Abstract 117P
Background
Stage IIIA non-small cell lung cancer (NSCLC) is a heterogeneous disease treated by a surgery-based approach or definitive chemoradiation (CRT). Surgery is thought to have superior outcomes despite an upfront mortality disadvantage. However, there is no real-world data on outcomes of stage IIIA NSCLC receiving definitive CRT and durvalumab (ICI) consolidation in comparison to surgery-based treatment since durvalumab was introduced.
Methods
We used National Cancer Database (NCDB) to identify 23,110 patients with clinical stage IIIA NSCLC treated with either surgery-based treatment or definitive CRT followed by ICI during 2017–2019, and surgery-based treatment or CRT during 2014–2016. The primary outcome analyzed was overall survival (OS). Kaplan-Meier (KM) plots were used to examine survival curves and Cox regression analysis was used to identify factors associated with OS.
Results
During 2017–2019, surgery consistently had a survival advantage (HR 0.81, 95%CI 0.75–0.88, p < 0.001) across all T and N groups compared to CRT-ICI. Consolidation ICI has improved 3-year OS from 39.1% during 2014–2016 to 56.5% during 2017–2019. A delay of 6+ weeks in initiating ICI after radiation did not confer a negative impact on survival. Lobectomy patients had better OS compared to pneumonectomy. On multivariate analysis, younger age (ages 19–39; HR 0.47, 0.35–0.64); (ages 40–64; HR 0.71, 0.67–0.75); (ages 65–74; HR 0.79, 0.76–0.83); (ages 75+ as HR 1.0), female sex (male sex; HR 1.24, 1.20–1.29; female sex as HR 1.0), non-squamous histology (adenocarcinoma; HR 0.90, 0.86–0.93; squamous histology as HR 1.0) and lower Charlson Comorbidity Index (CCI) (CCI 0; HR 0.81, 0.77–0.85), CCI 1 (HR 0.87, 0.83–0.92); (CCI 2 as HR 1.0), were associated with better OS (p < 0.001).
Conclusions
For stage IIIA NSCLC patients, surgery-based treatment is recommended if operable/resectable. In the first year, surgery has a small survival disadvantage, reflecting the upfront surgical mortality. Using CRT+ICI is slightly inferior to surgery but confers an impressive survival advantage compared with no ICI. Interestingly, delay in ICI did not cause a loss in efficacy.
Legal entity responsible for the study
J. Sekkath Veedu.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.