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J. Zhang
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P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.01-025 - Radical Resection for Supraclavicular Lymph Node Metastasis (N3-Stage IIIB) Adenocarcinoma of the Lung (ID 1672)
09:30 - 17:00 | Author(s): J. Zhang
- Abstract
Background:
In China, lung cancer is increasing rapidly, of which 80% are non-small cell lung cancer, and most belong to Stage IIIB and IV when diagnosed, losing opportunity of surgery, and the prognosis is worse, the average survival time is about 6-12 months. Recently we perform radical resection for part N3-Stage IIIB non-small cell lung cancer, hope to improve the prognosis of these patients. A typical case is discussed here.
Methods:
Case1: Man, aged 43 in Dec 2012, found right supraclavicular lymph node swollen, CT showed right lower lobe tumor 7X6X5cm3, invading right inferior pulmonary vein and pericardium, regional and mediastinal lymph node 11,10,7,4R,3,2R,1R swollen badly; right supraclavicular lymph node biopsy revealed the diagnosis of lung adenocarcinoma; no other distant metastasis was found in brain, liver, and bone; cT3-4N3M0 Stage IIIB, which is usually contraindication of surgery. Three cycles’ preoperative chemotherapy of Pemetrexed and cisplatin (DDP) was conducted, the lung tumor shrunk 1/3, mediastinal lymph node shrunk significantly, and the right supraclavicular lymph node disappeared. PET-CT showed right lower lobe tumor and part mediastinal lymph node positive, however, showed negative in the neck and other part of the body; cT2aN1-2M0 Stage IIA-IIIA, prepared for operation.
Results:
Standard “large-incision” right posterolateral thoracotomy was performed, pleural adhesion, tissue edema, fragile, easily broken, easy bleeding were encountered. Right lower lobe lobectomy, systematic lymph node dissection including No.2R,3A,3P,4R,7,9,10,11,12 group lymph node and surrounding adipose tissue were en block dissected. Tumor size 4X4X3cm3, postoperative pathology diagnosed as lung adenocarcinoma, No.12 lymph node metastasis, others were negative, pT2aN1M0 Stage IIA. Two cycles’ postoperative chemotherapy was followed. Regular follow-up showed the patient recovered very well. Now he is in his 3rd year postoperatively, living a healthy man’s life. CT, Ultrasound, ECT, and blood tumor markers’ test showed no sign of recurrence and metastasis.
Conclusion:
Part supraclavicular lymph node metastasis N3-Stage IIIB non-small cell lung cancer, if prepared carefully, could gain the opportunity of receiving surgical resection, could achieve a much more better prognosis, even to get cured as usual Stage IA-IIIA lung cancer patients who receive regular radical resection of lung cancer.
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P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.02-028 - miMRST Wedge Resection Cured Aged, Cardiopulmonary Dysfunction Patients with Small Lung Cancer (≤2cm) (ID 1670)
09:30 - 17:00 | Author(s): J. Zhang
- Abstract
Background:
In China, lung cancer is increasing rapidly. There are more and more aged, cardiopulmonary dysfunction patients were found with peripheral small lung cancer (≤2cm); chemotherapy and radiation are usually denied because of age, cardiopulmonary dysfunction, and fear of the serious side effects of chemo-radiation; surgery was denied because they could not tolerate traditional “large-incision” posterolateral thoracotomy. Video-assisted thoracoscopic surgery (VATS) is good for them; however, most Chinese patients refuse VATS because of the high cost not covered by medical insurance. “miMRST”, minimally invasive small incision, muscle- and rib-sparing thoracotomy, minimally invasive lung cancer radical surgery, was developed to help resolve these problems: helps resect the tumor, minimally invasive, not cost too much, with good prognosis, widely accepted by Chinese patients. We discussed typical cases here.
Methods:
Case1: Man, aged 80 in Nov 2007, right upper lobe suspected peripheral lung cancer 2.0cm; smoking 57 years, with years’ serious chronic bronchitis, pulmonary bullae, emphysema, and diabetes mellitus, encephalatrophy; chemotherapy and radiation was denied; surgery was denied; VATS was not available then. Case2: Man, aged 68 in Oct 2007, right lower lobe suspected peripheral lung cancer or metastatic cancer 1.5cm; gastric cancer resection in 2002, lung cancer left lower lobe resection in 2006, followed by chemo-radiation; chemotherapy and radiation was denied because of sickly status, age, cardiopulmonary dysfunction, possible resistance to chemotherapy; surgery was denied because of suspected potential multi metastasis, and the heavy risk and difficulties may meet in operation, fear of single one left upper lobe could not ensure the safety of operation and anesthesia, and further resection of the lung will obviously aggravate postoperative pulmonary dysfunction. Both patients were transferred to CMU Lung Cancer Center. “miMRST” wedge resection became the best choice for these aged, cardiopulmonary dysfunction patients with suspected peripheral small lung cancer (≤2cm).
Results:
About 10cm lateral chest incision was enough for most lung cancer resection and mediastinal lymph node dissection, with the latissimus dorsi and serratus anterior muscles were protected, no rib cut needed. Wedge resection was performed for both patients, and cutting edges of the lung were more than 2-3cm away from the tumors. No swelling lymph node was found and no dissection done. The patients recovered much better and quickly than other patients who underwent traditional “large-incision” posterolateral thoracotomy. Regular follow-up: Case 1 now alive healthily for his 8th year postoperatively, no sign of recurrence and metastasis; Case 2 lived healthily for more than 4 years, no sign of recurrence and metastasis, but died at the 5th year postoperatively due to other reason not lung cancer.
Conclusion:
miMRST, neither causes serious damage as traditional “large-incision” posterolateral thoracotomy does, nor costs too much as VATS does. miMRST wedge resection is a good choice for aged cardiopulmonary dysfunction patients with peripheral small lung cancer (≤2cm), with a good acceptable prognosis, even cure lung cancer, very suitable for lung cancer surgery in developing countries. (This study was partly supported by the Fund for Scientific Research of The First Hospital of China Medical University, No.FSFH1210).
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P3.02-029 - Micro- Small Lung Cancer (≤1cm) Needs Lobectomy with Systematic Lymph Node Dissection or Sublobular Limited Resection Only? (ID 1671)
09:30 - 17:00 | Author(s): J. Zhang
- Abstract
Background:
Lung cancer is increasing rapidly in China. More and more pulmonary ground-glass opacity (GGO) were detected, most are not malignant, but some are indeed early stage lung cancer, micro- small lung cancer (≤1cm) (mi-SLC), either adenocarcinoma in situ (AIS), or minimally invasive adenocarcinoma (MIA). Surgical resection could cure most of them, but the resection extent for mi-SLC is a dilemma. Typical cases will be discussed.
Methods:
Case 1: Woman, aged 67 in Mar 2013, left upper lobe GGO 0.8cm, not peripheral; hypertension and coronary heart disease 10 years; anti-inflammatory strategy used, GGO size increased a little one month later. Her mental stress increased greatly. Case 2: Woman, aged 59 in Nov 2013, right middle lobe pure GGO 1.0cm, peripheral; sickly status for years; anti-inflammatory strategy used, GGO size no change. Both patients were referral to China Medical University Lung Cancer Center for surgical resection, “miMRST”, minimally invasive small incision, muscle- and rib-sparing thoracotomy, minimally invasive lung cancer radical surgery, was scheduled.
Results:
About 10cm lateral chest incision was enough for most lung cancer resection and mediastinal lymph node dissection, with the latissimus dorsi and serratus anterior muscles were protected, no rib cut needed. For Case 1, the lesion could not be located, left upper lobe resection was undergone as expected; frozen pathological diagnosis was AIS; swollen lymph node 3a,5,6,10,11,12 and surrounding adipose tissue were systematicly dissected. No lymph node in subcarinal and pulmonary ligament region was found. Postoperative pathology confirmed AIS, no lymph node metastasis. For Case 2, wedge resection was performed as expected; cutting edges of the lung were more than 2cm away from the tumor. The frozen pathological diagnosis was atypical adenomatous hyperplasia (AAH), cancer to be excluded by wax slide pathology. No swollen lymph node was found and no dissection done. Postoperative pathology was minimally invasive adenocarcinoma (MIA). The patients recovered much better and quickly than other patients who underwent traditional “large-incision” posterolateral thoracotomy. Regular follow-up: both patients are alive healthily, in her 3rd year postoperatively for Case 1, in her 2nd year postoperatively for Case 2; no sign of recurrence and metastasis. No adjuvant treatment used.
Conclusion:
For these micro- small lung cancer (≤1cm), wedge resection is the first choice for frozn pathological diagnosis; if the diagnosis is AAH, wedge resection should be enough; if is AIS, lobular resection, at least segment resection is to be performed; if the diagnosis is MIA or just lung cancer, thus standard lobectomy plus systematic lymph node dissection is essential. For AIS, lymph node dissection is a dilemma. For GGO not in peripheral part, if segment resection is difficult, loectomy become dilemma. But for wedge resection of AAH, it would become a bigger dilemma when the postoperative pathology become MIA. Prospective observation of more patients with long follow-up will be more helpful. (This study was partly supported by the Fund for Scientific Research of The First Hospital of China Medical University, No.FSFH1210).
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P3.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 235)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.04-133 - ADAM9 and EGFR Correlated With Lymph Node Metastasis Predicts Worse Prognosis in Surgically Resected Non-Small Cell Lung Cancer (ID 1379)
09:30 - 17:00 | Author(s): J. Zhang
- Abstract
Background:
Recently we first reported that a disintegrin and metalloproteinase-9 (ADAM9) was highly expressed in resected non-small cell lung cancer (NSCLC), correlated with lymph node metastasis, shorterned survival time. ADAM9 has been known of being able to enhance the expression of epidermal growth factor receptor (EGFR) pathway, here, we investigate the expression of EGFR in surgically resected NSCLC, to elucidate the relationship between EGFR expression and lymph node metastasis, prognosis, and further evaluate the consistence of ADAM9 expression and EGFR expression, and their significance as novel biomarkers in molecular staging, predicting the prognosis for surgically resected NSCLC.
Methods:
One hundred and six cases of completely resected stage Ⅰ, Ⅱ and Ⅲ NSCLC with mediastinal N2 lymph nodes dissected were immunohistochemically analyzed for EGFR and ADAM9 protein expression. Survival analysis was conducted to assess the significance of EGFR and ADAM9 expression and the relationship with other clinicopathological characteristics.
Results:
Of the 106 NSCLC, 49 were stage Ⅰ, 16 stage Ⅱ and 41 stage Ⅲ; 60.4% was found with EGFR protein highly expressed (EGFR+), significantly higher when compared with normal control lung tissues (P=0.000). The EGFR+ rate in stage Ⅱ and Ⅲ NSCLC was 73.7%, significantly higher than 44.9% in stage Ⅰ (P=0.003). Stratified, EGFR+ rates in N1 and N2 cases was 72.0%, significantly higher than 50.0% in N0 NSCLC (P=0.021); the difference between EGFR+ rates in T factor groups was not statistically significant (P>0.05). The overall 5-year survival rate was 55.7% for this group of 106 completely resected NSCLC. The 5-year survival rate in EGFR low expression (EGFR-) group (42 cases) was 74.9%, however, the 5-year survival rate was sharply decreased to 43.2% in EGFR+ group (64 cases) (P=0.001). For ADAM9, the ADAM9+ rates in stage Ⅱ and Ⅲ NSCLC was significantly higher than in stage Ⅰ (P=0.013). Stratified, ADAM9+ rates in N1 and N2 cases was significantly higher than in N0 NSCLC (P=0.040). The difference between ADAM9+ rates in T factor groups was not statistically significant (P>0.05). The 5-year survival rate in ADAM9+ group was statistically lower than in ADAM9- group (P=0.040). EGFR expression was revealed correlated positively and significantly with ADAM9 expression in this group of surgically resected NSCLC (Pearson r=0.275, P=0.004).
Conclusion:
This report for the first time revealed the relationship of expression of EGFR and ADAM9 protein in human lung cancer tissues. EGFR and ADAM9 are highly expressed in human resected NSCLC, correlated with lymph node metastasis and pTNM stage; highly expressed EGFR and ADAM9 predicts worse prognosis, suggesting that EGFR and ADAM9 are useful molecular staging biomarkers, and prognostic biomarkers for NSCLC. EGFR and ADAM9 may also become useful predictive biomarkers helping decide if postoperative chemo-radiation therapy should be selected or not. (This study was partly supported by grants from the Education Department of Liaoning Province, China, No. 20060991; the Nature Science Foundation of Liaoning Province, China, No.20102285; and the Fund for Scientific Research of The First Hospital of China Medical University, No.FSFH1210).
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P3.06 - Poster Session/ Screening and Early Detection (ID 220)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.06-020 - CT-Guided Percutaneous Fine Needle Biopsy for Small Lung Tumor (≤ 2cm) and Diffficult Pulmonary Lesions (ID 2579)
09:30 - 17:00 | Author(s): J. Zhang
- Abstract
Background:
lung cancer is increasing rapidly in China. There are more and more peripheral small lung cancer (≤2cm) was found. CT-guided percutaneous fine needle biopsy becomes first of choice for pathological diagnosis of peripheral small lung tumor (≤2cm) and some central pulmonary lesions which could not be pathologically diagnosed by fiberoptic bronchoscopy. We developed CT-guided percutaneous fine needle biopsy (CT-NB) for detecting early stage lung cancer (size ≤2cm peripheral small lung cancer) since 1992. We discuss typical cases here.
Methods:
Case1: Man, aged 52, right lower lobe 1.5cm ball tumor, no typical malignant sign; unwilling to undergo surgery due to years’ coronary heart disease; CT-NB was performed and lung adenocarcinoma was diagnosed. Case2: Man, aged 63, right upper lobe 1.2cm ball tumor, with cardiopulmonary dysfunction; CT-NB was performed and found some inflammatory cells, but no malignant tumor cells found. Case3: Man, aged 40, heavy smoker, cough and blood-tinged sputum for one month, left lower lobe 3.5cm irregular mass, regional and subcarinal lymph node swollen, clinically progressed rapidly, suspected small-cell lung cancer (SCLC), T2N2M0; at least pneumonectomy was needed if want resected; CT-NB was performed and non-small cell lung cancer (NSCLC) was diagnosed, and SCLC was excluded.
Results:
For Case 1: right lower lobe resection and lymph node dissection was performed, postoperative diagnosis was adeno-squamous cell carcinoma, 1.5X1.3X1.3cm, lymph node negative, pT1N0M0 Stage I, early stage lung cancer. He was alive healthily more than five years postoperatively. For Case 2: considered as a benign disease; carefully follow-up for more than 5 years, no malignant sign. For Case 3: left pneumonectomy and lymph node dissection was performed; postoperative diagnosis was squamous cell carcinoma; pulmonary ligament lymph node positive, others negative, pT2N2M0 StageIIIA; radiation followed. He was alive healthily more than five years postoperatively.
Conclusion:
CT-NB is a very useful diagnostic method for peripheral small lung tumor (≤2cm) and some central pulmonary lesions with fiberoptic bronchoscopy failed. CT-NB could be used to confirm the diagnosis of lung cancer, to help make decision for surgically resection, to help cure more early stage lung cancer patients, to help improve the prognosis of lung cancer treatment. CT-NB could also be used to exclude lung cancer diagnosis, to avoid unnecessary surgery, especially for those aged, cardiopulmonary dysfunction, high risk patients. CT-NB could be used to confirm the pathological type of lung cancer before treatment applied, to help distinguish SCLC from NSCLC, to help select the best choice of treatment modality of chemotherapy and radiation according to patient’s age, cardiopulmonary function status, pathological type, and gene types.
