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H. Xie



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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): H. Xie

      • 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): H. Xie

      • 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.