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K. Kaynak
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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
- Moderators:R. Meguid, J. Yoshida
- Coordinates: 9/07/2015, 16:45 - 18:15, 605+607
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MINI06.14 - The Impact of Serum EGFR Levels on Survival of Resected Patients with Non-Small Cell Lung Cancer (ID 3237)
16:45 - 18:15 | Author(s): K. Kaynak
- Abstract
- Presentation
Background:
Lung cancer is an important cause of cancer mortality. Mutations of the EGFR gene may cause deranged activation leading to cell proliferation and the inhibition of apoptosis and metastases. Screening for EGFR mutation plays a key role for managements of lung cancer cases. The aim of our study is to determine a possible relationship between EGFR gene mutations in exon 19,20,21, along with serum EGFR levels and non small cell lung cancer.
Methods:
A total of 35 patients; 29 (%82.9) male and 6 (%17.1) female with non small cell lung cancer who underwent surgical resection between February 2011 and July 2013 were analyzed.Mean age of the patients was 60.1(41-79) Mediastinoscopy was performed to all patients prior to the resection. Lobectomy, pneumonectomy and bilobectomy were performed to 30(%85.7), 4(%11.4) and 1 (%2.9) patients respectively. The most common tumour histopathology was adenocarcinoma(%55.6). EGFR gene mutations were analyzed for exon 19,20 and 21 by direct sequencing. In addition, serum EGFR levels were determined by ELISA in non small cell lung cancer patients and control group
Results:
Exon 19,20 and 21 aminoacid substitutions that could cause significant mutations were detected.At exon 19,20 and 21, totally 17 mutations were detected in 10 different regions.One of these mutations were (2237-MT) E746- T751>V, E746-T751VA, E746-S752>V on exon 19. In one sample 5 different regions of exon 20 mutations were detected. On exon 21 two mutations that cause aminoacid changes were detected which includes Leu 861 Gln ve Leu 861 Arg. In our study there was no significant difference in survival rates between the cases who have EGFR mutations or who have not(p=0.21). Serum EGFR average levels of non small cell lung cancer patients and healthy control groups were calculated respectively as, 341,49±125,41 pg/ml ve 574,9±125,96 pg/ml and the difference was found statistically significant (p<0,001). According to the EGFR levels survival rate at 3 years was %45 and mean survival time is 19 (%95 confidence interval :14-29 months)and 23 (%95 confidence interval 18-29 months)month in patients with serum EGFR levels higher and lower than 400 pg/ml respectively. The patients with high serum EGFR levels (>400 pg/ml) have better survival time than the ones who had low serum EGFR levels (p=0.04).
Conclusion:
EGFR mutation did not lead to survival difference in resected patients with lung adenocarcinoma.. However, survival of patients with higher serum EGFR levels seems better. The modus operandi of this effect and validation of the data need further studies.
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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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MINI19.12 - The Value of Video-Assisted Mediastinoscopic Lymphadenectomy in Clinical Stage I Non-Small Cell Lung Cancers (ID 2921)
16:45 - 18:15 | Author(s): K. Kaynak
- Abstract
- Presentation
Background:
The rate of mediastinal lymph node metastasis is controversial for patients with clinical N0 non-small cell lung cancer. The primary advantage of video-assisted mediastinoscopic lymphadenectomy(VAMLA) over conventional mediastinoscopy or videomediastinoscopy is to reduce the false-negative rate. We aimed to analyze to evaluate the value of routine VAMLA for patients with clinical T1a-T2aN0 patients prospectively.
Methods:
From March 2010-January 2015, 41 patients with non-small cell lung cancer with clinical stage T1-T2aN0 by postireon emission tomography/computed tomography underwent routine VAMLA before planned resectional surgery.Routinely, stations #2L, 2R, #4R, #4L, 7 were nearly completely resected. In some patients, #10R and #8 lymph nodes were biopsied. The prevalence of mediastinal lymph node metastases at VAMLA and lung resection was recorded.
Results:
There were 5 females (12.2%) and 36 (87.8%) males. The mean age was 62.5 . years. A total of 5 patients were had cT1a-bN0, whereas 36 patients had T2aN0. Eleven patients (26.8%) had occult mediastinal lymph node metastasis. A total of 26 patients underwent lung resectional surgery; only one patient (3.8%) were upstaged to pN2, whereas 3 patients (11.5%) were upstaged to pN1.
Conclusion:
VAMLA seems to disclose considerable number of mediastinal lymph node metastasis in these patients with T1 and T2 clinically staged N0 by positron emission tomography/computed tomography. Routine use of VAMLA is recommended with limited use of mediastinal lymph node evaluation in patients during resectional surgery.
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P1.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 224)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.08-023 - Induction Chemotherapy Increases the Survival of Patients with Primary Neuroectodermal Tumors of the Thorax (ID 2415)
09:30 - 17:00 | Author(s): K. Kaynak
- Abstract
Background:
Primary neuroectodermal tumors (PNETs) of the thorax are rare, small-round cell tumors with a poor prognosis despite multimodal therapy, including surgery and chemoradiotherapy. The ideal treatment was unknown since no comparative clinical series with surgical therapy had been reported. We evaluated the results of multimodal treatment in patients with PNETs located in the thoracic region.
Methods:
Between 2000 and 2013, 27 patients with PNETs in the thoracic region were treated in 3 tertiary-care hospitals. There were 15 males and 10 females with a mean age of 26.3 years (range, 6 – 60). The tumor was located in the chest wall in 21 (involving the costovertebral junction in 7), the lung in 6 patients. Thirteen patients had induction chemotherapy, whereas 22 patients underwent resectional surgery. All the patients received adjuvant chemo/radiotherapy.
Results:
There was no hospital mortality. The overall 5-year survival rate was 42% and median survival was 36±14 months in all patients. Five year survival in patients who had induction chemotherapy was 56%, whereas it was 36% in cases who did not receive induction chemotherapy (p=0.045). The 5-year survival rate of patients with and without costovertebral junction involvement was 21% and 64%respectively(p=0.076). The 5-year survival in the patients who had pulmonary involvement without vertebral or chest wall invasion had 50%.
Conclusion:
Primary thoracic PNET is an aggressive entity that often requires multimodal therapy. Induction chemotherapy seems to lead a greater complete resection rate and better survival, while involvement of the costovertebral junction indicates a slightly worse prognosis.
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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
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.02-017 - Video-Assisted Mediastinoscopic Lymphadenectomy Decreases the Need for Lymph Node Dissection during Lobectomy in Lung Cancer Patients (ID 2933)
09:30 - 17:00 | Author(s): K. Kaynak
- Abstract
Background:
Mediastinoscopy has been accepted as a gold standard in preoperative staging of patients with cT1-3N1-3M0 non-small cell lung cancer. However, video-assisted mediastinoscopic lymphadenectomy (VAMLA) has been shown to provide higher negative predictive value. We aimed to investigate the role of VAMLA on the need and time for lymph node dissection following anatomical resection in these patients.
Methods:
Between May 2005 and March 2014, 299 patients who have undergone lobectomy following mediastinoscopy or VAMLA were analyzed.One-hundred-four patients (34.8%) underwent VAMLA, wehereas 195 patients (65.2%) had standard mediastinoscopy. 245 patients (81.9%) underwent open lobectomy while 54 (8.1%) had videothoracoscopic lobectomy. The median and mean numbers of resected lymph node stations were 5 and 4.9 in the VAMLA group and 4 and 4.2 in the mediastinoscopy group.
Results:
The mean number of lymph nodes per biopsy specimen using standard mediastinoscopy was 11.0 (ranging 2 to 33), whereas it was 29.7(Ranging 16-110) using VAMLA (p<0.001). ,The negative predictive value, sensitivity, false-negative value, and accuracy of VAMLA were statistically higher in the VAMLA groups compared with those of standard mediastinoscopy. In the VAMLA group, lymph node dissection of stations 2R, 2L, 4R, 4L, 7, and 8 was achieved in 90 (86.5%), 61 (59.6%), 90 (86.5%), 88 (84.6%), 101 (97.1%), and 30 (28.8%) of the patients, respectively. In the standard mediastinoscopy group, 2R, 2L, 4R, 4L, 7, and 8 underwent biopsy in 101 (52.0%), 46 (23.7%), 145 (74.7%), 91 (46.9%), 157 (80.9%), and 0 of the patients, respectively. The difference was statistically significant (p < 0.001). The mean number of dissected mediastinal lymph nodes following pulmonary resection was 9.4 (ranging 0 to 32) or 4.4 (ranging, 0-11) in patients who underwent standard mediastinoscopy or VAMLA, respectively (p<0.001). A statistical difference was found when analyzing the VATS lobectomy patients (mean 8.6 vs 3.1 lymph nodes )(p<0.001). The time for lymph node dissection was also found to be shorter(p=0.02).
Conclusion:
VAMLA provides bilateral lymph node dissection before resectional surgery and it decreases the necessity of lymph node dissection and alleviates it during VATS and open lobectomies performed in non-small cell lung cancer patients.
