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H.Y. Lee



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    MO24 - NSCLC - Chemotherapy III (ID 110)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Medical Oncology
    • Presentations: 1
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      MO24.13 - Volume based growth tumor kinetics as a predictive biomarker in patients with EGFR-mutant lung adenocarcinoma receiving EGFR tyrosine kinase inhibitor (ID 1229)

      10:30 - 12:00  |  Author(s): H.Y. Lee

      • Abstract
      • Presentation
      • Slides

      Background
      To determine whether volumetric assessment has potential as a predictive biomarker and to assess relationship between longitudinal tumor data during treatment and prognosis in lung adenocarcinoma patients with sensitizing EGFR mutations treated with EGFR tyrosine kinase inhibitor (TKIs).

      Methods
      We retrospectively assessed patients with EGFR-mutant stage IV lung adenocarcinoma, who underwent EGFR TKIs as second-line therapy and this treatment was repeated every three weeks until disease progression. All 106 patients with at least one measurable lung lesions were quantitatively analyzed in terms of tumor size and volume based on the whole tumor volume, on baseline contrast-enhanced CT scans and on follow-up CT scans of every two treatment cycle. A quantify for tumor response was evaluated with growth tumor kinetics, followed by determining correlation with early tumor parameters including change of size, volume, and response rate. Cox-proportional hazard model and Log-rank test were also applied to predict the overall survival. Figure 1

      Results
      Percent of volume change after two cycles of TKI treatment had a strong correlation with progression rate based on growth tumor kinetics (P < 0.001). Responders based on percent of volume change after two cycles of TKI treatment had a higher overall survival rate than non-responders (P = 0.001). The velocity of progression was also a good potential parameter to predict overall survival (P < 0.001). Figure 1

      Conclusion
      Early radiologic parameters of the tumor helped predict treatment response and overall survival in EGFR mutant lung adenocarcinoma patients treated with TKIs. Longitudinal tumor data also showed potential as a predictive factor.

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    O17 - Anatomical Pathology I (ID 128)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Pathology
    • Presentations: 1
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      O17.02 - Clinicopathologic, radiologic, and molecular characteristics of completely resected mucinous adenocarcinomas in the lung: Implications for prognosis (ID 3316)

      10:30 - 12:00  |  Author(s): H.Y. Lee

      • Abstract
      • Presentation
      • Slides

      Background
      The real prognosis of mucinous adenocarcinomas (MAs) diagnosed according to the current IASLC/ATS/ERS lung adenocarcinoma classification is controversial, and in particular, the prognostic value of MA and the relationship among pathologic features, clinicoradiologic presentation, and response to surgical treatment are still unclear. Therefore, the aim of this single-institution retrospective study is to analyze the prognostic role of clinicopathologic and radiologic features in surgically resected MA in a homogenous population of Asian patients.

      Methods
      Analyzed variables are clinicoradiologic presentations, operation type, histologic subtypes, and stage. Univariate and multivariate analyses of survival were performed.

      Results
      From 1994 through 2011, 161 resected lung carcinomas were diagnosed as MA in 158 patients, according to the IASLC/ATS/ERS classification. 158 patients included 114 in 1 stage (72%), 29 in 2 (18%), and 15 in 3 (10%). 117 tumors (73%) were nodular-type and 44 (27%) were consolidation-type. Among 117 nodular MAs, 6 were pure GGO nodules.7 tumors presented as multiple lesions. 4 were AIS (lepidic pattern), 1 was MIA (acinar), and 156 (97%) were invasive adenocarcinoma (147 with acinar and 9 with cribriform pattern). The 5-year recurrence rate was 22%, and the 5-year survival rate was 88%. Five-year OS for patients with nodular type compared with those with consolidation-type was 89 versus 57 % (P < 0.001). Based on the multivariate Cox-proportional analysis, consolidation-type on CT (HR 1.42), cribriform pattern (HR 10.35), higher stage (HR 1.51), and higher SUVmax (HR 1.27) were significant poor prognostic predictor for DFS. As for recurrence, SUV max was the only significant predictor in both multivariate Cox-proportional analysis (HR 1.16, P = 0.016) and the log-rank test (cut-off 4.4, P = 0.045). Figure 1 Figure 2

      Conclusion
      Consolidation-type on CT, cribriform pattern, higher stage, and higher SUVmax would be predictive for lower overall survival. Also, SUVmax would be predictive for higher recurrence and may necessitate more aggressive adjuvant treatment.

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    P1.21 - Poster Session 1 - Diagnosis and Staging (ID 169)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P1.21-009 - Reliability of transthoracic fine needle aspiration and core needle biopsy for the diagnosis of pulmonary mucinous adenocarcinoma (ID 2759)

      09:30 - 16:30  |  Author(s): H.Y. Lee

      • Abstract

      Background
      In case of mucinous adenocarcinoma (MA), cytologic atypia is usually mild to moderate and can be absent in some cases, creating a diagnostic pitfall in recognizing MA in small tissue biopsy and cytology specimens. Specific diagnosis of mucinous subtype in small tissue n FNA is important because it is considered an invasive neoplasm until proven otherwise, and it carries a worse prognosis for its aggressive behavior with frequent multicentricity and intrapulmonary metastatic spread. The purpose of this study was to evaluate the diagnostic accuracy of transthoracic fine needle aspiration (FNA) or core needle biopsy (CNB) of MA of the lung.

      Methods
      We retrospectively reviewed a consecutive series of 184 patients who underwent curative operation for MA. Among those patients, 105 patients underwent pre-operative percutaneous FNA (n= 34) or CNB (n= 79). Eight patients underwent both FNA and CNB for the same tumors. Diagnostic accuracies of FNA and CNB for MA were evaluated, and the contribution of various clinicopathologic parameters to subtyping accuracy was analyzed.

      Results
      Diagnostic accuracies of FNA and CNB in determining malignancy were 67.6% and 87.3%, respectively. 20.6% and 59.5% were successfully diagnosed as MA through FNA and CNB, respectively. Univariate analysis implicated type of procedure and prominent growth pattern of mucinous adenocarcinoma as significant factors for successful pathologic diagnosis. Figure 1

      Conclusion
      CNB of diagnosis of MA is feasible and accurate. Our data support the suitability of small biopsy specimens for the new therapeutic paradigms even in mucinous adenocarcinoma.

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    P3.09 - Poster Session 3 - Combined Modality (ID 214)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P3.09-013 - Outcomes and predictors for recurrence and survival after neoadjuvant concurrent chemoradiation followed by operation in patients with clinical stage III-N2 non-small-cell lung cancer (ID 2053)

      09:30 - 16:30  |  Author(s): H.Y. Lee

      • Abstract

      Background
      This study assessed the impact of imaging, surgical, histopathologic and patient-related factors on the risks of local and distant recurrence and overall survival for patients with stage III-N2 non small cell lung carcinoma (NSCLC) undergoing definitive resection after neoadjuvant concurrent chemoradiation (neoCCRT).

      Methods
      We retrospectively examined 129 consecutive patients with stage III-N2 NSCLC received neoCCRT followed by curative surgery between 2008 and 2011. We reviewed clinical data and operation method. We also analyzed histopathologic factors such as subtype, pathologic invasive tumor characteristics, differentiation, residual tumor size, or the number of residual LNs as well as imaging characteristics on chest CT and PET/CT. Disease free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and predictive factors for recurrence and survival were identified by univariate and multivariate Cox-proportional analyses.

      Results
      112 (87%) patients were pathologically staged for N2-positive status (82 patients by mediastinoscopic biopsy and 30 patients by EBUS). The 5-year recurrence rate was 28.3 %, and the 5-year survival rate was 43.4 %. Five-year OS for patients with recurrence compared with those without was 29.5 versus 59.1 % (P = 0.028). Based on the multivariate Cox-proportional analysis and log-rank test, history of adjuvant therapy was the only significant prognostic predictor for prolonged OS (HR 0.134, 95 % CI 0.039–0.455, P = 0.001). As for recurrence, less size decrease on CT (HR 1.030, 95 % CI 1.005–1.056, P = 0.017), higher T stage (HR 2.450, 95 % CI 1.322–4.540, P = 0.004), larger residual tumor size on the pathologic specimen (HR 1.124, 95 % CI 1.010–1.252, P = 0.016), and presence of lymphovascular invasion (HR 4.180, 95 % CI 1.093–15.984, P = 0.037) were the significant predictors in both the multivariate Cox-proportional analysis and the log-rank test. Figure 1

      Conclusion
      Recurrence remains high in resected stage III-N2 NSCLC patients after neoCCRT and nodal downstaging, and patients who received adjuvant therapy had longer overall survival rate than patients who did not. Size decrease on CT, T stage, residual tumor size on the pathologic specimen, and presence of lymphovascular invasion would be predictive for higher recurrence and may necessitate more aggressive adjuvant treatment.