Journal Thoracic Oncology

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
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