Journal Thoracic Oncology

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Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 P1.08-021 PREDICTORS OF POST-OPERATIVE MORTALITY IN NONpoint. Keywords: long term survivor with 5 years disease free, late recurrence risk factor, positive N stage, non-small cell lung cancer POSTER SESSION 1 - P1.08: SURGERY RISK ASSESSMENT & PROGNOSTIC FACTORS – MONDAY, DECEMBER 5, 2016 P1.08-019 RISK FACTORS AND SURVIVAL OF OCCULT N2 LYMPH NODE METASTASIS IN NSCLC PATIENTS WITH CLINICAL N0-1 DIAGNOSED BY PREOPERATIVE PET-CT Ks Park 1 , Ch Bae 1 , Eb Lee 2 1 Dcmc, Daegu/Korea, Republic of, 2 Kyungpook National University Medical Center, Daegu/Korea, Republic of Background: Accurate staging of NSCLC for N2 lymph node metastasis is crucial for prognosis and optimal therapy. Suggestion of occult mediastinal lymph node metastasis could help physicians for decision making of staging and management. This study was aimed to know risk factors and survival for occult N2 lymph node metastasis in NSCLC patients with clinical N0 and N1 diagnosed by preoperative PET-CT. Methods: This study was evaluated NSCLC patients with clinical N0-1 who underwent R0 lung resection with complete lymphadenectomy. Clinicopathological factors such as tumor size, tumor location, tumor laterality, histology, and FDG uptake were analyzed to delineate risk factors. Overall survival was analyzed. Results: Between November 2005 to December 2014, the incidence of N2 lymph node metastasis was 13.3%(22 patients of 166). The risk factors for pN2 were central located tumor(p
Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017 SMALL CELL LUNG CANCER (NSCLC) IN A HIGH MORTALITY REGION OF THE US Matthew Smeltzer 1 , Yu-Sheng Lee 1 , Edward Robbins 2 , Nicholas Faris 3 , Chris Mutrie 3 , Meredith Ray 1 , Sam Signore 2 , Carrie Fehnel 3 , Cheryl Houston-Harris 2 , Meghan Meadows 1 , Raymond Osarogiagbon 2 1 Epidemiology and Biostatistics, University of Memphis School of Public Health, Memphis/TN/United States of America, 2 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis/TN/United States of America, 3 Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis/TN/United States of America Background: Surgical resection is recommended for most patients with early-stage NSCLC. High postoperative mortality risk diminishes the benefit of curative-intent surgery. We examined factors associated with mortality within 120 days of curative-intent resection in a population-based cohort. Methods: We examined all NSCLC patients with curative-intent resections from 2009-2016 in all 11 hospitals in 4 US Dartmouth Referral Regions. We evaluated patient demographics, disease characteristics, pre-operative evaluation, treatment, and perioperative complications to identify risk factors for 30-, 60-, 90-, and 120-day mortality using logistic regression models. Results: The 2,258 patients’ median age was 67, 48% were female; 78% were White, 21% Black. The 30-, 60-, 90-, and 120-day post-operative mortality rates were 4%, 6%, 8%, and 9%. After adjusting for all other factors, American Society of Anesthesiologists score (ASA) (p=0.0405), prior lung cancer (p=0.0406), and Charlson comorbidity score (p=0.0163) were associated with 30-day mortality. Adjusted models for 120-day mortality indicate associations with age (p=0.0001), tumor size (p=0.0012), intraoperative blood loss (p=0.0150), hospital (p=0.0065), ASA (p=0.0035), prior lung cancer (p=0.0466), and Charlson score (p=0.0064) (Table 1). Patients >75 years old had 1.5 times the odds of 120-day mortality compared with those =3 (vs. 0) conferred 2.7 times the odds of 120-day mortality. On average, each 1 cm increase in tumor size increased the odds of 120-day mortality by 12%. Patients with all three risk factors (age >75, Charlson score >=3, tumor >4cm) had 26.5% 120-day mortality. Although 17.5% of pneumonectomy patients died within 120 days, extent or duration of surgery were not significant after adjusting for other factors. POSTER SESSION 1 - P1.08: SURGERY RISK ASSESSMENT & PROGNOSTIC FACTORS – MONDAY, DECEMBER 5, 2016 P1.08-022 RISK STRATIFICATION MODEL TO PREDICT SURVIVAL FOLLOWING SURGICAL RESECTION FOR LUNG CANCER USING PATHOLOGICAL VARIABLES Timothy Edwards, Charlene Tennyson, Haval Balata, Phil Foden, Anshuman Chaturvedi, Rajesh Shah, Philip Crosbie, Richard Booton, Matthew Evison University Hospitals of South Manchester, Manchester/United Kingdom Background: The risk of lung cancer recurrence remains a significant problem following curative-intent treatment. Novel methods of calculating this risk may have potential benefits in defining adjuvant strategies and stratifying the intensity of surveillance programs. The aim of this study was to identify factors at surgical resection of NSCLC that influenced survival in attempt to develop a probability model to predict mortality. Methods: Pathological variables were recorded from 1311 patients undergoing surgical resection for NSCLC from 2011 to 2014 at a tertiary UK lung cancer centre. Pathological variables analysed included T-stage, N-stage, adequacy of intra-operative lymph node sampling, pleural invasion, lymphovascular invasion, extracapsular spread, histological sub-typing, extent of surgery, grade of differentiation and R status (residual disease). Survival data was obtained from national death registries and logistic regression was used to develop a probability model to predict mortality. Results: Table 1. Pathological predictors of survival 1 year post surgery for NSCLC N (total=2258) 30-Day Mortality 120-Day Mortality % % Age < 49 101 3 7.9 50-64 730 2.6 4.3 65-74 937 4.7 9.9 75+ 490 6.1 13.1 p=0.1954 p=0.0001 Tumor Size(mean) 2258 3.6 3.9 p=0.1834 p=0.0012 Surgery Type Lobectomy/Wedge 1696 3.5 7.8 Pneumonectomy 143 9.1 17.5 Bilobectomy 126 6.4 11.9 Segmentectomy/Wedge 293 5.5 7.9 p=0.4359 p=0.6029 Previous Lung Cancer No 2166 4 8.3 Yes 92 10.9 17.4 p=0.0406 p=0.0466 Charlson Comorbidity 0 455 1.8 4.2 1-2 1132 3.8 8.2 ≥3 671 6.7 12.5 p=0.0163 p=0.0064 Blood loss(surgical) 0-500cc 2048 4 7.8 501-1000cc 136 6.6 16.9 >1000cc 74 8.1 18.9 p=0.4842 p=0.015 Conclusion: Age, ASA, Charlson score, and tumor size are important risk factors for post-operative mortality. Inter-hospital disparity suggests an opportunity for institution-level corrective interventions. Patients with the combination of age >75, Charlson score >=3, and advanced T-category had a high rate of post-operative mortality. Keywords: Surgical resection, Early-stage NSCLC, Post-operative Mortality Using the probabilities from the logistic regression model to predict one year mortality gives an AUC of 0.741. If a probability of 0.144 is used to predict whether a patient will die within one year of surgery, sensitivity is 70.0% (119/170), specificity is 67.3% (625/929), PPV is 28.1% (119/423) and NPV is 92.5% (625/676). Conclusion: Survival post-curative intent surgery for NSCLC is based on multiple pathological factors as described above. Further analysis of these factors will be performed in the future to determine a risk stratification model to predict patients with low versus high risk mortality post surgery. Whilst indications for adjuvant therapy are well documented, the optimal surveillance regime is not as clear. Given the heterogenous group of patients receiving surgery for NSCLC, a predictive model may be useful in determining optimal surveillance strategies. Keywords: non small cell lung cancer, survival, Surgical resection Copyright © 2016 by the International Association for the Study of Lung Cancer S385
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LILLY ONCOLOGY IS DEDICATED TO ADVA
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