Overall Survival Analysis of Stage Iv Non Small Cell Lung Cancer with Synchronous Isolated Metastasis in a Large Retrospective Cohort of 4935 Patients with Lung Cancer

9044 Background: Prior studies have shown superior surgical outcomes of stage I-III non-small cell lung cancer (NSCLC) in centers with higher patient volumes. However, there is a lack of such information in stage IV NSCLC. In this study, we aim to determine the association between the number of patients with stage IV NSCLC treated annually at a treatment facility (volume) and all-cause mortality (outcome). Methods: Using the National Cancer Database, we identified patients diagnosed with stage IV NSCLC between 2004 and 2013. We classified the facilities by quartiles (Q; mean patients with NSCLC treated per year): Q1: < 13.8; Q2: 13.8 to 23.6, Q3: 23.6 to 30.3, and Q4: > 30.3. We used sandwich variance estimators to account for clustering of patients within facilities and Cox regression to determine the volume-outcome relationship, adjusting for demographic (sex, age, race), socioeconomic (insurance type), receipt of chemotherapy, and comorbid (Charlson-Deyo score) factors and year of diagnosis. Results: There were 281,654 patients with stage IV NSCLC treated at 1,275 facilities. The median age at diagnosis was 66 years, and 55.7% were men. The median annual facility volume was 23.6 patients per year (range, 1.0 to 301.4). The distribution of patients according to facility volume was: Q1: 6.6%, Q2: 14.9%, Q3: 25.4%, and Q4: 53.1%. The unadjusted median overall survival by facility volume was: Q1: 4.4 months, Q2: 4.5 months, Q3: 4.7 months, and Q4: 5.3 months ( P< .001). Multivariable analysis showed that facility volume was independently associated with all-cause mortality. Compared with patients treated at Q4 facilities, patients treated at lower-quartile facilities had a small but significantly higher risk of death (Q3 hazard ratio [HR], 1.05 [95% CI, 1.03 to 1.07]; Q2 HR, 1.06 [95% CI, 1.03 to 1.09]; Q1 HR, 1.09 [95% CI, 1.06 to 1.13]). Conclusions: Patients who were treated for stage IV NSCLC at lower-volume facilities had a significantly higher risk of all-cause mortality compared with those who were treated at lower-volume facilities. [Table: see text]

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Higher Dose Thoracic Radiation Therapy Is Associated With Improved Overall Survival in Limited-stage Small Cell Lung Cancer: Analysis of the 15-year Experience From a Retrospective Cohort of 296 Patients

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.07.1539 ◽

2012 ◽

Vol 84 (3) ◽

pp. S577

Author(s):

V. Janardanan Nair ◽

A. Sirisegaram ◽

G. Nicholas ◽

R. Mallick ◽

S. Laurie ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Radiation Therapy ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Retrospective Cohort ◽

Small Cell ◽

Small Cell Lung ◽

Limited Stage ◽

Thoracic Radiation

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Activin as a biomarker for platinum resistance in non-small cell lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e21737 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e21737-e21737

Author(s):

Jennifer Wen Ying Lim ◽

Alexander David Murphy ◽

Sandra O'Toole ◽

Adnan Nagrial ◽

Deme John Karikios ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Retrospective Cohort ◽

Small Cell ◽

Platinum Resistance ◽

P Value ◽

Small Cell Lung ◽

Radiological Response

e21737 Background: Lung cancer is the leading cause of cancer death in Australia with 13,000 new cases per year. Although targeted therapy and immunotherapy have drastically changed the treatment landscape, the majority of patients will receive platinum-based chemotherapy for which the response rate is approximately 30% (Reck et al, 2016). An immunohistochemistry-based, predictive biomarker would be beneficial for patients and help avoid toxicity for patients unlikely to respond. Marini et al (2018) identified 3 biomarkers associated with in-vitro platinum resistance – activin A, growth differentiation factor-11 and transforming growth factor-b – which were investigated in a real-world retrospective cohort to determine their relation to objective radiological response and overall survival. Methods: We identified 101 patients with advanced non-small cell lung cancer who received platinum chemotherapy at 2 cancer centres between 2014-2015. Archival formalin-fixed paraffin embedded tissue samples were stained with activin A. Slides were manually scored by 2 independent clinicians using the multiplicative quickscore method (Detre et al, 1995). Kaplan Meier analysis for overall survival, a Cox-proportional hazards model for confounding variables and a chi-square analysis was performed to analyse the relationship between high immunohistochemistry scores (greater or less than 6) and radiological response. Results: We performed statistical analysis around the median cytoplasmic score (6). The overall median survival was 15.3 months. No significant difference in survival was detected between the two populations (p value = 0.97). The immunohistochemistry score was also not associated with rates of partial response (p value = 0.98) or progressive disease (p value 0.22). Conclusions: Despite an association with lower progression-free survival in a retrospective cohort in a previous study, high expression of activin does not appear to be a useful biomarker for platinum response in the setting of non-small cell lung cancer. Further research into associated antibodies including GDF-11 and TGF-b is in progress.

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