Virtual Library

Start Your Search

Emily Brooke Butts



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
    • +

      P08.05 - Risk Factors Associated with Recurrence Following Curative Therapy for Stage I NSCLC (ID 3410)

      00:00 - 00:00  |  Presenting Author(s): Emily Brooke Butts

      • Abstract
      • Slides

      Introduction

      Lung cancer remains the leading cause of cancer-related deaths globally. For those patients identified at an early stage, the prognosis is encouraging, with a five-year survival of 70-90% for Stage I non-small cell lung cancer (NSCLC). Lobectomy remains the standard of care for definitive management of Stage I NSCLC with radiation therapy considered for non-surgical candidates. Following curative therapy, current guidelines support the use of computed tomography (CT) scan for surveillance every six months for two to three years followed by CT scan annually. However, the pattern of recurrence following curative therapy, associated risk factors, and optimal duration of surveillance scans remain unknown. The objective of our study is to assess the pattern of recurrence and associated risk factors for recurrence following curative therapy for Stage I NSCLC.

      Methods

      Patients diagnosed with Stage I NSCLC and treated with either curative surgery, radiation therapy, or ablation from 06/1995-10/2017 at Mayo Clinic in Florida were identified. Through retrospective chart review, data was collected on clinical and demographic features, surveillance imaging, pathology, time to recurrence or second primary lung cancer (SPLC), location of recurrence (loco-regional vs. distant), and treatment of recurrence or SPLC. Kaplan-Meier method was used to evaluate the disease free survival (DFS). Cox proportional hazard model was used to identify prognostic associations.

      Results

      A total of 271 patients with Stage I NSCLC were included. The majority of patients were treated with surgery (n=243) compared with radiation therapy or ablation (n=28). Median time of follow up was 78 months (CI 95% 64-91 months). Of patients who had a recurrence (n=68), 60 patients (88.2%) recurred within 5 years, eight patients (11.8%) recurred between five and ten years, and no patients recurred after ten years. Of patients who developed a SPLC (n=29), 15 patients (51.7%) occurred within 5 years, ten patients (34.5%) occurred between five and ten years, and four patients (13.8%) occurred following ten years. Female, negative tobacco history, Stage IA, and well differentiated carcinoma were associated with significantly prolonged DFS with univariate analysis (p<0.05). Treatment (surgery vs radiation) and histology subtype (adenocarcinoma vs squamous vs others) had no significant effect on DFS. The multivariate Cox proportional hazards model showed a dramatically increased hazard ratio (HR) 3.4 (CI 95% 1.2-9.4) of recurrence in patients with tobacco use, after adjustment for other covariates. Stage IB and tumors which were not identified as well differentiated (i.e: moderate, poorly, or undifferentiated) were also associated with a worse prognosis with HR of 1.8 (CI 95% 1.1-2.9) and HR of 2.0 (CI 95% 1.1–3.8), respectively. None of the patients who were non-smokers with well-differentiated, Stage IA tumors developed a recurrence or SPLC.

      Conclusion

      The clinical features including Stage IA, non-smokers, and well differentiated histology were associated with a significant lower risk of developing recurrence or SPLC. Thus, an individualized approach, which takes into account these risk factors, may be useful in determining whether to continue annual CT surveillance after five years post curative therapy for Stage I NSCLC.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.