NSCLC: indeterminate margins linked to worse overall survival

  • Raman V & al.
  • J Thorac Cardiovasc Surg
  • 30 Sep 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Patients with indeterminate margins following surgical resection for NSCLC had worse OS than those with negative margins, despite the receipt of adjuvant therapy.

Why this matters

  • Surgical NSCLC patients with indeterminate margins may not be good candidates for adjuvant therapy, given its high toxicity and lack of OS benefit in these patients.

Study design

  • 232,986 stage I NSCLC patients from the National Cancer Database underwent surgical resection.
  • Funding: None disclosed.

Key results

  • 0.31% of patients had indeterminate margins.
  • Anatomic resection was independently associated with decreased risk of indeterminate margins (segmentectomy HR, 0.48; P<.001 lobectomy hr p and pneumonectomy>
  • 5-year OS was 34% in patients with indeterminate margins vs 56% in margin-negative patients (HR, 1.53; P<.001 for worse survival>
  • Indeterminate margins were associated with worse OS in patients with stage I disease (HR, 1.66; P<.001 and stage iii p compared with margin-negative patients.>
  • Among patients with indeterminate margins, 62% received no adjuvant therapy, 17% adjuvant chemotherapy, 6% adjuvant radiation, and 15% adjuvant chemoradiation.
  • After multivariable analysis, patients with indeterminate margins had worse OS than margin-negative patients whether they had adjuvant therapy (HR, 1.51; P<.001 or not p>

Limitations

  • Retrospective study.