Temporal trend in the use of surgery in the management of stage IIIa non-small cell lung cancer (NSCLC) between 2000-2013: A SEER analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8524-8524
Author(s):  
Veena Iyer ◽  
Hosam Hakim ◽  
Arindam Bagchi ◽  
Qiang Nai ◽  
Danae Hamouda ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Survival Rates ◽  
Relative Survival ◽  
Tumor Grade ◽  
Geographic Region ◽  
Stage Iiia ◽  
N2 Disease ◽  
Time Period ◽  
Iiia Nsclc ◽  
Nsclc Patients

8524 Background: The optimal treatment of patients with Stage IIIA NSCLC, a heterogeneous group comprised of T1-T4, N0-N2 disease, is controversial. Lack of clear data and guidelines allows several options for treatment, and hence there has been significant variability in clinical practice. The purpose of this study was to evaluate the nationwide trends in rates of surgery for Stage IIIA lung cancer diagnosed between 2000-2013. Methods: The study included patients with Stage IIIA NSCLC, 18 years and older diagnosed between 2000 and 2013. We used Z-tests in SEER*Stat to compare relative survival rates for patients diagnosed between 2000-2010. Results: Among the 27,697 patients with Stage IIIA NSCLC, 45% were females and median age was 67. 35% were treated with surgery. Multivariate analysis demonstrated that year of diagnosis, race, marital status, geographic region, tumor size, tumor grade, nodal status all were significantly associated with the use of surgery. Relative survival at 24 months (RS24) was 62% for patients who had surgery and 29% for patients without surgery (z = -47.3). The proportion of patients receiving surgery decreased from 55.6% in 2000 to 32.6% in 2010 and 29.7 in 2013 (p < 0.0001) while the relative survival at 24 months (RS24) from 2000 to 2010 rose from 34.7% to 43.2% (z = -4.89). The RS24 for patients who received surgery rose from 55.3% in 2000 to 77.6 % in 2010 (z = -3.58). Change in RS24 for patients who did not have surgery also improved from 19.6% to 31.2%. The median RS of the surgical cohort changed from 28 m to 44 m. Conclusions: Based upon reporting within the SEER database, the proportion of stage IIIA NSCLC patients undergoing surgery has decreased over the study time period. However, the relative survival rates have improved significantly for both the overall group and those having surgery, suggesting that significant strides have been made both in selecting the group of patients who would benefit from surgical resection and in the overall management of this group of patients.

scholarly journals Effects of Postoperative Radiotherapy on Survival of Patients With Stage IIIA Resected Non–Small Cell Lung Cancer: Analysis of the SEER Database

2020 ◽  
Vol 18 (6) ◽  
pp. 718-727 ◽  
Author(s):  
Fei Gao ◽  
Nan Li ◽  
YongMei Xu ◽  
GuoWang Yang
Keyword(s):  
Lung Cancer ◽  
Lymph Nodes ◽  
Postoperative Radiotherapy ◽  
Seer Database ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
N2 Disease ◽  
Iiia Nsclc ◽  
Related Mortality ◽  
Positive Lymph Nodes

Background: The role of postoperative radiotherapy (PORT) in patients with resected stage IIIA non–small cell lung cancer (NSCLC) remains controversial. The purpose of this study was to explore the effect of PORT on survival of these patients. Methods: Patients aged ≥18 years with stage IIIA NSCLC were identified in the SEER database from 2010 through 2015. Cox regression analysis was used to identify independant prognostic factors in patients with stage IIIA NSCLC. Subgroup analysis of patients stratified by N stage was also performed. Overall survival and lung cancer–related death were compared among the different groups by using Kaplan-Meier analysis and competitive risk analysis. Results: A total of 5,168 patients (1,711 of whom received PORT) were included in the study. In multivariable analysis, PORT was an independent prognostic risk factor for patients with N1 stage (hazard ratio [HR], 1.416, 95% CI, 1.144–1.753; P=.001). PORT was a favorable prognostic factor for patients with stage IIIA, N2 disease with ≥6 positive lymph nodes (HR, 0.742; 95% CI, 0.587–0.938; P=.012). Median survival time of patients with stage IIIA, N2 disease with ≥6 positive lymph nodes who received postoperative chemotherapy combined with PORT was significantly longer compared with those who received postoperative chemotherapy alone (32 vs 25 months, respectively; P=.009). The competitive risk model revealed that 3- and 5-year lung cancer–related mortality rates increased by 8.99% and 16.92%, respectively, in patients with N1 disease who were treated with PORT, whereas the 3-year mortality rate decreased by 4.67% and the 5-year mortality rate by 10.08% in patients with N2 disease and ≥6 positive lymph nodes who were treated using PORT. Conclusions: Our results revealed that PORT significantly improved overall survival and decreased lung cancer–related mortality in patients with stage IIIA, N2 disease with ≥6 positive lymph node metastases. PORT was not recommended for patients with N0 and N1 disease.

Management of locally advanced non-small cell lung cancer (NSCLC) at a community hospital: A retrospective analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e17506-e17506
Author(s):  
Laura Jane Spranklin ◽  
Jon Willis Heflin ◽  
Alejandro R. Calvo
Keyword(s):  
Performance Status ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Relative Survival ◽  
Concurrent Chemoradiation ◽  
Poor Performance Status ◽  
Stage Iiia ◽  
Unresectable Stage ◽  
Iiia Nsclc ◽  
Nsclc Patients

e17506 Background: The optimal management of stage IIIA NSCLC has not been clearly defined. Much of this controversy is due to the heterogenity of this group. The current standard for unresectable stage IIIA disease is concurrent chemoradiotherapy. In patients with resectable stage IIIA disease however, neoadjuvant treatment followed by surgery provides better outcomes but not a significant survival benefit. Our study analyzed the management of stage IIIA NSCLC patients diagnosed at Kettering Health Network (KHN) and the observed 5-year survival as compared to the current NCCN guidelines and national 5-year relative and observed survival using the SEER database and National Cancer Database statistics. Methods: This retrospective study included all patients treated at KHN for Stage IIIA NSCLC from January 2004 to December 2009. 117 cases were analyzed, 53% female and 47% male. 42% were squamous cell, 28% adenocarcinoma, and the final 30% accounting for the remaining histology. 20 patients were not candidates for therapy due to poor performance status or comorbidity. 37 of the 97 patients under active treatment underwent resection at some point during treatment and 60 patients were deemed unresectable. Results: 68% of individuals with unresectable NSCLC received definitive concurrent chemoradiation, 32% received chemotherapy alone. In regards to resectable stage IIIA, 25% were treated with neoadjuvant therapy. 54% received postoperative therapy. 21% were treated with surgery alone due to multiple factors. The observed 5-year survival was 12.2% as compared to 10% nationally. The SEER data 5-year relative survival from 2001 to 2007 for stage IIIA NSCLC is 14%. Conclusions: In this heterogenous group of patients, treatment provided at KHN was individualized and followed national trends. The majority of unresectable stage IIIA NSCLC patients at KHN received the standard approach of concurrent chemoradiation. In terms of resectable stage IIIA NSCLC, approximately 25% were treated with either neoadjuvant chemotherapy or chemoradiotherapy. Overall, the 5-year survival rate for stage IIIA NSCLC at KHN is comparable to other community hospitals however slightly lower than the national average.

Prostate Cancer: Population-Based Survival Rates in Central Italy

1995 ◽  
Vol 81 (2) ◽  
pp. 81-85 ◽  
Author(s):  
Emanuele Crocetti ◽  
Eva Buiatti ◽  
Andrea Amorosi
Keyword(s):  
Prostate Cancer ◽  
Central Italy ◽  
Survival Rates ◽  
Relative Survival ◽  
Tumor Grade ◽  
Population Based ◽  
Prognostic Effect ◽  
Disease Extension ◽  
The One ◽  
Histological Verification

Aims To evaluate survival in prostate cancer patients in the Province of Florence where the Tuscany Cancer Registry is active. Methods The survival of 777 patients with prostate cancer diagnosed in the period 1985-87 was evaluated. The observed and relative survival rates 1, 3 and 5 years after diagnosis were computed. Also the prognostic effect of age, disease extension, tumor grade, histological verification, place of residence and year of diagnosis were evaluated using univariate and multivariate analysis. Results The observed survival was 73.4% 1 year, 42.5% 3 years and 29.2% 5 years after diagnosis. The relative survival was respectively 78.7%, 53.0% and 43.0%. Significant independent risks were evident when the disease was extended out of the prostate, for patients older than 80 years, for high grade tumors and for patients without histological verification. Conclusion The 5-year relative survival rate in the province of Florence is similar to those from other European Registries and the Latina Registry, but much lower than the one reported by the SEER program in the US. Data on histological verification percentage, availability of information on disease extension, and tumor grade are discussed as indicators of the quality of the diagnostic approach in comparison with other registries.

scholarly journals Clinical Significance of SERPINA1 Gene and Its Encoded Alpha1-antitrypsin Protein in NSCLC

Cancers ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 1306 ◽  
Author(s):  
Ercetin ◽  
Richtmann ◽  
Delgado ◽  
Gomez-Mariano ◽  
Wrenger ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Survival Rates ◽  
Active Role ◽  
Serum Levels ◽  
Serum Samples ◽  
Serpina1 Gene ◽  
Alpha1 Antitrypsin ◽  
Nsclc Patients ◽  
The Impact

Abstract: High expression of SERPINA1 gene encoding acute phase protein, alpha1-antitrypsin (AAT), is associated with various tumors. We sought to examine the significance of SERPINA1 and AAT protein in non-small-cell lung cancer (NSCLC) patients and NSCLC cell lines. Tumor and adjacent non-tumor lung tissues and serum samples from 351 NSCLC patients were analyzed for SERPINA1 expression and AAT protein levels. We also studied the impact of SERPINA1 expression and AAT protein on H1975 and H661 cell behavior, in vitro. Lower SERPINA1 expression in tumor but higher in adjacent non-tumor lung tissues (n = 351, p = 0.016) as well as higher serum levels of AAT protein (n = 170, p = 0.033) were associated with worse survival rates. Specifically, in NSCLC stage III patients, higher blood AAT levels (>2.66 mg/mL) correlated with a poor survival (p = 0.002). Intriguingly, levels of serum AAT do not correlate with levels of C-reactive protein, neutrophils-to-leukocyte ratio, and do not correlate with SERPINA1 expression or AAT staining in the tumor tissue. Additional experiments in vitro revealed that external AAT and/or overexpressed SERPINA1 gene significantly improve cancer cell migration, colony formation and resistance to apoptosis. SERPINA1 gene and AAT protein play an active role in the pathogenesis of lung cancer and not just reflect inflammatory reaction related to cancer development.

Concurrent cisplatin/etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small-cell lung cancer: mature results of Southwest Oncology Group phase II study 8805.

1995 ◽  
Vol 13 (8) ◽  
pp. 1880-1892 ◽  
Author(s):  
K S Albain ◽  
V W Rusch ◽  
J J Crowley ◽  
T W Rice ◽  
A T Turrisi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Survival Rates ◽  
Small Cell ◽  
Oncology Group ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Term Survival ◽  
Southwest Oncology Group

PURPOSE To assess the feasibility of concurrent chemotherapy and irradiation (chemoRT) followed by surgery in locally advanced non-small-cell lung cancer (NSCLC) in a cooperative group setting, and to estimate response, resection rates, relapse patterns, and survival for stage subsets IIIA(N2) versus IIIB. PATIENTS AND METHODS Biopsy proof of either positive N2 nodes (IIIAN2) or of N3 nodes or T4 primary lesions (IIIB) was required. Induction was two cycles of cisplatin and etoposide plus concurrent chest RT to 45 Gy. Resection was attempted if response or stable disease occurred. A chemoRT boost was given if either unresectable disease or positive margins or nodes was found. RESULTS The median follow-up time for 126 eligible patients [75 stage IIIA(N2) and 51 IIIB] was 2.4 years. The objective response rate to induction was 59%, and 29% were stable. Resectability was 85% for the IIIA(N2) group eligible for surgery and 80% for the IIIB group. Reversible grade 4 toxicity occurred in 13% of patients. There were 13 treatment-related deaths (10%) and 19 others (15%) died of causes not related to toxicity or tumor. Of 65 relapses, 11% were only locoregional and 61% were only distant. There were 26 brain relapses, of which 19 were the sole site or cause of death. There was no survival difference (P = .81) between stage IIIA(N2) versus stage IIIB (median survivals, 13 and 17 months; 2-year survival rates, 37% and 39%; 3-year survival rates, 27% and 24%). The strongest predictor of long-term survival after thoracotomy was absence of tumor in the mediastinal nodes at surgery (median survivals, 30 v 10 months; 3-year survival rates, 44% v 18%; P = .0005). CONCLUSION This trimodality approach was feasible in this Southwest Oncology Group (SWOG) study, with an encouraging 26% 3-year survival rate. An Intergroup study is currently being conducted to determine whether surgery adds more to the risk or to the benefit of chemoRT.

scholarly journals Lung Cancer Survival in Lithuania: Changes by Histology, Age, and Sex From 2003-2007 to 2008-2012

2019 ◽  
Vol 26 (1) ◽  
pp. 107327481983608 ◽  
Author(s):  
Vaida Gedvilaitė ◽  
Edvardas Danila ◽  
Saulius Cicėnas ◽  
Giedrė Smailytė
Keyword(s):  
Lung Cancer ◽  
Cell Carcinoma ◽  
Cancer Survival ◽  
Survival Rates ◽  
Age Groups ◽  
Relative Survival ◽  
International Classification Of Diseases ◽  
Advanced Lung Cancer ◽  
Almost All ◽  
Disease Stages

Lung cancer is the most common cancer-related death worldwide. The aim of this study is to describe the most recent survival rates by sex, age group, extent of disease, and histology of lung cancer in Lithuania. The study is based on the Lithuanian Cancer Registry database. The analysis included patients with primary invasive lung cancer diagnosed in 1998 to 2012 (International Classification of Diseases, Tenth Revision C33 and C34). Patients were followed up with respect to vital status until December 31, 2012. Five-year relative survival estimates were calculated using period analysis. Relative survival was calculated as the ratio of the observed survival of patients with cancer and the expected survival of the underlying general population. In our study, the overall 5-year relative survival was low but increased slightly (10.7%) from 2003–2007 to 2008–2012. Positive changes in survival were evident in both sexes, in almost all age groups and for all histological groups and disease stages. Adenocarcinoma relative survival increased from 6.7% in 2003–2007 to 12.8% in 2008–2012 and squamous cell carcinoma increased from 7.4% in 2003–2007 to 11.1% in 2008–2012. Patients with small-cell carcinoma had the worst survival (2.9% in 2003-2007 and 3.6% in 2008–2012). The majority of patients with lung cancer are diagnosed with advanced disease. The number of new cases of advanced lung cancer increased from 35.1% to 37.8%. Despite low overall survival, there were positive changes in survival in both sexes, in almost all age groups, and for all histological groups and disease stages. The survival rate of patients with lung cancer in Lithuania is similar to that in other European countries.

scholarly journals Negativation of PD-L1 Postoperatively in Initially Inoperable Stage III Non-Small Cell Lung Cancer Treated with Pembrolizumab: Two Case Reports

2019 ◽  
Vol 12 (2) ◽  
pp. 421-425
Author(s):  
Fadi Nasr ◽  
Ahmad Al Ghoche ◽  
Roland Eid ◽  
Lewis Nasr ◽  
Saada Diab ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Incidental Finding ◽  
Case Reports ◽  
Small Cell ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Iiia Nsclc

Stage III non-small cell lung cancer is a border line stage between localized and metastatic disease. PDL-1 is gaining an important role in the therapeutic arsenal of lung cancer, the most frequent cancer worldwide. We report for the first time a negativation of PDL-1 status in 2 cases of stage IIIA NSCLC with conversion to operable disease after using immunotherapy. The first patient was a 59-year old female diagnosed incidentally to have stage IIIA inoperable NSCLC that was treated with combination chemo-immunotherapy, and converted to operable disease with a negative PD-L1 in the postoperative setting. The second case is that of a 56-year old male that also had an inoperable stage IIIA NSCLC treated with chemotherapy first line followed by pembrolizumab at progression, then operated after surgical conversion, with negative PD-L1 postoperatively. In front of these findings, further work should be done to elucidate if the reverse of the PDL-1 status and the conversion to operability were due to the use of immunotherapy or to an incidental finding. If confirmed, it may have a therapeutic impact.

Size of Stage IIIA Primary Lung Cancers and Survival: A Surveillance, Epidemiology and End Results Database Analysis

2012 ◽  
Vol 78 (11) ◽  
pp. 1232-1237 ◽  
Author(s):  
Steven Maximus ◽  
Danh V. Nguyen ◽  
Yi Mu ◽  
Royce F. Calhoun ◽  
David T. Cooke
Keyword(s):  
Lung Cancer ◽  
Risk Factor ◽  
Tumor Size ◽  
Early Stage ◽  
Large Population ◽  
Nonsmall Cell Lung Cancer ◽  
Stage Iiia ◽  
Early Stage Lung Cancer ◽  
Iiia Nsclc ◽  
End Results

Size of early-stage lung cancer is important in the prognosis of patients. We examined the large population-based Surveillance, Epidemiology and End Results database to determine if tumor size was an independent risk factor of survival in patients undergoing lobectomy for N2 positive Stage IIIA nonsmall cell lung cancer (NSCLC). This study identified 1971 patients diagnosed with N2 positive Stage IIIA NSCLC, from 1998 to 2007, and who underwent lobectomy. Five tumor groups based on the seventh edition TNM lung cancer staging system (pathologic T1a 2 cm or less; T1b greater than 2 cm and 3 cm or less; T2a greater than 3 cm and 5 cm or less; T2b greater than 5 cm and 7 cm or less; T3 greater than 7 cm) were analyzed. Survival was reduced in patients with T3, T2a, and T2b tumors compared with patients with T1a and T1b ( P < 0.001). Survival estimates correlated with tumor size with poorer survival in T3 followed by T2b, T2a, and then T1b and T1a. Cohorts with T1a (hazard ratio [HR], 0.53; P = 0.01) and T1b (HR, 0.54; P = 0.01) were both found to have decreased hazard of death. Negative predictors of survival, in addition to increasing tumor size, included age and male gender, whereas positive predictors included tumor Grade I and upper lobe location. Increasing size of tumor is an independent negative risk factor for survival in patients undergoing lobectomy for N2 positive Stage IIIA NSCLC.

XPD 312 single nucleotide polymorphism (SNP) in stage IIIA-B non-small cell lung cancer (NSCLC) patients (p) <59 years (y) treated with chemotherapy followed by surgery

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7652-7652
Author(s):  
M. Santarpia ◽  
P. Garrido ◽  
J. Gonzalez-Larriba ◽  
P. Azagra ◽  
F. Cardenal ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Univariate Analysis ◽  
Complete Response ◽  
Incomplete Resection ◽  
Stage Iiia ◽  
Single Nucleotide ◽  
Nsclc Patients ◽  
Repair Genes

7652 Background: SNPs in DNA repair genes may affect response to cytotoxic therapy. We investigated SNPs in XPD codons 751 and 312 and in RRM1 −37 in 109 stage IIIA (N2) and IIIB NSCLC p treated with neoadjuvant chemotherapy and correlated results with event- free (EFS) and median (MS) survival. Methods: p eligible for surgery received cisplatin day (d) 1, gemcitabine d 1,8, docetaxel d 1,8,15, every 3 weeks for 3 cycles, followed by thoracotomy. DNA was extracted from baseline peripheral lymphocytes and genotyping was performed by Taqman. Results: Median age, 60 y (range 31–77); 92 males (84%); 45 squamous cell (41%). 4 p (3.9%) attained complete response; 55 (53.9%) partial response. 75 p underwent surgery (62 complete, 13 incomplete resection); remaining 34 p were unresectable. Median follow-up was 15.7 months (m) (range, 0.5–74). MS for p still alive is 49.8 m (range, 6.7–74). MS: 48 m with complete resection, 13 m with incomplete resection, 17 m for unresected p. In the univariate analysis of survival, age <59 y (P=0.03), resection (P<0.001) and XPD312 AspAsp (P=0.05) emerged as predictive markers of longer survival. For all 109 p, those with XPD312 AspAsp had longer EFS and MS than p with Asn variants ( Table ). In addition, for 51 p <59 y, EFS was longer for 24 p with XPD312 AspAsp (36.4 m) than for 27 p with Asn variants (9.8 m) (P=0.009); MS in this group of younger p was 45.4 m for AspAsp vs 15.8 m for Asn (P=0.04). No other significant correlation between SNPs and survival was observed ( Table ). Conclusions: Interaction between SNPs, age and risk of lung cancer has previously been described. XPD312 AspAsp in p <59 y predicts longer survival in stage IIIA (N2) and IIIB NSCLC treated with neoadjuvant chemotherapy. No significant financial relationships to disclose. [Table: see text]

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