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Kenji Suzuki



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    MS10 - Part Solid Nodules, GGN and STAS (ID 789)

    • Event: WCLC 2018
    • Type: Mini Symposium
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 15:15 - 16:45, Room 206 F
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      MS10.05 - Should We Resect GGNs (ID 11444)

      16:15 - 16:30  |  Presenting Author(s): Kenji Suzuki

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P2.09 - Pathology (Not CME Accredited Session) (ID 958)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.09-25 - Abundant Tumor Promoting Stromal Cells in Lung Adenocarcinoma with Hypoxic Regions (ID 12409)

      16:45 - 18:00  |  Author(s): Kenji Suzuki

      • Abstract
      • Slides

      Background

      Carbonic anhydrase IX (CAIX) is a marker of hypoxia and its expression by cancer associated fibroblasts (CAFs) was reportedly associated with the poor prognosis of lung adenocarcinoma. This study aimed to characterize the hypoxic microenvironment containing CAIX (+) CAFs.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      First, we evaluated the clinicopathological significance of CAIX expression by CAFs in 3 cm and above lung adenocarcinoma (n = 188). We then compared the expressions of E-cadherin, ezrin, ALDH1, CD44, EGFR, HSF-1, Glut-1, and PD-L1 in cancer cells, as well as those of CD204 and podoplanin in stromal cells between CAIX (+) CAFs and CAIX (−) CAFs cases (n = 25, each).

      4c3880bb027f159e801041b1021e88e8 Result

      In total, 48 patients had CAIX (+) CAFs (26%). Multivariate analysis revealed that CAIX expression by CAFs could serve as an independent unfavorable prognostic factor for recurrence-free survival (p < 0.05). The staining score of hypoxia marker Glut-1 in cancer cells was significantly higher in cases with CAIX (+) CAFs than in those with CAIX (−) CAFs (median: 20 vs. 0, p < 0.01). In addition, the numbers of CD204 (+) tumor associated macrophages (TAMs) and podoplanin (+) CAFs were significantly higher in the CAIX (+) CAFs group than in the CAIX (−) CAFs group (TAMs: 31.5 vs. 17.0: p < 0.01, CAFs: 20 vs. 0: p < 0.05). The staining score of the other markers did not differ between the groups.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our results indicate that the presence of abundant tumor promoting stromal cells, CD204 (+) TAMs, and podoplanin (+) CAFs is characteristic of the tumor microenvironment containing CAIX (+) CAFs, which contributes to an increase in aggressive behavior in lung adenocarcinoma with hypoxic regions.

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    P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.17-14 - How Should Positive Margin for Bronchial Stumps (R1) Be Evaluated in Patients Undergoing Bronchoplasty for Lung Cancer? (ID 13637)

      16:45 - 18:00  |  Author(s): Kenji Suzuki

      • Abstract
      • Slides

      Background
      Bronchoplasty for lung cancer is a surgical procedure aimed at respiratory function preservation and curability. And it may be performed for tumors exposed in the respiratory tract or tumors with lymph node extranodal invasion. "Surgical margin positive for bronchial stump" in bronchoplasty surgery has both out-of-wall and carcinoma in situ (CIS), but the difference is not detailed. In this study, we clarify how to evaluate bronchial stump in bronchoplasty.
      a9ded1e5ce5d75814730bb4caaf49419 Method
      Of 2221 patients of resected lung cancer performed in our hospital from January 2002 to December 2015, 130 patients (5.8%) underwent pulmonary resection with bronchoplasty. The patient's background and its prognostic factors were examined by using Kaplan-Myer method. In addition, we examined details of microscopic residual disease (R1) of bronchial stump.
      4c3880bb027f159e801041b1021e88e8 Result
      There were 101 males and the median age of patients was 67 years old. 19 cases performed sleeve pneumonectomy and 18 cases performed extended sleeve lobectomy. There were 34 cases of pN0, 49 cases of N1 and 49 cases of N2. 30-day mortality was 2.3% (3cases) and 14 cases were R1 resection. 11 of which were positive for bronchial stump. pN2 and incomplete resection cases were significantly poor prognosis (p=0.03, p=0.009). 5 of the 11 microscopic bronchial stump positive cases were due to CIS and 6 were due to out-of-wall positives. However, among these 11 cases, there was only one case of anastomotic recurrence. And there were no statistical differences, but CIS was often found in long-term surviving cases.
      8eea62084ca7e541d918e823422bd82e Conclusion
      In cases of pulmonary resection with bronchoplasty, pN2 and incomplete resection are poor prognostic factors. Even in bronchial stump positive cases of incomplete resection, there was only one case of local recurrence. And long-term surviving cases were observed. There are some CISs for long-term survival, but there is no statistical difference because of small cases. Further examination is required.
      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P2.17-29 - Is Collagen Vascular Disease-Associated Interstitial Lung Disease a High Risk for Lung Cancer Surgery? (ID 12866)

      16:45 - 18:00  |  Author(s): Kenji Suzuki

      • Abstract
      • Slides

      Background

      Interstitial lung disease (ILD) frequently coexists with collagen vascular disease (CVD), and most of such patients are treated with immunosuppressive agents. Although the prognosis of CVD-ILD is better than that of idiopathic interstitial pneumonias (IIPs), the effect of CVD-ILD on the outcome and postoperative complication, including acute exacerbation (AE), after lung cancer surgery are unknown.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The subjects of this retrospective study were 2272 patients who underwent surgical resection of lung cancer at our institute between 2009 and 2016. We compared the characteristics, postoperative complication, and outcome of 18 patients with CVD-ILD with those of 201 Patients with IIPs. The pattern of ILD were based on chest computed tomography and classified into usual interstitial pneumonia (UIP) and the others.

      4c3880bb027f159e801041b1021e88e8 Result

      The numbers of UIP patterns were 7 (39%) in CVD-ILD and 77 (38%) in IIPs. Thirteen patients (72%) were taking corticosteroids and 6 patients (33%) were taking immunosuppressive agents in CVD-ILD. Although postoperative AE occurred in 6 (3%) in IIPs, there were no AE events in CVD-ILD. Female (P < 0.01), lower pack-year smoke (P = 0.04), never smoker (P = 0.04), high value of LDH (P < 0.01), and medication of corticosteroids or immunosuppressive agents (P < 0.01) were significantly more common in CVD-ILD. Although there were no significant differences on the incidents of postoperative complications and mortalities, the duration to postoperative onset of IP exacerbation in CVD-ILD were tended to be longer than IIPs (P = 0.07). There were no significant differences on the cause of death between the 2 groups..

      8eea62084ca7e541d918e823422bd82e Conclusion

      There were no significant differences on the outcome and the incidents of postoperative complication, including AE.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.01-71 - Results of Extended Resection in T4 Non-Small Cell Lung Cancer (ID 13143)

      12:00 - 13:30  |  Author(s): Kenji Suzuki

      • Abstract

      Background

      The strategy for T4 non-small cell lung cancer remains controversies. Extended resection carried a high mortality rate and high advances in surgical technique was needed. However, extended resection may improve survival in selected patients.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Between 2000 and 2015, 41 patients with pT4 non-small cell lung cancer, undergoing extended mediastinal resection, were selected. Patients with pulmonary metastasis were excluded. The type of extended resection was carina in 11 (27%), superior vena cava in 9 (22%), the aorta in 6 (15%), esophagus in 2 (5%), left atrium in 7 (17%) and mediastinal tissue in 4 (10%). We investigated the results of surgical resection and over-all survival.

      4c3880bb027f159e801041b1021e88e8 Result

      There were p-stage IIIA in 26 and p-stage IIIB in 15. In histology, squamous cell carcinoma was observed in 22, adenocarcinoma in nine, pleomorphic carcinoma in four and others in six. The median of in-hospital days was 17d, that of operative time was 302m, and that of operative bleeding was 470cc. The rate of induction therapy was 10%. Pneumonectomy was performed in 22 (54%) and bronchoplasty was did in 18 (44%). The rate of morbidity was 66% and that of reoperation was 17%. 30-day mortality was 5%, 90-day mortality was 7% and in-hospital death was 2%. The median follow-up time was 34 months and overall 3- and 5-year survival was 57% and 39%. Significant prognostic factors were complete resection (p-value=0.0485) and smoking status (p-value=0.0498) in univariate analysis. Multivariate analysis did not reveal significant prognostic factors.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Surgical resection for T4 lung cancer was feasible in this study. But, the frequency of morbidity and reoperation was high because of high ratio of pneumonectomy and mediastinal extended resection. So, we need to care for patients after operation, intensively.

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    P3.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 981)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.15-28 - Prognostic Nutritional Index for Predicting Postoperative Complications After Surgery Thoracic Tumor Involving the Neighboring Structures (ID 13845)

      12:00 - 13:30  |  Author(s): Kenji Suzuki

      • Abstract
      • Slides

      Background

      The prognostic nutritional index (PNI), which is scored based on laboratory data of albumin and lymphocyte count, predicts postoperative complications in various types of malignancies. This study aimed to assess the risk factors of postoperative complications, especially the preoperative immune nutritional condition as estimated with the PNI, after surgical treatment of patients for thoracic tumor involving the neighboring structures.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From July 2008 to December 2015, 159 patients with resected thoracic tumor involving the neighboring structures were retrospectively analyzed and the relationship between the preoperative PNI and postoperative complications was evaluated. There were 119 men and 40 women with a median age of 61 years (range 21–88 years). Invading neighboring structures, including chest wall, superior sulcus, diaphragm, tracheal carina, left atrium, superior vena cava, aorta, and vertebrae were performed when possible in patients with locally advanced disease.

      4c3880bb027f159e801041b1021e88e8 Result

      Multivariate logistic regression analysis revealed that a preoperative PNI was a significant independent predictor of postoperative complications of Clavien-Dindo Grade ≥Ⅱ (odds ratio:3.87, p=0.0489). Using receiver-operating characteristics curve analysis predicting postoperative complications, we established cutoff values 46 (Area Under the Curve; 0.61) for the PNI. Patients were divided into two groups according to the preoperative PNI: high (≥46; n=95 (59.7%)), low (<46, n=64 (40.3%)). The incidence of postoperative complications of Grade ≥ Ⅱ and Grade ≥Ⅲ was higher in the low PNI groups than in the high PNI groups (p=0.019 and p=0.009, respectively). The incidence of pneumonia and the length of postoperative hospital stay were significantly higher in the low PNI groups than in the high PNI groups. However, the 30 day mortality (1.88%) and 90 day mortality (4.40%) were not correlation with PNI.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The preoperative PNI might be a useful marker to predict the risk of postoperative complications after surgery for thoracic tumor involving the neighboring structures. We have to intensive attention to the low PNI patients in the perioperative management.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.16-25 - Impact of Diabetes Mellitus on Survival Outcome in Patients with Pathological Stage IA Non-Small Cell Lung Cancer (ID 12245)

      12:00 - 13:30  |  Author(s): Kenji Suzuki

      • Abstract
      • Slides

      Background

      The aim of this study was to investigate the impact of diabetes mellitus (DM) on prognosis of non-small cell lung cancer (NSCLC) patients with pathological stage IA.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A retrospective study was performed on 506 patients with pathological stage IA in NSCLC, who underwent complete resection between 2008 and 2012. We investigated the clinicopathological features and prognosis of patients with DM (DM group; N = 62) and those without (non-DM group; N = 444) retrospectively. Median follow-up period was 5.2 years.

      4c3880bb027f159e801041b1021e88e8 Result

      The DM group consisted of more males, high serum CEA level, history of smoking and heart disease, vascular invasion and lymphatic permeation than the non-DM group. 5-year overall survival (OS), recurrence free survival (RFS) and disease specific survival (DSS) rate in the DM group (5-year OS rate, 80.6%; 5-year RFS rate, 77.4%; 5-year DSS rate, 91.6%) were significantly worse than those in the non-DM group (5-year OS rate, 92.0%; 5-year RFS rate, 90.6%; 5-year DSS rate 97.6%) (p = 0.001, p = 0.001 and p = 0.014; respectively). The univariate and multivariate analyses revealed that DM was an independent prognostic factor for RFS and OS (P = 0.027 and P = 0.020, respectively). Relapse in the DM group was higher than that in the non-DM group (p = 0.036). Distant metastases in the DM group (10%) were significantly more common than in the non-DM group (3%) (p = 0.015).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Pathological stage IA in NSCLC patients having diabetes mellitus have a decreased survival compared with those without.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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