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Keisuke Asakura
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P1.05 - Early Stage NSCLC (ID 691)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 2
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.05-002 - Characteristics and Prognosis of Ground Glass Opacity Predominant Primary Lung Cancer Larger Than 3.0 Cm on Thin-Section Computed Tomography (ID 7396)
09:30 - 16:00 | Author(s): Keisuke Asakura
- Abstract
Background:
The solid component size of lung cancer showing ground glass opacity (GGO) on thin-section computed tomography (TSCT) has been regarded as a more important preoperative prognostic indicator than the whole tumor size. Moreover, previous study revealed that radiological early lung adenocarcinoma which has an excellent prognosis could be defined as an adenocarcinoma 3.0 cm or less with consolidation to tumor ratio (CTR) of 0.5 or less on TSCT. However, the characteristics and the prognosis of lung cancer larger than 3.0 cm showing GGO remain unclear.
Method:
From January 2002 through June 2012, we retrospectively reviewed 3,735 consecutive patients with primary lung cancer, which underwent complete resection at our institution. We extracted 686 (18.4%) patients with lung cancer larger than 3.0 cm in diameter and evaluated their preoperative TSCT findings. In total, 160 (4.3%) lung cancers larger than 3.0 cm showing GGO were eligible for this analysis. We divided the 160 lesions into three types based on CTR; type A: 0
Result:
Type A, type B, and type C were found in 16 (10%), 37 (23%), and 107 (67%) lesions, respectively. Regarding the operative mode, all patients except for two patients underwent lobectomy. All patients except for one patient was diagnosed as having adenocarcinoma. Lymph node metastasis was seen in none of types A and B, in 34 (32%) lesions of type C. Lymphovascular invasion was seen in 73(68%) lesions of type C, 6 (16%) lesions of type B but not in type A. The median follow-up period was 68 (2-162) months. Recurrence was not observed in patients with type A and type B. The 5-year overall survival (OS) and disease free survival (DFS) rates were both 100% in type A, both 97.2% in type B, and 88.4%, 66.7% in type C, respectively. Patients with type C had a significantly worse prognosis than did those with the other types with respect to OS (p = 0.033) and DFS (p < 0.001).
Conclusion:
Tumors with type A and type B on TSCT showed an excellent prognosis with no lymph node metastasis. Therefore, GGO predominant lung cancer could be considered “early” lung cancer even if tumor size was larger than 3.0 cm in diameter.
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P1.05-017 - Prognostic Significance of Preoperative Plasma D-Dimer Level in Patients with Surgically Resected Clinical Stage I Non-Small Cell Lung Cancer (ID 8091)
09:30 - 16:00 | Author(s): Keisuke Asakura
- Abstract
Background:
The plasma D-dimer (D-dimer) level, a marker of hypercoagulation, has been reported to be associated with survival in several types of cancers. The aim of this study was to evaluate the prognostic significance of the preoperative D-dimer level in patients with surgically resected clinical stage I non-small cell lung cancer (NSCLC).
Method:
A total of 237 surgically resected NSCLC patients were included in this study. In addition to age, sex, the smoking status, etc., the association between the preoperative D-dimer level and survival was explored.
Result:
The patients were divided into two groups according to the D-dimer level: group A (≤ 1.0 µg/ml, n = 170) and group B (> 1.0 µg/ml, n = 67). The 5-year overall survival rate was 89.0 % (95 % confidence interval [CI] 77.7–95.3) for group A, 78.2 % (95 % CI 62.3–83.6) for group B (p = 0.015). A multivariate survival analysis showed that the D-dimer level was an independent significant prognostic factor, in addition to age and SUVmax of the tumor.
Conclusion:
The preoperative D-dimer level is an independent prognostic factor in patients with surgically resected clinical stage I NSCLC.
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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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P3.16-025 - Tumor Doubling Time Is the Most Important Predictor of Survival and Pathological Diagnosis in Metachronous Lung Cancer (ID 9101)
09:30 - 16:00 | Presenting Author(s): Keisuke Asakura
- Abstract
Background:
Good prognosis following surgery for metachronous second primary lung cancer has been reported. However, distinguishing pulmonary metastasis from metachronous second primary lung cancer is difficult.
Method:
Patients who underwent multiple pulmonary resections for metachronous lung cancer at our institution between 2000 and 2014 were retrospectively analyzed. Metachronous lung cancer was defined as non-small cell cancer regardless of disease-free interval or histologic concordance.
Result:
The retrospective chart review identified 86 patients. The median patient age at the time of second resection was 72 years, and 53 out of 86 patients (62%) were male. The median time interval between first and second resection was 1540 days. The mean tumor size was 19 ± 8 mm, the mean tumor doubling time was 316 ± 305 days, and 71 out of 86 patients (83%) had concordant histology. Upon postoperative pathological examination, the metachronous lung cancer was diagnosed as second primary lung cancer in 72 patients (84%), and pulmonary metastasis in 4 patients (5%). In the remaining 10 patients (12%), second primary lung cancer was indistinguishable from pulmonary metastasis. In second primary lung cancer, pulmonary metastasis, and indistinguishable tumors, the 5-year overall survival rates were 82%, 50%, and 53%, respectively. Factors significantly associated with improved overall survival included: tumor doubling time >180 days; pathological diagnosis of second primary lung cancer; pathological stage IA; >2 year interval between first and second surgery; and a consolidation/tumor ratio of ≤0.5. A tumor doubling time of >180 days was significantly associated with pathological diagnosis of second primary lung cancer. Using multivariate analysis, we also found that tumor doubling time >180 days was the only independent predictor of superior overall survival.
Conclusion:
This study found that tumor doubling time is the most important preoperative predictor of survival and pathological diagnosis of second primary lung cancer in metachronous lung cancer. The classic criteria for the diagnosis of a metachronous primary lung cancer were defined by Martini and Melamed. A tumor was considered to be metachronous primary lung cancer if the histologic type was discordant, or if the disease-free interval was at least 2 years for tumors with a histologic type similar to that of the primary cancer. However, due to the rising incidence of adenocarcinoma, earlier detection by computed tomography, and later recurrence due to adjuvant chemotherapy, Martini and Melamed’s criteria should be modified. We propose that tumor doubling time of >180 days should be a new criterion among Martini and Melamed’s criteria.
