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T. Ohira
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ES 05 - Surgical Skills (ID 514)
- Event: WCLC 2017
- Type: Educational Session
- Track: Surgery
- Presentations: 1
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ES 05.03 - Management of Early Stage Lung Cancer (ID 7601)
15:45 - 17:30 | Author(s): T. Ohira
- Abstract
- Presentation
Abstract:
In recent years, the number of early stage lung cancers has enormously increased mainly due to frequent use of chest CT in routine practice or screening purpose. Both curability and non-inavasiveness are required especially for such early disease. Increased number of VATS lobectomy and sublobar resection for selected patients is the international trend in such situation. Diagnosis: Retrospective data revealed that the sensitivity of conventional bronchoscopic examination for peripheral cancer < 2cm is only 34%. The combination of Virtual bronchoscopic navigation and EBUS guide-sheath has demonstrated the improved sensitivity, thus this new combination strategy should be necessary for differential diagnosis of small cancers detected by chest CT[1)]. Surgical procedure: A total of 38000 lung cancers were resected in Japan in 2013 and 70% of surgeries were video-assisted[2)]. Segmentectomy has been performed intentionally mainly for lung cancer 2cm or less in diameter. Several comparative studies between lobectomy and segmentectomy for tumors < 2cm showed no significant difference in survival[3)]. Recently, segmentectomy is selected based on the size and high resolution CT (HRCT) findings of the tumor. The proportion of consolidation diameter to tumor diameter correlates with biological malignancy and the establishment of robust image criteria predicting non-invasive cancer is desirable to find candidates for segmentectomy. The Japan Clinical Oncology Group (JCOG) conducted a prospective study to recognize the relationship between HRCT finding and pathological non-invasiveness in clicical stage IA cancer (JCOG0201)[4)]. This study revealed that adenocarcinoma <2.0 cm with <0.25 consolidation to the maximum tumor diameter showed pathological non-invasiveness in 98.7% and this criterion could be used to predict early lung cancer preoperatively[5)]. Based on the result of JCOG0201, two prospective studies were performed and finished recruitment, phase II trial of wide wedge resection for radiological non-invasive adenocarcinoma (tumor diameter 2cm or less and consolidationratio<0.25) (JCOG0804) and randomised phase III trial for radiological invasive adenocarcinoma (tumor diameter 2cm or less and consolidation ratio>0.25) to evaluate non-inferiority in OS of segmentectomy compared to lobectomy (JCOG0802)[6)]. The indication of segmentectomy will be demonstrated by the results of these studies. Clinical research: PET-CT has been routinely used for clinical staging and the standardized uptake value (SUV) of the main tumor is recognized to be as a predictor of the clinicopathological characteristics and prognosis. Analyses of 610 resected stage IA adecocarcinoma showed that maxSUV and GGO ratio cutoffs to predict recurrence were 2.9 and 25%, respectively. They were also related to nodal metastasis, histological tumor invasiveness and recurrence. The 5-year RFS of cases with maxSUV <2.9 (n=456) was 95%, while cases with maxSUV>2.9 (n=154), 72% (p<0.001)[7)]. Our result showed that maxSUV cutoff of possibility for recurrence was 2.6 in adenocarcinoma, which was also related to nodal metastasis and histological tumor invasiveness. The 3-year relapse-free survival was 99%/78% (maxSUV lower/higher than 2.6) and following multivariate analysis, pathological nodal status and SUVmax were found to be independent predictive factors for relapse-free survival. Surgical management of early stage lung cancer should be selected based on the tumor size and consolidation ratio on HRCT. The results of RCTs will demonstrate the indication of sublobar resection in near future. Further analysis is encouraged for the evaluation of biological aggressiveness in each case[8)]. References Asano F, Shinagawa N, Ishida T, et al. Virtual bronchoscopic navigation combined with ultrathin bronchoscopy. A randomized clinical trial. Am J Respir Crit Care Med 2013; 188:327-333 Committee for Scientific Affairs The Japanese Association for Thoracic Surgery, Thoracic and cardiovascular surgery in Japan during 2013 : Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg.2015;63:670-701. Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006; 132: 769-775 Suzuki K, Koike T, Asakawa T, et al.: A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol 2011;6:751-756 Asamura H, Hishida T, Suzuki K, et al. Radiographically determined noninvasive adenocarcinoma of the lung: Survival outcomes of Japan Clinical Oncology Group 0201 J Thorac Cardiovasc Surg 2013;146:24-30 Nakamura K, Saji H, Nakajima R, et.al. A Phase III Randomized Trial of Lobectomy Versus Limited Resection for Small-sized Peripheral Non-small Cell Lung Cancer (JCOG0802/WJOG4607L) Jpn J Clin Oncol 2010;40:271–274 Uehara H, Tsutani Y, Okumura S, et al. Prognostic Role of Positron Emission Tomographyand High-Resolution Computed Tomography in Clinical Stage IA Lung Adenocarcinoma Ann Thorac Surg 2013;96:1958–1965 Tsutani Y, Miyata Y, Nakayama H,et al.. Sublobar resection for lung adenocarcinoma meeting node-negative criteria on preoperative imaging. The Annals of thoracic surgery. 2014;97:1701-1707
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P1.01 - Advanced NSCLC (ID 757)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.01-041 - Role of Re-Biopsy During Disease Progression Non-Small Cell Lung Cancer for Acquired Resistance Analysis and Directing Oncology Treatments (ID 10340)
09:30 - 16:00 | Author(s): T. Ohira
- Abstract
Background:
It is not possible to properly target treatments in cases of relapse without knowing the nature of new lesions. Third-generation epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) can overcome T790M-mediated resistance in non-small-cell lung cancer (NSCLC). But the re-biopsy to confirm T790M status is occasionally difficult. In Japan, transbronchial lung tissue biopsy (TBLB / TBB) is the most common sampling method used for re-biopsy to confirm patients eligible for treatment. We aimed to investigate the success rate of re-biopsy and re-biopsy status of patients with advanced or metastatic NSCLC completing either 1st line chemotherapy or EGFR-TKI therapy.
Method:
We initially screened 39 consecutive patients with NSCLC harboring EGFR-sensitive mutations who had experienced PD after any chemotherapy at Tokyo Medical University Hospital January 2014 and December 2016.
Result:
38 patients who had experienced PD after EGFR-TKI treatment were eligible. Among 30 patients, tumor progression sites included 3 pleural effusion, 9 thoracic primary/metastatic lesions, 2 hepatic metastases, 15 lymph node metastases. Of the 38 patients, 47.3% underwent rebiopsy sucessfully. Of the 38 biopsied patients, 18 (47.3%) were analyzed for EGFR mutation, using tissue or cytology samples; T790M mutations were identified in 10 (55%) of the 18 patients. Of the 38 biopsied patients, 18 (47.3%) were analyzed for EGFR mutation, using tissue or cytology samples; T790M mutations were identified in 10 (55%) of the 18 patients.
Conclusion:
Most re-biopsy samples were diagnosed with malignancy. T790M mutations were identified as much as same in previous studies. However, tissue samples were less available in previous studies. Skill and experience with re-biopsy and noninvasive alternative methods will be increasingly important.
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P1.07 - Immunology and Immunotherapy (ID 693)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.07-012 - Prediction Sensitivity of PD-1 Checkpoint Blockade Using Pathological Tissues Specimens by Novel Computerized Analysis System (ID 8851)
09:30 - 16:00 | Author(s): T. Ohira
- Abstract
Background:
Recent development of immune checkpoint blockade such as anti-PD-1 antibody brought great benefits to non-small cell lung cancer (NSCLC) patients. However, some population of NSCLC showed resistance and pseudo-progressions against anti-PD-1 checkpoint blockade. Thus, it is very important for developing biomarkers which predict of efficacy of PD-1 checkpoint blockade. In this background, we developed novel digital pathology system that predict for response to anti-PD-1 checkpoint blockade using H&E staining sections and technology of AI.
Method:
In this study, we extract 361 ROIs(Region of Interest) and 254,205 nuclei were measured from NSCLC cases that treated with anti-PD-1 antibody. We used ilastik for nuclei image segmentation, CellProfiler and our CFLCM tool for features measurement, 992 features are evaluated for each ROI. At first, we analyzed by step-wise discriminant analysis for select the effective features, and using canonical discriminant analysis and SVM (Support vector Machine) RBF kernel model discrimination, we analyzed morphological data based PD-1 blockade response on statistical platform R.
Result:
Except undeterminable cases, we got the more than 95% accuracy level discrimination results. The mapping the discriminant scores, SD cases were mapped in the middle of PR and PD. Only using the average and standard deviation of ROIs’ nuclei shape features (size, roundness, perimeter, etc.) and inside nuclei features (mainly chromatin texture) more than 90% discrimination results were obtained. This means the nuclei morphological data is more important than CFLCM (pleomorphism and heterogeneity measurement data). We challenged the prediction for undeterminable cases by using canonical discriminant and SVM.
Conclusion:
This time analysis is small number samples, so the results application robustness may be limited. But our results show the possibility for clinical response prediction even on the pre-treatment pathological tissues specimens.
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P1.16 - Surgery (ID 702)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.16-010 - Development of a Novel Surgical Marking Method Using Low Power Laser Light (ID 8992)
09:30 - 16:00 | Author(s): T. Ohira
- Abstract
Background:
Small lung nodules which appear to be ground glass opacity in peripheral lung are difficult to identify during surgery. In order to identify the site of such lesions, various types of preoperative or intraoperative marking methods have been reported. However all of them have advantages and disadvantages, so there is no definitive way. Therefore, we developed a new safe and reliable intraoperative marking method using a thin laser fiber. This is a method to confirm a low power laser light from lung surface irradiated from a small diameter laser fiber inserted into or close to the lesion transbronchoscopically using a navigation system. In this study, we conducted an animal experiment to confirm whether the laser light can actually be observed safely from lung surface.
Method:
Bronchoscopy was performed to a hybrid dog under general anesthesia. A plastic laser probe was inserted into a peripheral bronchus from the biopsy channel of the bronchoscope. The plastic laser probe was a very thin (0.8 mm diameter) and flexible cylindrical-type probe. Therefore, it can be inserted into the peripheral lung. It was developed jointly with Keio University. The probe was induced just below the pleura and 50 mW low power laser irradiation was performed. We examined whether laser light could be confirmed from lung surface under thoracotomy. We also examined the difference in appearance from direct-type laser irradiation.
Result:
When the probe was guided to just below the pleura, laser light could be clearly observed from the lung surface. After that, the probe was gradually withdrawn. The laser light could be observed until the depth of 2.0 cm from the pleura. Moreover, laser irradiation was able to be performed safely without any damage around the laser irradiated area. The laser light was observed consistent with laser irradiation site by the cylindrical probe. On the other hands, it was observed on the pleura ahead of laser irradiation by the direct-type probe. Therefore, it is suggested that cylindrical probe might indicate the target area more accuracy.
Conclusion:
It might be possible to confirm the localization of small nodules in peripheral lung using low power laser light during surgery.
