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M. Rahouma
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P1.06 - Poster Session with Presenters Present (ID 458)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.06-033 - Non-Small Cell Lung Cancer in Young Patients; Clinico-Pathologic Criteria and Prognostic Factors (ID 3809)
14:30 - 15:45 | Author(s): M. Rahouma
- Abstract
Background:
A cancer registry was analyzed to determine the clinicopathologic characteristics and prognosis of non-small cell lung cancer (NSCLC) in patients < 45 years old at diagnosis as they were not thoroughly investigated
Methods:
Among enrolled NSCLC cases attending National Cancer Institute –Cairo (NCI) between 2007-2012, we retrospectively reviewed those who were 45 years old or younger. Data regarding demographics, ECCOG-performance status(PS), histology, grade, stage, chemotherapy type, number of cycles, overall and progression free survival (OS, PFS) were obtained. Pearson’s (X[2]) test , Cox regression and Kaplan-Meier survival curves were used for statistical analysis.
Results:
Among 99 NSCLC cases, we identified 22cases ≤ 45years. Lower stages were more prevalent among young (77.3%) versus old group(54.5%) p=0.05 Median OS in young versus old group was 18 versus 15 months(p=0.773), while PFS was 4 versus 6 months respectively (p=0.322) In our subgroup analysis(n=22); median age was 42years(30-45years), Nearly three-quarters were males, 40.9% were PS >1. The majority of cases in young group were stage IIIB(77.3.%). Pathology was squamous(40.9%), adenocarcinoma(22.7%), undifferentiated(22.7%) and adenosquamous carcinoma in 4.5% of our cases. Median OS and PFS was 18 and 4 months respectively. Significant difference in OS and PFS was observed among responder versus non responders in multivariate analysis (Figure)
Conclusion:
Good response to chemotherapy is the best way to prolong survival among young NSCLC cases irrespective of PS, gender, stage or pathology. Figure 1
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-001 - Advanced Large Cell Lung Cancer; Biological Behavior and Prognostic Factors (ID 3810)
14:30 - 15:45 | Author(s): M. Rahouma
- Abstract
Background:
Large cell lung cancer (LCLC) is a newly recognized clinicopathologic entity. The clinical criteria and optimal treatment for patients with LCLC are not yet established. The aim of this study is to understand the clinicopathologic criteria of LCLC.
Methods:
Among enrolled NSCLC cases attending National Cancer Institute –Cairo (NCI) between 2012-2014, we retrospectively reviewed those had LCLC. Data regarding demographics, ECCOG-performance status(PS), tumor histology, grade and stage, chemotherapy type, number of cycles, response to chemotherapy, overall and progression free survival(OS, PFS) were retrieved. Pearson’s(X[2])test and Kaplan-Meier survival curves were used in statistical analysis.
Results:
Among 99 NSCLC cases, we identified squamous cell carcinoma (35.4%), adenocarcinoma(29.3%), ,undifferentiated(20.2%),large cell carcinoma (12.1%) and adenosquamous carcinoma(3%). Among 12 LCLC cases; median age was 52years (range;41-62years), Male : Female was 3:1. Three-quarters of our cohort were PS=1. Progressive disese occurred in 58.3%. All were grade 3. Near 60% were stage IV while stage IIIB represents the remaining. Median OS was not reached while mean OS was 16.2 months. Median PFS was 6 months. Nearly 90% of disease progression were found within 1 year after start of chemotherapy. There was no difference in median OS or PFS in LCLC vs other NSCLC(OS= not reached vs 13 months in other NSCLC(p=0.372) while PFS=6months in both groups(p= 0.915)). Further analysis by stage was conducted and revealed same results(in STAGE III; median OS not reached,mean OS was 18.2 vs 19.1for other NSCLC(p=0.400),median PFS was 8 vs 6monthsin other NSCLC(p=0.948). In STAGE IV; median OS was 12 vs 9 months (p=0.511), median PFS was 5months in both groups (p=0.956) See figure.
Conclusion:
Most cases of LCLC represents high grade tumors and indeed aggressive treatment is warranted. Although previously reported data revealed poor prognosis of LCLC (stage-I) in comparison to other NSCLC, our cohort represents similar prognosis in both groups in advanced stagesFigure 1
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P2.03a - Poster Session with Presenters Present (ID 464)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.03a-034 - RRM1 - A Prognostic Marker in Advanced NSCLC among Male Smokers Receiving Chemotherapy (ID 6218)
14:30 - 15:45 | Author(s): M. Rahouma
- Abstract
Background:
RRM1 is the regulatory subunit of ribonucleotide reductase. It has important role in DNA synthesis and damage repair as it is linked to G2 cell cycle arrest. Previous studies showed its prognostic significance in early stage NSCLC post-operatively (NEJM 356:800, 2007)
Methods:
We prospectively analyzed formalin fixed and paraffin-embedded (FFPE) tumor specimens to identify RRM1 mRNA expression (using Real-time quantitative PCR). Tumor cells isolated from male smoker with advanced NSCLC who will receive Cisplatin and Gemcitabin was measured in patients attending National Cancer Institute(NCI), Cairo between Jan2011-Jan2014
Results:
70 cases were involved, median age was 57years (35-76). 90% had ECOG-PS1 while 59(84.3%) had Stage IV and 55.7% had ≥4 chemotherapy cycles. 62.7% were responders(SD/PR), High RRM1 RNA was encountered in 33(37.1%) specimens. High RRM1 protein and IHC were encountered in 37(52.9%) and 33(47.1%) specimens respectively. RRM1 RNA was correlated and collinear with RRM1 protein and IHC (Kappa value 0.462 and 0.686, p<0.001 respectively) On Cox regression multivariate analysis (MVA) for predictors of overall survival; Advanced age (p=0.025, HR1.05, 95%CI:1.01-1.09), Non-responder(p=0.035, HR:1.95, 95%CI:1.05-3.63) and high RRM1.RNA(p=0.048, HR:1.93, 95%CI:1.01-3.70) adversely affect survival. Median OS in low RRM1.RNA was 11.6 vs 7.1 months in high group (Figure).Median PFS in low RRM1.RNA was 6.8 vs 5.1 months in high group. On logistic regression MVA for predictors of chemotherapy response; number of chemotherapy cycles was the only independent predictor (p<0.001).
Conclusion:
Low expression of RRM1 could be used to predict better survival in advanced NSCLC. The RRM1 could contribute to the future design of personalized cancer treatment in advanced NSCLC. Prospective multi-institutional clinical trials are warranted. Figure 1
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P2.03b - Poster Session with Presenters Present (ID 465)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.03b-067 - Predictors of Advanced Squamous Cell Lung Cancer Prior to Biopsy; Biological Behavior and Prognostic Factors (ID 3824)
14:30 - 15:45 | Author(s): M. Rahouma
- Abstract
Background:
Squamous cell lung cancer(SqCLC)has a unique clinico-pathologic criteria in comparison to other non-small cell lung cancer(NSCLC).SqCLC is infrequently reported in depth as a separate category in the literature.This study aims to identify patients with SqCLC prior to biopsy and understand clinico-pathologic criteria of SqCLC vs others.
Methods:
Among enrolled NSCLC cases attending National Cancer Institute(NCI)–Cairo University(2012-2014), we retrospectively reviewed those who had SqCLC. Data regarding demographics,ECOG-performance status(PS),tumor histology,grade and stage, chemotherapy type,response to chemotherapy, overall and progression free survival(OS,PFS)were retrieved. Pearson’s(X[2])test, Cox and logistic regression and Kaplan-Meier survival curves were used in statistical analysis.Outcomes and other clinical characteristics of SqCLC were analyzed and compared with of other NSCLC.
Results:
Among 99 NSCLC cases, we identified SqCLC(35.4%),adenocarcinoma(29.3%),undifferentiated(20.2%),large cell carcinoma(12.1%)and adenosquamous carcinoma(3%). Predictors of SqCLC among the whole cohort in uni-and multi-variate analyses(MVA)was PS>1(p=0.033;Odd Ratio2.54(95%CI=1.08-5.99)). Among(35)SqCLC cases; median age was 54years(range;41-70 years), Male:Female was 4:1. Three-fifth of our cohort were PS >1, nearly 55% were stage III while stage IV represents the remaining. Progressive disease(PD)occurred in 57.1%. Median OS and PFS was 12 and 6months respectively. Nearly 90% of disease progression were found within 1 year after the chemotherapy onset. There was no difference in median OS or PFS in SqCLC vs other NSCLC(OS= 12 vs 18 months in other NSCLC(p=0.832)while PFS=6months in both groups(p= 0.452)).Also, no difference in age(p=0.795)or response to chemotherapy(p=0.689) in both groups. Among SqCLC cohort;poor PS and PD were associated with adverse PFS.However,on MVA,the only predictor was PD(p=0.006, HR=3.06, 95%CI 1.38-6.79).Median PFS for patients with PS =1 vs >1 was 9 vs 4months respectively.Median PFS for non-progressive versus PD was 11 vs 4 months respectively(p<0.001,See figure). No difference in survival between stage III and IV(p=0.209)
Conclusion:
Good PS and chemotherapy responder predict good PFS in SqCLC. In advanced stages; no difference in survival among SqCLC and indeed aggressive treatment is warranted. Figure 1
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P2.04 - Poster Session with Presenters Present (ID 466)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-031 - Predictors of Pathological Complete Response (TRG=1) among Esophageal Cancer Cases; NCI Pooled Data (ID 5396)
14:30 - 15:45 | Author(s): M. Rahouma
- Abstract
Background:
Commonly used chemotherapy regimens for esophageal cancer(EC) are EOX(Epirubicin/Oxaloplatin/Capecitabine) for adenocarcinoma and CF(Cisplatin and 5-Fluorouracil) for squamous carcinoma. In this study we aim to assess prevalence of pathological complete response(pCR) after current chemotherapeutic regimens among our EC cases and compare pCR cases to the remaining cohort
Methods:
We retrospectively reviewed Pathology Department database to retrieve EC patients treated in our National Cancer Institute(NCI),Cairo University during the past 5-years. Available variables were age, gender, operation, diagnosis, tumor size and grade, LN-size, presence of Barrett’s esophagus or in-situ/micro-invasive carcinoma, gross and microscopic pictures. MANDARD’s pathological response using tumor regression grade(TRG) was quantitated into five grades(1-5) with TRG=1 showing absence of residual cancer(Mandard_et al.,1994.Esophageal carcinoma regression after chemoradiotherapy,Cancer,73(11),2680-86).Logistic regression was used to identify pCR(TRG-1)predictors. Kaplan-Meier survival curves were used.
Results:
334 patients were encountered with males predominance;202(60.5%), Median age was64(Inter-quartile range;IQR;58-68), Pathology was SqCC in 227(68%), adenocarcinoma in 94(28.1%), undifferentiated ca in 9(2.7%)and others in 4(1.2%). pCR(TRG-1) was evident in 15 cases(4.5%). Among mentioned variables, only advanced age, non SqCC and high grade tumors adversely affect pathological response to induction treatment. On MVA, Advanced age (Odd Ratio(OR)=0.923,95%Confidence interval(CI)=0.86-0.99) p=0.025),moderate/high grade tumors(OR=0.03,p<0.001)adversely affect response while SqCC pathology has better response trend(OR4.39, p=0.086). 3-years overall survival (OS) was 100% in pCR(TRG-1) vs 82.3% in the remaining cohort(Figure). Among esophagectomy cases, surgery was done in 71.7% males vs28.3%females(p=0.093). Gastric pull up was performed in all surgical cases. R1 was present in 2.2%. Median tumor size was 4.3cm(IQR;3-5.6cm),least surgical margin was3(2-4)and max(LN)size was 1(1-2cm).Median +veLN, total LNnumber&LN-ratio was0(0-1),10(7-17)and 0(0-5%)respectively.30-days-perioperative mortality was6.5%. 3years OS among esophagectomy patients was 79.6%.
Conclusion:
Young EC patients and low grade tumor show better response to chemotherapy so aggressive treatment is warranted among this cohort. SqCC carries a good prediction to pathological response and hence better survival mandating aggressive chemo-radiation in this cohort aiming to cure. Figure 1
