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Eric Lim



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    MA09 - Lung Cancer Surgical and Molecular Pathology (ID 908)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Pathology
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 15:15 - 16:45, Room 202 BD
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      MA09.07 - Developing a Pathological Grading System in Predicting Prognosis for Invasive Mucinous Adenocarcinomas (ID 12124)

      15:55 - 16:00  |  Author(s): Eric Lim

      • Abstract
      • Presentation
      • Slides

      Background

      Invasive mucinous adenocarcinoma (IMA) is a variant of lung adenocarcinoma with a predominance of mucinous type neoplastic epithelial cells, often showing aerogenous spreading and multifocality. The correlation between histopathological features and prognosis has not been well studied due to its relatively rare incidence compared to non-mucinous adenocarcinoma. Our study aims to evaluate the significance of histopathological features in relation to clinical outcome.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We reviewed a series of 101 cases of IMAs resected between 2000 to 2012, comprised of stage I~IV tumours. Five pathological features were scored for each tumour: predominant histological pattern (lepidic: 1, acinar/papillary: 2, solid/micropapillary/cribriform: 3), nuclear atypia (mild:1, moderate: 2, severe: 3), mitotic activity per 2mm2 (<4: 0, ≥4: 1), necrosis (absent: 0, present: 1), lymphovascular invasion (absent: 0, present: 1), and pleural invasion (PL0: 0, PL1: 1, PL2: 2, PL3: 3). Each pathological feature was correlated with disease-free (DFS) and overall survival (OS). Cases were then divided into three grades based on the total pathological score (grade I: 2-4, grade II: 5-7, grade III: 8-11) and correlated with outcome.

      4c3880bb027f159e801041b1021e88e8 Result

      Nuclear atypia, mitotic activity, lymphovascular invasion, and pleural invasion showed significant correlation with OS (p < 0.05). Histological pattern and necrosis showed no significant correlation in relation to OS (p = 0.09). Pleural invasion and lymphovascular invasion were significantly correlated with DFS (p < 0.05), while a trend was noted for nuclear atypia (p = 0.086). No correlation with DFS was seen for histological pattern (p = 0.499), necrosis (p = 0.464), and mitotic activity (p = 0.931). There was an inverse correlation between OS and grade, with grade III tumours showing a significantly worse prognosis (p = 0.001). There was no significant difference in DFS between the three groups (p = 0.201).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our pathological scoring system was able to stratify IMAs into three separate groups with statistically significant differences in overall survival between grade III and grades I/II tumours.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P1.09 - Pathology (Not CME Accredited Session) (ID 941)

    • 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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      P1.09-25 - Invasive Size (Not Total Size) Predicts Overall Survival in Invasive Mucinous Adenocarcinomas (ID 12127)

      16:45 - 18:00  |  Author(s): Eric Lim

      • Abstract
      • Slides

      Background

      The 8th TNM pathological staging system advocates usage of the invasive size, rather than the total size, in the pT staging of pulmonary non-mucinous adenocarcinomas. However, few studies have addressed this issue regarding invasive mucinous adenocarcinomas (IMAs). Our study aimed to determine whether invasive size correlates with individual histological parameters and also whether it provides better prognostic stratification than overall tumour size.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We reviewed a series of 101 cases of IMAs resected between 2000 to 2012, comprised of stage I~IV tumours. In each IMA, the percentage of each growth pattern (lepidic, acinar, papillary, solid, micropapillary, and cribriform) was assessed in 5% increments. Due to the frequent multifocal nature of IMAs, the invasive size was calculated by multiplying the total tumour size with the total percentage of invasive (non-lepidic) components in all cases. The adjusted T (aT) stage, as determined by the cumulative size of invasive components, was correlated with disease-free (DFS) and overall survival (OS). Correlation with 7th and 8th T stage (using total tumour size) were also performed as comparison.

      4c3880bb027f159e801041b1021e88e8 Result

      The 7th aT stage was positively correlated with higher host response (tumour-associated inflammation), necrosis, pleural invasion, and nodal metastasis, while the 8th aT stage was significantly correlated with necrosis, vascular invasion, pleural invasion, and nodal metastasis. Using aT stage for risk stratification, we found a significant difference in OS in both 7th and 8th aT stage between the subgroups (p = 0.002 and 0.006, respectively), whereas DFS failed to reach statistical significance. There was a significant difference in DFS when using the 8th T stage (p = 0.002), whereas no significant difference was noted in OS. A trend was noted in DFS (p = 0.054) while OS failed to reach statistical significance when applying the 7th T staging.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our study showed that invasive size may be a superior prognostic indicator compared to total size, which provides a rationale for prognostic stratification of IMAs based on the extent of invasive growth patterns (or invasive size) rather than total tumour size.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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