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M. Chiba
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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
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.02-016 - Prevalence of Preoperative DVT in Japanese Patients Who Underwent Thoracic Surgery by Intensive Screeng (ID 3038)
09:30 - 17:00 | Author(s): M. Chiba
- Abstract
Background:
Pulmonary thromboembolism (PTE) is a well-recognized potentially fatal complication after thoracic surgery. In Japan, PTE had been relatively uncommon. However, it has recently been increasing probably due to changes in lifestyle. Therefore the first guideline for the prevention of venous thromboembolism (VTE) were published in February 2004 in Japan. In this guideline, the patients with history of VTE are classified as highest risk group for PTE. Recently, it has been reported that the presence of normal D-dimer levels can exclude acute-phase deep vein thrombosis (DVT). Therefore, in our institution, DVT had been intensively screened by measuring preoperative D-dimer. The objective of this study was to investigate prevalence of preoperative DVT in Japanese patients scheduled for thoracic surgery.
Methods:
A total of 276 patients who underwent thoracic surgery from June 2013 through July 2014 in our institution were reviewed. The patients who were deemed high-risk for DVT (those with elevated preoperative D-dimer (≧1.0μg/ml), with past history of thrombosis, or with varicose veins in their lower extremities) were defined as preoperative screening positive. They were examined with venous ultrasonography of lower extremities. Those with DVT underwent contrast-enhanced computed tomographic scan (CT) for PTE.
Results:
Of all patients, only 1 failed to undergo preoperative measurement of D-dimer because of emergency surgery. Among the remaining 275 patients, a total of 113 patients ( 95 with elevated D-dimer, 15 with varicose veins in their lower extremities, one with swelling in his extremities, one with paralyzed inferior limbs, and one with previously diagnosed PTE ) were examined with venous ultrasonography of lower extremities. Of them, 34 patients (12.6%) were diagnosed DVT (Figure 1) Proximal and distal DVT were diagnosed in ten patients ( three with isolated DVT, three with multiple DVT, and four with a wide range of huge clots ) and 24 patients ( 15 with isolated DVT and nine with multiple DVT ) , respectively. Of them, none was diagnosed preoperative PTE. For a peri-operative management, all the patients received unfractionated heparin. In addition, of four patients with a wide range of huge clots, three had prophylactic inferior vena cava filter placed. Of 34 patients, one was diagnosed asymptomatic exacerbation of DVT by ultrasonography one week after surgery, but none developed symptomatic PTE. Figure 1
Conclusion:
This study showed an DVT prevalence of 12.6% in patients undergoing thoracic surgery in Japan. However, none developed symptomatic PTE in the peri-operative period.
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P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.03-007 - Prognosis of Microscopic Residual Disease (R1) at Different Resection Margins and Efficacy of Adjuvant Therapy (ID 2608)
09:30 - 17:00 | Author(s): M. Chiba
- Abstract
Background:
The aims of this study were to assess the prognosis of microscopic residual (R1) disease at different resection margins and to evaluate the prognostic impact of adjuvant therapy for R1 disease at different sites.
Methods:
We retrospectively reviewed the clinical records of 1,667 patients who underwent lung resection at the Aichi Cancer Center from 1998 to 2007. Twenty-eight patients (1.7%) were found to have R1 disease, and they were divided into three groups according to the site of residual disease. The “bronchus group” included 9 patients: 5 with cancer cells at the bronchial stump, 3 with carcinoma in situ change at the bronchial stump, and 1 with a clump of tumor cells in the parabronchial tissues (1 patient). The “lymph node group” included 5 patients with residual cancer cells in the lymph node. The “chest wall and lung tissue group” included 14 patients with cancer cells present at the following locations: the margin of chest wall invasion (9 patients), vertebral bodies (2 patients), the pericardium (1 patient) and lung tissue (2 patients). Actuarial survival curves were estimated by the Kaplan-Meier method. Statistical comparisons between survival distributions were performed using the log-rank test. A multivariate analysis was performed using the Cox proportional hazards model for overall survival analysis. A probability value of less than 0.05 was considered to be statistically significant.
Results:
This study included 24 men and 4 women with an age range of 49 to 80 years (median, 64 years). Six (21%), 18 (64%), and 4 (15%) patients had undergone pneumonectomy, lobectomy, and the other procedures, respectively. One (4%), 5 (18%), 19 (68%), and 3 (10%) patients had stage I, II, III, and IV disease, respectively. All 28 patients had non-small cell lung carcinoma. Eleven (39%), 12 (43%), and 5 (18%) patients had adenocarcinoma, squamous carcinoma, and other forms of carcinoma, respectively. The 5-year survival rate and median survival period were 30.3% and 37 months, respectively. The median recurrence-free survival time was 14.8 months. Regarding recurrence patterns, 11 (39%) patients did not experience recurrence, 4 (14%) developed only local recurrence, 5 (18%) developed only distant metastasis, 7 (25%) developed both local recurrence and distant metastasis, and 1 was lost to follow up. Sixteen patients received adjuvant therapy: 11 received radiotherapy, 3 received chemotherapy, and 2 received chemo-radiotherapy. Six patients (66%) in the bronchus group received radiotherapy. Six of the 11 patients with no recurrence were in the bronchus group. The univariate survival analysis identified the following factors that significantly influenced the 5-year overall survival rate: R1 anatomical sites (other sites vs the bronchus, p=0.0467, HR 2.775) and adjuvant therapy (no adjuvant therapy vs adjuvant therapy, p=0.0084, HR 3.509). The multivariate survival analysis identified only one factor that influenced survival: adjuvant therapy (adjuvant therapy vs no adjuvant therapy, p=0.0056, HR7.284).
Conclusion:
Patients with R1 disease generally had a poor prognosis, but this study suggested that adjuvant therapy improves the prognosis of these patients. In terms of sites of R1 disease, the bronchus group had a better prognosis than the other groups.
