Alwatari, Yahya

8077 Background: Small cell lung cancer (SCLC) is an aggressive malignancy with poor prognosis. This study evaluates national trends in surgical management of early-stage SCLC using the National Cancer Database (NCDB), aiming to identify factors associated with improved outcomes and assess the survival benefit of surgical resection. Methods: Patients diagnosed with clinical stage T1–T3 N0 M0 SCLC between 2004 and 2022 were identified from the NCDB. Exclusions included non-SCLC histologies, advanced or missing staging, non-lobectomy surgeries, and incomplete survival data. Propensity score matching (1:1) was used to balance surgical and non-surgical cohorts based on demographic, clinical, and socioeconomic variables. Kaplan-Meier and Cox regression analyses were used to evaluate overall survival, stratified by T stage. Results: Among 17,762 patients with early-stage SCLC, 3,234 (18.2%) underwent lobectomy with mediastinal lymph node dissection. Surgical rates increased from 5% in 2004, 17% in 2013 to 24% in 2021. Surgery was more common in T1 (26.5%) than T2 (11.4%) or T3 (4.6%) disease. After matching, surgery was associated with improved survival across all T stages, with no significant interaction between T stage and surgical benefit (p=0.43). Older age, male sex, and higher comorbidity scores predicted worse outcomes. Among surgical patients, 2.3% received neoadjuvant therapy and 71.6% received adjuvant treatment. Systemic therapy-both neoadjuvant (HR 0.63) and adjuvant (HR 0.69)-was significantly associated with improved survival. Conclusions: Lobectomy remains underutilized in early-stage SCLC but is linked to significantly improved survival. Albeit small patient's number, neoadjuvant systemic therapy further enhanced survival, supporting broader use of surgery and multimodal treatment in appropriately selected patients Univariable results 1 Multivariable results 2 Characteristic No. deaths Person-months HR (95% CI) p-value HR (95% CI) p-value Charlson score <0.001 <0.001 0 761 77727 1.00 (ref) 1.00 (ref) 1 623 60483 1.06 (0.95,1.18) 1.07 (0.96,1.20) 2 or more 350 27025 1.30 (1.15,1.48) 1.30 (1.13,1.48) Clinical T-stage 0.011 0.014 cT1N0M0 1266 124916 1.00 (ref) 1.00 (ref) cT2N0M0 406 33924 1.18 (1.06,1.32) 1.20 (1.06,1.35) cT3N0M0 62 6393 0.96 (0.75,1.24) 1.00 (0.76,1.31) Residual disease <0.001 <0.001 No residual tumor 1626 158838 1.00 (ref) 1.00 (ref) Residual tumor 92 4699 1.91 (1.55,2.36) 1.91 (1.52,2.40) Neoadjuvant systemic treatment 0.253 0.034 No 1629 154116 1.00 (ref) 1.00 (ref) Yes 30 3495 0.81 (0.56,1.16) 0.63 (0.41,0.97) Adjuvant radiation 0.067 <0.001 No 1209 118925 1.00 (ref) 1.00 (ref) Yes 452 40471 1.11 (0.99,1.23) 1.33 (1.18,1.51) Adjuvant systemic treatment <0.001 <0.001 No 563 44045 1.00 (ref) 1.00 (ref) Yes 1096 113566 0.75 (0.68,0.83) 0.69 (0.62,0.78)

Thymic tumors are exceedingly rare, and most available treatment data come from pooled retrospective analyses. The cornerstone of management is resection, with the use of systemic therapy and radiation therapy (RT) as tools to facilitate surgery and prevent recurrence, or as primary management in unresectable or metastatic disease. Despite the challenges of managing such rare entities, a number of advances have occurred in surgical techniques, systemic therapy, and RT indications and technologies. There is a growing shift toward minimally invasive surgical techniques and the use of surgery to treat pleural metastases, the most common site of recurrence in thymic tumors. Systemic therapy options now include targeted therapies and immunotherapy. RT continues to evolve as new data clarify postoperative recurrence risks and as more targeted treatment approaches become available. Achieving optimal outcomes relies on multidisciplinary care that thoughtfully individualizes and integrates multimodality treatments.

8051 Background: The National Comprehensive Cancer Network (NCCN) currently recommends the use of Atezolizumab, Nivolumab, Osimertinib, and Pembrolizumab in the perioperative management of non-small cell lung cancers (NSCLC) and esophageal cancers (EC). As the therapeutic landscape evolves, we aim to evaluate the cost implications of these guidelines for eligible patients in the United States. Methods: The Medicare Part B payment allowance limits of each medication were ascertained except Osimertinib for which an approximate wholesale acquisition cost (WAC) was reported due to privately administered Medicare Part D coverage. Using national data and published literature, we estimated the annual incidence of patients with newly diagnosed EC and NSCLC who would be eligible for surgery combined with neoadjuvant and/or adjuvant immune and targeted therapy. We applied the estimated cost of the medication based on dosing and duration of treatment, which spanned 1 year for all but adjuvant Osimertinib, which spanned 3 years. Using these data, the cost per patient and the total cost for an incident cohort were estimated. Results: We estimated that 8,602 patients with newly diagnosed EC would be eligible for adjuvant Nivolumab; the cost to treat one patient was $248,529, and the cost to treat one incident cohort was approximately $2 billion (Table). We estimated that 50,409 patients with NSCLC will meet the criteria for neoadjuvant Nivolumab with a total cost of three cycles of $32,894 per patient and $1.7 billion per cohort. Among NSCLC patients who may undergo resection and qualify for adjuvant therapy (Stage IB – IIA with high-risk features or IIB-IIIA), 85,063 patients are anticipated to be EGFR-negative and treated with adjuvant Atezolizumab or Pembrolizumab. Treatment costs range from $178,584 – $197,320 per patient with up to $16 billion cost per cohort. The cost to treat one patient with adjuvant Osimertinib was $556,720, and the cost to treat one incident cohort was close to $10 billion. In total, the cost to treat an incident cohort of eligible operable thoracic malignancies could exceed $30 billion. Conclusions: Neoadjuvant and adjuvant immune and targeted therapy in operable thoracic patients is associated with a significant cost burden. Prospective large-scale studies are needed to assess cost-effectiveness, particularly given the paucity of superior overall survival data with these agents. [Table: see text]

Abstract Cardiac surgeries often require the use of cardiopulmonary bypass to allow visualization and manipulation of tissues. Vascular anomalies may impose challenges with access configuration. A patient was evaluated for robot-assisted mitral valve repair and found to have an atretic inferior vena cava secondary due to chronic occlusion. The patient was cannulated arterially through the left common femoral artery, and two cannulation sites were applied for venous drainage: the right intrajugular vein and a second percutaneous access site directly into the right atrium through the chest wall. The procedure was completed without immediate complications, and the patient’s perioperative course was unremarkable.