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H. Nakamura
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MINI 19 - Surgical Topics in Localized NSCLC (ID 138)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:D. Jablons, B. Stiles
- Coordinates: 9/08/2015, 16:45 - 18:15, 605+607
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MINI19.02 - Mediastinal Nodal Involvement in Patients with Clinical Stage I Non-Small-Cell Lung Cancer - Possibility of Rational Lymph Node Dissection - (ID 2320)
16:45 - 18:15 | Author(s): H. Nakamura
- Abstract
- Presentation
Background:
Recent developments of radiological examinations have been able to bring more accurate information about the biological malignancy of primary tumors in non-small cell lung cancer (NSCLC). The aim of this study is to elucidate the optimal candidate of lobe-specific selective lymph node dissection (LND) that reduces the extent of mediastinal LND according to clinical information including radiological evaluation of primary tumor on thin-section computed tomography (TSCT) and tumor location in clinical(c)-stage I NSCLC patients.
Methods:
Eight hundred and seventy-six patients with c-stage I NSCLC (adenocarcinoma and squamous cell carcinoma), who underwent complete surgical resection between January 2003 and December 2009 were included in this study. For all tumors, we obtained the maximum dimension of the tumor (tumor) and solid component (consolidation) using a lung window level setting from the TSCT scan images, and estimated the consolidation-to-tumor ratio (C/T ratio) for each tumor. We elucidated the lymph node metastatic incidence and distribution according to the primary tumor lobe location and extracted the associated clinicopathological factors with mediastinal lymph node involvement.
Results:
The patients included 490 men and 386 women, with a median age of 66 years old. The radiological findings were ground glass opacity (GGO)-predominant (C/T ratio ≤ 0.5) in 134 patients and solid-predominant (C/T ratio > 0.5) in 742 patients. There were 744 adenocarcinoma cases and 132 squamous cell carcinoma cases, and the incidences of mediastinal lymph node metastasis were 9.9% in adenocarcinoma cases and 4.5% in squamous cell carcinoma cases, respectively. There were no cases with hilar and mediastinal lymph node metastasis in GGO-predominant tumors. There was no significant association of clinical factors with subcarinal lymph node metastasis in right upper-lobe and left upper-division lung adenocarcinoma. In 257 bilateral lower-lobe lung adenocarcinomas, a total of 32 cases (12.5%) were positive for mediastinal lymph node metastasis, and seven cases (2.7%) were negative for subcarinal lymph node metastasis but positive for upper mediastinal lymph node metastasis (mediastinal skip metastasis). An elevated preoperative serum carcinoembryonic antigen (CEA) level (p < 0.001) showed only a significant association with upper mediastinal lymph node metastasis in the patients with bilateral lower-lobe primary lung adenocarcinoma.
Conclusion:
It would be acceptable to perform selective LND in patients with c-stage I NSCLC with GGO-predominant tumor. Elevated serum CEA was associated with upper mediastinal lymph node involvement in lower-lobe primary lung adenocarcinoma with radiologically solid-predominant tumor. We should be careful when applying selective LND to patients with solid-predominant tumor, especially located in the lower lobe.
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P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.04-022 - Prognostic Significance of Solid or Micropapillary Component in Pulmonary Invasive Adenocarcinoma Measuring ≦ 3cm (ID 623)
09:30 - 17:00 | Author(s): H. Nakamura
- Abstract
Background:
According to the International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification, both solid- and micropapillary-predominant pulmonary adenocarcinoma have been reported to have a poor prognosis. Although pulmonary adenocarcinoma with some solid or micropapillary component have also been reported to have a poor prognosis, the ratio of these component to be chosen as the cutoff value for a prognostic factor remains controversial.
Methods:
A total of 115 patients with pulmonary invasive adenocarcinoma measuring ≦ 3 cm who underwent curative surgery at Tottori University Hospital between January 2005 and December 2008 were included. Patients with variants of invasive adenocarcinoma were excluded from this study. The median follow-up time was 78.0 months. A total of 84, 9, and 22 patients underwent lobectomy, segmentectomy, and wedge resection, respectively, and 100, 5, and 10 patients had stages I, II, and III, respectively. The tumors were divided into subtypes according to the IASLC/ATS/ERS classification. Cases with solid component occupying ≧ 5% of the entire tumor were defined as S-positive (S+), and cases with micropapillary component occupying ≧ 1% of the entire tumor were defined as MP-positive (MP+). Of the 115 adenocarcinoma, 30 and 85 were S+ and S-, and 27 and 88 were MP+ and MP-. The clinical characteristics and pathologic data of all 115 adenocarcinoma were retrospectively evaluated. The Kaplan-Meier method was used to estimate the recurrence-free survival (RFS) and overall survival (OS) rates, and the log-rank test was used to compare the RFS and OS among the subgroups.
Results:
The 5-year OS rate of cases that were S＋ and S- was 92.5% and 62.1%, respectively (log rank P < 0.001). The 5-year RFS rate of cases that were MP＋ and MP- was 77.3% and 51.9%, respectively (log rank P = 0.001). On multivariate survival analysis, the presence of solid component proved to be an independent prognostic factor, and the presence of micropapillary component proved to be an independent recurrence factor.
Conclusion:
The presence of solid component occupying ≧ 5% of the entire tumor was an independent predictor of a poor prognosis in pulmonary invasive adenocarcinoma measuring ≦ 3cm. The presence of any micropapillary component, even if only in 1% of the entire tumor, was a risk factor for post-operative recurrence and it affected the prognostic value.
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-022 - Feasibility of Adjuvant Therapy with S-1 plus Carboplatin Followed by Maintenance Therapy with S-1 for Resected Non-Small-Cell Lung Cancer (ID 470)
09:30 - 17:00 | Author(s): H. Nakamura
- Abstract
Background:
The prognosis of patients with locally-advanced stages (II or IIIA) non-small-cell lung cancer (NSCLC) is unsatisfactory, even after complete resection, and the 5-year survival rate is <50%, indicating the need for further improvements in postoperative survival. This multicenter study (the Setouchi Lung Cancer Group Study 0701) aimed to evaluate the feasibility of novel adjuvant chemotherapy with S-1 plus carboplatin followed by single-agent, long-term maintenance with S-1 in patients with completely-resected stage II–IIIA NSCLC.
Methods:
Figure 1 Patients received four cycles of S-1 (80 mg/m2/day for 2 weeks, followed by 2 weeks’ rest) plus carboplatin (area under the curve 5, day 1) followed by S-1 (80 mg/m2/day for 2 weeks, followed by 1 week’s rest). Patients unable to continue S-1 plus carboplatin because of severe toxicity converted to single-agent S-1 maintenance. The duration of adjuvant chemotherapy was 10 months in both situations. The primary endpoint was feasibility, defined as the proportion of patients who completed four cycles of S-1 plus carboplatin and single-agent S-1 maintenance for 10 months. The treatment-completion rate was determined and treatment was considered feasible if the lower 90% confidence interval (CI) was ≥50%.
Results:
Figure 1 Eighty-nine patients were enrolled, of whom 87 were eligible and assessable. Seventy-eight patients (89.7%) completed four cycles of S-1 plus carboplatin and 55 (63.2%) completed the following S-1 maintenance therapy for a total of 10 months. The treatment-completion rate was 63.2% (90% CI: 54.4–71.2%), indicating feasibility. There were no treatment-related deaths. Grade 3/4 toxicities included neutropenia (11.5%), thrombocytopenia (10.3%), and anorexia (2.3%). The 2-year relapse-free survival rate was 59.8%.
Conclusion:
We concluded that novel adjuvant chemotherapy with S-1 plus carboplatin followed by single-agent maintenance therapy with S-1 was feasible and tolerable in patients with completely-resected NSCLC.
