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S. Moriyama



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    O13 - Limited Resections (ID 101)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O13.03 - Survival of 1963 lobectomy-tolerable patients who underwent limited resection for cStage I non-small cell lung cancer (ID 1030)

      10:30 - 12:00  |  Author(s): S. Moriyama

      • Abstract
      • Presentation
      • Slides

      Background
      Although the standard operation for lung cancer is lobectomy, precise preoperative diagnosis of the “very early” lung carcinomas may identify patients that can be treated by limited resection. Previous reports on limited resection included patients who were not candidates for lobectomy. The survival of non-small cell lung cancer (NSCLC) patients who were fit for lobectomy and underwent limited resection has not been studied in a large enough scale.

      Methods
      A nationwide multi-institutional project collected clinical data of patients who underwent limited resection (segmentectomy or partial resection) for clinical T1-2N0M0 non-small cell lung carcinoma, who were 75 years old or younger at the time of operation and were considered fit for lobectomy by the physician. Overall and disease free survival, freedom from recurrence were analyzed and factors affecting survival or recurrence were identified.

      Results
      The median age of 1963 patients was 63 years. The mean maximal diameter of the tumor was 1.4 ± 0.6 cm. The overall and recurrence free survival after limited lung resection was 93.7 % and 90.4 % at 5 years, respectively. The recurrence free proportion and local recurrence free proportion were 93.3 % and 98.4 % at 5 years, respectively. Prognostic factors in overall survival were pathologically proven lymph node metastasis, interstitial pneumonia, male gender, older age, complications (cardiac disease, diabetes etc.), radiological invasive cancer, and multiple lesions. The consolidation/tumor ratio on CT of ≤ 0.25 predicted good outcome especially in cT1aN0M0 disease. Prognosis and recurrence was not affected by the method of limited resection (segmentectomy (n=1225) or partial resection (n=738)).

      Conclusion
      If the patient was 75 years old or younger and was judged fit for lobectomy, the result of limited resection for cStage I NSCLC was excellent and was not inferior to the reported result of lobectomy for small sized NSCLC. The radiological noninvasive carcinomas rarely recur and are especially good candidates for limited resection.

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    P3.02 - Poster Session 3 - Novel Cancer Genes and Pathways (ID 149)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P3.02-001 - KIF5B/RET fusion gene in surgically-treated Japanese adenocarcinoma of the lung (ID 33)

      09:30 - 16:30  |  Author(s): S. Moriyama

      • Abstract

      Background
      Recently, a novel fusion gene resulting from linkage between the kinesin family member 5B gene (KIF5B; 10p11.22) and rearranged during transfection gene (RET; 10q11.21) was identified in non-small cell lung cancer (NSCLC). RET translocation was previously reported in thyroid cancer, as CCD6/RET translocation. However, the correlation between KIF5B/RET fusion gene status and clinicopathologic features of surgically-treated lung cancer has not been well characterized.

      Methods
      We have investigated KIF5B/RET fusion gene status in 371 surgically treated NSCLC (270 were adenocarcinoma and 101 were squamous cell carcinoma), 60 breast cancers, 11 metastatic lung cancers from colon cancers and thyroid papillary adenocarcinoma case at Nagoya City University Hospital. The fusion gene and CCD6/RET statuses were analyzed by RT-PCR based assay and direct sequencing. We have performed immunohistochemical (IHC) analysis using C-ternimal specific anti RET antibody (EPR2871, 1:250) (Epitomics Inc., Burlingame, CA, USA, n=86) with Dako linker kit using intercalated antibody-enhanced polymer (iAEP) method. Cytoplasm was stained either granular (G1) or diffuse (G2). G2 staining was defined as positive staining.

      Results
      We detected 3 of 270 cases of KIF5B/RET fusion genes in adenocarcinomas (1.5 %) from the present study; all were mixed subtype adenocarcinomas and three were female and never-smokers. The fusion genes were exclusive with the other mutations, such as EGFR, Kras, Braf, erbB2 mutations, and EML4-ALK fusion. KIF5B/RET fusion was not detected in the cases with squamous cell carcinoma or other types of cancers. Of the 3 cases, 2 cases were KIF5B (exon15): RET (exon12) fusions with papillary dominant and 1 cases were KIF5B (exon22): RET (exon12) fusion with solid dominant adenocarcinoma. Matched normal lung tissues did not show translocation. In the present study, we did not detect CCD6/RET fusion genes. as a driver somatic mutation of lung adenocarcinomas. Although all 3 had positive IHC staining, 35/86 had more than 10% staining and 15/86 had more than 50% staining.

      Conclusion
      In the present study, we reported KIF5B/RET fusion genes as a possible new driver somatic mutation of lung adenocarcinomas. Cinico-pathological backgrounds of the KIF5B/RET fusion positive patients were similar with that of the EML4/ALK fusion positive patients. The chimeric oncogene might be as a promising molecular target for the personalized diagnosis and treatment of NSCLC. However, the chimeric oncogene might not be determined using IHC analysis.