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K. Hirai



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    P1.17 - Poster Session 1 - Bronchoscopy, Endoscopy (ID 182)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pulmonology + Endoscopy/Pulmonary
    • Presentations: 1
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      P1.17-010 - Diagnostic medical thoracoscopy for pleural effusions of unknown etiology: Inspection delay may cause non-deterministic endoscopic diagnosis (ID 3056)

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

      • Abstract

      Background
      Thoracoscopy is a useful tool for diagnosis of exudative pleural effusion of unknown etiology, and the efficacy and safety have already been established. The procedure is relatively easy and can be performed under local anesthesia with conscious sedation. We investigated the factors associated with thoracoscopically undiagnosed patients in our hospital.

      Methods
      Clinical records were reviewed retrospectively. We found 101 patients who underwent medical thoracoscopy from April 2000 to May 2013, and then we identified 91 eligible patients for the detailed analysis. All the procedures were performed utilizing a flexible bronchoscopy (type-240, Olympus Corporation, Tokyo, Japan) or a semi-rigid thoracoscopy (LTF type-240, Olympus Corporation, Tokyo, Japan) from a single-port under local anesthesia.

      Results
      The median age of the patients was 69 years old (range, 32-89), and 79 (86.8%) were male. Affected sides of effusion were right/left/bilateral = 60/26/5. Definitive diagnoses were obtained in 73 (80.2%) cases. In 21 (23.1%) patients, the duration from the disease-onset to the examination was more than 3 months. In 18 (19.8%) thoracoscopically undiagnosed patients, the number of patients according to the time from disease-onset to the examination was as follows; none within 1 month, 7/46 patients (15.2%) in 2 to 3 months, and 11/36 patients (30.6%) in more than 4 months. No remarkable complications, other than a moderate hemoptysis, were seen.

      Conclusion
      Medical thoracoscopies were safe, and they contributed to definitive diagnoses. The delay of thoracoscopic examination from the disease-onset tended to lead non-specific findings in pathological diagnosis. Diagnostic medical thoracoscopy should be performed as soon as possible when the cause of pleural effusion is undetermined with thoracentesis.

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    P3.10 - Poster Session 3 - Chemotherapy (ID 210)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.10-017 - The role of cytokeratin fragment antigen 21-1 ( CYFRA21-1 ) as a predictive marker for the patients with non-small-cell lung cancer treated with pemetrexed (ID 1378)

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

      • Abstract

      Background
      Pemetrexed plays an important role in the treatment of advanced non-small-cell lung cancer (NSCLC). The expression of thymidylate synthase in NSCLC has been reported to be a predictive marker for patients treated with pemetrexed; however, no practical marker has been established except for histopathological features. Thus we attempted to select a practical predictive marker for pemetrexed treatment from clinical characteristics.

      Methods
      We retrospectively reviewed the charts of patients with advanced non-squamous NSCLC treated with pemetrexed in our hospital from January 2009 to December 2012. We investigated clinical variables such as smoking history, gender, clinical stage, serum tumor marker levels at the diagnosis (CEA, CYFRA21-1, ICTP, and SLX), and epidermal growth factor receptor (EGFR) mutation status. The relationships between those variables and the patients survival or response to pemetrexed were evaluated.

      Results
      We identified 60 patients, 37 male, and the average age was 65 (range, 22-83) years. There were 59 patients with adenocarcinoma. The clinical stages were; IIIA/IIIB/IV = 3/3/54 (UICC TNM ver.7). Pemetrexed with platinum (cisplatin or carboplatin) was administered to 46 patients (bevacizumab was concurrently employed in 5 patients) and 14 patients underwent pemetrexed monotherapy. When the serum CYFRA21-1 cut-off level was set at 2.1 ng/ml, the patients with low serum levels had a significantly longer progression free survival (PFS) than those with high serum levels (130 versus 263 median days; p=0.038). There was no significant difference in overall response rate and overall survival between the two groups.

      Conclusion
      High serum levels of CYFRA21-1 might reflect the higher degree of biological characteristics of squamous cell carcinoma in a tissue; therefore they could be used to identify the individuals with short PFS among patients treated with pemetrexed. Serum levels of CYFRA21-1 may become a predictive marker for advanced NSCLC patients treated with pemetrexed.