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David R. Jones
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MA01 - Early Stage Lung Cancer: Questions and Controversies (ID 894)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 10:30 - 12:00, Room 202 BD
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MA01.02 - Histologic Subtyping in Pathologic Stage I Lung Adenocarcinoma Provides Risk-Based Stratification for Surveillance (ID 13400)
10:35 - 10:40 | Author(s): David R. Jones
- Abstract
- Presentation
Background
Current national practice guidelines (NCCN, ACCP, ESMO) recommend a uniform follow-up protocol with intensive surveillance within the first two years following lung resection for stage I NSCLC. We hypothesize that the recurrence hazard following lung resection for stage I lung adenocarcinoma (ADC) varies according to histologic subtype.
a9ded1e5ce5d75814730bb4caaf49419 Method
A total of 1572 patients with resected pathologic stage I lung ADC were investigated. Two thoracic pathologists reviewed all tumor H&E slides (range 1-8, median 3) for histologic subtyping and percentage of each subtype. Recurrence hazard was estimated using the Kernel-Epanechnikov smoothing procedure. Association between recurrence hazard and high-grade histologic subtypes (micropapillary [MIP] and solid [SOL]) was assessed.
4c3880bb027f159e801041b1021e88e8 Result
Presence (≥5%) of these high-grade subtypes (MIP and/or SOL) was associated with significant increase of recurrence hazard compared to high-grade pattern negative (<5%) tumors (Figure): 1) patients with presence of either MIP or SOL had significant recurrence hazard peaks within two years after surgery; 2) SOL was associated with early hazard peak at the first year after surgery especially in distant recurrence hazard; 4) one-third of patients (515/1572, 33%) had no high-grade subtypes, in which the recurrence hazard was consistently very low (<2% risk each year) during the 10-year period after surgery without any hazard peak (red arrow).
8eea62084ca7e541d918e823422bd82e Conclusion
Our data suggest the utility of histologic subtyping for identifying patients with very low recurrence hazard, and provide foundation for establishing risk-based follow-up protocols. A potential option for low-risk patients may be omission of intensive follow-up during the first two years after surgery.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MA05 - Improving Outcomes in Locoregional NSCLC II (ID 901)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 13:30 - 15:00, Room 105
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MA05.03 - Immune Microenvironment and its Association with Adjuvant Chemotherapy Benefit in Locoregionally Advanced Lung Adenocarcinoma (ID 12999)
13:40 - 13:45 | Author(s): David R. Jones
- Abstract
- Presentation
Background
The impact of the tumor immune microenvironment on the effectiveness of platinum-based adjuvant chemotherapy (ACT) in locoregionally advanced (stage II-III) lung adenocarcinoma (ADC) is unknown. We performed an analysis of the cellular components of the tumoral and tumor-associated stromal immune environment in stage II-III lung ADC and examined their association with ACT benefit.
a9ded1e5ce5d75814730bb4caaf49419 Method
Tissue microarrays (6 tumor and 3 stromal cores from each tumor) were constructed using resected tissue from patients with pT2-T4N1 lung ADC (n=500, 2000-2012) who did (n=225) and did not (n=214) receive ACT. Multiplex immunofluorescence was used to determine the quantity, localization, and colocalization of 21 types of immune cells and markers (including PD-1, PD-L1, CD3, CD20, CD68, CD163, MPO, and PanCK). The association between immune cell infiltration and recurrence free probability (RFP) was compared using Kaplan-Meier methods, and benefit from ACT by unsupervised hierarchical cluster modeling.
4c3880bb027f159e801041b1021e88e8 Result
Overall, increased tumoral infiltration of CD20+ B-cells and CD3+ and CD4+ T-cells was associated with an improvement in 5-yr RFP (CD20+ low vs high: 37% vs 49%, p=.03; CD3+: 39% vs 48%, p=.003; and CD4+: 39% vs 47%, p=.02, respectively) whereas increased stromal MPO+ neutrophil infiltration was associated with a worse 5-yr RFP (low vs high: 50% vs 38%, p=.003). Among patients who received ACT, cluster modeling revealed 5 risk groups (Groups A-E; Figure) with immune signatures including tumoral B-cells and CD163+PD-1+ macrophages as well as stromal CD57+ NK-cells and CD163+PD-L1+ macrophages that provided a progressive stratification of RFP following adjuvant treatment.
8eea62084ca7e541d918e823422bd82e Conclusion
Immune infiltration analysis can predict benefit from ACT and thereby provide a rationale to select patients for either chemotherapy, immunotherapy, or combination therapy following surgical resection.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.16-20 - A Systematic Review and Meta-Analysis of Stereotactic Body Radiation Therapy Versus Surgery for Patients with Non-Small Cell Lung Cancer (ID 11835)
16:45 - 18:00 | Author(s): David R. Jones
- Abstract
Background
Stereotactic body radiation therapy (SBRT) is the preferred treatment modality for patients with inoperable early-stage NSCLC. However, comparative outcomes of SBRT versus surgery for high-risk patients remain controversial. The primary aim of the present meta-analysis was to assess the overall survival of SBRT versus surgery in matched and unmatched patient cohorts. Secondary endpoints included cancer-specific survival, disease-free survival, disease recurrence, and perioperative outcomes.
a9ded1e5ce5d75814730bb4caaf49419 Method
A systematic review was performed through online databases using predefined criteria. The most updated studies were selected for meta-analysis according to unmatched and matched patient cohorts.
4c3880bb027f159e801041b1021e88e8 Result
Thirty-two studies were identified in the systematic review. Surgery was associated with superior overall survival in both unmatched (OR 2.49, 95% CI 2.10–2.94, p<0.00001) and matched (OR 1.71, 95% CI 1.52–1.93, p<0.00001) cohorts. Cancer-specific survival, disease-free survival, and freedom from locoregional recurrence were found to be superior after surgery compared to SBRT, in both unmatched and matched cohorts. However, SBRT was associated with fewer perioperative mortalities.
8eea62084ca7e541d918e823422bd82e Conclusion
Current evidence suggests that surgery is superior to SBRT in mid- and long-term clinical outcomes. However, improved outcomes after surgery may at least be in part due to an imbalance of baseline characteristics. Mortality outcomes for SBRT were also more favorable in the perioperative period.
6f8b794f3246b0c1e1780bb4d4d5dc53
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PC08 - The Great Oligometastatic Debates (ID 847)
- Event: WCLC 2018
- Type: Pro-Con Session
- Track: Oligometastatic NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 13:30 - 15:00, Room 105
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PC08.04 - Debate #2: Optimal Therapy for OM Disease: Thoracic Surgery Should Be the Treatment of Choice Whenever Possible (ID 11635)
14:00 - 14:10 | Presenting Author(s): David R. Jones
- Abstract
- Presentation
Abstract not provided
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