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Y. Matsuura
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P1.13 - Radiology/Staging/Screening (ID 699)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.13-005 - Is Tumor Size for the T4 Descriptor in Lung Cancer Staging Appropriate? (ID 8085)
09:30 - 16:00 | Author(s): Y. Matsuura
- Abstract
Background:
According to the 8th Edition of the TNM Classification of Lung Cancer, a tumor of >7 cm in diameter is upstaged to T4 from T3 based on the prognostic analysis of patients with pT1–4N0M0R0. However, there are two major problems with this classification. The first is selection bias; very few patients with non-size-based T4 undergo resection, whereas most patients with large tumors have surgery. The second is a diagnostic problem. Additional tumor nodules in a different ipsilateral lobe (pm2) are also T4 descriptors; however, multiple primary lung cancers may be misdiagnosed as T4 lung cancer with intrapulmonary metastasis.
Method:
A total of 378 patients with pT3–4N0–1M0 (according to the new classification) underwent complete or incomplete resection from 1992 to 2011. T4 was subdivided into invT4 (local invasion), multiple-pmT4 (pm2 with multiple nodules), single-pmT4 (single pm2), and sizeT4 (>7 cm).
Result:
The number of patients with invT4/multiple-pmT4/single-pmT4/sizeT4/T3 was 13/12/9/61/283; 5-year overall survival (OS) was 23%/25%/67%/46%/64%; and 5-year disease-free survival (DFS) was 15%/17%/67%/39%/55%, respectively. Patients with invT4 and multiple-pmT4 had poorer prognosis than those with sizeT4 in multivariate analysis (OS, hazard ratio = 2.6, p < 0.05; DFS, hazard ratio = 3.2, p < 0.01). Figure 1
Conclusion:
The extremely favorable outcome of single-pmT4 suggests the possibility of it being mixed up with multiple primary cancers. Non-size-based T4 patients had poorer prognosis than did sizeT4 patients even in surgical candidates, and the outcome of non-surgically treated patients seemed still worse. Tumors of >7 cm in diameter should not be treated the same as a non-size-based T4 and should be reclassified as T3b.
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P3.13 - Radiology/Staging/Screening (ID 729)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.13-009 - Rapid Detection of Lung Cancer by Fluorescent Imaging using a γ-Glutamyltranspeptidase-activatable Fluorescent Probe (ID 8326)
09:30 - 16:00 | Author(s): Y. Matsuura
- Abstract
Background:
Visualizing the spread of cancer cells in lung cancer surgery is sometimes difficult. γ-Glutamyl-transpeptidase (GGT) is a cell surface-associated enzyme that is overexpressed in various type of human cancers. γ-Glutamyl hydroxymethyl rhodamine green (gGlu-HMRG), an activatable fluorescent probe, is non-fluorescent under a neutral pH and normal cellular environment. However, it becomes highly fluorescent upon reaction with GGT. We evaluated ex vivo fluorescent imaging of lung cancers using the GGT-activatable fluorescent probe.
Method:
Between April 2011 to November 2014, 116 resected cancer cells (91 primary lung cancers, 21 pulmonary metastases, and 4 pleural disseminations) were prospectively included in this study. Each tumor was analyzed by first taking a baseline image before gGlu-HMRG was sprayed onto the freshly resected specimen (termed N0; fluorescent intensity of normal lung, T0; that of lung cancer), and then by taking fluorescent images 30 min after spraying (N30 and T30) with the Maestro In-vivo imaging system (PerkinElmer Inc.). Positive fluorescent activity was defined as follows: in cases where fluorescence was observed only in tumor tissues, ΔN(=N30-N0) < 0 and ΔT(=T30-T0) < 0, in cases where fluorescence was observed in both normal and tumor tissues, ΔN > 0 and ΔT/ΔN > 1.
Result:
Figure 1In primary lung cancer, 61 of 91 (67%) cases rapidly developed fluorescent activity. In cases with pulmonary metastases, 15 of 21 (71.4%) cases showed positive fluorescent activity. Four disseminated pleural nodules all showed positive fluorescent activity (100%). Age, gender, tumor size, tumor marker, histology (adenocarcinoma (Ad) vs. non-Ad, squamous cell carcinoma (Sq) vs. non-Sq), pleural invasion, and angio-lymphatic invasion were not significant factors influencing fluorescent intensity.
Conclusion:
Fluorescence imaging with gGlu-HMRG may become one of the most powerful tools for accurate staging by rapidly detecting cancer cells and thus become highly useful for cancer resection.
