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Wen Feng
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P17 - Locoregional and Oligometastatic Disease - Biomarkers (ID 127)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P17.01 - Adaptive Elastic-Net Nomogram Predicting Disease-Free Survival in Resected Stage IIIA (N2) Non–Small Cell Lung Cancer (ID 2188)
00:00 - 00:00 | Author(s): Wen Feng
- Abstract
Introduction
Pathologic stage IIIA (N2) non–small cell lung cancer (NSCLC) is prominently intrinsic heterogeneous. This study was designed to establish a nomogram to predict disease-free survival and individualize forward therapy selection of this population.
Methods
We retrospectively selected patients with pathologic T1-3N2M0 NSCLC treated in one institution from 2013 to 2015 and randomly allocated them (3:1) to the training set and validation set 1. Meanwhile, we collected patients from another institution between 2005 and 2011 with the same inclusion and exclusion criteria. Significant prognostic variables identified by Log-rank test were used to build a multivariate adaptive Elastic-Net Cox regression model. Nomogram was built based on the regression model and was validated by internal (validation set 1) and external validation (validation set 2) to ensure model’s generalization ability. Discriminative ability and calibration ability of the model was assessed by time-dependent ROCs and calibration curves.
Results
A total of 1189 patients were included in this study (624 in the training set, 208 in the validation set 1 and 357 patients in the validation set 2). Pathologic T stage, histology, skip N2 (yes or no), involved N2 stations (single or multiple), positive lymph nodes rate(pLNR) and adjuvant treatment pattern were identified as significant prognostic factors and entered into the adaptive Elastic-Net Cox regression model. A nomogram was developed from the training set and validated in two validation sets. The calibration curves showed optimal consistency between nomogram prediction and actual observation. The median AUC in the validation set 1 (0.68; range 0.62 to 0.71) was similar to that in the validation set 2 (0.67; range 0.61 to 0.73).
Conclusion
We developed and validated a nomogram to predict disease-free survival of patients with resected stage IIIA (N2) NSCLC individually, through which clinicians could make specific treatment strategy precisely.
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P20 - Locoregional and Oligometastatic Disease - Radiation (ID 130)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P20.02 - To Evaluate the Efficacy and Optimal Timing of Postoperative Radiotherapy in Completely Resected stage IIIA(N2) Non-Small Cell Lung Cancer (ID 2023)
00:00 - 00:00 | Presenting Author(s): Wen Feng
- Abstract
Introduction
Completely resected non-small cell lung cancer (NSCLC) patients with histologically confirmed N2 disease are a heterogeneous population, with a 5-year overall survival (OS) in the range of 10-30%. After postoperative chemotherapy (POCT), 20%-40% of cases have a risk of locoregional recurrence (LRR). Due to a high degree of heterogeneity among IIIA(N2) disease, the value and optimal timing of postoperative radiotherapy (PORT) for completely resected stage IIIA(N2) NSCLC remains controversial. In this randomized clinical trial (RCT), we aimed to investigate the clinical efficacy of PORT for patients with low risk of LRR and investigate the optimal timing of PORT for those with high risk of LRR.
Methods
Eligibility criteria included patients aged 18-75 with complete resection with microscopically negative resection margins; undergone systematic nodal assessment; with histologically proven lung adenocarcinoma or squamous cell lung carcinoma of stage pT1-3N2M0 (according to the UICC7th ed. TNM classification); without prior neoadjuvant therapy. In our institution, the clinical risk prediction model for LRR has been established and validated based on our large retrospective database. The Prognostic Index (PI) equation was built including the three categorical variables and coefficients based on their level of significance: PI＝(0.9×smoking history)＋(0.5×clinical N status)＋(0.8×number of involved lymph nodes). Patients with the PI score<3.5 were considered as low risk of LRR, whereas patients with the PI score≥3.5 were considered as high risk. Subjects will be assessed by the risk stratification for LRR. If with low LRR risk, patients will be randomized (1:1) to Arm I (four cycles of POCT + sequential PORT) versus Arm II (four cycles of POCT). If with high LRR risk, patients will be randomized (1:1) to Arm I (PORT-first strategy) versus Arm II (PORT-last strategy) (Figure 1). PORT was administrated using 3DCRT following the proposed institutional standard clinical target volume (CTV) delineation guideline. The primary endpoint was disease free survival. The secondary endpoints included OS, patterns of recurrence and safety. Accrual goals are 300 patients in low risk and 1094 patients in high risk stratification to reach the DFS events, respectively. Enrollment is currently underway. Clinical trial information: NCT02977169 and NCT02974426.
Conclusion
Pending further readout of the ongoing multicenter, randomized study, the clinical efficacy and the optimal timing of PORT would be determined in completely resected stage IIIA(N2) NSCLC. In addition, by prospective multidimensional data collection, the two dimensional prediction models for LRR and distant metastasis would be further established and optimized in order to facilitate individualized PORT decision making.
