7539 Background: Adjuvant chemotherapy (AC) is considered standard of care in patients with resected stages 2 and 3 non-small cell lung cancer (NSCLC). However data regarding its utility in older patients are sparse. This analysis was conducted to evaluate the role of AC in older patients with early stage NSCLC. Methods: We conducted a retrospective analysis of patients with stages 1-3 NSCLC between 2001 and 2008 in the VA Central Cancer Registry. Patients were divided into two groups based on age: <70 yrs and ≥70 yrs. Descriptive statistics were used to examine patterns of AC use and to obtain survival rates associated with use of AC in the two age groups. Chi-square was used to compare distributions. Results: Of the 10,036 patients who underwent surgical resection, 3958 (39.4%) were ≥70 yrs, while 6078 were <70 yrs old. Overall, 11.2% of older patients (6.3% - stage 1, 21% - stage 2, 26.2% - stage 3) and 22.3% of younger pts (11.6% - stage 1, 41.1% - stage 2, 47.1% - stage 3) received AC. Of the patients who received AC, a greater proportion of younger patients received platinum-based AC (91.8 vs 86.4% vs; p=0.0008). Also, in each stage younger patients had a better 3 yr overall survival (OS) (Stage 1-69.2 vs 58%, stage 2 – 52.8 vs 39.1%, stage 3 – 42.5 vs 33.7%). Younger patients with stages 2 and 3 NSCLC who received AC had improved 3 yr OS (58.8 vs 48.6%; p=0.0009 and 48.8 vs 36.9%; p=0.0002 respectively). There was no difference in 3 yr OS for older patients based on AC when all stages were included. For patients with stages 2 and 3, a larger proportion of younger patients received cisplatin-based AC (11.3 vs 3.5%). Older patients with stages 2 and 3, who received cisplatin-based AC had a better 3 yr OS compared to those who received carboplatin-based AC or no AC (55.3 vs 42.2 vs 35.3% respectively; p=0.01). Similarly cisplatin-based AC had an improved 3 yr OS in younger patients with stages 2 and 3 NSCLC (61.4 vs 52 vs 43.4% respectively; p=0.0001). Conclusions: This analysis suggests that older patients do not benefit from AC after resection of stage 1-3 NSCLC to the same degree as younger patients. This differential effect may be due to less common use of cisplatin among older patients. Multivariate analyses are planned.
A prognostic and predictive computational pathology image signature for added benefit of adjuvant chemotherapy in early stage non-small-cell lung cancer
