Borgert, Andrew J.

9022 Background: Lobectomy is the current standard of care for patients with stage I non-small cell lung cancer (NSCLC). There is a lack of prospective data on the benefit of adjuvant chemotherapy (CT) in patients with negative margins but with high-risk features: lympho-vascular invasion (LVI) or visceral pleural invasion (VPI). We aimed to investigate the benefit of adjuvant CT in patients with pathological stage I NSCLC with high-risk features. Methods: The 2016 National Cancer Database was queried to identify patients with pathological stage I NSCLC (8th edition AJCC staging) diagnosed from 2010-2015 who received lobectomy/pneumonectomy with clear surgical margins. Patients were stratified into high risk (tumor size ≥2 cm with LVI and/or VPI) or low risk group. Multivariate Cox proportional hazards regression and propensity score matched Kaplan-Meier survival analysis were used to compare overall survival between those who received adjuvant CT and those who did not. Results: 34,556 patients were identified with 1114 (3.2%) receiving adjuvant CT. On multivariate Cox regression analysis, high risk tumors (hazard ratio [95% confidence interval] = 1.31 [1.25-1.38]) and lack of adjuvant chemotherapy (1.25 [1.09-1.44]) were associated with worse overall survival (OS). Additionally, male sex, age ≥ 60 years, higher comorbidity burden, lack of insurance, low facility volume, low median income, non-squamous histology were associated with worse OS. After propensity score matching, Kaplan-Meier survival analysis of the high risk subgroup (n = 2923) showed a significant difference in overall survival (OS) between those who received adjuvant CT (n = 1032, 5 year OS, 74.7%; 95% CI, 70.9%-78.0%) and those who did not (n = 1891, 5 year OS, 66.9%; CI, 63.9%-69.6%; p = 0.0002). In patients with no high risk factors for recurrence (n = 384), OS was not significantly different between the patients who received adjuvant CT (n = 78, 5 year OS, 75.8%; CI, 61.3%-85.5%) and those who did not receive adjuvant CT (n = 306, 5 year OS, 77.1%; CI, 70.0%-82.7%; p = 0.3). Conclusions: Our study showed better survival with adjuvant CT in patients with pathological stage I NSCLC who have tumor size greater than 2 cm, LVI and/or VPI.

Abstract Background: Prolymphocytic leukemia (PLL) is a rare cancer with incidence of 0.48/1,000,000. It is comprised of 2 subtypes, T or B cell. It generally is associated with a poor median OS of 1-3 years. However, some patients have an initial smoldering course not requiring treatment. Limited population data exists describing the outcomes of PLL. We studied PLL patients who met a definition of smoldering, not requiring treatment within 180 days of diagnosis, using the National Cancer Data Base (NCDB). Methods: Patient level data were obtained from the NCDB Participant User File. The NCDB collects hospital cancer registry data representing 70% of newly diagnosed cancer cases in the US population. We identified PLL patients (ICD-O: 9832 PLL, NOS, ICD-O: 9833 B-PLL, and ICD-O: 9834 T-PLL) diagnosed in 2004-2015 for demographics, disease and treatment characteristics. We included patients diagnosed from 2004-2013 in the overall survival (OS) analyses. Patients who received no treatment as part of their first course of treatment and who did not have a subsequent treatment within 180 days were considered smoldering PLL. Results: From 2004-2015, 1606 patients were diagnosed with PLL and 451(28%) were smoldering PLL. Of the 1606 patients, T-PLL represented 781(49%), B-PLL 480(30%), and PLL, NOS 345(21%). Of the 451 smoldering PLL patients observed as T-PLL represented 48%(215), B-PLL 29%(133), and PLL, NOS 23%(103). The median age at diagnosis was 69 [59 - 78] years. There was a male predominance with 60 % males. The median OS for the entire cohort was 20.6 months. The % 5yr overall survival (OS) for smoldering PLL was 40% vs 29%(for non-smoldering). Within the PLL subtypes PLL, NOS and B-PLL were associated with better 5yr OS 38.56% and 35.53%, compared to T-PLL 12.89%. Only 65(4%) patients underwent an early stem cell transplant(SCT). Conclusions: We identified a population of patients not needing treatment within 180 days of diagnosis representing smoldering PLL with a significantly improved OS. Additionally, PLL, NOS and B-PLL were associated with an improved OS. The use of early SCT is low in PLL. Disclosures No relevant conflicts of interest to declare.

Purpose Data that guide selection of optimal local ablative therapy for the management localized hepatocellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of radiofrequency ablation (RFA) versus stereotactic body radiotherapy (SBRT) by using the National Cancer Database. Methods We conducted an observational study to compare the effectiveness of RFA versus SBRT in nonsurgically managed patients with stage I or II HCC. Overall survival was compared by using propensity score–weighted and propensity score–matched analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to evaluate the effect of severe fibrosis/cirrhosis. In addition, we performed exploratory analyses to determine the effectiveness of RFA and SBRT in clinically relevant patient subsets. Results Overall, 3,684 (92.6%) and 296 (7.4%) nonsurgically managed patients with stage I or II HCC received RFA or SBRT, respectively. After propensity matching, 5-year overall survival was 29.8% (95% CI, 24.5% to 35.3%) in the RFA group versus 19.3% (95% CI, 13.5% to 25.9%) in the SBRT group ( P < .001). Inverse probability–weighted analysis yielded similar results. The benefit of RFA was consistent across all subgroups examined and was robust to the effects of severe fibrosis/cirrhosis. Conclusion Our study suggests that treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC.