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P1.01-055 Clinicoepidemiological Trends of Lung Cancer from a Premier Regional Cancer Centre in South India
January 2017
P1.01-054 Lung Cancer: Histology, Gender and Age Changes Over Past 30 Years in Brazil Topic: Descriptive Epidemiology Maria Teresa Ruiz Tsukazan,1 Álvaro Vigo,2 Vinícius Duval Da Silva,1 Flávio Cabral,1 Renata Rosenthal,1 Arthur Vieira,1 Jayme Rios,1 José Antônio Figueiredo Pinto1 1Hospital São Lucas Da Pucrs, Porto Alegre/Brazil, 2Universidade Federal Do Rio Grande Do Sul - Ufrgs, Porto Alegre/Brazil Background: Lung is the leading death cause cancer related worldwide when considering both genders. The great effort to reduce smoking and introduce of cigarette changed lung cancer epidemiology. In developed countries the increase of adenocarcinoma and decrease of squamous cell carcinoma are well known. Other characteristic reported is the rising number of with the disease. Better understanding of current lung cancer epidemiology is necessary to design public health strategies for prevention, diagnosis and treatment. Methods: Retrospective analysis of all patients with non-small cell lung cancer submitted to anatomical lung resection between 1986 and 2015 in the University Hospital of South Brazil. Patients were divided in three periods 1986-1995, 1996-2005 and 2006-2015. The same pathologist group made histology diagnosis and all staging was updated according to the new IASLC 7th edition. All analyses were performed using the SAS program. Results: In our Institution 1030 patients underwent anatomical lung resection for lung cancer between 1986 and 2015. 64.5% were males, average age 62.1 years, 40.6% squamous cell carcinoma and 44.5% adenocarcinoma, 23% advanced stage IIIA. The female proportion increased from 26.6% on first period to 44.2% on last period. Mean age at surgery treatment was 56.4 years for women and 58.9 for men on first period, and 62.2 for woman and 64.6 for men on the last period (p<0.001). The proportion of squamous cell changed from initially 49.6%, then 43% to 34.8% on the last period (p<0.001). In comparison in the same sequence we have for adenocarcinoma prevalence starting on 38.1%, 41.2% and most recently 49.5%. Stage IIIA was predominant on all periods with 23%, however early stages IA and IB combined represent 47.1% in the last group. Type of surgery was predominantly lobectomy and was verified decreasing in pneumonectomy rate. Conclusion: Analyses including gender showed that lung cancer in women is raising over the years but didn’t surpassed men yet. Women adenocarcinoma has
Abstracts
S483
increased the participation on total cases. The significant decrease of pneumonectomy reinforces the changes on surgical management technics and also correlates with more early staging diagnosis. The mean average age on surgery has increased for both men and women. Keywords: histology, gender, lung cancer, epidemiology
P1.01-055 Clinicoepidemiological Trends of Lung Cancer from a Premier Regional Cancer Centre in South India Topic: Descriptive Epidemiology Abhijit Das, Arvind Krishnamurthy Surgical Oncology, Cancer Institute (Wia), Chennai/India Background: Lung Cancer is one of the leading causes of morbidity and mortality worldwide. It is most commonly attributed to smoking; a smaller proportion is attributed to occupational exposure. However, an earlier published study by Krishnamurthy et al 2012 from the authors institute reported the increasing trends of “Nonsmoking associated lung cancers” in the Indian subcontinent. A larger prospective study aimed at validating the initial findings was planned and this formed the basis of the present study. Methods: All consecutive histologically confirmed patients with lung cancer who presented to the outpatient department over a year (November 2014 to October 2015) were included in this current prospective study. A comprehensive questionnaire administered by a trained social worker captured all the demographic details including age, sex, occupation, smoking habits including exposure to second hand smoke, type of cooking fuel, histopathology and stage at presentation among others. (And later analyzed by SPSS Version 22.0). Results: 713 patients presented with clinico-radiologicaly suspicious findings of lung cancer in the said period. A pathological confirmation of lung cancer could be ascertained in 495 patients and this cohort was further analyzed. The median age of presentation was 58 years; the male to female ratio was approximately 2.5:1. 52.12 % patients were nonsmokers. Adenocarcinoma (63 %) was the predominant histology. Nonsmokers, both among men (p¼0.02) and women (0.001) presented more frequently with adenocarcinoma histology. Interestingly, 84.9 % (45/53) rural and 76.1 % (19/25) urban women who were nonsmoker reported exposure to indoor air pollution (second hand smoke/fuel used for cooking purposes) which was significantly associated with adenocarcinoma histology. (p¼0.01) A majority of
S484
the patients (69.1 %) presented with clinical stage IV. (7th edition TNM) Nearly 60% of patients presented in ECOG performance status 3-4, nonsmokers incidentally presented in a better performance status than smokers (p ¼ 0.017). 53% of the patients unfortunately were deemed suitable only for best supportive care. Only 97 patients (19.6 %) were offered potentially curative treatment and radical surgery accounted for < 3 % of the overall management. Conclusion: This prospective study validated our initial observation of the increasing trends of lung cancers among nonsmokers. Further, this study also reflected the global trend of rise in adenocarcinoma histology. These findings in a larger perspective will help clinicians better understand the magnitude and the direction of the lung cancer epidemic and also aid policymakers in better channelizing the resources for effective public health interventions. Keywords: smoking, lung cancer, epidemiology, Adenocarcinoma
P1.01-056 Lung Cancer Epidemiology in Croatia Topic: Descriptive Epidemiology Robert Zorica, Vida Popovic, Toni Bozinovic University Hospital “split”, Split/Croatia Background: To analyze principal histological types of lung cancer, as well as sex and the age of patients, staging, tumor location, smoking history, Chronic obstructive pulmonary disease (COPD) history, and survival of lung cancer patients in Croatia. Methods: This was a retrospective study based on the analysis of medical charts of patients treated at the University Hospital “Split“, Split, Croatia, during 2015 and 2016. Results: From July 2015 to February 2016, 332 patients with lung cancer, most of whom (75,30%) were male, were treated. Patients were between 36 and 85 years, with median age 65,5 years. There were 273 (84,78%) patients with NSCLC (Non-Small Cell Lung Cancer) and 49 (15,22%) patients with SCLC (Small Cell Lung Cancer). The most common histological type in patients with NSCLC was adenocarcinoma (58%), followed by squamos cell carcinoma (38%), NSCLC NOS (not otherwise specified) (2%), adenosquamos carcinoma (1%) and large cell carcinoma (1%). Among patients with NSCLC 13% are EGFR positive. Patients had mostly lung cancer in right lung (59,35%), most of them were smokers (88,40%), 20,70% patients had COPD and 21,05 % patients had pleural effusion. Concerning staging, 73,80%
Journal of Thoracic Oncology
Vol. 12 No. 1S
patients had stage IIIB and IV at the time of diagnosis, and the remaining 26,20% were classified as stage I-IIIA. The principal sites of metastases were lungs (24,45%), bones (23,6%), and liver (12,9%). One-year survival was 23,21% and median overall survival was 8,82 months for patients presented with stage IIIB and IV. Median age at death was 67,5 years. Conclusion: In accordance with the literature most of the lung cancer patients in Croatia are men, older age (but younger compared to developed countries), the most common histological type is adenocarcinoma. Most of the patients have cancer in the right lung, most of them are smokers and minority had COPD or pleural effusion. Most cases are presented in advanced stages at the moment of diagnosis. This effects on survival rate, which is lower compared to developed countries. To increase survival rate in Croatia smoking cessation should be encouraged, lung cancer screening, diagnosis and therapy should be improved, patients should be included in clinical trials and palliative care for terminal patients should be improved. Keywords: lung cancer, epidemiology, Croatia
P1.01-057 Metastatic Lung Cancer at a Tertiary Cancer Centre in South India Topic: Descriptive Epidemiology Govind Babu, Lakshmaiah Kc, Mangesh Kamath, Lokanath D Medical Oncology, Kidwai Memorial Institute of Oncology, Karnataka/India Background: Nonsmall cell lung cancer (NSCLC) has varying epidemiological patterns in different countries and also in different regions of each country. In a country with a high prevalence of lung cancer such as India, regional variations in demography exist. Methods: We did a retrospective analysis of histologically confirmed metastatic NSCLC patients who presented to our Department of Medical Oncology between August 2012 and July 2014. The patients were interviewed regarding their history of smoking (never smokers, light smokers, and heavy smokers). Never smokers were defined as those who have smoked <100 bidi/cigarettes in their life until disease onset. Light smokers were defined as those who smoke <10e100 bidi/cigarette pack years. Heavy smokers were defined as those who smoke more than 100 bidi/ cigarette pack years until disease. All lung cancer biopsy specimens were histologically characterized by morphology and immunohistochemistry (IHC). A diagnosis of AC was made if IHC staining was positive for CK7, TTF1, and
P1.01-054 Lung Cancer: Histology, Gender and Age Changes Over Past 30 Years in Brazil Topic: Descriptive Epidemiology Maria Teresa Ruiz Tsukazan,1 Álvaro Vigo,2 Vinícius Duval Da Silva,1 Flávio Cabral,1 Renata Rosenthal,1 Arthur Vieira,1 Jayme Rios,1 José Antônio Figueiredo Pinto1 1Hospital São Lucas Da Pucrs, Porto Alegre/Brazil, 2Universidade Federal Do Rio Grande Do Sul - Ufrgs, Porto Alegre/Brazil Background: Lung is the leading death cause cancer related worldwide when considering both genders. The great effort to reduce smoking and introduce of cigarette changed lung cancer epidemiology. In developed countries the increase of adenocarcinoma and decrease of squamous cell carcinoma are well known. Other characteristic reported is the rising number of with the disease. Better understanding of current lung cancer epidemiology is necessary to design public health strategies for prevention, diagnosis and treatment. Methods: Retrospective analysis of all patients with non-small cell lung cancer submitted to anatomical lung resection between 1986 and 2015 in the University Hospital of South Brazil. Patients were divided in three periods 1986-1995, 1996-2005 and 2006-2015. The same pathologist group made histology diagnosis and all staging was updated according to the new IASLC 7th edition. All analyses were performed using the SAS program. Results: In our Institution 1030 patients underwent anatomical lung resection for lung cancer between 1986 and 2015. 64.5% were males, average age 62.1 years, 40.6% squamous cell carcinoma and 44.5% adenocarcinoma, 23% advanced stage IIIA. The female proportion increased from 26.6% on first period to 44.2% on last period. Mean age at surgery treatment was 56.4 years for women and 58.9 for men on first period, and 62.2 for woman and 64.6 for men on the last period (p<0.001). The proportion of squamous cell changed from initially 49.6%, then 43% to 34.8% on the last period (p<0.001). In comparison in the same sequence we have for adenocarcinoma prevalence starting on 38.1%, 41.2% and most recently 49.5%. Stage IIIA was predominant on all periods with 23%, however early stages IA and IB combined represent 47.1% in the last group. Type of surgery was predominantly lobectomy and was verified decreasing in pneumonectomy rate. Conclusion: Analyses including gender showed that lung cancer in women is raising over the years but didn’t surpassed men yet. Women adenocarcinoma has
Abstracts
S483
increased the participation on total cases. The significant decrease of pneumonectomy reinforces the changes on surgical management technics and also correlates with more early staging diagnosis. The mean average age on surgery has increased for both men and women. Keywords: histology, gender, lung cancer, epidemiology
P1.01-055 Clinicoepidemiological Trends of Lung Cancer from a Premier Regional Cancer Centre in South India Topic: Descriptive Epidemiology Abhijit Das, Arvind Krishnamurthy Surgical Oncology, Cancer Institute (Wia), Chennai/India Background: Lung Cancer is one of the leading causes of morbidity and mortality worldwide. It is most commonly attributed to smoking; a smaller proportion is attributed to occupational exposure. However, an earlier published study by Krishnamurthy et al 2012 from the authors institute reported the increasing trends of “Nonsmoking associated lung cancers” in the Indian subcontinent. A larger prospective study aimed at validating the initial findings was planned and this formed the basis of the present study. Methods: All consecutive histologically confirmed patients with lung cancer who presented to the outpatient department over a year (November 2014 to October 2015) were included in this current prospective study. A comprehensive questionnaire administered by a trained social worker captured all the demographic details including age, sex, occupation, smoking habits including exposure to second hand smoke, type of cooking fuel, histopathology and stage at presentation among others. (And later analyzed by SPSS Version 22.0). Results: 713 patients presented with clinico-radiologicaly suspicious findings of lung cancer in the said period. A pathological confirmation of lung cancer could be ascertained in 495 patients and this cohort was further analyzed. The median age of presentation was 58 years; the male to female ratio was approximately 2.5:1. 52.12 % patients were nonsmokers. Adenocarcinoma (63 %) was the predominant histology. Nonsmokers, both among men (p¼0.02) and women (0.001) presented more frequently with adenocarcinoma histology. Interestingly, 84.9 % (45/53) rural and 76.1 % (19/25) urban women who were nonsmoker reported exposure to indoor air pollution (second hand smoke/fuel used for cooking purposes) which was significantly associated with adenocarcinoma histology. (p¼0.01) A majority of
S484
the patients (69.1 %) presented with clinical stage IV. (7th edition TNM) Nearly 60% of patients presented in ECOG performance status 3-4, nonsmokers incidentally presented in a better performance status than smokers (p ¼ 0.017). 53% of the patients unfortunately were deemed suitable only for best supportive care. Only 97 patients (19.6 %) were offered potentially curative treatment and radical surgery accounted for < 3 % of the overall management. Conclusion: This prospective study validated our initial observation of the increasing trends of lung cancers among nonsmokers. Further, this study also reflected the global trend of rise in adenocarcinoma histology. These findings in a larger perspective will help clinicians better understand the magnitude and the direction of the lung cancer epidemic and also aid policymakers in better channelizing the resources for effective public health interventions. Keywords: smoking, lung cancer, epidemiology, Adenocarcinoma
P1.01-056 Lung Cancer Epidemiology in Croatia Topic: Descriptive Epidemiology Robert Zorica, Vida Popovic, Toni Bozinovic University Hospital “split”, Split/Croatia Background: To analyze principal histological types of lung cancer, as well as sex and the age of patients, staging, tumor location, smoking history, Chronic obstructive pulmonary disease (COPD) history, and survival of lung cancer patients in Croatia. Methods: This was a retrospective study based on the analysis of medical charts of patients treated at the University Hospital “Split“, Split, Croatia, during 2015 and 2016. Results: From July 2015 to February 2016, 332 patients with lung cancer, most of whom (75,30%) were male, were treated. Patients were between 36 and 85 years, with median age 65,5 years. There were 273 (84,78%) patients with NSCLC (Non-Small Cell Lung Cancer) and 49 (15,22%) patients with SCLC (Small Cell Lung Cancer). The most common histological type in patients with NSCLC was adenocarcinoma (58%), followed by squamos cell carcinoma (38%), NSCLC NOS (not otherwise specified) (2%), adenosquamos carcinoma (1%) and large cell carcinoma (1%). Among patients with NSCLC 13% are EGFR positive. Patients had mostly lung cancer in right lung (59,35%), most of them were smokers (88,40%), 20,70% patients had COPD and 21,05 % patients had pleural effusion. Concerning staging, 73,80%
Journal of Thoracic Oncology
Vol. 12 No. 1S
patients had stage IIIB and IV at the time of diagnosis, and the remaining 26,20% were classified as stage I-IIIA. The principal sites of metastases were lungs (24,45%), bones (23,6%), and liver (12,9%). One-year survival was 23,21% and median overall survival was 8,82 months for patients presented with stage IIIB and IV. Median age at death was 67,5 years. Conclusion: In accordance with the literature most of the lung cancer patients in Croatia are men, older age (but younger compared to developed countries), the most common histological type is adenocarcinoma. Most of the patients have cancer in the right lung, most of them are smokers and minority had COPD or pleural effusion. Most cases are presented in advanced stages at the moment of diagnosis. This effects on survival rate, which is lower compared to developed countries. To increase survival rate in Croatia smoking cessation should be encouraged, lung cancer screening, diagnosis and therapy should be improved, patients should be included in clinical trials and palliative care for terminal patients should be improved. Keywords: lung cancer, epidemiology, Croatia
P1.01-057 Metastatic Lung Cancer at a Tertiary Cancer Centre in South India Topic: Descriptive Epidemiology Govind Babu, Lakshmaiah Kc, Mangesh Kamath, Lokanath D Medical Oncology, Kidwai Memorial Institute of Oncology, Karnataka/India Background: Nonsmall cell lung cancer (NSCLC) has varying epidemiological patterns in different countries and also in different regions of each country. In a country with a high prevalence of lung cancer such as India, regional variations in demography exist. Methods: We did a retrospective analysis of histologically confirmed metastatic NSCLC patients who presented to our Department of Medical Oncology between August 2012 and July 2014. The patients were interviewed regarding their history of smoking (never smokers, light smokers, and heavy smokers). Never smokers were defined as those who have smoked <100 bidi/cigarettes in their life until disease onset. Light smokers were defined as those who smoke <10e100 bidi/cigarette pack years. Heavy smokers were defined as those who smoke more than 100 bidi/ cigarette pack years until disease. All lung cancer biopsy specimens were histologically characterized by morphology and immunohistochemistry (IHC). A diagnosis of AC was made if IHC staining was positive for CK7, TTF1, and