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Shaohua Lu
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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): Shaohua Lu
- 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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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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MS10.04 - Therapeutic Implications of Spread Through Air Spaces (STAS) (ID 11443)
16:00 - 16:15 | Author(s): Shaohua Lu
- Abstract
- Presentation
Abstract not provided
Only 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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P1.11 - Screening and Early Detection (Not CME Accredited Session) (ID 943)
- 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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P1.11-01 - The NELSON Triage Algorithm Applied to a Chinese Biopsied Population: A Pilot Study (ID 12115)
16:45 - 18:00 | Author(s): Shaohua Lu
- Abstract
Background
The Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) lung cancer screening study sequentially tests nodules’ volume, growth and doubling time with an increasing screening interval length. For now, classification performances of NELSON are known only for a European population with specific eligibility criteria.
We tested the NELSON trial triage algorithm on a cohort of biopsied Chinese patients.
a9ded1e5ce5d75814730bb4caaf49419 Method
Our study utilized a data subset from the NCT02693496 clinical trial. The data consisted of onsite prospective evaluations of 85 Chinese patients who underwent CTs within an average time interval of 259 days (Min=63; Max=1092). NCT02693496 readers applied the Chinese consensus low-dose CT management guidelines with referral to biopsy, when required.
The eligibility criteria were: All genders; age: 18 to 90 years old; chest lesion <3cm. Smoking status was not considered.
In our subset of 85 patients, 15 nodules from 15 patients were biopsied: 10 were confirmed malignant; of these, 3 were solid nodules (SN) and 7 were sub-solid nodules (SSN). Five biopsied nodules were confirmed benign. Of the whole cohort, 11.8% (10/85), were declared positive patients. The 75/85 others (88.2%) were declared negative by radiologists and/or pathologists.
Using the Lesion Management Solution (LMS) platform (Median Technologies), we retrospectively re-processed the subset of images to analyze NELSON sensitivity at detecting malignant lung nodules. We used R CRAN software for statistics and Chi-Squared test for non-parametric comparison of two sample proportions.
4c3880bb027f159e801041b1021e88e8 Result
We found 12.9% of patients (11/85) displayed no findings. There were 155 detected findings in the remaining 74 patients, which were documented as: 5.2% (8/155) benign as NODCAT I; 9.0% (14/155) pleural; 27.7% (43/155) SSN and 58.1% (90/155) SN. According to NELSON triage, five Patients were declared positive.
In the biopsy-confirmed nodules group (10 patients), four were detected by NELSON, one at baseline.
All patients displaying SNs were detected (3/3) whereas only one (1/6) patient displaying SSNs was detected. NELSON was better at detecting SNs (p=0.036).
One patient with confirmed negative biopsy patient (1/5) was declared positive by NELSON with one SN and one SSN.
Additionally, one SN in patient without biopsy was declared positive at baseline by NELSON triage algorithm.
8eea62084ca7e541d918e823422bd82e Conclusion
Prevalence of different nodule types in this Chinese population was different from the observations of the original European NELSON trial. The NELSON triage algorithm correctly classified patients with malignant SNs but misclassified most patients displaying SSNs. Further studies are needed to better evaluate SSNs by NELSON.
6f8b794f3246b0c1e1780bb4d4d5dc53
