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Ting Mei



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    P30 - Palliative and Supportive Care (ID 163)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Palliative and Supportive Care
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P30.09 - Exposure to Antibiotics May Affect Progression-Free Survival Negatively in NSCLC Patients Receiving First-Line Chemotherapy (ID 1719)

      00:00 - 00:00  |  Author(s): Ting Mei

      • Abstract
      • Slides

      Introduction

      Pre-clinical and clinical data indicates the microbiome plays an important role in carcinogenesis and influences response to PD-1/PD-L1 inhibitors among patients with several solid tumors. Also, chemotherapeutic regimens have been shown to disrupt the intestinal barrier and promote antitumor efficacy in humans and mice. From this point of view, exposure to antibiotics before systematic therapy might have impacts on the clinical outcomes in non-small cell lung cancer (NSCLC) patients receiving first-line chemotherapy.

      Methods

      Between Jan 2015 and Dec 2018, patients with pathologically confirmed NSCLC who had received first-line chemotherapy in West China Hospital and Sichuan Provincial People's Hospital were recruited in present study. The definition of “exposure to antibiotics” was an at least 7-day period antibiotic exposure 21 days before chemotherapeutic regimens infusion in the first-line settings. Progression-free survival (PFS) among patients with or without exposure to antibiotics (Exposure group or Control group) were analyzed using the Kaplan-Meier method and the Cox proportional hazard models.. The p value was considered statistically significant if less than 0.05.

      Results

      Totally, 2212 patients with NSCLC were retrospectively analyzed, and 1021 advanced stage cases with the ECOG PS 0-1 receiving first-line chemotherapy were recruited in present study. The population exposed to antibiotics was 41.6% (425/1021). Compared to the PFS in Exposure group [4.1 months, 95% confidence interval (CI) 3.5-4.7 months], the median PFS in Control group was significantly prolonged (6.6 months, 95% CI 6.1-7.0 months), with a hazard ratio (HR) of 0.48 (95% CI 0.39-0.60, p<0.001). In addition, the difference of PFS between patients with non-squamous (median 6.1 months, 95% CI 5.6-6.6 months) and squamous cell NSCLC (median 5.2 months, 95% CI 4.6-5.8 months) was significant (p=0.038). No association was observed between the PFS and the other clinical characteristics (such as age, gender, brain or liver metastasis) (all p>0.05). Among patients exposed to antibiotics, the median PFS were similar depending on the different kinds of drugs prescribed (for Penicillin: 4.1 months, 95% CI 3.2-5.0 months; for Cephalosporin: 3.9 months, 95% CI 2.9-4.9 months and for Quinolones: 4.1 months, 95% CI 2.9-5.4 months) (p= 0.91).

      antibiotics exposure.jpeg

      Conclusion

      Although its retrospective nature and relative small sample size, our data indicated that exposure to antibiotics might negatively affect the PFS of NSCLC patients receiving first-line chemotherapy, calling attention to the unnecessary antibiotics prescription before systematic treatment in practice. The analysis of overall survival was ongoing in a larger multi-center population.

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    P50 - Small Cell Lung Cancer/NET - Real World Outcomes (ID 232)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 2
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P50.12 - A Novel Nomogram and Risk Classification System Predicting The Survival of Patients with Extensive-stage Small Cell Lung Cancer (ID 855)

      00:00 - 00:00  |  Presenting Author(s): Ting Mei

      • Abstract
      • Slides

      Introduction

      We aimed to develop and validate a nomogram to predict the survival of ES-SCLC patients.

      Methods

      583 patients with initially diagnosed ES-SCLC patients were recruited in the present study. Patients were randomly divided into the training and validation cohorts (7:3). The putative prognostic indicators for constructing the nomogram were identified using multivariable Cox regression analysis with backward elimination. its calibration and discriminative ability were evaluated with calibration plots and the Uno C statistic, respectively. The risk group stratification analysis further validated the evaluation ability of this model

      Results

      figure.jpgIn the Multivariate Cox regression analysis, age, ECOG performance status, distant metastases and superior vena cava syndrome (SVCS) were identified as independent predictors for ES-SCLC patients. A nomogram model was constructed based on these factors. The bootstrapped-concordance index of the nomogram was 0.663. And the area under the curve of 3-, 6-, 9-months, 1-, 2-year was 1, 0.8, 0.8, 0.7, 0.74, respectively. The calibration curves also showed good consistency in the probability of 3-, 6-, 9-months, 1-,2-years survival time between the actual observation and the nomogram prediction. A risk classification system was established and patients were divided into high-risk and low-risk groups. Univariate analysis suggested a poorer prognosis in the high-risk groups than in the low-risk groups in all three groups (all cohorts, training cohort, validation cohort, all p < 0.01).

      Conclusion

      The prognostic nomogram can be useful for assessing the probability of survival of ES-SCLC, and it may guide clinicians in treatment strategy making, survival predicting and design of clinical studies.

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      P50.13 - A Nomogram for Assessing Survival in Extensive-stage SCLC patients with SVCS Referred To Thoracic Radiotherapy:Upfront vs. Consolidative ? (ID 861)

      00:00 - 00:00  |  Presenting Author(s): Ting Mei

      • Abstract
      • Slides

      Introduction

      We aimed to develop and validate a nomogram to predict the impact of the time of radiotherapy on the survival of ES-SCLC patients with SVCS.

      Methods

      Between 2009 and 2017, ES-SCLC patients with SVCS were recruited in present study. We integrated the important factors affecting survival and built a nomogram. The model was subjected to bootstrap internal validation, and patients were randomly divided into training and validation cohorts (7:3). The cox proportional hazard model is used to select factors with significant differences to build the nomogram. Concordance index (C-index) and risk group stratification are used to measure the prediction accuracy and discriminative ability of the model.

      Results

      figure.pngSex (female vs. male , hazard ratio(HR), 0.57; 95%CI, 0.374-0.869, p=0.009), age(<60 years vs. ≥60 years, HR 0.73, ; 95%CI, 0.504-1.04, p=0.084) ECOG performance status(PS=2 vs. PS=0-1, HR 2.31, 95%CI, 1.51-3.51, p<0.001), distant metastases(liver: yes vs. no, HR 1.61, 95%CI, 1.09-2.37, p=0.016;bone: yes vs. no ,HR 2.07, 95%CI, 1.38-3.11, p<0.001;brain: yes vs. no, HR 1.49, 95%CI, 1.01-2.21, p=0.045; retroperitoneal lymph node: yes vs. no, HR 2.53, 95%CI, 1.58-4.04, p<0.001; supraclavicular lymph node: yes vs. no, HR 1.68, 95%CI, 1.00-2.83, p=0.052;) and treatment (chemotherapy alone vs. chemotherapy-based consolidative thoracic radiotherapy (cc-TRT) vs. chemotherapy-based upfront thoracic radiotherapy (cu-TRT), HR 1.28, 95%CI, 1.00-1.64, p=0.056) were entered into the nomogram. The bootstrapped-concordance index of the nomogram was 0.764. And the area under the curve of 3-, 6-, 9-months, 1-, 2-year was 1, 0.9, 0.8, 0.8, 0.87, respectively. The calibration curves also showed good consistency in the probability of 3-, 6-, 9-months, 1-,2-years survival time between the actual observation and the nomogram prediction. A risk classification system was established and patients were divided into high-risk and low-risk groups. Univariate analysis suggested a poorer prognosis in the high-risk groups than in the low-risk groups in all three groups (all cohorts, training cohort, validation cohort, all p < 0.01).

      Conclusion

      We established and validated a novel nomogram that can provide an individual prediction of OS for ES-SCLC patients with SVCS. From this nomogram, the strategy of cu-TRT has a significant positive impact on the prognosis of ES-SCLC patients with SVCS. Further studies are warranted to verify these findings

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    P76 - Targeted Therapy - Clinically Focused - EGFR (ID 253)

    • Event: WCLC 2020
    • Type: Posters
    • Track: Targeted Therapy - Clinically Focused
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      P76.25 - Radiation Pneumonitis in NSCLC Patients Receiving EGFR-TKI and Once-Daily Thoracic RT: Predicting Values of Clinical and DVH Parameters (ID 1358)

      00:00 - 00:00  |  Author(s): Ting Mei

      • Abstract
      • Slides

      Introduction

      Studies show effective clinical outcomes by EGFR-tyrosine kinase inhibitor (EGFR-TKI) in advanced-stage non-small cell lung cancer (NSCLC) harboring EGFR mutation. Also, data indicated that thoracic radiotherapy (usually stereotactic body radiotherapy, not conventionally-fractionated RT) plays an important role on local disease control for specific patients. However, radiation pneumonitis (RP) is a common complication of thoracic RT, and TKI-related interstitial pneumonia may increase the incidence of RP. In present study, we reported the real-world symptomatic RP incidence in NSCLC patients receiving EGFR-TKI and once-daily thoracic RT, and analyzed the value of clinical and dose-volume histogram (DVH) parameters to predict the risk for RP.

      Methods

      Between 2011 and 2019, we retrospectively analyzed 1279 patients with NSCLC who had received the EGFR-TKI and identified 85 patients had received once-daily thoracic RT simultaneously. The median prescription dose was 58 Gy, with a range of 50-66Gy (2Gy/fraction). The symptomatic RP was recoded according to the CTCAE criteria (grade 2 or above). The follow-up time was from the beginning of the RT to 6 months after the RT. Statistical analyses were performed with SPSS 26.0.

      Results

      the roc curve and kaplan–meier  estimates of cumulative hazards.jpgIn total, the incidences of symptomatic and severe RP (grade ≥3) were 43.5% (37/85) and 16.5% (14/85) respectively in present population. Univariate and multivariate analysis indicated that percentage of ipsilateral lung volume receiving ≥30 Gy (ilV30) (Odds ratio[OR]: 1.163, 95% confidence interval [CI]: 1.036-1.306, p=0.011), percentage of total lung volume receiving ≥20 Gy(tlV20)(OR:1.171, 95% CI: 1.031-1.330, p=0.015), with chronic obstructive pulmonary disease(COPD) or not(OR:0.158, 95% CI:0.041-0.600, p=0.007) were independent predictors of symptomatic RP. The ROC curve analysis showed the AUC of the combination of ilV30, tlV20 and COPD was 0.823 (95% CI:0.734-0.912, p < 0.001) with its sensitivity and specificity of 0.757 and 0.792 respectively. While the optimal cut-off point of ilV30/tlV20 were 25.8%/22.1% with their sensitivity and specificity of 0.757/0.703 and 0.729/0.729 respectively. Compared to those patients with low ilV30 and tlV20 value (ilV30 and tlV20 ≤ cut-off point value) without COPD, patients with high ilV30 and tlV20 value (ilV30 and tlV20 > cut-off point value) with COPD had a significant higher risk of symptomatic RP, and its hazard ratio (HR) was 1.350 (95% CI: 1.190-1.531, p < 0.001).

      Conclusion

      The ilV30, tlV20 and diagnosed with COPD may predict the risk for symptomatic RP among NSCLC patients receiving EGFR-TKI and conventionally-fractionated thoracic radiotherapy concurrently. Meanwhile, prospective studies are needed to verify our findings.

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