OA 16.03 Recurrences and 2nd Primary Cancers in the IFCT-0302 Trial Assessing a CT-Scan-Based Follow-Up after Lung Cancer Surgery

Abstract

After reviewing 1039 records, 17 PS-adjusted studies with a total of 20151 patients were included in the final analysis. Overall survival (OS) favored surgery over SABR (HR ¼ 1.52 [95% CI: 1.33-1.74], p <0.001). However, the rate at which patients died from lung cancer (DSS) was not significantly different (HR ¼ 1.13 [95% CI: 0.86-1.49], p ¼ 0.38). On subgroup analysis, OS was superior for both lobectomy (HR ¼ 1.61 [95% CI: 1.27-2.03], p <0.001) and sublobar resection (HR ¼ 1.33 [95% CI: 1.15-1.55], p <0.001) versus SABR while DSS again did not significantly differ (HR ¼ 1.35 [95% CI: 0.70-2.62] and HR ¼ 1.18 [95% CI: 0.84-1.67], respectively). On secondary analysis, meta-analysis of proportions revealed a lymph node upstaging rate of 16.0% (95% CI: 13.6%-18.6%) and adjuvant chemotherapy usage rate of 11.5% (95% CI: 8.6%-14.8%) among patients who received surgery. On metaregression, with every increase of 0.1 in the maximum allowable difference in propensity score within a matched pair-representing increases in imbalance between cohorts, DSS outcomes increasingly favored surgery by 1.36-fold. Critical appraisal revealed inconsistent reporting of propensity score methods. Conclusion: Overall survival favored surgery over SABR in this meta-analysis of 17 propensity score analyses. However, the effectiveness of SABR was reflected in a similar DSS to surgery, supporting ongoing clinical equipoise. A direct relationship between propensity score methodology and DSS outcomes were demonstrated. Whether this observed benefit in OS for surgery is real or due to limitations in the propensity score methodology requires confirmation through randomized data.

Surveillance After Curative-Intent Treatment for NSCLC: More to It Than Meets the Eye

“…Furthermore, 13% of recurrences and 45% of SPLCs were treated with a second surgery alone in the CT-based surveillance arm versus 5% and 19%, respectively, in the minimal follow-up arm. 9 These data are congruent and suggest that follow-up imaging can detect recurrence earlier and increase the chances of curative-intent retreatment.…”

“…Details of recurrences and SPLCs were presented during the World Conference on Lung Cancer in 2017. 9 The addition of thoracic CT scan to postoperative follow-up detected significantly more recurrences (33% versus 28%), which were more often asymptomatic (44% versus 17%). The distinction between recurrence and SPLC is critical but was available in only four studies of the meta-analysis by Stirling et al, 6 precluding separate results for recurrences and SPLCs.…”

“…These results compare favorably with those of a large randomized trial evaluating the interest of chest CT scan in stages I to IIIA operated NSCLC, the IFCT-0302 study, conducted by the French Thoracic Intergroup. 8,9 The IFCT-0302 study compared a CT-based follow-up including HPE, chest radiograph, chest CT scan, and fiberoptic bronchoscopy (optional in case of nonsquamous cell carcinoma) with a minimal follow-up consisting of HPE and chest radiograph. In both arms, the procedures were planned every 6 months for the first 2 postoperative years and annually between year 1 and year 5.…”