EP1.17-08 Good Survival in Females Undergoing Surgery Without Adjuvant Chemotherapy for Stage Three Lung Cancer: A Review of Our 12-Year Experience

Abstract

Lung cancer is a major disease in Singapore. Anatomical surgical resection is the treatment of choice for early lung cancer. No study on outcome of surgery on early lung cancer has been reported in a mixed Asian population. We aim to review the outcome of patients with early lung cancer who underwent surgery in our tertiary centre. We performed a retrospective cross-sectional study on all patients who underwent lung resection between 1st January 2006 and 31st December 2017. Information collected included patient”s age, gender, race, stage of disease and outcome data. Those with a diagnosis of primary lung cancer were included whilst those whose surgery was not for curative intent were excluded. 404 patients are included in our study. The mean age is 62.9 years with the modal age group between 60 and 69 years old. Females are significantly younger than males (mean 61.6 years vs 64.0 years, p = 0.019). 76.6% (n = 310) are early disease (Stage 1 or Stage 2) and 20.0% (n = 81) are late disease (Stage 3). Overall survival is significantly higher in early than late disease and in females than males. In female patients with Stage 3 disease, there is no significant difference in 1-year survival between early (97.3%) and late (89.7%) (p = 0.177) disease. Those aged between 70 and 79 years has a significantly higher mortality at 3 years (27.3%, odds ratio 3.73 (1.0 – 13.5, CI 95%)). There is no significant difference in 3 year mortality between early and late disease in females younger than 60 years old (87.5% vs 77.8%, p = 0.303). T3/T4 disease patients have better survival rates than N2 disease patients. All female patients with T3/T4 disease are still alive at 5 years even in those without adjuvant chemotherapy. In females with N2 disease, 3 and 5-year survival is also higher in patients with partial or no adjuvant chemotherapy but this is not statistically significant. The use of adjuvant chemotherapy is also associated with a significant higher rate of recurrence (53.5% vs 16.1%, p = 0.001) in all patients with Stage 3 disease, especially in female patients (68.2% vs 18.2%, p = 0.009). In females with N2 disease, the recurrence rate is significantly higher in those who had adjuvant chemotherapy (68.4% vs 25.0%, p = 0.049). For those with T3/T4 disease, there is no recurrence in patients who did not have any adjuvant chemotherapy but this is not statistically significant. Our study demonstrate that female patients with early lung cancer present earlier and have significant higher survival rates than males. Even in patients with stage 3 disease, there is good survival benefit up to 3 years post-surgery for patients aged 60 years old and below. Three and five year survival are better in female patients with N2 disease who did not have or did not complete their adjuvant chemotherapy than those who did. The use of adjuvant chemotherapy is also associated with a higher rate of recurrence, especially in females with N2 disease.