91P: Validation of the 7th and upcoming 8th TNM staging system in small cell lung cancer

91P: Validation of the 7th and upcoming 8th TNM staging system in small cell lung cancer

Abstracts, ELCC 2016 Journal of Thoracic Oncology Vol. 11, Suppl. 4S (2016) S96–S98 SCLC Legal entity responsible for the study: Karolinska Institu...

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Abstracts, ELCC 2016

Journal of Thoracic Oncology Vol. 11, Suppl. 4S (2016) S96–S98

SCLC

Legal entity responsible for the study: Karolinska Institute Funding: Karolinska Institute Disclosure: All authors have declared no conflicts of interest.

91P Validation of the 7th and upcoming 8th TNM staging system in small cell lung cancer S. Tendler, R. Lewensohn, K. Viktorsson, L. de Petris. OncologyPathology, Karolinska University Hospital-Solna, Stockholm, Sweden Background: The purpose of this study was to evaluate whether the 7th and upcoming 8th TNM staging system can provide additional prognostic information in comparison with the previous 6th TNM version and the older 2-stage LD vs ED system, on a Swedish cohort of small cell lung cancer (SCLC). Methods: We retrospectively reviewed the medical records of patients (pts) with proven histology/cytology SCLC diagnosed between Jan 2008 and Jan 2013 in the Stockholm region. A baseline CT thorax/upper abdomen was a requirement for inclusion. Patients with stage IA-IIB (n = 7 pts), combined-type histology were excluded. Each patient file was revised and reclassified from the VASGL system to the 6th , 7th and 8th TNM system respectively. We assessed overall survival (OS) according to the T, N, M-descriptor and compared LD/ED with the 6th , -7th , -8th editions of TNM. Four separate multivariate models (adjusted for basic patient characteristics i.e. age, gender, WHO performance status and baseline levels of Hb, CRP and Na) were therefore performed. Results: In total, 249 pts were eligible for the study. Median age was 69 years and 136 pts (55%) were females. Median OS was 6.2 months. The results of re-staging patients according to the different classification systems are presented in Table 1, where HR and 95% CI for multivariate analyses are given. There were no cases of M1b classified according to the 8th TNM. Conclusions: The results from this ongoing study indicate that the 8th TNM classification system is a more accurate predictor of prognosis in patients with locally-advanced/ metastatic SCLC patients as compared to previous TNM versions and the old VALSG classification. Nonetheless, the majority of patients (> 70%) were stage IV at diagnosis with multiple metastatic localizations. For this large group a more detailed prognostic classification based on the extension of tumor burden is warranted. Additional data on a larger cohort will be presented at the conference.

92P Validation of prognostic scores in small cell lung cancer S.I. Rothschild, R. Hagmann, A. Zippelius. Medical Oncology, ¨ Universitatsspital Basel, Basel, Switzerland Background: Treatment decisions in small-cell lung cancer (SCLC) are made based on the extent of the disease. However, the outcome differs among patients at the same stage. A simple tool to predict outcome in SCLC patients would be helpful for decision-making. In recent years, several prognostic scores have been proposed. However, most of them have never been validated in independent patient population. Methods: From January 2000 to December 2010, 92 SCLC patients were treated at our institution. Data acquisition from consecutive patients was done through patients’ medical records, and blood results recorded at the time of diagnosis. Univariate and multiple cox regression analyses of survival were performed to assess the prognostic value of relevant clinical and laboratory factors for SCLC. Furthermore, we investigated the relationship between seven published prognostic scores for SCLC and overall survival (OS). Results: We recently published clinical data of our study population (Hagmann R. J Cancer 2015). In a univariate analysis, we evaluated 29 parameters. Staging (p < 0.001), number of metastatic sites (p < 0.001), liver metastasis (p < 0.001), bone metastasis (p < 0.001), adrenal gland metastasis (p = 0.028) and response to initial therapy (p < 0.001) were significantly related to OS. From the established laboratory markers hypoalbuminemia (< 35 g/l; p = 0.044), hyponatraemia (< 131 mmol/l; p = 0.041), and elevated alkaline phosphatase (AP) ( 129 U/l; p < 0.001) significantly predicted OS. Multivariate analysis confirmed staging (HR 2.7; p = 0.022) and elevated AP (HR 3.3; p = 0.004) as independent prognostic factors. The Manchester Score incorporating LDH, tumor stage, serum sodium, Karnofsky performance status, AP and serum bicarbonate (Cerny T. Int J Cancer 1987) was the only published scoring system significantly associated with OS. Patients in good, intermediate and poor prognosis groups had a median OS of 12.9, 6.6 and 5.8 months, respectively (p = 0.008).

Table 1 (abstract 91P).

P-value LD ED IIIA IIIB IIIC IV IVA IVB

VALSG # (%)

HR (95% CI)

36 (14) 213 (86)

0.0012 1 1.44 (1.14–1.87)

6th TNM # (%)

HR (95% CI)

7th TNM # (%)

0.06

HR (95% CI)

8th TNM # (%)

0.002

12 (5) 34 (14)

0.59 (0.29–1.04) 1.14 (0.76–1.76)

14 (5) 37 (15)

0.55 (0.30–0.90) 1.09 (0.75–1.60)

203 (81)

1

198 (80)

1

Copyright © 2016 by the European Lung Cancer Conference organisers, ESMO and IASLC. Published by Elsevier Inc. All rights reserved.

HR (95% CI) 0.0004

10 (4) 28 (11) 13 (5)

0.40 (0.17–0.78) 1.06 (0.66–1.65) 1.32 (0.72–2.2)

22 (9) 176 (71)

0.99 (0.61–1.54) 1