Haider Al-Najjar

Physiological predictors of mortality in high-risk patients undergoing surgery for lung cancer

Introduction: Surgical resection is optimal for patients with early stage lung cancer. Physiological measurements help predict mortality associated with surgery, particularly in high-risk patients. These include spirometry(FEV1%) diffusion capacity(DLCO%) Cardiopulmonary Exercise Testing(CPET) plus predicted post-operative(PPO) data derived from segment-counting based on proposed surgery. We aim to identify parameters best predicting post-operative mortality in this group. Method: All patients having pre-op CPET at a tertiary thoracic oncology centre between 01/01/2012 and 31/12/2015 were reviewed. Data from physiology, survival and clinical databases were analysed for those undergoing surgery. Results: 158 patients were included for statistical analysis. Single-variable analysis showed BMI<25(p=0.003) and PPO DLCO%(p=0.005) were associated with increased mortality post-op. Multivariable analysis identified PPO DLCO%(p=0.021) as the only independently statistically-significant variable Conclusion: In our population, low BMI and PPO DLCO% were the strongest predictors for mortality. Analysis appeared to show that CPET measurements did not predict mortality post-op. Further analysis is planned to analyse stage-specific parameters.

Non-small cell lung cancer (NSCLC) pathological sub-typing in convex and radial endobronchial ultrasound (EBUS) specimens compared to surgical resection

Background: Categorisation of NSCLC into squamous and non-squamous sub-types is important to guide treatment regimens and molecular testing. Minimising the rate of NSCLC not otherwise specified (NSCLC-NOS) is key. We have previously documented low rates of NSCLC-NOS (2.2%) and high rates of successful non-squamous molecular testing (97%) on EBUS sampling. The aim of this study was to review whether the NSCLC pathological sub-typing of EBUS specimens corresponded to surgical resection NSCLC sub-type. Methods: All patients with NSCLC from convex or radial EBUS sampling who underwent surgical resection from 1/1/2013 to 31/12/2015 were included. This was collected from a prospectively maintained database in a tertiary thoracic oncology centre. Results: A total of 39 patients were diagnosed with NSCLC on convex (n=32) or radial (n=7) EBUS who proceeded to surgical resection. EBUS sampling correctly identified the pathological sub-type in 36/39 patients (92%). NSCLC sub-typing was unable to be performed on one EBUS specimen found to be squamous cell carcinoma. Two patients had a change in diagnosis after surgical resection (Table 1). Discussion: Convex and radial EBUS sampling can yield low rates of NSCLC-NOS with accurate sub-typing as demonstrated in this small cohort of patients.

Achieving a tissue diagnosis in PS3 patients with advanced lung cancer: What are the safety and diagnostic outcomes with EBUS?

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