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P1.05-059 Factors Associated with Recurrence and Survival in Patients with Curatively Resected Stage IA Adenocarcinoma of the Lung
January 2017
P1.05-059 Factors Associated with Recurrence and Survival in Patients with Curatively Resected Stage IA Adenocarcinoma of the Lung Topic: Recurrence Masahiko Harada, Hirotoshi Horio Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo/Japan Background: Even when meticulously clinically and pathologically studied, completely resected stage IA adenocarcinoma of the lung does recur. However, there are few data regarding the patterns of recurrences and their risk factors in this population. Therefore, this study characterizes cancer recurrence and its risks and assesses recurrence-free survival in patients with curatively resected stage IA adenocarcinoma. Methods: Between January 1990 and December 2005, a total of 214 patients were given a final diagnosis of pathologic stage IA (UICC-7) adenocarcinoma of the lung. The medical records of these patients were retrospectively reviewed with regard to patient characteristics, tumor pathologic findings and follow up status. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. Results: The median follow up after curative resection was 83 months. Cancer recurred in 28 patients (13%). Among them, local recurrence occurred in 10 patients (5%), whereas distant recurrence occurred in18 patients (8%). Recurrence earlier and later than 5 years after surgery was in 15 patients (7%) and in 13 patients (6%), respectively, with nearly constant risk. At 5 years after index resection, 175 patients (82%) were alive without evidence of cancer recurrence, 11 patients (8%) had experienced recurrence of cancer but still alive and 11 patients (5%) had died with non-cancer causes. Recurrence-free 5- and 10-year survival rates were 92.5 and 70.0%, respectively. Univariate analysis revealed five significant prognostic factors: gender (p¼0.0177); lepidic component (p ¼0.0007); tumor location (p¼0.0099); pleural invasion (p¼0.0274) and lymphatic or vascular vessel invasion (LVI) (p< 0.0001). Multivariate analysis revealed lepidic component, tumor location, and LVI as significant factors. Hazard ratios for recurrence were 0.381 for having lepidic component (95% CI, 0.147-0.979; p¼ 0.0451), 0.361 for right sided tumor (95% CI, 0.188-0.692;
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p¼ 0.0022), and 2.785 for having LVI (95% CI, 1.392-5.555; p¼ 0.0038). Conclusion: Surgically “cured” stage IA adenocarcinoma of the lung recurs. Our analyses indicate no-lepidic component, tumor location, LVI as an independent indicator for cancer recurrence. Identifying high-risk patients for recurrence will simplify decision making for postoperative treatment strategies. Keywords: recurrence, adenocarcinoma of the lung, lymphovascular invasion, p-stage IA
P1.05-060 Adherence to Surveillance Guidelines in Resected NSCLC: Physician Compliance and Impact on Outcomes Topic: Miscellaneous Cheryl Ho, Jennifer Siegfried, Karen Remo, Janessa Laskin Medical Oncology, BC Cancer Agency, Vancouver/BC/Canada Background: Guidelines on resected NSCLC have varying recommendations on appropriate post-operative surveillance. There is general consensus that patients require follow up q6m with clinic visits or CT scans for the first 2 y. This study evaluated compliance with surveillance guidelines and the impact on outcomes. Methods: The BC Cancer Agency provides comprehensive cancer control for a population of 4.5 million. Inclusion criteria included referred patients from 2005-2010, resected stage Ib/II NSCLC, minimum 2 y f/u at the BCCA, no prior lung cancer diagnosis. Retrospective chart review collected baseline parameters, follow up visits, CT imaging, recurrence and death. Results: 479 were referred and 263 were eligible. Baseline characteristics median age 68, male 52%, current/former/never smoker 38/52/10%, stage Ib/II 51/ 49%, squamous/non 30%/70%, wedge/lobectomy/ pneumonectomy 8/76/16%, adjuvant chemotherapy 46%. Adherence to 4 interventions in 2 y: clinic visits 62%, CT scans 18%, visit and/or CT 67%. Multivariate analysis (MVA) for predictors of guideline adherence demonstrated only stage was significant. Recurrence rate was 46% at 2 y with patterns of recurrence and treatment in table 1. Surveillance below vs per/above guidelines; PFS 26.6 m vs 22 m (p¼0.54), OS 47 m vs 41.8 m (p¼0.27).
P1.05-059 Factors Associated with Recurrence and Survival in Patients with Curatively Resected Stage IA Adenocarcinoma of the Lung Topic: Recurrence Masahiko Harada, Hirotoshi Horio Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo/Japan Background: Even when meticulously clinically and pathologically studied, completely resected stage IA adenocarcinoma of the lung does recur. However, there are few data regarding the patterns of recurrences and their risk factors in this population. Therefore, this study characterizes cancer recurrence and its risks and assesses recurrence-free survival in patients with curatively resected stage IA adenocarcinoma. Methods: Between January 1990 and December 2005, a total of 214 patients were given a final diagnosis of pathologic stage IA (UICC-7) adenocarcinoma of the lung. The medical records of these patients were retrospectively reviewed with regard to patient characteristics, tumor pathologic findings and follow up status. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. Results: The median follow up after curative resection was 83 months. Cancer recurred in 28 patients (13%). Among them, local recurrence occurred in 10 patients (5%), whereas distant recurrence occurred in18 patients (8%). Recurrence earlier and later than 5 years after surgery was in 15 patients (7%) and in 13 patients (6%), respectively, with nearly constant risk. At 5 years after index resection, 175 patients (82%) were alive without evidence of cancer recurrence, 11 patients (8%) had experienced recurrence of cancer but still alive and 11 patients (5%) had died with non-cancer causes. Recurrence-free 5- and 10-year survival rates were 92.5 and 70.0%, respectively. Univariate analysis revealed five significant prognostic factors: gender (p¼0.0177); lepidic component (p ¼0.0007); tumor location (p¼0.0099); pleural invasion (p¼0.0274) and lymphatic or vascular vessel invasion (LVI) (p< 0.0001). Multivariate analysis revealed lepidic component, tumor location, and LVI as significant factors. Hazard ratios for recurrence were 0.381 for having lepidic component (95% CI, 0.147-0.979; p¼ 0.0451), 0.361 for right sided tumor (95% CI, 0.188-0.692;
Abstracts
S651
p¼ 0.0022), and 2.785 for having LVI (95% CI, 1.392-5.555; p¼ 0.0038). Conclusion: Surgically “cured” stage IA adenocarcinoma of the lung recurs. Our analyses indicate no-lepidic component, tumor location, LVI as an independent indicator for cancer recurrence. Identifying high-risk patients for recurrence will simplify decision making for postoperative treatment strategies. Keywords: recurrence, adenocarcinoma of the lung, lymphovascular invasion, p-stage IA
P1.05-060 Adherence to Surveillance Guidelines in Resected NSCLC: Physician Compliance and Impact on Outcomes Topic: Miscellaneous Cheryl Ho, Jennifer Siegfried, Karen Remo, Janessa Laskin Medical Oncology, BC Cancer Agency, Vancouver/BC/Canada Background: Guidelines on resected NSCLC have varying recommendations on appropriate post-operative surveillance. There is general consensus that patients require follow up q6m with clinic visits or CT scans for the first 2 y. This study evaluated compliance with surveillance guidelines and the impact on outcomes. Methods: The BC Cancer Agency provides comprehensive cancer control for a population of 4.5 million. Inclusion criteria included referred patients from 2005-2010, resected stage Ib/II NSCLC, minimum 2 y f/u at the BCCA, no prior lung cancer diagnosis. Retrospective chart review collected baseline parameters, follow up visits, CT imaging, recurrence and death. Results: 479 were referred and 263 were eligible. Baseline characteristics median age 68, male 52%, current/former/never smoker 38/52/10%, stage Ib/II 51/ 49%, squamous/non 30%/70%, wedge/lobectomy/ pneumonectomy 8/76/16%, adjuvant chemotherapy 46%. Adherence to 4 interventions in 2 y: clinic visits 62%, CT scans 18%, visit and/or CT 67%. Multivariate analysis (MVA) for predictors of guideline adherence demonstrated only stage was significant. Recurrence rate was 46% at 2 y with patterns of recurrence and treatment in table 1. Surveillance below vs per/above guidelines; PFS 26.6 m vs 22 m (p¼0.54), OS 47 m vs 41.8 m (p¼0.27).