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D. Vursol



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    O20 - Staging and Advanced Disease (ID 102)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O20.05 - Prognosis and outcome after surgical resection of solitary brain metastasis in 82 NSCLC patients: a single institution experience (ID 302)

      16:15 - 17:45  |  Author(s): D. Vursol

      • Abstract
      • Presentation
      • Slides

      Background
      The brain is one of the most frequent sites of distant metastasis in patients with lung cancer. Surgical resection of isolated brain metastases in NSCLC patients is not widely accepted and still a matter of debate. The study was aimed to evaluate the long-term results and prognosis after surgical resection of primary tumor and solitary brain metastasis in NSCLC patients.

      Methods
      In this retrospective study, the data of 82 patients who underwent lung resection for primary NSCLC and brain metastasectomy for solitary metastasis between 1991 and 2011 in our clinic were analyzed. There were 68 (82,9%) males and 14 (17,1%) females, median age – 59,6 years. The most common histologic type of lung cancer was adenocarcinoma (70,7%). Synchronous brain metastasis was detected in 21 (25,6%), metachronous – in 61 (74,4%) patients. The primary lung cancer was completely resected in all cases. Surgery included pneumonectomy – in 7 (8,5%), lobectomy – in 69 (85,4%) and wedge resection – in 5 (6,1%) patients. In all cases of synchronous brain metastasis, except one, we performed brain metastasectomy first followed by lung surgery in 4-6 weeks interval. Simultaneous lung resection and brain metastasectomy was performed only in one patient. Surgery in patients with metachronous brain metastasis depended on the time of detection and varied from 4 to 38 months.

      Results
      Postoperative complications were registered in 10 (12,2%) patients, mortality rate was 3,7% (3 patients). Overall 1, 3 and 5-year survival after brain metastasectomy was 52,0%, 29,0% and 25,6% respectively with median survival 18,6 months. The most important prognostic factors were N-status of primary lung cancer and synchronous or metachronous diagnosis of brain metastasis. Three and 5-year survival after brain metastasectomy in patients with N0 status was significantly better than in N+ patients: 56,8% and 34,8% versus 21,4% and 6,5% respectively (p<0,01). Median survival was 19,8 months in N0 group and only 12,4 months in patients with positive lymph nodes. Five-year survival in patients with metachronous brain metastases was 19,8% versus 10,0% in synchronous group (p<0,05). Eight patients are alive free of recurrence, 10 patients – with recurrence in the brain and 64 (78,0%) patients died of disease progression in the brain or other distant sites.

      Conclusion
      Surgery in NSCLC patients with operable solitary brain metastasis is justified especially in N0 cases and metachronous disease. Surgical resection improves long-term results and quality of life in patients with operable brain lung cancer metastasis.

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    P2.06 - Poster Session 2 - Prognostic and Predictive Biomarkers (ID 165)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P2.06-004 - Serum levels of MUC1 glycoprotein (ICO25) in primary lung cancer patients (ID 319)

      09:30 - 16:30  |  Author(s): D. Vursol

      • Abstract

      Background
      The elevated serum level of MUC1 (KL-6, CA15.3) in lung cancer patients is considered to be a marker for advanced adenocarcinoma and a prognostic factor for disease progression after treatment. The aim of this study was to evaluate the serum MUC1 levels in primary lung cancer patients in the Russian Federation, a large portion of which are patients with squamous cell lung cancer (SCC).

      Methods
      Serum samples were obtained from 346 patients at admission. Two hundred ninety three patients were diagnosed with a malignant lung tumor (MLT), i.e. SCC (n=136); adenocarcinoma, AC (n=89); adenosquamous cancer, ASqC (n=21); bronchioloalveolar carcinoma, BAC (n=12); large cell carcinoma, LCC (n=3); small cell cancer (n=4); anaplastic cancer (n=8); carcinoid (n=17); sarcoma (n=3). A non-malignant lung disease (NMLD) was confirmed histologically in 53 patients: benign tumors (n=10), pneumofibrosis (n=13), tuberculosis (n=9), a resolution stage of pneumonia (n=21). Anti-MUC1 ICO25 monoclonal antibody-based and validated inhibition enzyme-linked immunosorbent assay was used (normal range 9 - 38 U/ml, median 24 U/ml).

      Results
      An occurrence of the elevated serum MUC1/ICO25 levels (³40 U/ml) in patients with MLTs was significantly higher than in patients with NMLDs (151 [51.5%] vs. 7 [13.2%] cases, correspondingly; р<0.001), and it positively correlated with clinically aggressive tumor histology: AC, 61.0%; ASqC, 61.9%; SqCC, 44.9%; BAC, 25.0%; LCC and small cell cancer, 100%; anaplastic cancer, 50.0%; carcinoid, 23.5%; sarcoma, 0%. The significantly elevated serum MUC1/ICO25 levels (³60 U/ml) were found in 81 (27.6%) patients with MLTs and 1 (1.9%) patient with NMLDs. In patients with nonsquamous non-small cell lung cancers (AC, BAC, LCC) and ASqC the serum MUC1/ICO25 ³60 U/ml were found in 44.0% (55/125) of cases. The rate of these cases positively correlated with the advanced TNM stage and depended on the patients’ age: statistically significant difference between stages I-II and stages IIIB-IV was found in patients aged 65 years and older (15.8% [3/19] vs. 84.2% [16/19]; p<0.001), but not in patients aged less than 65 years (28.6% [8/28] vs. 48.6% [17/35]; p=0.127). In patients with SCC the overall rate of serum MUC1/ICO25 ³60 U/ml was 16.9% (23/136), and the reversed age-related dependence of those levels on the tumor stage was bserved. In patients aged less than 65 years the higher rate of the serum MUC1/ICO25 ³60 U/ml correlated with more advanced TNM stage: 0% (0/13), 13.8% (4/29),28.6% (6/21) and 52.9% (9/17) for stages I, II, IIIA and IIIB-IV, respectively (I-II vs. IIIB-IV, p<0.001). In patients with SCC aged 65 years or older the serum MUC1/ICO25 ³60 U/ml was found in 0% (0/19), 30.0% (3/10), 7.7% (1/13) and 0% (0/14) of cases for stages I, II, IIIA and IIIB-IV, respectively. In the entire group of patients the rate of the serum MUC1/ICO25 ³60 U/ml did not depend on the tumor histological grade, local tumor extension, location of distant metastases or comorbidities.

      Conclusion
      The abnormal MUC1/ICO25 serum levels correlate with unfavorable prognostic clinical characteristics of the lung cancer, and its potential clinical significance is not restricted to the cases of lung adenocarcinoma.