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C. Chen



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    MINI 06 - Quality/Prognosis/Survival (ID 111)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      MINI06.08 - Recognition Of 'Aggressive' Nodal Metastatic Behavior In 'Indolent' Ground Glass Opacity Lesions (ID 2345)

      16:45 - 18:15  |  Author(s): C. Chen

      • Abstract
      • Presentation
      • Slides

      Background:
      Radiologically characteristic ground-glass opacity (GGO) represents a special cohort of pulmonary adenocarcinomas that has been unanimously defined as biologically inert. Lymph node metastasis, however, occurs occasionally in these biologically "indolent" cancers. The incidence and underlying risk factors of nodal metastasis remain unknown.

      Methods:
      All surgically removed GGO lesions between Jan. 2008 and Dec. 2014 were reviewed from a single treatment institution. Pathologically-confirmed adenocarcinomas with systemic lymph node dissection or sampling were enrolled into the present study. All the lesions were classified into three groups according to the proportion of solid densities: Group I, pure GGO; Group II, 1% to 50%; and Group III, 50% to 100%. Risk factors analysis of lymph node involvement was performed by multivariate logistic regression.

      Results:
      Of the 867 patients eligible for this study, there were 566 (65.3%) females and 301 (34.7 %) males. 553 (63.7%) presented as pure GGOs (Group I) and 314 (36.2%) were mixed GGOs, of which 160 (18.5%) were in Group II and 154 (17.8%) group III. Lymph node metastasis was confirmed in 25 patients, including 12 pN1 and 13 pN2 cases. Among these 25 cases, 11 were Group II and 14 were Group III; 13 (13/367) had1-2cm tumors and 12 (12/136) had 2-3cm tumors, which also showed a significant statistical difference (p=0.016). Two of the 25 patients were deceased from lung cancer metastases at postoperative 23rd and 36thmonths, respectively. Statistical analysis revealed three predictors for lymph nodal metastasis: tumor size, preoperative serum carcinoembryonic antigen level, and proportion of the mix density. The ROC curves show cutoff values at 1.1cm, 2.75ng/ml and 21%, respectively.Figure 1

      Table1. Independent predictors of lymph node involvement by multivariate analysis
      Variables Odds Ratio 95%CI P
      Tumor size 2.544 1.271-5.092 0.008
      GGO status(Ratio) 3.272 1.759-6.089 <0.001
      CEA level 9.672 3.805-24.584 <0.001




      Conclusion:
      Among the majority of "indolent" GGO lesions, lymph node metastasis occurs occasionally at 2.9%. A larger size, mixed GGOs with a higher proportion of solid component, and elevated serum CEA level were associated with a higher preference for nodal metastasis.

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    P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      P1.02-006 - Visceral Pleural Invasion Was Common in Larger (> 2 cm) Ground Glass Nodules, but Showed No Aggressive Prognostic Impact (ID 2348)

      09:30 - 17:00  |  Author(s): C. Chen

      • Abstract

      Background:
      Visceral pleural invasion (VPI) had been demonstrated as an aggressive sign in solid-density non-small-cell lung cancers. However, its incidence and clinical relevance in ground glass nodules (GGNs) has not been clarified. The present study aims to investigate the clinical, radiological and pathological features of GGNs in patients with VPI.

      Methods:
      All consecutive surgically treated patients with solitary GGNs between 2008 and 2013 were retrospectively reviewed. Inclusion criteria were defined as: lesions < 3 cm and pleura abutting on computed tomography scan; pathologically confirmed non-small cell lung cancers. Patients with and without VPI were compared for clinical, radiological and pathologic parameters and survival.

      Results:
      A total of 121 patients were enrolled and 38 had pathologically proven VPI. The median patient age was 61 years old (range, 30-81 years old) and 45 (37.2%) patients were male. The mean follow-up duration was 30 months. The incidence of VPI was 43.9% (25/57) if the tumor diameter was > 2.0 cm and 20.3% (13/64) in < 2.0 cm (p=0.005). It was 20.9% (9/43) in pure GGNs and 37.2% (29/78) in part-solid GGNs (p=0.065). In cases with pleura indentation the incidence was 37.5% (24/64). In lepidic predominant, acinar predominant, papillary predominant and mucinous variant adenocarcinomas, the VPI rate was 44.7%, 84.60%, 52.9% and 100%, respectively (p=0.07). There were five lymph node involvement cases and three death cases due to distant metastasis. There was no statistical difference in 3-year overall survival between patients with VPI and without, nor between pure (all alive) and part-solid GGNs (p=0.956).

      Conclusion:
      VPI was more commonly seen in large (> 2 cm) GGNs and those with pleural indentations. Histologically it was more frequently seen when acinar was also predominant. Although commonly taken as an aggressive sign predictive of poor prognosis, the presence of VPI in GGNs may be associated with less prognostic significance. Therefore, upgrading of the TNM stage on the basis of VPI for such patients needs further verification.

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    P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      P2.02-013 - Strategy of Management for Synchronous Pure GGOs Detected in Patients Undergoing Resection for Primary NSCLC (ID 2599)

      09:30 - 17:00  |  Author(s): C. Chen

      • Abstract

      Background:
      It is quite common to discover some synchronous pure ground-glass opacity (GGO) nodules in other lobes beside the operable primary tumor on initial CT scans, while the appropriate surgical strategy for these pure GGOs remains controversial.

      Methods:
      We included patients with primary tumor lesion and pure GGOs in different lobes between June 2010 and December 2013. The radiographic manifestations of all GGOs, pathologic features of resected GGOs and follow-up outcomes of unresected GGOs were analyzed to make clear which GGOs should be resected concomitantly with the primary tumor.

      Results:
      A total of 59 patients with 72 pure GGOs were included, of which, 29 were resected at the primary surgery and 43 were left behind and followed up. In the resection group, 8 (27.6%) were invasive or minimally invasive lesions, 12 (41.4%) were preinvasive lesions and 9 (31%) were benign lesions. In the follow-up group, 7 nodules grew, and the growth rate was 16.3% (7 of 43) on a per-nodule basis, and 19.4% (7 of 36) on per-person basis. In all, concomitant resection at the primary surgery was considered for 15 of 72 GGOs (8 malignant lesions and 7 growth lesions). Multivariate analysis showed that the initial size was an independent risk factor for these GGOs (P=0.011), and a cut-off value was calculated as 9.9 mm by receiver operating curve (ROC) curve analysis. Tabel Predictors for synchronous GGO nodules which need concomitant resection

      Univariate analysis Multivariate analysis
      P value OR P value OR
      Age at operation 0.056 1.075 0.872 1.01
      Sex 0.279 0.527
      Smoking 0.136 2.667
      Size <0.001 18.733 0.011 10.922
      Location
      LUL Reference
      LLL 0.345 0.333
      RUL 0.217 0.381
      RML 0.577 1.778
      RLL 0.886 0.889
      Location of primary lesion
      Ipsilateral Reference
      Contralateral 0.334 1.8
      Shape
      Round Reference
      Oral 0.584 1.625
      Irregular 0.349 2.275
      Margin
      Smooth Reference
      Lobulated 0.629 1.4
      Spiculated 0.125 3.111
      Air bronchogram 0.001 8 0.355 2.199
      Bubble lucency 0.024 6.545 0.274 3.356
      Pleural tag 0.006 6.933 0.175 3.724
      Figure 1



      Conclusion:
      About 20% of synchronous pure GGO nodules should need surgical treatment at the time of primary operation, and a lesion size of more than 9.9 mm is an effective discriminator of these GGOs. As to the unresected GGOs, a close follow-up is always indispensible.