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Hiroshige Nakamura
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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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MA01.06 - Evaluation of Safety and Efficacy in Surgical Treatment for Octogenarian Lung Cancer Patients by Multicenter Prospective Study: JACS1303 (ID 13117)
11:05 - 11:10 | Author(s): Hiroshige Nakamura
- Abstract
- Presentation
Background
The percentage of octogenarian lung cancer patients have increased on the background of the aging of Japan’s demographics. Although some retrospective studies reported clinicopathological scoring systems for predicting postoperative complications and survival outcomes for elderly lung cancer patients, optimized scoring systems remain controversial. This study (JACS1303) aims to evaluate the clinical factors to develop a comprehensive operative risk scoring (RS) system for octogenarian patients with lung cancer.
a9ded1e5ce5d75814730bb4caaf49419 Method
JACS conducted a nationwide multicenter prospective cohort and enrolled a total of 1,019 octogenarians with medically operable lung cancer. Details of the clinical factors, comorbidities, and comprehensive geriatric assessment were recorded for 895 patients to develop a comprehensive risk scoring (RS) system capable of predicting severe complications.
4c3880bb027f159e801041b1021e88e8 Result
Operative (30 days) and hospital mortality rates were 1.0% and 1.6%, respectively. Complications were observed in 308 (34%) patients, of whom 81 (8.4%) had grade 3–4 severe complications. Pneumonia was the most common severe complication, observed in 27 (3.0%) patients. The following five predictive factors: gender, comprehensive geriatric assessment (CGA)75: memory, Simplified Comorbidity Score (SCS): diabetes mellitus, Alb, and %VC were identified as independent predictive factors for severe postoperative complications (odds ratio = 2.73, 1.86, 1.54, 1.66, and 1.61, respectively) through univariate and multivariate analyses. A 5-fold cross validation was performed as an internal validation to reconfirm these five predictive factors (average AUC: 0.70). We developed a simplified RS system as follows: RS = 3 (Gender: male) + 2 (CGA75: memory: yes) + 2 (Alb: <3.8 ng/ml) + 1 (%VC: ≤90) + 1 (SCS: Diabetes mellitus: yes).
8eea62084ca7e541d918e823422bd82e Conclusion
The current study shows that octogenarians can be successfully treated for lung cancer with surgical resection with an acceptable rate of severe complications and mortality. We propose a simplified RS system to predict severe complications in octogenarian patients with medically operative lung cancer.
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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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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P2.09-26 - Clinical Significance of Subcellular Localization of Maspin in Patients with Pathological Stage IA Lung Adenocarcinoma (ID 12563)
16:45 - 18:00 | Author(s): Hiroshige Nakamura
- Abstract
Background
There were a lot of tumor-associated proteins before. Maspin is a tumor-suppressor protein and its prognostic value in lung adenocarcinoma has been reported. However, little is known about the clinical impact of subcellular localization of maspin in early-stage lung adenocarcinoma. We aimed to evaluate the clinical significance of subcellular localization of maspin in patients with pathological stage (p-stage) IA lung adenocarcinoma patients categorized by the new eighth edition TNM classification.
a9ded1e5ce5d75814730bb4caaf49419 Method
We immunohistochemically analyzed 181 tissue samples from p-stage IA1 (n=37), IA2 (n=92) and IA3 (n=52) lung adenocarcinomas using antibody for maspin.
4c3880bb027f159e801041b1021e88e8 Result
The 181 cases fell into five predominant subtypes: lepidic (n=32), acinar (n=97), papillary (n=30), solid (n=20) and micropapillary (n=2). The frequencies of maspin staining were: cytoplasmic-only in 24.9%; pancellular (nuclear and cytoplasmic) in 8.8%; nuclear-only in 0.6%; no staining in 65.7%. Cytoplasmic-only staining significantly correlated with high pathological T-classification (p=0.039), lymphatic invasion (p=0.002) and poorer tumor differentiation (p=0.002). The patients were followed up for 12-151 months (median=74 months), and the cytoplasmic-only staining significantly correlated with shorter disease-free survival (DFS) (p=0.034) and disease-specific survival (DSS) (p=0.036) by log-rank tests. In Cox’s multivariate analysis, lymphatic invasion had the most significant effect on shorter DFS and DSS.
8eea62084ca7e541d918e823422bd82e Conclusion
The expression of maspin in the cytoplasm alone could be useful for predicting unfavorable prognoses in patients with p-stage IA lung adenocarcinoma.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.09 - Pathology (Not CME Accredited Session) (ID 975)
- 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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P3.09-24 - The Concordance of Histological Diagnosis from Transbronchial Biopsy and Resected Specimen of Lung Cancers (ID 13106)
12:00 - 13:30 | Author(s): Hiroshige Nakamura
- Abstract
Background
Advances in radiological and diagnostic technics have improved the evaluation of pulmonary nodules, leading to an increase in preoperative histological diagnosis. For thoracic surgeons, it is important to know histological types of lung cancer preoperatively for the determination of surgical treatment strategy. The aim of this study is to evaluate the concordance of histological types between biopsy and resected specimens.
a9ded1e5ce5d75814730bb4caaf49419 Method
A total of 653 patients with primary lung cancer were operated on in our hospital between January 2013 to March 2018. Among them there were 438 patients who underwent bronchofiberscopic examination, and 364 patients (83.1%) were diagnosed preoperatively as lung cancer. We retrospectively reviewed 316 patients who underwent both transbronchial biopsy (TBB) and then surgical resection for primary lung cancer between January 2013 to March 2018. We compared diagnosed histological types, examined the accuracy of preoperative diagnosis by TBB, and evaluated the concordance between those two kinds of specimens.
4c3880bb027f159e801041b1021e88e8 Result
In 302 of the 316 patients (95%), the histological types of lung cancer diagnosed from TBB matched those from resection specimens (κ=0.878). Concordance rate was the highest in adenocarcinoma (243/245; 99%), followed by squamous cell carcinoma (52/55; 95%). On the other hand, it was only 50% in neuroendocrine carcinoma (small cell carcinoma and LCNEC ± combined with adenocarcinoma / squamous cell carcinoma). Due to histological heterogeneity, 6 of 14 patients were diagnosed with different types of postoperative diagnosis, and four were due to the inconsistency of immunohistochemical (IHC) staining between biopsy and resected specimens.
8eea62084ca7e541d918e823422bd82e Conclusion
We considered that lung cancer has not only histological heterogeneity but also IHC heterogeneity. If larger samples are taken, the preoperative diagnosis of histological type could be more reliable.
6f8b794f3246b0c1e1780bb4d4d5dc53
