Latest information for the thoracic surgeon from the Annual Meeting of the American Society of Clinical Oncology.
- Sarita Dubey, Giorgio Scagliotti
- The Journal of thoracic and cardiovascular…
7512 Background: Curative treatment of early stage NSCLC requires good quality oncologic resection (GQR). For GQR, the National Comprehensive Cancer Network (NCCN) requires a minimum of segmentectomy, negative margins, lymph node (LN) sampling from stations 10-14 (level-1) and >2 mediastinal (level-2) stations. We reviewed details of consecutive resections for NSCLC to determine the proportion that met NCCN GQR criteria and the proportion who would have met eligibility for the RADIANT trial which requires >1 level-2 stations. METHODS Retrospective review of medical records of all patients who underwent curative- intent resection for NSCLC in the Memphis Metropolitan Area from 1/1/2004 to 12/31/2007. Resections for benign and metastatic disease were excluded. Death information was obtained from a national death index search. Categorical variables were compared by chi-square test or Fisher's exact test, survival curves by log-rank test. RESULTS 746 patients were eligible (Table). Median age was 67.7 (range, 36.5 - 89.4). 61/746 (8.2%) met NCCN GQR criteria. Black patients were more likely than whites to have GQR (P=0.022). No other patient demographic factor was associated with GQR. Three year survival was 72% in those with GQR versus 63% in those without GQR (P=0.50). There was a difference in achievement of GQR between the 3 major institutions where surgery was done (P=0.001) although it was low across the board. 77.9% of patients would have been disqualified from the RADIANT trial. CONCLUSIONS Majority of surgical resections for NSCLC did not achieve GQR standards per RADIANT and NCCN. The greatest deficit is in surgical sampling of level-2 LNs, but evaluation of level-1 LNs is also frequently sub-optimal. Intervention is needed to improve current surgical and pathology practices in collection and examination of surgical specimens in order to achieve minimum standards for accurate staging, prognostication, determination of candidacy for post-operative adjuvant therapy, and eligibility for clinical trials. [Table: see text] [Table: see text].