3:18 PM Abstract No. 148 Current United States nationwide utilization of thermal ablation for lung cancer

Thermal ablation has been increasingly studied for treatment of lung cancer in recent years. However, there are no representative data on the current nationwide utilization of pulmonary thermal ablation in the United States. The most recent version of the National Cancer Database (NCDB) was queried for adult patients diagnosed with lung cancer between 2004-2016. Inclusion criteria were treatment of the pulmonary tumor via thermal ablation (surgical code “12” and “15” including cryoablation, CRA, and radiofrequency ablation, RFA). Patients with surgical resection of metastases were excluded. Thermal ablation utilization was descriptively evaluated. Overall survival was assessed using Kaplan-Meier plots. A total of 5,284 patients were included (52% male, 48% female; median age 70 years, IQR: 62-78 years). CRA was used in n = 3,344 cases (63.3%) and RFA in n = 1,940 cases (36.7%). Most patients presented with squamous cell carcinomas (n = 2,025, 38.3%) or adenocarcinomas (n = 1,453, 27.5%). Thermal ablation was most commonly applied for stage I lung cancer (n = 2,354, 44.6%), followed by stage III (n = 1,431, 27.1%) and stage IV disease (n = 1,160, 22%). Median size of the pulmonary primary was 26 mm (IQR: 16-45 mm). The absolute number of thermal ablation cases increased from 2004-2009 and plateaued until 2016 at approximately 450 cases annually. Utilization of CRA increased from 2004-2016, while RFA case numbers increased until 2009 (n = 218) and decreased afterwards (n = 217 in 2016, Figure 1). Most thermal ablations were performed in East North Central (22.6%) and South Atlantic States (19.1%). Overall survival inversely correlated with lung cancer stage, with longest survival seen for stage 1 lung cancer (Figure 2). Longer overall survival was further associated with RFA vs. CRA (multivariable HR = 0.91, 95% CI: 0.84-0.98, P = 0.012), female gender, fewer comorbidities, smaller tumors and tumor histology. Pulmonary thermal ablation is commonly utilized for early stage NSCLC with median diameter of 26 mm, with increasing case numbers from 2004-2016. After adjustment for confounders, RFA demonstrates longer overall survival versus CRA.