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Pietro Bertoglio
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MA 17 - Locally Advanced NSCLC (ID 671)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:S. Jheon, Georgios Stamatis
- Coordinates: 10/17/2017, 15:45 - 17:30, F203 + F204 (Annex Hall)
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MA 17.01 - Skip N2, an Independent Prognostic Factor of Survival: Analysis of a Favourable N2 Subgroup (ID 8743)
15:45 - 17:30 | Author(s): Pietro Bertoglio
- Abstract
- Presentation
Background:
To date the nodal status is considered one of the most important indicators of prognosis for resectable NSCLC. The latest edition of lung TNM does not include any changes to N descriptors, but several changing proposals are under evaluation: IASLC proposed a subclassification of pN1-N2 based on the number of nodal station involved (pN1a, pN1b; pN2a1, pN2a2, pN2b). The number of positive lymph nodes and the lymph node ratio were also proposed as prognostic indicators of resected NSCLC. The aim of this study was to compare overall survival (OS) and Disease Free Interval (DFI) of pN2a1 (“skip” metastasis) to pN1b and pN2a2-pN2b.
Method:
A retrospectively analysis of 155 patients who underwent a complete resection and a systematic lymph node dissection for T1/T2 N1-N2 NSCLC (VII TNM edition) between 2006 and 2010 was conducted. Patients who underwent induction therapies or extended resections were excluded. All patients were restaged with the new IASLC proposal. OS, DFI and risk factors of pN1b, pN2a and pN2b patients were analysed.
Result:
An overall mean number of 16 (DS 8,4) lymph nodes were resected: 7,18 (DS 4,2) from the hilum and 8,72 (DS 5,9) from the mediastinum. After restaging all cases with new IASLC proposal we observed: 48 (30,9%) pN1b, 26 (16,8%) pN2a1, 63 (40,7%) pN2a2 and 18 (11,6%) pN2b. With a median follow up of 93 months, the median overall survival of the entire cohort was 27 months. pN2a1 had a significant better overall survival when compared with the other three groups (p=0,042). 1, 3 and 5-year survival for pN1b, pN2a1, pN2a2 and pN2b were 75%, 90%, 81% and 71%; 46%, 53%, 37% and 24%; 24%, 45%, 26% and 19% respectively. A number of more than 5 positive lymph nodes and a lymph node ratio >50% were independent prognostic factors of a worse survival (p=0,004 and p=0,035).
Conclusion:
Our data supports the new IASLC proposal for the revision of N descriptors. Patients with skip lymph node metastasis (pN2a1) have a significant better prognosis compared both to other pN2 groups and to pN1b. Moreover, we confirmed the important prognostic value of the number of the involved lymph node, which should be considered as well in the next edition of the lung cancer staging system.
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P1.08 - Locally Advanced NSCLC (ID 694)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.08-005 - Preoperative Analysis of 18FDG-PET Features May Predict Loco-Regional Invasiveness in NSCLC (ID 8328)
09:30 - 16:00 | Presenting Author(s): Pietro Bertoglio
- Abstract
Background:
Prognosis of surgically resectable NSCLC is strongly affected by local invasiveness as well as unexpected lymph node diffusion found at surgery (nodal upstaging). Recently, texture analysis of PET imaging has emerged as a powerful tool to better define the metabolic features and behavior of neoplasms. This study is meant to evaluate the relationship of texture analysis features of surgically resected NSCLC with local invasiveness, represented by lymphovascular invasion (LI), and regional subclinical diffusion, evaluated as nodal upstaging (NU) at the pathological staging.
Method:
The study is a retrospective evaluation of prospectively collected data. We performed a spatial texture analysis of the preoperative PET-CT scans of completely resected clinical stage Ia-IIb (T1-3, N0-1) NSCLC, focusing on 11 parameters: SUVmax, Metabolic Tumor Volume (MTV), Entropy (baseline), Homogeneity, High Intensity Run Emphasis, Low Intensity Run Emphasis, Coarseness, Busyness, Normalized Entropy, Normalized Homogeneity, Normalized Inverse Difference Moment (NIDM), SUV standard deviation (SUV SD), SUV Entropy. We then evaluated their relationship with LI, NU and Disease-Free Survival (DFS).
Result:
In the period between February 2012 and September 2016 we operated on 75 patients (53 male and 22 female); pathological stage revealed a nodal upstaging in 12 cases (6 pN1 and 6 pN2), while in 11 patients it showed a LI. Patients with NU had a restricted mean DFS of 19.8 months (CI 95% 12.7-26.8) and showed higher levels of SUVmax; SUV Entropy; Normalized Entropy; SUV SD and lower level of Normalized Homogeneity and NIDM. Patients with LI had a restricted mean DFS of 21.4 months (CI 95% 8.8-34,1) and displayed higher levels of SUVmax, SUV Entropy, Normalized Entropy, SUV SD and lower level of NIDM. ROC analysis confirmed a stronger predictive value of heterogeneity indexes when compared to SUVmax; in particular SUV SD had the best ROC area for LI and SUV entropy showed the best ROC for NU. Concurrently, both LI and NU emerged as significant prognostic factors for DFS both in univariate (p=0.0076 and p=0.0167 respectively) and multivariate analysis (p=0.005 and p=0.021 respectively).
Conclusion:
In our analysis, preoperative PET-CT texture analysis has a significant correlation with prognostic indicators and tumor local invasiveness; this analysis may provide a more precise stratification of patients affected by highly aggressive tumors from the very beginning of patient’s diagnostic path.
