Hi everyone, my name is Josh Herman. I'm a third year medical student at the University of Toronto and today I'm presenting clinical demographic factors, EGFR status and their association with stage of diagnosis and lung adenocarcinoma patients. I want to acknowledge the Princess Margaret Cancer Centre and the research team, which is where this research project took place. I have no financial relationships to disclose. So EGFR positive lung adenocarcinoma is more common in atypical lung cancer populations, including younger Asian female and non-smoking patients. Now there's little evidence exploring whether EGFR positive adenocarcinomas are diagnosed at later stages than EGFR wild type, given this atypical patient population. Interestingly enough, one large Korean study found a significant association between EGFR mutations and early stage diagnosis. However, this and existing studies are limited by being race specific, smoking restricted and treatment specific. So our objective was to evaluate the relationship between EGFR status and clinical demographic factors on stage of diagnosis and an unselected single institution lung adenocarcinoma patient sample. So the primary variable we were interested in was EGFR mutation status. Our secondary variables included age, sex, ethnicity, smoking status and ALK mutation status. Our outcomes of interest included stage of diagnosis, which we grouped into stage one, two, three and four. So this was a retrospective cohort design using data manually extracted from the Princess Margaret Cancer Registry between the years of 2014 and 2016. Data analysis was conducted using Madden-Witness U-Test for continuous variables, CHI-squared for categorical variables and a multivariate logistic regression analysis. So if you look at table one, here are our population characteristics. So all in all, we had mutation data available for about 1,124 patients of which about 31% were EGFR positive. If you look at the other distribution of demographic factors, about 46% of our sample was female. We had known ethnicity data for 70% of our sample of which 53.3% were Caucasian. We had smoking data available for about 96% of our population of which about 81% did have a smoking history. Now, if you look at the actual breakdown of this data, it's not too surprising based on what we already know about EGFR positive lung adenocarcinomas in the sense that they are more common in younger females who are of Asian or other non-Caucasian races. They're also more common in never smokers. So this is where things start to get interesting in our second table. And this is a multivariate regression comparing or looking at risk factors for being diagnosed at stage four versus being diagnosed at stages one through three. So if you actually go through the variables, you can see that interestingly enough, as age increased, there was actually a lower chance of being diagnosed at stage four. However, males were at a significantly higher chance of being diagnosed at stage four disease, as did those of Asian and other non-Caucasian ethnicities. Interestingly, in this analysis, status did not play a role and neither did EGFR positive mutation status. So based on this analysis alone, it does not seem that EGFR positive adenocarcinomas are diagnosed at stage four versus stage one to three at a higher rate than wild type. Although we do see that there are some certain factors that are a risk for being diagnosed at later stage disease. We also conducted this other analysis, which is quite interesting. So instead of comparing stage four to stage one to three, we actually grouped stage three and four together in what you might call a late stage disease. So as you can see, when we actually conduct this analysis, all the relationships from the previous table hold true. But when you actually group stage three and stage four together, you can actually see that never smokers actually had a much lower risk of being diagnosed at stage four to three cancer, showing that when you actually look at the analysis in this way, smoking did seem to be a risk factor for being diagnosed at a later stage disease. But either way, there still is no effect of the EGFR positive mutation to suggest that these patients are diagnosed at a later stage compared to wild type. So in conclusion, in a large multi-ethnic Canadian population diagnosed with long adenocarcinoma, there's no association between EGFR mutation status and stage of diagnosis. That being said, male sex, non-Caucasian ethnicity, and being an ever smoker were all independently associated with the higher stage of disease diagnosis. We think that further research exploring explanation for these disparities may aid in risk stratifying patients in the future and trying to find ways to ensure that these cancers are caught at earlier stages. So thank you very much. And here's a list of references available on my slide deck, which has been posted. Thank you for listening to the presentation today.

EGFR status

lung adenocarcinoma diagnosis

EGFR positive

non-smokers

higher stage of disease diagnosis