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Fei Xiao
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MA 13 - New Insights of Diagnosis and Update of Treatment (ID 674)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:S. Ishikura, H. Nakayama
- Coordinates: 10/17/2017, 15:45 - 17:30, Room 311 + 312
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MA 13.11 - Clinical Significance of Lobar and Segmental Lymph Node Metastasis in cT1N0M0 Lung Adenocarcinoma (ID 7311)
15:45 - 17:30 | Presenting Author(s): Fei Xiao
- Abstract
- Presentation
Background:
The regularity of intrapulmonary lobar and segmental lymph node (LSN) metastasis in cT1N0M0 stage lung adenocarcinoma remains unclear. Thus, segmentectomy with uncertain LSNs metastatic status remains a potential oncological risk. We aimed to facilitate more accurate determination of N staging and identification of more suitable cases for segmentectomy.
Method:
A prospective study was performed from March 2014 to March 2016. A total of 156 patients diagnosed with cT1N0M0 stage lung adenocarcinoma received lobectomy and mediastinal lymph node dissection. The intrapulmonary LSNs were dissected and classified as adjacent LSNs or isolated LSNs. The metastatic status of the LSNs together with the TNM stage were analyzed. A comparison of the metastatic probability of isolated LSNs was carried out considering imaging features, serum carcinoembryonic (CEA) levels, pathological subtypes, size of the lesions, and metastatic status of adjacent LSNs.
Result:
Among the 156 cases enrolled, 129 were confirmed as pN0, 21 as pN1, 5 as pN1+N2, and 1 as skip pN2. When the LSNs had not been dissected, the false negative rate for N staging was 5.1% (7/136). Patients with a pure ground-glass-nodule had a lower isolated LSN metastasis rate (p = 0.027). Non-lepidic predominant invasive adenocarcinoma (p = 0.003), the cT1c group (p = 0.020), and those with adjacent LSN metastasis (p < 0.001) were detected with a higher isolated LSN metastasis rate. No significant difference in isolated LSN metastasis rate was found between groups with different serum CEA levels (p = 0.121).
Conclusion:
Dissection of intrapulmonary LSNs reduces the false negative rate of lymph node metastasis. Partial solid or solid lung adenocarcinoma, non-lepidic predominant invasive adenocarcinoma, and cT1c lung adenocarcinoma might not be suitable for segmentectomy. The lymph node sampling area during segmentectomy should include adjacent LSNs of the target segment. When metastasis to the adjacent LSNs is confirmed by fast frozen pathology, segmentectomy would not be suitable.
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P3.16 - Surgery (ID 732)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.16-031 - Survival and Prognostic Factors of Synchronous Multiple Primary NSCLC and Further Differentiation from Intrapulmonary Metastasis (ID 7308)
09:30 - 16:00 | Presenting Author(s): Fei Xiao
- Abstract
Background:
The diagnosis, staging, and therapeutic strategy for synchronous multiple primary non-small-cell lung cancer (SMP-NSCLC) remain unclear. Distinguishing SMP-NSCLC from intrapulmonary metastasis is difficult but of great importance for selecting the surgical procedure and prognoses.
Method:
Fifty-two patients diagnosed with SMP-NSCLC according to the modified Martini-Melamed criteria in the thoracic surgery department of the China-Japan Friendship Hospital from November 2004 to December 2015 were enrolled in this retrospective study. A total of 106 tumors were subjected to pathological examination. Close follow-up and survival analysis were performed.
Result:
The perioperative morbidity rate was 5.8%, with no cases of perioperative death. The overall 5-year survival rate was 40.6%, the cancer-specific 5-year survival rate was 54.5%, and the median survival time was 52 months. Older age (p=0.553), sex (p=0.600), smoking history (p=0.496), tumor distribution (p=0.461), video-assisted thoracoscopic surgery (p=0.398), and adjuvant chemotherapy (p=0.078) did not affect survival. Preoperative percentage of forced expiratory volume in the first second (p=0.022), Charlson comorbidity index (p=0.034), surgical procedure (p=0.040), and highest pT stage (p=0.022) were independent risk factors in the multivariate analysis. Different pathological subtypes were identified in 13 of 18 cases of multiple adenocarcinomas. Different gene mutation types and correlations between tumors were identified through next generation sequencing in those with the same pathological subtype.
Conclusion:
Postoperative survival rates in SMP-NSCLC were satisfactory. Non-radical resection might improve the prognosis for patients with a tolerable general condition and pulmonary function. Higher pT stage might result in poorer survival rates. Larger sample size and future study are still needed to identify the prognostic factors. Comprehensive histologic assessment and next generation sequencing could be effective methods for screening SMP-NSCLC.
