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K. Fujii



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    P1.07 - Poster Session 1 - Surgery (ID 184)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P1.07-035 - Uncertain Resection due to incomplete intraoperative nodal assessment (ID 2321)

      09:30 - 16:30  |  Author(s): K. Fujii

      • Abstract

      Background
      The standard surgical approach for non-small-cell lung cancer is lobectomy with systematic hilar and mediastinal lymph node dissection. The purpose of lymph node dissection is considered to be improvement of prognosis and intraoperative staging. Although improvement of prognosis is controversial, it is clear that intraoperative nodal assessment is important for identifying N2 disease and making postoperative therapeutic decisions． For complete resection (CR), at least three mediastinal nodes including subcarinal nodes and three hilar/ intrapulmonary nodes had to be retrieved. Otherwise It is defined as uncertain resection(UR). The objective of this study is to clarify the difference of prognosis between CR and UR.

      Methods
      The medical records and the follow-up data of the patients operated for NSCLC(c-stage I to III) between January 2005 and December 2006 in Yokohama City University Hospital and 8 associate hospitals were analyzed retrospectively. Four hundred-eighty-four patients with NSCLC who underwent lung resections (lobectomy or pneumonectomy) with negative surgical margins were included in this study. Complete resection (CR) was performed in 198 patients. And in 286 patients, uncertain resection was done. We compared these 2 groups.

      Results
      There were no statistically difference between the both groups for age, gender, pathological stage( IA:CR n=69/UR n=153，IB 59/71，IIA 4/12，IIB 27/21，IIIA 36/24，IIIB 3/5), and histology (adenocarcinoma: CR n=122/UR n=185，squamous carcinoma:51/68，large cell carcinoma:15/14，others:14/20 respectively). Five-year disease-free-survival rate in the CR group was 58.1% compared with 63.3% in the UR group. Among patients with p-stage I, the 5-year disease-free-survival rate was significantly lower in UR group (78.1%) than in CR group (88.0%, p=0.027).

      Conclusion
      Uncertain resection might not be enough for accurate intraoprerative staging to determine pN0 status. However whether the accurate intraoperative staging leads to good prognosis was unclear.

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    P2.02 - Poster Session 2 - Novel Cancer Genes and Pathways (ID 148)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P2.02-008 - Elevated microsatellite alterations at selected tetra-nucleotide (EMAST) in non-small cell lung cancers - a potential determinant of susceptibility to multiple malignancies (ID 1757)

      09:30 - 16:30  |  Author(s): K. Fujii

      • Abstract

      Background
      Microsatellite instability (MSI) can be analyzed by microsatellite markers consisting of mono-, di- and trinucleotide repeat sequences. In primary lung cancer, chromosomal instability including loss of heterozygosity (LOH) has been thought to play an important role in carcinogenesis. Although MSI was thought to be unrelated to lung carcinogenesis, recent findings suggest the role of tetranucleotide repeat sequence instability in prostate, skin, bladder and lung cancers. Unlike Bethesda panel markers (D17S250, D2S123, D5S346, BAT25 and BAT26) for Lynch syndrome, these tetranucleotide markers are not unified. Moreover, there are frequent elevated microsatellite alterations at selected tetranucleotides (EMAST) that are distinct from traditional MSI in several tumor types. EMAST in lung cancer has not been reported to date. We investigated EMAST in non-small cell lung cancers (NSCLCs) using selected tetranucleotide repeat markers (EMAST markers: D8S321, D20S82, UT5037, D8S348, D2S443, D21S1436, D9S747, D9S303, D9S304 and MYCL1) based on previous reports and analyzed their correlation to clinicopathological factors.

      Methods
      Sixty-five NSCLC tissue samples (19 squamous cell carcinomas, 39 adenocarcinomas, one adenosquamous cell carcinoma and six large cell carcinomas) without lymph node metastasis and preoperative chemotherapy or radiation therapy were obtained after resection from Yokohama City University Medical Center. Tumorous DNA was extracted by laser captured microdissection, and paired normal DNA was extracted from non-tumorous tissue or normal lymph nodes. Genotyping for EMAST determination was carried out using ten tetranucleotide repeat markers and five Bethesda panel markers.

      Results
      Using the ten tetranucleotide repeat markers, MSI was detected in 42 of 65 (64.9%) of the tissue samples. There was a higher rate of MSI at selected tetranucleotide markers than at Bethesda panel markers in the tissue samples (12.3%). The high EMAST group (MSI found at two or more markers) was significantly correlated to the presence of multiple malignant neoplasms (p=0.021) compared to the low EMAST group (MSI at none or one marker). We also examined a representative malignant neoplasm (renal pelvic carcinoma) complicated with NSCLC using EMAST markers. The tumor showed EMAST in the two markers (D2S443 and D21S1436).

      Conclusion
      Our results suggest that EMAST could participate in carcinogenesis of NSCLCs and lead to other malignant neoplasms.