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MO02 - General Thoracic and Minimally Invasive Surgery (ID 99)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track: Surgery
- Presentations: 1
MO02.02 - Size decrease of ground-glass nodules should not be end of follow-up, but may be optimal timing of curative surgery (ID 2234)
10:30 - 12:00 | Author(s): T. Saito
As observed in colon carcinogenesis, recent reports support an atypical adenomatous hyperplasia (AAH)–adenocarcinoma sequence in lung carcinogenesis. Recent accumulating experiences based on pathologic–radiologic correlation show that most cases of AAH, adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and lepidic predominant adenocarcinoma can be detected by ground-glass nodules (GGNs)—the radiographic appearance of hazy lung opacity not associated with obscuration of underlying vessels. In this study, we retrospectively reviewed radiological and pathological characteristics of resected GGNs that were radiologically observed for at least 12 months before surgery, and discuss optimal timing of curative surgery.
We retrospectively reviewed clinical charts and chest computed tomography (CT) of patients on whom pulmonary resection was performed between January 2006 and March 2013 at the Kansai Medical University Hirakata Hospital. The definitions of pure GGNs and part-solid nodules were based on the tumor shadow disappearance rate. The histologic classification of adenocarcinoma followed the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma. We evaluated the radiologic findings, such as size change of whole tumor and appearance of solid component, and pathological findings. All statistical tests were performed with JMP software.
A total of 568 patients underwent pulmonary resection during the study periods and 404 cases were adenocarcinoma (ADA), including 207 tumors with lepidic growth pattern. Total 32 GGNs of 31 patients were observed in chest CT before surgery for at least 12 months. Mean GGN size before surgery was 18.6 mm and mean follow-up period was 25.8 months. Pathological findings of 32 tumors were 6 AISs, 4 MIAs, 8 lepidic predominant ADA, 13 papillary predominant ADA, 1 acinar predominant ADA. On last CT before surgery, 15 lesions showed pure GGNs and 17 showed part-solid nodules. Thirteen of the 17 tumors showed slight size reduction of GGNs during the follow-up, mostly just before or just after appearance of solid component inside GGNs.
Some GGNs showed size reduction during the follow-up with chest CT. Even when mild collapse of the GGNs are observed, you should neither diagnose non-malignant tumors, such as inflammatory nodules, nor decide cessation of follow-up. And instead, we recommend rather careful follow-up in order to identify solid component inside the GGNs. If you confirm appearance of the solid component, the finding would be a sign of progression from AAH/AIS to invasive adenocarcinoma and may be optimal timing of pulmonary resection as curative treatment.
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P1.07 - Poster Session 1 - Surgery (ID 184)
- Event: WCLC 2013
- Type: Poster Session
- Track: Surgery
- Presentations: 1
- Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
P1.07-017 - Prognostic impact of cytoreductive surgery for non-small cell lung cancer with malignant pleural effusion detected at surgery (ID 1390)
09:30 - 16:30 | Author(s): T. Saito
Malignant cells in the pleural effusion are classified as stage Ⅳ in the 7th edition of the TNM-staging of lung cancer. The prognosis of non-small cell lung cancer patients with malignant pleural effusion is reported to be poor as the patients with malignant pleural effusion are generally not subjected to surgery. However, clinically relevant question whether or not the primary tumor should be resected when malignant pleural effusion is first detected at thoracotomy, is controversial. Our purpose is to address the role of surgical resection for main tumor in such patients.
A retrospective review was conducted with clinical charts of 155 patients with non-small cell lung cancer who had pleural effusion detected at radical surgery between January 2006 and December 2012 at Kansai Medical University Hirakata Hospital. We compared prognosis of the patients with or without surgical tumor resection.
Of the 155 patients with pleural effusion, 30 patients had malignant cells and 125 did not. Of the 30 patients, 18 were men and 12 were women. Twenty-five tumors were adenocarcinoma, 3 were large-cell neuroendocrine carcinoma, 1 was small cell carcinoma and 1 was squamous cell carcinoma. Seven patients were treated with lobectomy, 12 were treated with wedge resection and 11 were with exploratory thoracotomy. Five-year survival rate was 35.0% in patients with primary tumor resection, whereas none of the patients without surgical resection of tumors survived 5 years. Two-year survival rate was 22.7% in patients with exploratory thoracotomy.
The prognosis of patients with malignant pleural effusion detected at surgery was not such poor compared to that of generally reported stage IV patients. Patients with surgical resection of main tumor showed better survival compared to those without surgical resection, suggesting that cytoreductive surgery contributed to multimodality treatment in patients with malignant pleural effusion. Based on our series of patients, status of N0 may be candidates for primary tumor resection even in patients with malignant pleural effusion.