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K. Hayashi



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    P1.03 - Poster Session with Presenters Present (ID 455)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      P1.03-001 - The Utility of Liquid-Biopsy for Detecting EGFR Mutation in Clinical Practice: 169 Cases in a Single Institution Research Study (ID 6321)

      14:30 - 15:45  |  Author(s): K. Hayashi

      • Abstract
      • Slides

      Background:
      EGFR-TKIs have promising anti-tumor activities for EGFR-mutant NSCLC, however, almost all patients invariably experience progression on EGFR-TKI therapy. The T790M mutation is known as a major mechanism of resistance to EGFR-TKIs, and re-biopsy is essential for detecting the T790M mutation in EGFR-TKI failure patients. We conducted both tissue-biopsy and liquid-biopsy for all patients who were diagnosed with NSCLC in our institution, and we retrospectively evaluated the utility of liquid-biopsy in clinical practice.

      Methods:
      We reviewed all patients who were diagnosed with or suspected of having NSCLC and received a liquid-biopsy between April 2015 and June 2016 in Matsusaka Municipal Hospital. The aim of this study was to evaluate the clinical benefit of liquid-biopsy by comparing of the results of the liquid-biopsies against the results of the tissue-biopsies. The proportions were compared using Chi-square statistics, or the Fisher’s exact test where appropriate.

      Results:
      A total of 169 patients who received liquid-biopsy for the purpose of detecting an EGFR mutation were enrolled in this assessment. The median patient age was 74 (range 37-95); 104 patients were male, 66 patients were never-smokers, 102 patients(58.3%) had been pathologically diagnosed with adenocarcinoma; 14 patients(8.3%) were both liquid-positive and tissue-positive for an EGFR mutation, 32 patients(18.9%) displayed a discrepancy, having a liquid-negative and a tissue-positive result, although no patients were liquid-positive and tissue-negative.(sensitivity, 33.3%; specificity, 100%) There were 20 patients who had an EGFR mutation detected by liquid-biopsy, and all patients with a liquid-positive result were either clinical stage 3B, 4, or in recurrence. There was a significant difference in the proportion of stage 3B, 4, and recurrent patients between liquid-positive and liquid-negative patients among EGFR mutated patients. (p<0.0001) Of all patients, 19 patients with a liquid-positive result, and 4 patients with a tissue-positive result alone, experienced EGFR-TKI therapy. There was no significant difference in the response rate to EGFR-TKIs between the liquid-positive and liquid-negative patients among EGFR mutated patients. (61.1% vs. 66.6%, p=0.684)

      Conclusion:
      This study demonstrated that liquid-biopsy indicates high specificity, and is available for detecting EGFR mutation in clinical practice. In addition, our institutional experience indicated that liquid-biopsy could be beneficial especially for patients who are unable to receive a tissue biopsy procedure for any reason. Although some patients had a discrepancy between the results of the liquid biopsy and the tissue-biopsy, advanced EGFR mutated NSCLC was highly detectable by liquid-biopsy. Further investigation is warranted to confirm the clinical benefit of liquid-biopsy.

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    P1.08 - Poster Session with Presenters Present (ID 460)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P1.08-056 - Surgical Results of Thoracoscopic Anatomical Sublobar Resections for Early-Stage Lung Cancer (ID 5390)

      14:30 - 15:45  |  Author(s): K. Hayashi

      • Abstract
      • Slides

      Background:
      High-resolution computed tomography (HRCT) has been used to detect ground glass nodules (GGN), and sublobar resections might be currently accepted for patients with early stage malignant GGN. Aim of this study was to evaluate the surgical results of thoracoscopic sublobar resections for early-stage lung cancer.

      Methods:
      Twenty patients (6 males and 14 females, a mean age of 72.5 years) performed surgical treatment for thoracoscopic anatomical sublobar resections from April 2012 to May 2016. Anatomic sublobar resections were selected with the following criteria; stage IA disease with no regional lymph node metastasis; tumor up to 2 cm in diameter; a low tumor standardized uptake value (SUV) evaluated in (18)F fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET) ; predominantly ground-glass appearance on CT imaging. The high resolution CT scanner, Philips Brilliance iCT (Medical Imaging Resources, An Arbor, MI) with both 128 and 256 slice configurations was used. CT data were transferred to an imaging analysis system (Zio station ver.2, Tokyo, Japan) for image reconstruction and we performed preoperative CT-guided marking in surface of near the tumor.

      Results:
      In all 20 cases, the reconstruction of the pulmonary artery and vein could image branches and resected in lung segment. Right side: One case of the upper lobe S1; 5 cases of the lower lobe S6 (3), S8 (1) and S10 (1). Left side: 10 cases of the upper lobe S1+2a, S1+2c, S1+2a+b, S1+2c+S3a, S3b+c, apicoposterior segmentectomy, S3(2) and upper lober trisegmentectomy (2); 4 cases of the lower lobe S6, S8+S9, S10 and basal segmentectomy. All pulmonary nodules were found in the excised target segments with safety margin. According to postoperative pathological examination of the all operative specimens were adenocarcinoma , and the diameters of pulmonary tumors resected were 15.8±3.3 and invasive size were 6.2±3.1 mm. Furthermore, the pathological results were given Atypical adenomatous hyperplasia (2), adenocarcinoma in situ (2), minimally invasive adenocarcinoma (5), Lepidic predominant adenocarcinoma (10) and papillary predominant adenocarcinoma (1).

      Conclusion:
      At the time of writing, local recurrences had not occurred in sublobar resection, so we should be considered for early stage lung cancer in these conditions. Moreover the 3D-CT angiography could be used preoperatively as a tracing method to identify the resected line of lung segment and very useful for anatomic sublobar resections, especially in thoracoscopic surgery.

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