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A. Hattori
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MA10 - Facing the Real World: New Staging System and Response Evaluation in Immunotherapy (ID 393)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:P. Kosmidis
- Coordinates: 12/06/2016, 14:20 - 15:50, Stolz 2
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MA10.05 - Proposals for the Novel Clinical T Categories Based on the Presence of Ground Glass Opacity Component in Lung Adenocarcinoma (ID 6041)
14:20 - 15:50 | Author(s): A. Hattori
- Abstract
- Presentation
Background:
In lung adenocarcinomas, the histologic lepidic growth pattern tends to correlate with the ground glass opacity (GGO) component, while solid components correspond with invasive adenocarcinoma. The Eighth edition of the TNM staging system suggests that the tumor size be determined according to the invasive size excluding the lepidic component. However, this new concept causes fatal confusion, i.e., tumors are classified into a same T category despite the part-solid or pure-solid appearances provided they showed a same solid component size.
Methods:
Between 2008 and 2012, we retrospectively evaluated 719 surgically resected cN0 lung adenocarcinomas that measures 30mm or less in total dimension to assess the prognostic impact on the presence of GGO among the Eighth TNM classification. According to the new T category, it was defined based on the solid component size as follow: Tis; 0 cm (pure-GGO), T1mi; ≤ 5 mm, T1a; 6-10 mm, T1b; 11-20 mm, T1c; 21-30mm. Furthermore, all tumors were classified into 2 groups, i.e., GGO or Solid arms based on the presence of GGO component.
Results:
Of the cases, 133 (18%) were categorized in Tis, 88 (12%) in T1mi, 121 (17%) in T1a, 244 (34%) in T1b and 133 (19%) in T1c, respectively. Multivariate analysis revealed that both a presence of GGO and solid component were independently significant prognostic factors (p=0.007, 0.002). The 5y-overall survival (OS) was 99.2% in Tis, 95.8% in T1mi, 96.5% in T1a, 81.8% in T1b and 66.4% in T1c (p=0.038) with a median follow-up period of 56 months. When we evaluated the impact of T category based on GGO presence, the 5y-OS was significantly different between GGO and Solid arm in each T categories (T1a; 99.0% vs. 95.7%, p=0.045, T1b; 89.8% vs. 73.3%, p=0.004, T1c; 90.0% vs. 62.6%, p=0.046). Furthermore, clinical T categories significantly separated the OS in Solid arm (p=0.015) (T1a vs. T1b; p=0.090, T1b vs. T1c; p=0.037). In contrast, the 5y-OS was approximately 90% or more in GGO arm despite their T categories. Moreover, regarding radiological and pathological correlations, the rates of AIS was only 65% in Tis, and 51% showed invasive adenocarcinoma even in T1mi.
Conclusion:
Clinical T category should be considered based on the presence of GGO on thin-section CT, and tumor size should be applied exclusively to radiological solid lung cancer. In contrast, oncological outcomes of the tumor with GGO component were excellent despite their T categories, which should be described as Tis for pure-GGO, and T1a for part-solid tumor.
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-011 - Feasibility of Surgical Resection for Lung Cancer Patients Aged over 85 Years (ID 5636)
14:30 - 15:45 | Author(s): A. Hattori
- Abstract
Background:
Pulmonary resections for lung cancer in patients aged 80 years or over have been increasing in the aging society, which are accounted for approximately 10% in Japan. Due to the prolonged life expectancy in the elderly, it is inevitable to assess the feasibility of pulmonary resection for lung cancer especially in patients over 85 years in age.
Methods:
From 1995 to 2015, we underwent 3,099 pulmonary resections for lung cancers in our department. Among them, 213 (6.8%) were aged 80 years or older. They were divided into 2 groups based on the age, i.e., “Over80” who were aged from 80 to 84 and “Over85” who were aged 85 or elder. Clinicopathological factors were analyzed between these two groups, using the t-test or the Chi-squared test. Survivals were calculated by Kaplan-Meier estimation methods.
Results:
Of the cases, 174 (84%) showed Over80 and 39 (18%) showed Over85. The proportions for male, comorbidity rate, c-stage I disease in the Over85 group were not significantly different than those of the Over80 group (age; 20 (51%) vs. 105 (60%), p=0.189: comorbidity; 36 (92%) vs. 154 (89%), p=0.489: c-stage I; 36 (92%) vs. 143 (82%), p=0.119). The surgical candidates of the octogenarian included 167 (78%) radiological pure-solid lung cancer, however, there was not significant difference between the 2 groups (28 (72%) vs. 139 (80%), p=0.267). Lobectomy was equally performed in 28 (72%) on the Over85 and 126 (72%) of the Over80 (p=0.938), respectively. Perioperative morbidities were observed in 104 (48%) of the patients, though, significant difference was not found between the two study arms (84 (48%) vs. 20 (51%), p=0.734) and the 30-day mortality rates was observed just one patient for the Over80 group. The 5-year overall survival was 51.1% in the Over80 group, 62.6% in the Over85 group (p=0.275), respectively.
Conclusion:
In the octogenarians, a patient with radiological pure-solid lung cancer was more common as a surgical candidate for the definitive local management. Although proper patient selection and meticulous perioperative management were mandatory for surgical resection of the very elderly, our results support the finding that radical surgical intervention could be feasible even for the patients with high age over 85 years.
