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Takuya Nagashima
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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: 3
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.05-011 - Comparison of Tumor Measurement Methods in Patients with Clinical Stage IA Non-Small Cell Lung Cancer (ID 10018)
09:30 - 16:00 | Presenting Author(s): Takuya Nagashima
- Abstract
Background:
The consolidation size of tumor in early lung cancer is related to prognosis. However, the tumor area and volume can show the amount of tumor more precisely. The purpose of this study was to compare the prognostic impact of the tumor size, the area, and the volume in whole tumor and consolidation of it.
Method:
We retrospectively reviewed the clinicopathological characteristics of 160 patients with clinical stage IA NSCLC who received curative pulmonary lobectomy and mediastinal lymph node dissection between January 2008 and June 2011. We measured the size, the area and the volume in whole tumor and consolidation part respectively by using the volume analyzer SYNAPSE VINCENT by Fujifilm. We evaluated the relationships between these measurement methods and pathological upstage, tumor recurrence with receiver operating characteristics curve.
Result:
The median duration of follow up was 64.9 months. Thirty four percent of patients (n=55) were pathologically upstaged. Twenty three patients developed recurrence (14%). The mean whole tumor size, the area and the volume were 21 mm, 264 mm[2], 3741 mm[3], respectively. The mean consolidation tumor size, the area and the volume were 17 mm, 156 mm[2], 1861 mm[3], respectively. The receiver operating area under the curve for the consolidation tumor size, the area, and the volume used to predicting pathological upstage were 0.686, 0.692 and 0.687 respectively, and they all had significant correlations. The receiver operating area under the curve for the consolidation tumor size, the area, and the volume used to predicting tumor recurrence were 0.626, 0.649 and 0.623 respectively. The tumor area had significant correlation and the others had marginally significant correlations. On the other hand, there was no significant correlation between the whole tumor measurements and either pathological upstage or tumor recurrence.
Conclusion:
Each measurement method in consolidation of the tumor can be useful for predicting prognosis.
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P1.05-018 - Prognostic Impact of Tumor Shadow Disappearance Rate in Patients with Clinical IA Lung Adenocarcinoma (ID 8092)
09:30 - 16:00 | Author(s): Takuya Nagashima
- Abstract
Background:
The aim of this study was to clarify whether tumor shadow disappearance rate (TDR) or consolidation to tumor diameter ratio (CTR) predict outcomes in patients with clinical stage IA lung adenocarcinoma.
Method:
We reviewed 250 patients with completely resected clinical stage IA lung adenocarcinoma between 2007 and 2014 and examined the prognostic impact of TDR and CTR. We classified all tumors into each two groups based on the TDR and CTR on high-resolution computed tomography: TDR >50% (Group A, n=77), TDR ≤50% (Group B, n=173), CTR <0.5 (Group C, n=33), and CTR ≥0.5 (Group D, n=217). TDR and CTR were calculated using the following formulas: TDR = 100 – (tumor size on mediastinal window/tumor size on lung window) ´ 100 and CTR = maximum diameter of consolidation/maximum tumor diameter.
Result:
The study group comprised 117 men (47%) and 133 women (53%), with a median age of 66 years (range, 36-83 years). The median follow-up was 50 months (range, 1 to 110 months). The disease-free survival rate at 5 years was 100%, 78.2%, 100%, and 82.5% in Groups A, B, C, and D, respectively. The lung cancer-specific survival rate at 5 years was 100%, 94.8%, 100%, and 95.9% in Groups A, B, C, and D, respectively. Multivariate analysis showed that the following factors were significant predictors of recurrence: lymph-node metastasis, lymphatic vessel invasion, blood vessel invasion, and TDR (TDR: hazard ratio=3.61, 95% confidence interval: 1.01-12.8, p=0.048). On the other hand, multivariate analysis revealed that lymph-node metastasis and TDR were significant predictors of lung cancer-specific mortality (TDR: hazard ratio=23.85, 95% confidence interval: 1.22-466.5, p=0.037).
Conclusion:
TDR is a significant predictor of not only recurrence but also lung cancer-specific mortality in patients with clinical stage IA lung adenocarcinoma.
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P1.05-021 - Are Prognostic Factors Different from That Which Predicts Recurrence in Completely Resected Pathological Stage IB Adenocarcinoma? (ID 9747)
09:30 - 16:00 | Author(s): Takuya Nagashima
- Abstract
Background:
The 5-year survival rate of pathologic stage IB stage lung adenocarcinoma is reported to be 73%, and adjuvant chemotherapy is expected to improve prognosis about 10%. In Japan, UFT is the standard regimen as adjuvant chemotherapy for completely resected pathological stage IB. In addition to conventional clinicopathological factors, adenocarcinoma tissue subtype, EGFR mutation status and maxSUV of primary tumor like have also been found to have a large Impact as a recurrence / prognostic predictor. The purpose of this study is to investigate the factors which affect recurrence and prognosis in stage IB lung adenocarcinoma．
Method:
From 2008 to 2015 lung, completely resected 218 cases that undergo lobectomy with mediastinal lymph node dissection and diagnosed as pathological stage IB (7th UICC) . We examined the relationship between clinical pathologic factors including postoperative adjuvant therapy and, recurrence and prognosis.
Result:
Median follow-up period was 45.4 months. There were 122 male and 96 female. Mean age was 69.4 years old, BMI 22.2, smoking 122 cases (56.0%). CEA elevation was noted in 63 cases (28.9%). Median value of max SUV was 2.96. Median operative time was 166 minutes and blood loss was 45.7 g. Histological adenocarcinoma subtypes were followed; MIA 6, Lepidic 62, Acinar 79, Papillary 27, Solid 40 and Micopapillary 4. Lymph vessel invasion was noted in 35 (16.0%) and vascular vessel invasion was in 72 (33.0%) and pleural invasion was in102(46.8%), EGFR mutation was noted in 62 among 150 examined cases (41.3%)． Mean tumor diameter was 3.33 cm, collapse-fibrosis size was 2.18 cm. Adjuvant chemotherapy was performed in 90 cases (41.3%). The relapse-free survival rate (RFS) at 5-year was 77.1%, the factors influencing RFS were lymph vessel invasion, vascular vessel invasion, pleural invasion, histological adenocarcinoma subtypes, blood loss and maxSUV. In multivariate analysis, RFS was significantly affected by pleural invasion (HR=3.141 (95% CI 1.122 - 8.798)), blood loss (HR = 1.004 (1.000 - 1.007)) and maxSUV (HR = 1.083 (1.004 - 1.169)). However, the presence or absence of EGFR mutation did not contribute to relapse (p = 0.208). The overall survival rate (OS) at 5-year was 88.3%, the histological subtype and BMI statistically affected OS. In multivariate analysis, only histological subtype (lepidic vs. non-lepidic) (HR = 4.710 (95% CI = 1.097-20.218) was left, it was an independent prognostic factor. After matching the distribution of histological subtype to examine the effect of adjuvant chemotherapy, but no significant difference was observed. On the other hand, when focusing on prognosis based on the presence or absence of EGRF mutation in recurred cases (35 cases), the 5-year OS was 58.8% in wild type and 90.0% in mutant; it was not statistically significant difference (p = 0.165), but the mutant case seemed to have a high probability of long-term survival after relapse.
Conclusion:
Factors that contribute to recurrence were pathological malignancy (vascular invasion, histological subtype) and biological malignancy (high value of maxSUV). On the other hand, only histological subtypes contributed to prognosis. In addition, lepidic predominant was almost free from relapse and survived. Even if lepidic subtype was excluded, the effect of adjuvant UFT administration was not observed. Cytotoxic agent or EGFR-TKI should be examined in the future. On the other hand, the presence or absence of EGFR mutation seems to be an important OS predictor after recurrence.
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P2.17 - Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies (ID 718)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.17-003 - Is Complete Resection Mandatory for Mediastinal Germ Cell Tumor Which Shows Severe Adhesion to Greater Vessels? (ID 9748)
09:30 - 16:00 | Author(s): Takuya Nagashima
- Abstract
Background:
Surgical resection for mediastinal germ cell tumors is one of important modality to cure. But it sometimes shows severe adhesion to greater vessels, complete resection without vessel replacement is difficult. But, no viable cells are found in the resected specimen in many cases. Is vessel replacement really needed for this situation? The aim of this study is to confirm whether complete resection is really needed for mediastinal germ cell tumor.
Method:
The data of 13 patients with resected mediastinal germ cell tumor were retrospectively analyzed for recurrence.
Result:
Median follow up period was 72.2 months. All cases were male. Mean age was 33.1 years old. Pathological diagnosis was mature teratoma in 5 cases, seminoma in 5 and non-seminomatous malignant germ cell tumor in 3. Seven cases received preoperative chemotherapy. Mean tumor size before surgery was 7.1cm. Median sternotomy was performed in 10 cases and posterolateral approach in 3 cases. Mean operative time was 225 minutes and blood loss was 228 g. Mean postoperative in-hospital duration was 8.2 days. There were not any life-threatening postoperative complications. Macroscopic residual tumor (R2) was found in 5 cases; 2 mature teratoma and 2 seminomas and a germ cell tumor because of severe adhesion to aorta. Four cases received adjuvant therapy. But in R2 case; 2 of mature teratoma and a seminoma without viable cell did not receive adjuvant therapy. Only a case of non-seminoma with complete resection, which did not achieve negative tumor marker preoperatively, showed distant metastases 4 months later after surgery.
Conclusion:
The surgery for mediastinal germ cell tumor in selected situation can show good survivability without recurrence. To balance the invasiveness and curability, minimizing the extent of surgery; not performing greater vessel replacement is one of choice.
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P3.15 - SCLC/Neuroendocrine Tumors (ID 731)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.15-012 - Surgical Outcome in Early Stage Small Cell Lung Cancer (ID 10501)
09:30 - 16:00 | Author(s): Takuya Nagashima
- Abstract
Background:
Chemo-radiation is considered to be the standard treatment for the management of limited disease of small cell lung cancer (SCLC). Even in this early stage, the role of surgery in SCLC is still controversial. We sought to examine the role of surgery; complete resection in terms of survival in SCLC.
Method:
A retrospective review was undertaken of patients who underwent surgery for SCLC between 2001 and 2015. Patients were staged according to the 7[th] edition of the Tumor, Node, Metastasis classification of lung cancer. Actuarial survival estimated with Kaplan Meier method and comparisons were undertaken using Cox regression hazard model. Clinicopathological factors and predictors of survival were analyzed.
Result:
We identified 49 patients who underwent complete resection. The mean follow up period was 1343 days. The mean age was 70.7 years. 40 patients were men and 9 were women. The number of patients of clinical stage was stage IA :21, IB: 15, IIA: 4, IIB: 6, IIIA:3. Operative procedure was lobectomy in 43, segmentectomy in 1, wedge resection in 5. The number of patients of pathological stage was stage IA :15, IB: 11, IIA: 14, IIB: 7, IIIA:2. Adjuvant chemotherapy was performed in 26 patients (53.1%). The 5-year overall survival (OS) rate in all patients was 58.8%. The 5-year OS was 61.3% in c-stage I, 54.5% in c-stage II, and 50% in c-stage III. The 5-year OS were 66.2% in p-stage I, 55.4% in p-stage II, and 50% in p-stage III. The 5-year OS of patients with adjuvant chemotherapy was significantly better than that of patients without adjuvant chemotherapy (77.8% vs. 39.8%, p=0.005). Multivariable Cox regression hazard model demonstrated that adjuvant chemotherapy was prognostic factor of overall survival (OS) (hazard ratio 0.255 (.095-.688), p=0.007)
Conclusion:
Surgical outcome for early stage SCLC was satisfied one. The role of surgery for this group seemed to be important. Adjuvant chemotherapy may improve prognosis and long-term survival will be expected.
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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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P3.16-047 - Salvage Surgery for Locoregional Recurrence or Persistent Residual Tumor After Definitive Chemoradiation Therapy (ID 9886)
09:30 - 16:00 | Author(s): Takuya Nagashima
- Abstract
Background:
There are few treatment options with curative intent for locoregional recurrence or residual tumor of locally advanced lung cancer after definitive chemoradiation therapy. Lung resection; salvage surgery is likely to be one of the options for local control in this situation. However, perioperative complications and survival benefit of salvage surgery are not well-reported.
Method:
Patients who underwent lung resection after definitive chemoradiation therapy for the treatment of non-small cell lung cancer were selected. Frequency and content of perioperative complications, 5-y overall survival rate and disease free survival rate were retrospectively analyzed.
Result:
A total of 13 patients treated between January 2001 and December 2016 were eligible for evaluation. (12 men and 1 women, mean age 54 years, Median follow-up was 39.7 months.) The indication for surgery was primary tumor regrowth (69%) or tumor persistence (31%). The prior median radiation therapy dose was 60Gy (range 60-77Gy). The indication of for surgery were primary tumor regrowth (8 patients)or tumor persistence(5 patients). All patients underwent an anatomical resection, surgical procedure included lobectomy in 10 patients, pneumonectomy in 2 patients, bilobectomy in 1 patients. 2 patients underwent a bronchoplasty. Median estimated blood loss was 247ml, and median operative duration was 278 min. Compared with anatomical resection we usually perform, salvage surgery needs longer operative duration. Postoperative complications occurred in 4 patients(31%) without perioperative death within 90 days : arrhythmia, delayed pulmonary fistula, acute exacerbation of interstitial pneumonia and empyema. the 5-y overall survival and 5-y recurrence free survival rate were 73.3% and 55.0%,respectively.
Conclusion:
Salvage surgery for locoregional recurrence or residual tumor after definitive chemoradiotherapy was acceptable in safety. It should be considered as a treatment option for selected patients. However, the technique of salvage surgery is complicated, it needs an adequate experience.
