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X. Wang
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OA07 - Lymph Node Metastases and Other Prognostic Factors for Local Spread (ID 376)
- Event: WCLC 2016
- Type: Oral Session
- Track: Surgery
- Presentations: 1
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OA07.02 - Omitting Intrapulmonary Lymph Node Retrieval May Affect the Oncological Outcome of pN0 Lung Cancer Patients: A Propensity Score Match Analysis (ID 5267)
14:20 - 15:50 | Author(s): X. Wang
- Abstract
- Presentation
Background:
Clinical practice involving segmental nodes (No.13) and subsegmental nodes (No.14) retrieval for pathological examination varies during lung cancer surgery. This study aims to evaluate whether omitting No.13 and No.14 node retrieval could lead to an inferior oncological outcome for pN0 non-small cell lung cancer（NSCLC）patients.
Methods:
This retrospective study analyzed 442 cases of NSCLC, both treating with R0 resection and systematic mediastinal lymphadenectomy and confirming as pN0 on postoperative pathology. Study group defined cases whose N1 nodes investigation involving from No.10 to No.14 in pathological report. In Control group, N1 nodes investigation only include No.10 to No.12. Clinical and pathological parameters of above two groups were balanced by propensity score matching based on surgical quality and the oncological outcomes between two groups were assessed by log-rank test.
Results:
Seven cases were lost during follow up and 435 cases entered final analysis (Study group, n=170 vs. Control group, n=265). A total of 5.0±3.0 nodes per case were collected from No. 13 and No. 14 in Study group, which included 3.1±1.9 nodes of No. 13 and 2.0±2.2 of No. 14. Tumor-located segments harbored 2.8±2.2 lymph nodes, compared to 2.2±2.3 from non-tumor located segments (p=0.006). After propensity score matching, 143 cases remained in each group. Overall survival (OS) and disease-free survival (DFS) were improved in Study group compared with Control group (the 5-year OS rates, 89±3% vs. 77±4%, p=0.027; the 5-year DFS rates, 81±4% vs. 67±4%, p=0.021, Figure1A,1B). In multivariate analysis, T staging and performing intrapulmonary nodes collection were the prognostic factors for pN0 cases. For the whole cohort, patients with two intrapulmonary stations collected showed better survival than those with zero intrapulmonary station retrieved（Figure1C, 1D）.
Conclusion:
Inferior oncological outcomes of pN0 cases without intrapulmonary node retrieval suggests this procedure may play a role in outcome evaluation for pN0 NSCLC patients.
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P1.05 - Poster Session with Presenters Present (ID 457)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-018 - LncRNA16 is a Potential Biomarker for Early-Stage Lung Cancer That Promotes Cell Proliferation by Regulating the Cell Cycle (ID 4693)
14:30 - 15:45 | Author(s): X. Wang
- Abstract
Background:
Early diagnosis of lung cancer greatly reduces mortality; however, the lack of suitable plasma biomarkers presents a major obstacle. Recent studies showed that long noncoding RNAs (lncRNAs) play important roles in cancer initiation and development.
Methods:
Here, we identify differential expressed lncRNAs by using custom designed microarray on 20 lung cancer samples and evaluate the expression by Real-time PCR (qRT-PCR) on 118 lung cancer samples.The role of lncRNA16 in lung cancer was studied in vitro and in vivo, utilizing the lung cancer cell line PC9 ,A549 and xenograft mouse models.
Results:
lncRNA16 (ENST00000539303) expression level was highly in lung cancer (80/118) and in plasma (32/42) of lung cancer patients. In early stage, lncRNA16 expression levels were significantly higher compare to that in adjacent matched normal tissues (Figure 1C-1F) . Importantly, this increase was mirrored in plasma samples of early stage lung cancer patients (Figure 2A) . Our study reveals that knockdown of lncRNA16 inhibited proliferation of PC9 cells in vitro and also inhibited tumor growth in xenograft mouse models. Specifically, we show that lncRNA16 promotes G2/M transition through regulating cyclin B1 transcription.
Conclusion:
In conclusion, lncRNA16 was identified as a potential biomarker for lung cancer diagnosis, as it displayed significantly elevated levels in cancer patient over baseline. Furthermore, we showed that the false-negative rate is significantly lower compared to markers those widely used for lung cancer assessment.
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-031 - Intermittent Chest Tube Clamping May Shorten Chest Tube Duration and Postoperative Hospital Stay of Lung Cancer Surgery (ID 5034)
14:30 - 15:45 | Author(s): X. Wang
- Abstract
Background:
Postoperative pleural drainage markedly influences the length of postoperative hospital stay and financial costs of medical care. Previous report documented the safety of chest tube clamping before removal. This study aims to see if intermittent chest tube clamping might shorten tube duration and hospital stay of lung cancer surgery.
Methods:
From July 2012 to June 2016, 285 consecutive cases of operable lung cancer patients undergoing lobectomy and systematic mediastinal lymphadenectomy were retrospectively analyzed. Chest tube management protocol was modified since January 2014 according to the literature. Before that time, patients (Group control, n=63) were managed with gravity drainage (water seal only and without suction). After that, patients (Group clamping, n=222) were managed with gravity drainage during first 24 hours after surgery (water seal only and without suction). Once a radiograph confirmed the reexpansion of the lung and no air leak detected, the tube would then be clamped intermittently at 24 hours after surgery and nurses checked the patients every 6 hours. If no abnormal symptoms developed (such as severe dyspnea, pneumothorax, subcutaneous emphysema), then unclamped 30 minutes to record drainage volume every 24 hours. The tube would be removed if drainage was normal and its volume was less than 200 ml in both group. All clinical data were recorded. Propensity score matching at 1:1 ratio was applied to balance variables potentially affecting chest tube duration between Group Clamping and Group Control. Analyses were performed to compare chest tube duration and postoperative hospital stay between the two groups. Variables linked with chest tube duration were gender, operation side, VATS and chylothorax, which were assessed using multivariable logistic regression analysis in whole cohort.
Results:
The rate of thoracocentesis after chest tube removal did not increase in Group Clamping compared with Group Control in whole cohort (0.5% vs. 1.5%, P=0.386). The rates of pyrexia were also comparable in two groups (2.3% vs. 3.2%, P=0.685). After propensity score matching, 61 cases remained in each group. Group Clamping showed shorter chest tube duration (4.0 days vs. 4.8 days, P=0.001) and shorter postoperative stay (5.7 days vs. 6.4 days, P=0.025) compared with Group Control. Factors significantly associated with shorter chest tube duration were being female, left lobectomy, chest tube clamping, VATS and absence of chylothorax (P<0.05).
Conclusion:
This study suggests that chest tube clamping may decrease the length of chest tube duration and postoperative hospital stay while maintaining patient safety.
