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J. Xu
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ESMO-IASLC Best Abstracts (ID 61)
- Event: ELCC 2018
- Type: Best Abstract session
- Track:
- Presentations: 1
- Moderators:M. Perol, L. Paz-Ares
- Coordinates: 4/13/2018, 16:45 - 18:30, Room B
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91O - Adjuvant chemotherapy candidates in stage I lung adenocarcinomas following complete lobectomy: What does an analysis based on recurrence risk stratification tell us? (ID 435)
16:45 - 18:30 | Author(s): J. Xu
- Abstract
- Presentation
Background:
The study aimed to (i) develop a recurrence risk-scoring model in stage I lung adenocarcinoma (LAD) after complete lobectormy; (ii) explore the high-risk population that would benefit from adjuvant chemotherapy (ACT).
Methods:
A retrospective study was performed on 4606 patients with pathologically confirmed stage I LAD who underwent complete lobectomy at Shanghai Chest Hospital from 2008 to 2014. Patients were categorized into the non-ACT group (n = 3514) and ACT group (n = 1092). The nomogram was developed in the non-ACT group using Cox proportional hazards regression to predict 5-year recurrence-free survival (RFS). The predictive value was compared between the nomogram and the 8[th] edition of TNM system. The population that benefited from ACT was determined by comparing RFS between the non-ACT and the ACT group as stratified by the TNM stage, risk score quartiles and 5-year recurrence probability, respectively. The optimal cut-off scores were determined using X-tile software.
Results:
Six independent predictors including age, gender, tumor size, pathological subtype, visceral pleural invasion (VPI), and lymphovascular invasion (LVI) were associated with recurrence. The nomogram showed a better accuracy in predicting RFS than the TNM staging [C-index: 0.784 (95% CI: 0.756–0.812) vs 0.719 (95% CI: 0.689–0.749), P = 0.0017]. A trend in ACT benefit was observed along with the increasing risk scores. An improved RFS was exhibited after ACT for patients having a 50% recurrence probability (P = 0.0286). The optimal cut-off of the risk score was set at 203 and 244. ACT was detrimental in patients with risk scores below 203 (P < 0.0001) and beneficial in those with risk scores above 245 (P = 0.0416). Patients with score ≥ 245 accounted for 0.4% of stage IA patients and 7.5% of stage IB patients, respectively. In stage IB, patients with predominant solid/micropapillary subtype (62.8%) was the subgroup with the most percentage of score ≥ 245.
Conclusions:
The nomogram provided a more accurate RFS prediction for lobectomized stage I LAD. High-risk population, determined as recurrence risk score ≥ 245, may benefit from postoperative ACT.
Clinical trial identification:
Legal entity responsible for the study:
Shanghai Chest Hospital, Shanghai Jiao Tong University, China
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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Poster Display session (Friday) (ID 65)
- Event: ELCC 2018
- Type: Poster Display session
- Track:
- Presentations: 4
- Moderators:
- Coordinates: 4/13/2018, 12:30 - 13:00, Hall 1
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100P - Prognostic factors in surgically resected N2 small cell lung cancer: Significance of the subcarinal node (ID 316)
12:30 - 13:00 | Author(s): J. Xu
- Abstract
Background:
Surgical resection is being increasingly used for stage IIIA-N2 small cell lung cancer (SCLC). The aim of this study was to determine the prognostic factors in patients with pathologic N2 (pN2) stage IIIA SCLC.
Methods:
A retrospective analysis of 163 consecutive patients with pN2 stage IIIA SCLC who underwent pulmonary resections and systemic lymphadenectomies was conducted. Potential clinicopathological factors that could influence OS were statistically analyzed. The prognostic significance was examined by Cox regression analysis.
Results:
The median overall survival (OS) was 10.6 months. Multiple-station lymph node metastasis indicated a poorer prognosis than single-station involvement (p = 0.003). With respect to the station of lymph node metastasis, the OS was only related to the involvement of the subcarinal node, regardless of tumor location (p < 0.05). Multivariate analysis showed two statistically significant risk factors for survival, including multiple-station lymph node and subcarinal node metastasis (hazard ratio [HR] = 1.76, 95% confidence interval [CI]:1.11–2.78, p = 0.015; HR = 1.61, 95% CI: 1.03–2.50, p = 0.036, respectively).
Conclusions:
We found multiple-station N2 metastases and subcarinal node involvement were independent prognostic factors for worse survival in pN2 stage IIIA SCLC patients, which may be helpful to identify a valid subpopulation of N2 patients who can benefit from surgical intervention and guide postoperative adjuvant therapy.
Clinical trial identification:
Legal entity responsible for the study:
Shanghai Chest Hospital
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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104P - Adjuvant chemotherapy may improve prognosis in surgically resected stage I NSCLC with lymphovascular invasion (ID 481)
12:30 - 13:00 | Author(s): J. Xu
- Abstract
Background:
The 8[th] edition of the TNM classification for non-small cell lung cancer (NSCLC) has recently been approved. Lymphovascular invasion (LVI) has been reported to be a strong risk factor for stage I patients. Meanwhile, the efficacy of adjuvant chemotherapy for surgically resected pathologic stage I NSCLC is controversial. This study aimed at exploring the association between adjuvant chemotherapy and survival in stage I NSCLC patients with LVI.
Methods:
A total of 2600 patients with stage I NSCLC treated in the Shanghai Chest Hospital (2008–2012) were included in the analysis, of which 221 were pathologically diagnosed with LVI. We divided these patients into an ACT (adjuvant-chemotherapy) group and a surgery alone group. By using the Kaplan–Meier method and Cox proportional hazard regression model, we explored whether lymphovascular invasion was a poor prognostic factor and the application of adjuvant chemotherapy could improve the prognosis.
Results:
For all stage I NSCLC patients, it was observed that patients with LVI had an unfavorable Lung-cancer specific survival (LCSS) (hazard ratio [HR]: 1.604; 95% confidence interval [CI]: 1.124–2.289; P = 0.009) and recurrence-free survival (RFS) (HR: 1.943; 95% CI: 1.491–2.532; P < 0.001). The presence of LVI was suspected to be correlated with larger tumor size, and adenocarcinoma. Analysis of 221 patients with LVI indicated an increased LCSS (HR: 0.31; 95% CI: 0.161–0.595; P < 0.001) and RFS (HR: 0.53; 95% CI: 0.530–0.286; P = 0.044) with adjuvant chemotherapy treatment. We saw significant differences in LCSS and RFS in patients treated with adjuvant chemotherapy with both stage IA and stage IB disease.
Conclusions:
For all stage I NSCLC patients, LVI was correlated with poorer prognosis, which was improved by adjuvant chemotherapy. Our preliminary study suggests that adjuvant chemotherapy might be an appropriate option for stage I NSCLC patients with LVI.
Clinical trial identification:
Legal entity responsible for the study:
Wang Shuyuan
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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106P - The value of adjuvant chemotherapy in patients with resected stage IB solid predominant and solid non-predominant lung adenocarcinoma (ID 472)
12:30 - 13:00 | Author(s): J. Xu
- Abstract
Background:
The adjuvant chemotherapy(ACT) of stage IB lung adenocarcinoma remain controversial, and solid ingredients were supposed to be connected to the poor survival. We are intended to explore the benefits adjuvant chemotherapy made on patients in IB with solid ingredients.
Methods:
a number of 334 completely resected patients with lung adenocarcinoma in stage IB from 2006 to 2015 were reviewed. All the pathological slides were evaluated with solid ingredients composed.
Results:
Our data showed that although disease-free survival (DFS)(p = 0.661) and overall survival (OS)(p = 0.130) were not significantly different in solid growth pattern with or without ACT, patients with solid predominant patterns tend to have longer DFS [hazard ratio (HR) 0.403, p = 0.021)]and OS (HR 0.286, p = 0.009) with ACT. In patients with solid non-predominant patterns, receiving ACT had little influence in DFS(p = 0.231) and OS (p = 0.611).
Conclusions:
the solid predominant pattern in postoperative patients of stage IB could benefit from adjuvant, and solid non-predominant pattern couldn't.
Clinical trial identification:
Legal entity responsible for the study:
Shanghai chest hospital
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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167P - Efficacy of pemetrexed-based chemotherapy in advanced lung adenocarcinoma patients with ROS-1 rearrangement (ID 413)
12:30 - 13:00 | Author(s): J. Xu
- Abstract
Background:
When chemotherapy is commenced as first-line treatment in advanced lung adenocarcinoma patients with ROS-1 rearrangement, it is unclear that which agent should be preferentially administered. The aim of this study is to compare the therapeutic efficacy of pemetrexed-containing (Pem-C) and non-pemetrexed-containing (Non-Pem-C) chemotherapy in these patients.
Methods:
We retrospectively identified patients who were demonstrated to be ROS-1 positive by multiplex reverse-transcriptase polymerase chain reaction (RT-PCR) between October 2014 and December 2016. Those who received platinum-based dual agent chemotherapy as palliative treatment were included for further analysis.
Results:
A total of 4596 consecutive individuals were screened and 55 eligible individuals were enrolled into this study. In first-line treatment, patients who received Pem-C treatment (n = 39) derived a higher objective response rate (ORR, 40.0% vs. 7.1%, P = 0.02) and progression-free survival (PFS1, 7.0 months vs. 3.9 months, P < 0.01) compared with those who received Non-Pem-C treatment (n = 16). However, in later-line treatment, progression-free survival (PFS2) was not statistically superior in the Pem-C group (3.1 months, 95% CI: 0.6–5.6 months) compared with the Non-Pem-C group (1.9 months, 95% CI: 0.1–3.1 months, P = 0.12).
Conclusions:
Pem-C treatment resulted in better clinical outcomes compared with other agents in patients with ROS-1 rearrangement when initiated as first-line treatment.
Clinical trial identification:
Legal entity responsible for the study:
Bo Zhang
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
