IIIA Non-small Cell Lung Cancer Research Articles

Locoregional Control, Overall Survival, and Disease-Free Survival in Stage IIIA (N2) Non–Small-Cell Lung Cancer: Analysis of Resected and Unresected Patients

IntroductionThe standard of care for stage IIIA (N2) non–small-cell lung cancer (NSCLC) includes concurrent definitive chemoradiation (dCRT) followed by durvalumab, thus challenging the role of surgery in resectable patients. We assessed locoregional disease control and survival in patients with surgically resected and unresected stage IIIA (N2) NSCLC disease. Patients and MethodsWe conducted a retrospective analysis from prospectively collected databases at MD Anderson Cancer Center. Patients undergoing neoadjuvant chemotherapy and surgery or dCRT for clinical stage IIIA (N2) disease (2004-2014) were evaluated. Primary outcomes included locoregional disease control, disease-free survival (DFS), and overall survival (OS). Kaplan-Meier outcome analyses were performed. ResultsOf the 159 resected patients, the majority had lobectomy (82.4%), followed by pneumonectomy (11.9%) and sublobar resection (5.7%). The 30- and 90-day mortality rates were 0.6% and 1.3%, respectively. At median follow-up of 52.8 months, recurrence was 55.3%, with 44.0% having distant and 15.1% locoregional recurrence. At 5 years, OS was 50.8% and DFS was 33.1% Median OS was 61.2 months. A total of 366 patients underwent dCRT, with intensity-modulated radiation in 64.5%, proton therapy in 26.0%, and 3-dimensional conformal radiotherapy in 9.6%. The mean dose was 68.1 Gy. At median follow-up of 20.8 months, recurrence was 53.6%, with distant and locoregional recurrence of 40.7% and 30.3%, respectively. At 5 years, OS was 29.2% and DFS was 20.5%. Median OS was 27.5 months. ConclusionStage IIIA (N2) NSCLC continues to be a heterogeneous disease, and patients with surgically resected and unresected disease represent different risk populations. Ongoing immunotherapy trials may further redefine treatment algorithms in this complex patient population.

Survival outcomes of adjuvant chemotherapy with modified weekly nab-paclitaxel and carboplatin for completely resected nonsmall cell lung cancer: FAST-nab.

The relatively low toxicity profile of nab-paclitaxel plus carboplatin and its feasibility as an adjuvant administration was reported previously. This study aimed to evaluate the survival efficacy for completely resected patients with stage IB, II, and IIIA nonsmall cell lung cancer (NSCLC). Twenty-nine eligible patients with NSCLC who received surgical resection for pathological stage IB, II, or IIIA, followed by postoperative adjuvant chemotherapy with modified 3-week cycles of either nab-paclitaxel (nab-P) (100 mg/m2) on days 1 and 8 followed by carboplatin area (area under the curve = 6) on day 1 were prospectively enrolled and assessed for survival outcomes against patients with the same stages who received other postoperative adjuvant chemotherapy regimens during the same period. There were no significant differences in clinicopathological features, including age, gender, smoking status, performance status, surgical procedures, tumor histology, and pathological stage between the two groups. The cumulative overall survival (OS) rates at 5 years of the experimental and control groups in pathological stage IB–IIIA were 85.4% and 63.9%, respectively (P = 0.598), while recurrence-free survival (RFS) rates in these groups at 5 years were 65.2% and 34.8%, respectively (P = 0.344). Moreover, the cumulative OS rates of the experimental and control groups in pathological stage II–IIIA were 83.6% and 63.6%, respectively (P = 0.970), while RFS rates in these groups at 5 years were 61.1% and 37.3%, respectively (P = 0.460). This new regimen was considered an attractive alternative postoperative adjuvant chemotherapy option with relatively low toxicity and moderate survival outcomes for completely resected NSCLC.

Platinum Drug Sensitivity Polymorphisms in Stage III Non-small Cell Lung Cancer With Invasion of Mediastinal Lymph Nodes

Patients with stage IIIA (N2) non-small cell lung cancer (NSCLC) with no progression after induction chemotherapy are usually selected for surgery. Nowadays, response to chemotherapy is not predictable. We aimed to identify genomic predictive markers for response to induction chemotherapy in stage IIIA (N2) NSCLC patients. Whole-exome sequencing (WES) was performed on samples from 11 patients with no response after induction chemotherapy and 6 patients with documented pathological response, admitted to the Hotel Dieu Hospital, Paris or Allegemeines Krakenhaus University, Vienna. A higher alternative allele frequency was found on SENP5, rs63736860, rs1602 and NCBP2, rs553783 in the non-responder group, and on RGP1, rs1570248, SLFN12L, rs2304968, rs9905892, and GBA2, rs3833700 in the responder group. These polymorphisms contribute to inter-individual sensibility to chemotherapy response. Interrogation of these genetic variations may have potential applicability when deciding the treatment strategy for patients with stage III NSCLC (N2).

A 12-Week Multi-Modal Exercise Program: Feasibility of Combined Exercise and Simplified 8-Style Tai Chi Following Lung Cancer Surgery.

Objective:To assess the feasibility, safety, and preliminary effect of a 12-week multi-modal rehabilitation program targeted at improving health-related quality of life and physical activity levels of patients with lung cancer following treatment.Methods:Patients with stage I to IIIA non-small cell lung cancer were included 6 to 12 weeks following completion of treatment. The intervention comprised of aerobic exercise (brisk walking), resistance training and 8-style Tai Chi. The 12-week program included 2 supervised center-based sessions per week of 90 minutes duration and home-based exercise. The primary outcomes were the feasibility and safety of the intervention. Secondary outcomes (assessed pre and post program) were physical and patient-reported outcomes.Results:Seventy-eight patients were approached during the 6-month recruitment period and 17 (22%) consented to the study. Eight participants (47%) met the definition of adherence to the program (attending at least 70% of supervised sessions). No serious adverse events occurred. A significant reduction in anxiety and depression was observed post-program. In addition, improvements in respiratory function, sleep quality, and some health-related quality of life domains were observed post-program. There were no significant differences in functional capacity or physical activity levels.Conclusion:This multi-modal exercise training program was safe, although the feasibility of the program in its current state is not supported given the low consent rate and low adherence to the intervention.

Relationship Between Xanthine Oxidoreductase Activity and BRCA1 Levels in Patients with Stage IIIA and IIIB Non-Small Cell Lung Cancer Being Treated with Neoadjuvant Chemotherapy

Relationship Between Xanthine Oxidoreductase Activity and BRCA1 Levels in Patients with Stage IIIA and IIIB Non-Small Cell Lung Cancer Being Treated with Neoadjuvant Chemotherapy

The prognostic significance of the 18F-fluorodeoxyglucose positron emission tomography/computed tomography in early-stage nonsmall cell lung cancer.

The prognostic criteria for early-stage nonsmall cell lung cancer (NSCLC) wait to be explored. In this study, our aim was to evaluate the prognostic significance of the positron emission tomography/computed tomography (PET/CT) maximum standardized uptake value (SUVmax) value of the primary tumor in patients with a diagnosis of early-stage NSCLC who received surgical treatment. This was a multicenter retrospective design. Patients who had been diagnosed with early-stage NSCLC and who underwent surgery for the condition were included in this study. The preoperative fluorodeoxyglucose (18F-FDG) PET/CT results of the patients were retrospectively accessed from their medical files. The disease-free survival (DFS) rates of patients who had SUVmax values above and below the determined cutoff value were compared. SPSS version 22 and Kaplan-Meier method were used for statistical analysis. A total of 92 patients were included in the study. The median age of the patients was 60 years (range: 36-79). The determined cutoff SUVmax value of the primary tumor was 13.6. A comparison of the DFS rates of the patients with an SUVmax value above and below 13.6 revealed a significant difference in patients with Stage I (22.9 months vs. 50.3 months; P = 0.02) and Stage II (28 months vs. 40.4 months; P = 0.04), Stage I + II (43.5 months vs. 26.1 months; P = 0,02), and Stage IIIA (14.7 months vs. 13.6 months; P = 0.92) NSCLC. We found that in early-stage NSCLC patients, the SUVmax value of the primary mass in 18F FDG PET/CT was a prognostic indicator for the DFS rates.

Factors Influencing Functional Exercise Capacity After Lung Resection for Non-Small Cell Lung Cancer.

Purpose: We investigated, in patients who underwent lung resection for non–small cell lung cancer (NSCLC), the magnitude of early limitation in functional exercise capacity and the associations with pre- and postoperative factors. Methods: Consecutive patients with preoperative clinical stage I to IIIA NSCLC who underwent lung resection were prospectively enrolled. We measured functional exercise capacity (6-minute walk distance [6MWD]) and skeletal muscle strength (handgrip [HF] and quadriceps force [QF]) within 2 days prior to surgery and on day 7 postoperatively. Results: Two hundred eighteen participants were recruited (median age 69 years) of whom 49 developed postoperative complications (POCs). 6MWD was markedly decreased (514 m vs 469 m, P < .001); HF and QF were slightly decreased following surgery. Multiple linear regression showed that preoperative vital capacity (P < .01), QF (P < .05), the duration of chest tube drainage (P < .001), and presence of POCs (P < .05) were significant predictors. However, intraoperative factors were not significantly associated with the decline in 6MWD. Conclusions: These results suggest that patients with preoperative impairments in pulmonary function and muscle strength, and those who require prolonged chest tube drainage or develop POCs are likely to have impaired exercise capacity. Therefore, individual assessment and follow-up of patients with such factors is indicated.

Chinese expert consensus on the multidisciplinary clinical diagnosis and treatment of stage Ⅲ non-small cell lung cancer (2019)

Lung cancer is the most common cancer and the leading cause of cancer death in China, with 733 thousands estimated new lung cancer cases and 610 thousands deaths in 2015. In the pathological type of lung cancer, non-small cell lung cancer (NSCLC) accounts for 80%~85%, and 30% of NSCLC patients have already reached stage Ⅲ at diagnosis, who have lost the optimal opportunity for surgical treatment. Stage Ⅲ NSCLC is highly heterogeneous, the 5-year survival rates of stage ⅢA, ⅢB and ⅢC NSCLC are 36%, 26% and 13%, respectively. For the great complexity of making decisions in the clinical practice of stage Ⅲ NSCLC, the experts of this consensus group combine the latest clinical research results and cutting-edge multidisciplinary concepts, conduct in-depth and detailed discussions on the hot issues and controversies in the diagnosis, treatment and follow-up surveillance of stage Ⅲ NSCLC. Chinese Anti-Cancer Association and Committee of Lung Cancer Society jointly publish this consensus to provide guidance for Chinese clinicians.

Extended resections for the treatment of patients with T4 stage IIIA non-small cell lung cancer (NSCLC) (T4N0-1M0) with or without cardiopulmonary bypass: a 15-year two-center experience.

Stage IIIA non-small cell lung cancer (NSCLC) is a heterogeneous group of patients, often requiring variable and individualized approaches. The dilemma to operate or not frequently arises, since more than 75% of the cases of NSCLC are diagnosed in advanced stages (IIIA). The main objective of this study was to assess whether the benefits outweigh surgical risks for the T4N0-1M0 subgroup. Data from 857 patients with locally advanced T4 NSCLC were retrospectively collected from two different institutions, between 2002 and 2017. Clinical data that were retrieved and analyzed, included demographics, comorbidities, surgical details, neoadjuvant or/and adjuvant therapy and postoperative complications. Twelve patients were in the cardiopulmonary bypass (CPB) group and thirty in the non-CPB. The most common types of lung cancer were squamous cell carcinoma (50.0%) and adenocarcinoma (35.7%). The most frequent invasion of the tumor was seen in main pulmonary artery and the superior vena cava. Significantly more patients of the CPB group underwent pneumonectomy as their primary lung resection (P=0.006). In all patients R0 resection was achieved according to histological reports. The overall 5-year survival was 60%, while the median overall survival was 22.5 months. Analysis revealed that patient age (P=0.027), preoperative chronic obstructive pulmonary disease (COPD) (P=0.001), tumor size (4.0 vs. 6.0 cm) (P=0.001), postoperative respiratory dysfunction (P=0.001) and postoperative atelectasis (P=0.036) are possible independent variables that are significantly correlated with patient outcome. We suggest that in patients with stage IIIA/T4 NSCLC, complete resection of the T4 tumor, although challenging, can be performed in highly selected patients. Such an approach seems to result in improved long-term survival. More specific studies on this area of NSCLC probably will further enlighten this field, and may result in even better outcomes, as advanced systemic perioperative approaches such as modern chemotherapy, immunotherapy and improvements in radiation therapy have been incorporated in daily practice.

Radiotherapy for patients with completely resected pathologic IIIA(N2) non-small-cell lung cancer: a retrospective analysis.

IntroductionAdjuvant radiotherapy in non–small-cell lung cancer (NSCLC) remains controversial,Whether the mutation status of epidermal growth factor receptor (EGFR) will affect the recurrence and survival of patients with resected NSCLC is rarely reported. Our purpose is to study the effect of postoperative radiotherapy on patients with stage IIIA(N2) NSCLC with EGFR mutation.MethodsTotal of of 115 patients diagnosed with stage IIIA(N2) resected NSCLC were analyzed retrospectively. Their EGFR mutations were detected by real-time quantitative PCR and DNA sequencing technology together.ResultsAt a median follow-up of 34.2 months for the postoperative adjuvant radiotherapy (PORT) group and 31.0 months for the non-PORT group, PORT group significantly improved progression free survival (PFS) and overall survival (OS). The median PFS and OS in the EGFR mutant group were not significantly longer than those in the EGFR wild-type group. The number of chemotherapy cycles, postoperative radiotherapy and the number of metastatic lymph nodes were independent factors influencing long-term survival.ConclusionOur retrospective analysis showed that PORT can improve survival of patients with stage IIIA(N2) NSCLC. EGFR-mutant group with stage IIIA(N2) NSCLC has a tendency of a higher survival than the wild-type EGFR group, but there was no significant difference for both groups. The EGFR mutation status was not associated with PFS or OS of stage IIIA(N2) NSCLC.

Proceedings to the 6th Annual Conference of the Particle Therapy Cooperative Group North America (PTCOG-NA): 14-16 October 2019, Hosted by Miami Cancer Institute, part of Baptist Health South Florida, Miami, FL, USA.

Proceedings to the 6th Annual Conference of the Particle Therapy Cooperative Group North America (PTCOG-NA): 14-16 October 2019, Hosted by Miami Cancer Institute, part of Baptist Health South Florida, Miami, FL, USA.

Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage IIB-IIIA non-small cell lung cancer.

With the rapid development of surgical technics and instruments, more and more locally advanced non-small cell lung cancer (NSCLC) patients are being treated by minimally invasive surgery (MIS), including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS). The aim of this retrospective study was to compare the perioperative and long-term outcomes of patients who underwent lobectomy by these two surgical approaches. We performed a retrospective review of the prospectively collected database of our hospital to identify patients with clinical stage IIB-IIIA NSCLC who underwent video-assisted thoracoscopic or robotic lobectomy. Perioperative outcomes, recurrence, and overall survival (OS) were compared. From January 2014 to January 2017, there were at total of 121 patients, including 36 robotic lobectomy patients and 85 VATS lobectomy patients. One patient (2.8%) in the RATS group and 5 patients (5.9%) in the VATS group were converted to thoracotomy (P=0.79). No perioperative death was observed in both groups. The postoperative morbidity was similar between the two groups (13.9% for RATS vs. 15.3% for VATS; P=0.84). Robotic lobectomy was associated with a shorter length of postoperative hospital stay (4 vs. 5 d, P<0.01) and more counts of lymph nodes harvested (13 vs. 10, P<0.01). The median disease-free survival (DFS) for the RATS and VATS groups were 31.1 and 33.8 months, respectively. The corresponding 3-year DFS was 40.3% in the RATS group and 47.6% in the VATS group (P=0.74). The 3-year OS was 75.7% in RATS and 77.0% in the VATS group (P=0.75). For selected NSCLC patients with lymph node involvement, robotic lobectomy is safe and effective with a low complication rate and similar long-term outcome compared with VATS lobectomy. Moreover, the robotic approach resulted in shorter postoperative length of stay and greater lymph node assessment.

Pharmacodynamics of Pre-Operative PD1 checkpoint blockade and receptor activator of NFkB ligand (RANKL) inhibition in non-small cell lung cancer (NSCLC): study protocol for a multicentre, open-label, phase 1B/2, translational trial (POPCORN)

BackgroundNeoadjuvant immunotherapy targeting immune checkpoint programmed death-1 (PD-1) is under investigation in various tumour settings including non-small-cell lung cancer (NSCLC). Preclinical models demonstrate the superior power of the immunotherapy provided in a neoadjuvant (pre-operative) compared with an adjuvant (post-operative) setting to eradicate metastatic disease and induce long-lasting antigen-specific immunity. Novel effective immunotherapy combinations are widely sought in the oncology field, targeting non-redundant mechanisms of immune evasion. A promising combination partner with anti-PD1 in NSCLC is denosumab, a monoclonal antibody blocking receptor activator of NF-κB ligand (RANKL). In preclinical cancer models and in a large retrospective case series in NSCLC, anti-cancer activity has been reported for the combination of immune checkpoint inhibition (ICI) and denosumab. Furthermore, clinical trials of ICI and denosumab are underway in advanced melanoma and clear-cell renal cell carcinoma. However, the mechanism of action of combination anti-PD1 and anti-RANKL is poorly defined.MethodsThis open-label multicentre trial will randomise by minimisation 30 patients with resectable stage IA (primary > 2 cm) to IIIA NSCLC to a neoadjuvant treatment regime of either two doses of nivolumab (3 mg/kg every 2 weeks) or two doses of nivolumab (same regimen) plus denosumab (120 mg every 2 weeks, following nivolumab). Each treatment arm is of equal size and will be approximately balanced with respect to histology (squamous vs. non-squamous) and clinical stage (I-II vs. IIIA). All patients will receive surgery for their tumour 2 weeks after the final dose of neoadjuvant therapy. The primary outcome will be translational research to define the tumour-immune correlates of combination therapy compared with monotherapy. Key secondary outcomes will include a comparison of rates of the following between each arm: toxicity, response (pathological and radiological), and microscopically complete resection.DiscussionThe POPCORN study provides a unique platform for translational research to determine the mechanism of action of a novel proposed combination immunotherapy for cancer.Trial registrationProspectively registered on Australian New Zealand Clinical Trials Registry (ACTRN12618001121257) on 06/07/2018.

Optimal Surgical Timing After Neoadjuvant Therapy for Stage IIIa Non-Small Cell Lung Cancer

Patients with clinically/pathologically diagnosed stage IIIa non-small cell lung cancer (NSCLC) considered for surgery are recommended to undergo neoadjuvant chemotherapy with or without radiation. The timing of an operation after therapy is not standardized; therefore, we investigated the timing of intervention after neoadjuvant therapy and the impact on outcomes in this demographic. The National Cancer Database was queried between 2010 and 2015 for patients with clinical/pathologic stage IIIa NSCLC. Patients were then divided into short (<77 days), mid (77-114 days), and long delay (>114 days) groups based on interquartile values. These groups were then compared for age, race, gender, insurance type, Charlson-Deyo score, length of stay, readmission rate, and overall survival based on timing of operation. There were 31,357 patients with clinical/pathologic stage IIIa NSCLC, and 5946 patients underwent surgical intervention. Preoperatively 3593 patients underwent chemoradiotherapy, 2185 underwent chemotherapy only, and 168 received radiation alone. The short, mid, and long delay groups were clinically and statistically similar in age, gender, insurance type, comorbidity index, treating facility type, and distance from home. Long delay groups had larger tumor size compared with other groups. Postoperative length of stay, rates of 30-day readmission, and 30- and 90-day mortality were similar across all groups. Cox modeling demonstrated a significant difference in survival when patients underwent earlier operative intervention compared with late operative intervention and when patients received chemoradiation compared with chemotherapy alone. Short, mid, and long delay group 1-year survivals were 82%, 83%, and 80% and 3-year survival 59%, 58%, and 52%, respectively (P= .0003). The delay in surgical resection of stage IIIa NSCLC is not associated increased early mortality; however, it is associated with worse 3-year postresection survival.

469P - Comparison of combined chemoradiotherapy regimens; Paclitaxel plus carboplatin and cisplatin plus etoposide for locally advanced non-small cell lung cancer: A randomised phase III trial

BackgroundThe optimal chemotherapy regimen to use with radiotherapy in stage III non–small cell lung cancer (NSCLC) is still unknown. This phase III comparative randomized trial was conducted to determine the optimal chemotherapy regimen with standard daily concurrent thoracic radiation therapy (CTRT), in patients with locally advanced unresected stage III NSCLC. MethodsWe recruited 188 patients aged 18–81 years with stage III, histologically confirmed NSCLC, an Eastern Cooperative Oncology Group (ECOG) performance status of 0–2, an estimated life expectancy of greater than 3 months, and adequate organ function from January 2011 to December 2018. Patients were randomised (1:1) to paclitaxel plus carboplatin and cisplatin plus etoposide arms. ResultsPatients with unresected stages IIIA and IIIB NSCLC received carboplatin (AUC=2) and paclitaxel (45 mg/m2) given weekly with CTRT (63 Gy) followed by two cycles of consolidation therapy (carboplatin AUC=6, paclitaxel 200 mg/m2) (arm CP) and cisplatin (50 mg/m2 on days 1, 8, 29, and 36) plus etoposide (50 mg/m2 daily on days 1 to 5, and 29 to 33) with CTRT followed by consolidation cisplatin plus etoposide (arm EP) were included. On hundred eighty eligible patients were evaluated. With median follow-up time of 41.7 months, median overall survival was 19.8 and 18.1 months for arms CP and EP, respectively (P = 0.279). But patients in arm EP, compared with patients in arm CP, had more grade 4 neutropenia (18.5% vs 11,1%, p < 0.001), grade 4 naussea/vomiting (18,5% vs 15.3 %, p < 0.001) grade 3-4 mucositis/esophagitis (23,4% vs 15,3%, p < 0.001) and acute kidney disease (27.1% vs 15,1%, p < 0.001). ConclusionsIn patients with stage III NSCLC treated with cisplatin plus etoposide and carboplatin plus paclitaxel had similar overall survival, but cisplatin plus etoposide arm was associated with increased toxicity. Legal entity responsible for the studyEast Mediterranean Oncology Initiation. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Glucose and glutamine metabolism in relation to mutational status in NSCLC histological subtypes.

BackgroundBoth hypoxia and oncogenic mutations rewire tumor metabolism. In this study, glucose and glutamine metabolism‐related markers were examined in stage I ‐ resectable stage IIIA non‐small cell lung cancer (NSCLC). Furthermore, expression of metabolism‐related markers was correlated with mutational status to examine mutations associated with rewired tumor metabolism.MethodsMutation analysis was performed for 97 tumors. Glucose and glutamine metabolism‐related marker expression was measured by immunofluorescent staining (protein) and qPCR (mRNA) (n = 81).ResultsGlutamine metabolism‐related markers were significantly higher in adeno‐ than squamous cell NSCLCs. Glucose transporter 1 (GLUT1) protein expression was higher in solid compared to lepidic adenocarcinomas (P < 0.01). In adenocarcinomas, mRNA expression of glutamine transporter SLC1A5 correlated with tumor size (r(p) = 0.41, P = 0.005). Furthermore, SLC1A5 protein expression was significantly higher in adenocarcinomas with worse pTNM stage (r(s) = 0.39, P = 0.009). EGFR‐mutated tumors showed lower GLUT1 protein (P = 0.017), higher glutaminase 2 (GLS2) protein (P = 0.025) and higher GLS2 mRNA expression (P = 0.004), compared to EGFR wild‐type tumors. GLS mRNA expression was higher in KRAS‐mutated tumors (P = 0.019). TP53‐mutated tumors showed higher GLUT1 expression (P = 0.009).ConclusionsNSCLC is a heterogeneous disease, with differences in mutational status and metabolism‐related marker expression between adeno‐ and squamous cell NSCLCs, and also within adenocarcinoma subtypes. GLUT1 and SLC1A5 expression correlate with aggressive tumor behavior in adenocarcinomas but not in squamous cell NSCLCs. Therefore, these markers could steer treatment modification for subgroups of adenocarcinoma patients. TP53, EGFR and KRAS mutations are associated with expression of glucose and glutamine metabolism‐related markers in NSCLC.

A nomogram for the prediction of overall survival in patients with stage II and III non-small cell lung cancer using a population-based study.

As a malignant tumor with poor prognosis, accurate and effective treatment of non-small cell lung cancer (NSCLC) is crucial. To predict overall survival in patients with stage II and III NSCLC, a nomogram was constructed using data from the Surveillance, Epidemiology and End Results database. Eligible patients with NSCLC with available clinical information diagnosed between January 1, 2010 and November 31, 2015 were selected from the database, and the data were randomly divided into a training set and a validation set. Univariate and multivariate Cox regression analyses were used to identify prognostic factors with a threshold of P<0.05, and a nomogram was constructed. Harrell's concordance indexes and calibration plots were used to verify the predictive power of the model. Risk group stratification by stage was also performed. A total of 15,344 patients with stage II and III NSCLC were included in the study. The 3- and 5-year survival rates were 0.382 and 0.278, respectively. The training and validation sets comprised 10,744 and 4,600 patients, respectively. Age, sex, race, marital status, histology, grade, Tumor-Node-Metastasis T and N stage, surgery type, extent of lymph node dissection, radiation therapy and chemotherapy were identified as prognostic factors for the construction of the nomogram. The nomogram exhibited a clinical predictive ability of 0.719 (95% CI, 0.718–0.719) in the training set and 0.721 (95% CI, 0.720–0.722) in the validation set. The predicted calibration curve was similar to the standard curve. In addition, the nomogram was able to divide the patients into groups according to stage IIA, IIB, IIIA, and IIIB NSCLC. Thus, the nomogram provided predictive results for stage II and III NSCLC patients and accurately determined the 3- and 5-year overall survival of patients.

Comparative Effectiveness of Robotic-Assisted Surgery for Resectable Lung Cancer in Older Patients

Robotic-assisted surgery (RAS) is a novel surgical approach increasingly used for patients with non-small cell lung cancer (NSCLC). However, data comparing the effectiveness and costs of RAS vsopen thoracotomy and video-assisted thoracoscopic surgery (VATS) for NSCLC are limited. Patients > 65 years old with stage I to IIIA NSCLC treated with RAS, VATS, or open thoracotomy were identified from the Surveillance, Epidemiology, and End Results-Medicare database and matched according to age, sex, stage, and extent of resection. Propensity score methods were used to compare adjusted rates of postoperative complications, adequate lymph node staging, survival, and treatment-related costs. In this matched study cohort of 2,766 patients with resected NSCLC, RAS was associated with lower complication rates (OR, 0.57; 95%CI, 0.42-0.79) compared with open thoracotomy, and similar complication rates (OR, 1.02; 95%CI, 0.76-1.37) compared with VATS. Patients undergoing RAS were as likely to have adequate lymph node sampling as those undergoing open thoracotomy (OR, 1.28; 95%CI, 0.94-1.74) or VATS (OR, 0.88; 95%CI, 0.66-1.18). There was no significant difference in overall survival after RAS vsopen thoracotomy (hazard ratio, 0.81; 95%CI, 0.63-1.04) or VATS (hazard ratio, 0.91; 95%CI, 0.70-1.18). Costs were similar for RAS ($54,702) vsopen thoracotomy ($57,104; P= .08), and higher compared with VATS ($48,729; P= .02). RAS led to improved operative outcomes compared with open thoracotomy but may not offer an advantage over VATS. The comparative effectiveness of RAS should be further evaluated prior to widespread adoption.

EP1.18-23 Is Salvage Lung Resection Necessary After Definitive Chemoradiation Therapy for Stage IIIA(N2) Non-Small Cell Lung Cancer?

A combination of platinum-based chemotherapy and definitive radiotherapy is the standard of care for Stage III (N2) NSCLC patients who have single or multiple lymph node metastasis. However, the role of salvage lung resection in patients with residual disease without lymph node metastasis is yet to be identified. Between January 2011 and December 2018 103 eligible patients who had pathologically proven in two university hospital clinics, stage IIIA/N2 non-small-cell lung cancer and were prospectively recorded. Those in the chemoradiotherapy group received three cycles of neoadjuvant chemotherapy (AUCx2 carboplatin and docetaxel 85 mg/m[2 ] docetaxel) and concurrent radiotherapy with 61.2-64.0 Gy in 34 fractions over 3 weeks followed by surgical resection. Also, a group of patients who had definitive chemoradiotherapy who did not undergo surgery was compared with the surgical group. A total of 103 patients were analyzed, of whom 75(72.8%) received chemoradiotherapy followed by surgical resection and 28(27.2) had chemoradiotherapy only. Median overall survival was 49 months (95% CI 8.0–58.0) in the chemoradiotherapy + surgery group and 33.0 months (95% CI:7.5–90.4) in the chemotherapy group (p=0.423). One patients died in the surgery group within 30 days(0.9%) after surgery. Complication rate in all patients and the patients who underwent pneumonectomy after chemoradiation were not statistically significantly different compared to those who had undergone resectional surgery without oncological therapy(p=0.321, p=0.08 respectively). Pulmonary salvage resection after definitive chemoradiotherapy is safe and surgical resection after chemoradiotherapy did not seem to provide better survival in histologically proven N2 stage IIIA non-small cell lung cancer.

A case of heart failure after radiation therapy for mediastinum

Abstract A case of a 65-year-old female with Stage IIIA non-small cell lung cancer (NSCLC) who developed congestive heart failure after radiation therapy for mediastinum is described. The patient was diagnosed with unresectable Stage IIIA NSCLC (squamous cell carcinoma). She received chemotherapy and curative sequential radiotherapy with a dose of 60 Gy on the primary site and mediastinum. She developed dyspnea and chest-X ray demonstrated pleural effusion in the right thorax as of 75 months after radiation therapy. Cardiac ultrasonography revealed a left ventricular ejection fraction of 28% and wall motion diffuse hypokinesis. Coronary angiography showed no signs of coronary stenosis. According to the clinical course and test results, the patient was diagnosed with congestive heart failure due to radiation therapy.