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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
OA07.05 - Prognostic Impact of Pleural Lavage Cytology (PLC): Significance of PLC after Lung Resection (ID 5801)
14:20 - 15:50 | Author(s): K. Sekihara
We previously reported the prognostic significance of pleural lavage cytology (PLC) in patients undergoing surgery for non-small-cell lung cancer (NSCLC). Based on a larger cohort of more than 3500 NSCLC patients, which is the largest ever reported from a single institution in the literature, we evaluated the prognostic impact of PLC on survival and recurrence.
From January 1993 to July 2015, 3671 patients underwent R0 surgical resection for NSCLC at our institution and PLC results before (pre-) and after (post-) lung resection were both available. The cytological evaluation was classified into 3 categories: negative (-), suggestive (±), positive (+). We excluded 77 patients whose PLC results were suggestive, and 3594 patients were analyzed. The impact of PLC results on survival and recurrence was evaluated with conventional clinicopathological factors.
The overall survival (OS) of pre-PLC (+) patients was significantly inferior to that of pre-PLC (-) patients. However, the 5-year OS rate of pre-PLC (+) patients was 43%, which was significantly better than that of patients with pleural dissemination (11%). In the following analyses, we divided the patients into 3 groups according to pre/post- PLC results as follows: Pre (-)/ post (-), Group A (n=3461); pre (+)/ post (-), Group B (n=43); and post (+), Group C (n=87). Statistically significant difference was not observed between Groups A and B in OS or in recurrence-free survival (RFS) (p=1.00, 0.28, respectively). However, there were significant differences in OS and RFS between Groups B and C (p=0.01 and p=0.02), and between Groups A and C (p<0.01 and p<0.01), respectively. In univariate and multivariate analyses of clinicopathological factors including post-PLC results to identify prognosticators for OS, post-PLC(+) (hazard ratio (HR) =2.20, p<0.01), older age (≥65 years; HR=1.95, p<0.01), smoking history (+) (HR=1.48, p<0.01), elevated serum CEA level (>5.0 mg/dL; HR=1.28, p<0.01), pathological(p)T≥2 (HR=1.28, p<0.01), pN≥1 (HR=1.48, p<0.01), pStage≥II (HR=1.51, p<0.01), pl(+) (HR=1.43, p<0.01), ly(+) (HR=1.32, p<0.01), and v(+) (HR=1.53, p<0.01) were found to be significant independent unfavorable prognosticators.
The prognostic impact of pre-PLC was moderate and not prohibiting lung resection. Post-PLC was shown to be a strong independent prognostic factor. Its impact on survival of NSCLC patients was very strong, and therefore should be incorporated in the future TNM classification.
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
P1.08-062 - The Short and Long-Term Outcomes of Completion Pneumonectomy Compared with Primary Pneumonectomy (ID 5828)
14:30 - 15:45 | Author(s): K. Sekihara
Completion pneumonectomy has been reported to be high morbidity and mortality procedure in lung cancer patients. However, we sometimes have no choice but to apply this procedure for the patients who developed secondary lung cancer in the remaining lung after lung resection, local recurrence, or postoperative complication. In this study, we investigated the short and long-term outcomes of completion pneumonectomy compared with primary pneumonectomy in our single institution.
Between January 1997 and December 2014, 243 patients who underwent pneumonectomy in our institution were enrolled in this study. Retrospectively, we investigated the postoperative complication, short and long-term outcomes of the patients who underwent completion pneumonectomy (CP) and primary pneumonectomy (PP). CP was defined as pneumonectomy in patients with previous lung resection conducting a hilar manipulation.
Thirty-three patients (14%) of 243 patients underwent CP. CP was performed for 28 malignant tumors and 5 benign diseases. Postoperative severe complication (CTCAE Grade3 or more) occurred in 36% of CP group and 12% of PP group (p<0.01).Especially, bronchopleural fistula (BPF) was more likely to occur in patients undergoing CP (PP 5％ vs CP 15%, p=0.03). The incidence of BPF in PP group was related to the side of procedure (right 70% versus left 30%, p=0.01), but those in CP group was not related (right 60% versus left 40%, p=0.57). In the patient with BPF after CP, Bronchial stump coverage was performed in 2 of 5 patients undergoing the right-side procedure, not performed in other 3 of 5 patients (2 left-side and 1 right-side). The 30-day mortality for CP group (9%) was a significantly higher compared with PP group (2％, p=0.04). However, the 90-day mortality (PP 5％ vs CP 12％, p=0.14) and the overall survival (PP 47％ vs CP 52％, p=0.44 ) were not significant difference between the two groups.
Postoperative morbidity and 30-days mortality rates in CP were higher than those in PP group, but the long-term survival of CP is acceptable compared with PP group. The incidence of left-side BPF is similar to right-side in CP group in this study. It will be also necessary to take preventive procedure against BPF (bronchial stump coverage) in left-side CP.