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A. Sakurada



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    OA19 - Translational Research in Early Stage NSCLC (ID 402)

    • Event: WCLC 2016
    • Type: Oral Session
    • Track: Early Stage NSCLC
    • Presentations: 1
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      OA19.07 - Difference of Postoperative Survival Due to the Type of EGFR Gene Mutation in Surgically Resected Lung Adenocarcinomas (ID 4726)

      11:00 - 12:30  |  Author(s): A. Sakurada

      • Abstract
      • Presentation
      • Slides

      Background:
      Epidermal growth factor receptor (EGFR) gene mutation is a robust prognostic factor in patients with advanced lung adenocarcinomas. Recently, on the other hand, there are some reports proposing the difference of survival due to the type of EGFR mutation. In this study, we analyzed the difference of postoperative survivals between two most common mutations, that is, exon 19 deletions (DEL) and exon21 L858R (PM), using multi-institutional data of patients with surgically resected lung adenocarcinomas.

      Methods:
      We retrospectively collected 1,063 consecutive patients who underwent surgical resections for lung adenocarcinoma between 2005 and 2012 in five institutions, and who were examined their EGFR mutation status. The patients with minor EGFR mutations were excluded. We compared their clinicopathological characteristics among DEL, PM, and wild type (WT) group. We also analyzed postoperative recurrence-free survival (RFS) and overall survival (OS) according to the type of EGFR mutation.

      Results:
      The number of patients with DEL, PM, and WT was 218 (20.5%), 301 (28.3%), and 544 (51.2%) respectively, and their median follow-up period was 47.6 months. The patients of PM were older and earlier pathological staged than those with DEL, whereas no significant difference was observed among other clinicopathological factors. Five-year RFS and OS of DEL, PM, and WT were 67.3/85.9%, 76.4/88.6%, 59.2/71.5%, respectively, and both survivals of each mutant were significantly better than those of WT. Regarding the difference between DEL and PM, RFS curve of DEL was significantly worse than that of PM (p = 0.027), but OS curves of both mutant weren’t significantly different. (p = 0.16). In multivariate analysis, the type of EGFR mutation (DEL vs PM) was not an independent factor both in RFS and OS.

      Conclusion:
      Exon 21 L858R might be a more favorable recurrence-risk factor than exon 19 deletions in patients with surgically resected lung adenocarcinomas.

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    P1.03 - Poster Session with Presenters Present (ID 455)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      P1.03-075 - Predictive Factors for Minimal Pleural Disease Detected at Thoracotomy or Positive Lavage Cytology (ID 5976)

      14:30 - 15:45  |  Author(s): A. Sakurada

      • Abstract

      Background:
      Minimal pleural disseminations and malignant pleural effusion is eventually diagnosed at the therapeutic thoracotomy. Pleural lavage cytology is another prognostic factor which is available through surgery. Although CT image have become high quality, prediction of such pleural disease is still difficult. To establish predictive markers for minimal pleural disease before surgery will be useful for planning strategy for the patients with minimal pleural disease.

      Methods:
      115 patients who underwent pulmonary resection in our hospital from January 2010 to December 2011 were retrospectively analyzed for their clinicopathological information such as tumor marker CT image, and histology. 65 were male and 50 female. Histology was squamous cell carcinoma, adenocarcinoma, and other histology for 32, 78, and 5 cases, respectively. Clinical staging according to WHO 7[th] edition stage IA, IB, IIA, IIB, and IIIA for 62, 31, 11, 3, and 8 cases, respectively. CT findings such as pleural indentation and contact of tumor on pleura were carefully measured on thin-slice CT sections with 0.5-1mm pitch. P value less than 0.05 was regarded as statistically significance.

      Results:
      Eight cases were positive for pleural disease, one for malignant effusion, 2 for minimal dissemination, and 6 for pleural lavage cytology. By statistical analysis regarding association between clinicopathological factors pleural disease, statistical positive factor was tumor diameter and CEA positivity (P=0.037 and 0.01, respectively), but tumor contact on pleura did not reach statistical significance (p=0.07). Pleural indentation and histologic type was not statistically significant.

      Conclusion:
      Based on current study, tumor diameter and serum CEA level could be possible predictive factors for minimal pleural disease. Upon limited number of patients, further study will be needed.

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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
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      P1.05-055 - Risk Factors of Postoperative Recurrence in Stage IA and IB Patients (ID 5606)

      14:30 - 15:45  |  Author(s): A. Sakurada

      • Abstract

      Background:
      The 5-year survival rates of the patients with pathological stage IA and IB NSCLC have been reported 86-93% and 67-84%, respectively. Among stage I disease, patients with stage IA of tumor diameter over 20 mm as well as stage IB are recommended to take oral UFT as adjuvant chemotherapy for 2 years in Japan. Even after complete resection and such adjuvant therapy, we still observe recurrence at a certain rate. Identifying clinicopathological factors which is associated with recurrence would be beneficial to establish alternative strategy. The purpose of this study is to identify the predictive factors for recurrence in the patients with stage I NSCLC.

      Methods:
      A total of 742 stage I NSCLC patients who underwent complete resection in our hospital from 1996 to 2012 were retrospectively analyzed. Medical records of these patients were reviewed carefully. The median age was 66.4 years with 512 stage IA and 281 stage IB. Histopathologically, there were 590 adenocarcinoma, 150 squamous cell carcinoma, 32 large cell carcinoma, and 21 other histology cases.　Surgical procedure was segmentectomy, lobectomy, and pneumonectomy for 46, 588, and 8 patients, respectively. Clinicopathological factors such as smoking history, histology, pathological vascular invasion (v), and lymphatic vessel invasion (ly) were analyzed.

      Results:
      Recurrence occurred in 132 cases. Multivariate analysis showed that T factor, v(+), ly(+), and smoking history have statistical significance with recurrence. n pT1a and T2a cases, there were no statistical significance between recurrence and pathological ly(+) and/or v(+). But only in T1b cases, ly(+) and/or v(+) had statistical significance with recurrence.

      Conclusion:
      We identified that T factor, v, ly, and smoking history were predictive factors for recurrence in stage IA and IB NSCLC patients. Because of good prognosis, pT1b patients whose both v and ly were negative may not take UFT as adjuvant chemotherapy.