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Junichi Shimada
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P1.02 - Biology/Pathology (ID 614)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.02-022 - Spontaneous Regression of Primary Pulmonary Synovial Sarcoma; A Case Report (ID 7990)
09:30 - 16:00 | Author(s): Junichi Shimada
- Abstract
Background:
Primary pulmonary synovial sarcoma is rare, comprising 0.5% of all primary lung malignancies, and spontaneous regression, defined as tumor disappearance without treatment, is very unusual.
Method:
This is a case report of a primary pulmonary synovial sarcoma showing spontaneous regression. The clinical and pathologic records were reviewed, and histologic analysis of the resected specimens was performed.
Result:
Clinical summary: A 38-year-old woman had no history of smoking and no respiratory symptoms. Chest computed tomography revealed a well-demarcated peripheral part-solid nodule measuring 3.8cm in the right lower lobe. Transbronchial biopsy was performed and the diagnosis was synovial sarcoma (SYT-SSX1 variants). She underwent thoracoscopic right lower lobectomy and systematic lymph node dissection. Pathological findings: The cut surface of the resected specimen showed a smooth walled cyst measuring 2.7 × 2.0 cm containing necrotic tissue. The histological examination revealed a widespread coagulative necrosis of tumor cells with peripheral granulation. Only a few regenerated residual tumor cells were observed.
Conclusion:
This is the first report of spontaneous regression of primary pulmonary synovial sarcoma. Although the mechanism is unknown, blood flow obstruction after the transbronchial biopsy may affect the tumor regression.
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P1.17 - Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies (ID 703)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.17-009 - Clinical Significance of Preoperative Neutrophil-Lymphocyte Ratio in Patients with Thymic Epithelial Tumor Undergoing Surgery (ID 9381)
09:30 - 16:00 | Author(s): Junichi Shimada
- Abstract
Background:
Preoperative neutrophil-lymphocyte ratio (NLR), which is an inflammatory marker, has been reportedly associated with a poor prognosis in patients with various cancers. This study aimed to investigate the clinical significance of preoperative NLR in patients with surgically resected thymic epithelial tumor.
Method:
A retrospective review was conducted of 64 patients who underwent surgical resection for thymic epithelial tumor between January 2000 and April 2017. Preoperative NLR was calculated as peripheral blood neutrophil (cells/m[3]) divided by lymphocyte (cells/m[3]). Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal value for NLR predicting recurrence. Univariate analysis was performed to assess the association between preoperative NLR and relevant clinicopathological variables. Recurrence-free survival (RFS) after first surgery was calculated using the Kaplan-Meier method.
Result:
The median follow-up period was 66 months. The patients were 32 men and 32 women with a median age of 60 years. The WHO classification was type A (n=10), AB (n=20), B1 (n=9), B2 (n=12), B3 (n=8), and thymic carcinoma (n=5). The patients were classified into two groups according to preoperative NLR: high NLR (≥2.1, n=29) and low NLR (<2.1, n=35) group. Univariate analysis showed that aggressive histology (B2/B3 and thymic carcinoma) and a lower incidence of myasthenia gravis were significantly correlated with high NLR. The RFS rate of the high NLR group was significantly poorer than that of the low NLR group (5- and 10-year RFS rates: 82.6% vs 93.2% and 48.3% vs 93.2%, p=0.034).Figure 1
Conclusion:
Preoperative high NLR value was significantly associated with aggressive histology (type B2/B3 thymoma and thymic carcinoma) and a lower incidence of myasthenia gravis. Preoperative high NLR could be a predictorof poor outcome in patients undergoing surgical resection of thymic epithelial tumor.
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-067 - Treatment of the Patients with Oncological Emergencies with Massive Pleural Effusion at the First Hospital Visit (ID 9108)
09:00 - 16:00 | Author(s): Junichi Shimada
- Abstract
Background:
Massive pleural effusion may cause the oncological emergencies in the patients with advanced lung cancer. We describe here the treatment experience of patients with the massive pleural effusion at the first visit.
Method:
Three patients had massive pleural effusion at the first visit from April 2016 to March 2017. We report these 3 patients treated with carboplatin, pemetrexed, and/or bevacizumab.
Result:
All of 3 patients urgently received the continuous chest tube drainage for several days (Table 1). Pleural effusion was examined for cytology. Patient A received pleurodesis therapy because of negative fluid cytology, while she was examined by CT guided needle biopsy. Patient B and C revealed malignant adenocarcinoma cytology in pleural effusion. Both of two received additional biopsy for EGFR-mutation and ALK-translocation. Patient A waited the result of the pathology of adenocarcinoma, EGFR-mutation of negative, and ALK-translocation of negative for 24 days. She received the chemotherapy of carboplatin and pemetrexed with pregressive disease and died of locally advanced lung cancer after 1 course of chemotherapy followed 20 days best supportive care. Patient B and C quickly began the first line chemotherapy of carboplatin, pemetrexed, and bevacizumab without waiting the result of EGFR-mutation and ALK-translocation. Patient B received the six-course of chemotherapy with partial remission, followed the one course of the maintenance chemotherapy of pemetrexed and bevacizumab, however, he died of brain metastasis 183 days after the first chemotherapy. Patient C received the six courses of chemotherapy, followed pemetrexed and bevacizumab maintenance therapy, and is living with partial remission more than 130 days.Table 1
Age Sex Pleural effusion cytology Additional pathology EGFR-mutation Period to the first chemotherapy 1st line chemotherapy Prognosis Patient A 77 F Class I Dissemination, adenocarcinoma wild 25 days Carboplation, Pemetrexed Dead, 58 days, Locally advancement Patient B 60 M Class IV Lung, adenocarcinoma wild 8 days Carboplatin, Pemetrexed, Bevaxizumab Dead, 183 days Brain metastasis Patient C 69 F Class IV Dissemination, Adenocarcinoma L858R 4 days Carboplatin, Pemetrexed, Bevaxizumab Alive, 130 days, PR
Conclusion:
Carboplatin, pemetrexed and bevcizumab treatment was well-tolerable in the patients with the oncological emergencies of massive pleural effusion. We should start the first line treatment as soon as possible. Two weeks of waiting period are so long for the patients with advanced lung cancer.
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P2.05 - Early Stage NSCLC (ID 706)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.05-013 - The Result of Preoperative Lipiodol Markings for 121 Small Pulmonary Nodules in 115 Patients (ID 9141)
09:30 - 16:00 | Author(s): Junichi Shimada
- Abstract
Background:
Some pulmonary nodules are so small that we surgeons can’t perceive by touch nor visually recognize during operation. For resection of such small nodules we have been undergoing preoperative lipiodol markings for 7 years. The appearance of the marking-spots on computed tomography (CT) is classified into 3 types in a previous research [H Miura, et al: CT findings after lipiodol marking performed before video-assisted thoracoscopic surgery for small pulmonary nodules. Acta Radiologica, 2016, Vol. 57(3) 303-310] .
Method:
CT-guided lipiodol marking for 121 nodules were performed in 115 patients before surgery. Lipiodol was injected using a 23-guage needle near the nodules. During surgery, the location of nodules could be detected using C-arm-shaped fluoroscopic unit as radiopaque spots and we resected them. We classified the CT appearance of the lipiodol marking retrospectively into 3 types; Dense, Punctate and Unclear as the previous research.
Result:
All nodules were successfully resected on the same day as marking performed. The results of pathological examination were 68 lung cancers (56%), 38 metastatic lung tumors (31%) and 15 others (12%). The classification of lipiodol spots resulted as following. 75 spots (62%) were Dense, 45 spots (37%) were Punctate, and 1 spot (0.8%) was Unclear. There was no significant difference in the average operative duration between the group of Dense and Punctate. Patients with smoking history occupied 67% of the Punctate group, on the other hand only 37% of the Dense group had smoking history (P<0.0001).
Conclusion:
Lipiodol marking for small pulmonary nodules are helpful and effective, especially for diagnosis and treatment of early stage lung cancer. Smoking history of patients has something to do with the CT appearance of lipiodol spots. Regardless of how marking shape is, difficulty of surgery doesn’t change in the point of operative duration.
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P2.16 - Surgery (ID 717)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.16-008 - Collapsed Lung Index Ten Minutes after Thoracotomy and Pre-Operative Pulmonary Function Tests (ID 8932)
09:30 - 16:00 | Presenting Author(s): Junichi Shimada
- Abstract
Background:
The lung is still pneumatized and we cannot take a broad view of the chest cavity. As for surgeons, the prediction of lung prolapse is valuable for surgical manipulations. We estimated the degree of the collapsed lung ten minutes after thoracotomy (collapsed lung index; CLI). We also evaluated the relationship between CLI and pre-operative pulmonary function test.
Method:
From December 2016 to June 2017, we included 38 patients undergoing video-assisted thoracoscopic surgery (VATS) without pleural adhesion. CLI was determined as the degree of collapse of the lung ten minutes after opening the first thoracic port. CLI definition was as follows; Grade 1: the distance between visceral pleura and chest wall was less than 1cm, Grade 2: the distance was less than 3cm, Grade 3: the distance was less than 5cm, Grade 4: the distance was more than 5 cm and the lung parenchyma was partially deflated, and Grade 5: the lung was completely collapsed. We also checked the relationship between CLI and pre-operative pulmonary function test of the patients.
Result:
The patients are 47 years old to 83 years old. They consist of 25 males and 13 females. The numbers of CLI Grade 1 were 0 cases, Grade 2 were 4 cases, Grade 3 were 18 cases, Grade 4 were 14 cases, and Grade 5 were 2 cases. VATS were easily undergone with broad surgical view Grade 4 and Grade 5. The 42% of the cases are included in CLI Grade 4 and Grade 5. The mean value of %VC was 102.6 %, FEV1.0G was 76.8 %, and FEV1.0% was 100.3 % in Grade 4 and Grade 5 patients. The preoperative pulmonary function tests were better in Grade 4 and 5 than the other Grades.
Conclusion:
We proposed CLI to estimate the surgical views at the beginning of VATS. The preoperative pulmonary function will predict the surgical field. We are waiting for some methods to deflate the lung in CLI Grade 1, 2, and 3 to Grade 4 or 5. The complete collapsed lung should make a good contribution for Single port VATS.
