be smokers than White patients (60% vs. 82%, p=0.015). Hispanic EGFR mutant patients had worse 3-year overall survival than White and Asian patients (3 year OS: 62% vs. 96% & 90%, respectively p= 0.021 & 0.075; median f/u = 24.4 months) Figure 1A. Hispanic EGFR wild-type patients had a similar 3 year OS to other racial/ethnic groups and had improved 3 year DFS compared to Asian patients (3 year OS: 92% vs 85% and 92%, p= ns; and DFS 85% vs 76% and 63%, p=0.048) Figure 1B. EGFR mutations were similar across groups Figure 1C.
Conclusion
Approximately one-third of U.S. Hispanics with lung adenocarcinoma displayed EGFR mutations which were associated with decreased survival compared to White and Asian patients. Increasing mutational analysis and investigation of biological differences of this growing ethnic group is essential for optimal neoadjuvant and adjuvant treatments as well as in the design of future clinical trials.
-
+
PDSC01 - Product Showcase (ID 294)
- Event: WCLC 2020
- Type: Product Showcases
- Track: N.A.
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, Product Theater (via Industry Hub)
-
+
PDSC01.01 - 360° Perspectives on Biomarker Testing in Non-Small Cell Lung Cancer by PFIZER (ID 4389)
00:00 - 00:00 | Author(s): Brendon Stiles
- Abstract
Abstract not provided
