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Ichiro Yoshino



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    MA23 - Early Stage Lung Cancer: Present and Future (ID 926)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 10:30 - 12:00, Room 105
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      MA23.11 - Lobe-Specific Nodal Dissection for Clinical Stage I and II Non-Small Cell Lung Cancer: Japanese Multi-Institutional Retrospective Study (ID 13741)

      11:40 - 11:45  |  Author(s): Ichiro Yoshino

      • Abstract
      • Presentation
      • Slides

      Background

      Systematic nodal dissection (SND) is an international standard of lymph node dissection for non-small cell lung cancer (NSCLC). Recently, lobe-specific patterns of mediastinal lymph node metastases have been recognized, and lobe-specific nodal dissection (LSD) has been proposed for early-stage NSCLC. The purpose of this study was to assess the surgical outcomes according to the extent of mediastinal lymph node dissection for patients with NSCLC by using a nationwide registry database.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From among 11,663 patients in a Japanese lung cancer registry study for 2004, 5392 patients with clinical stage (c-stage) I or II NSCLC that was completely resected by lobectomy and either SND or LSD were enrolled. Patients who received preoperative therapy or had middle lobe tumor were excluded. In the LSD group, inferior mediastinal (subcarinal) nodes were not dissected for upper lobe tumors, and superior mediastinal nodes were not dissected for lower lobe tumors. To reduce the selection bias, an inverse probability of treatment weighting (IPTW) method using a propensity score was implemented.

      4c3880bb027f159e801041b1021e88e8 Result

      LSD and SND were performed in 1,268 (23.5%) and 4,124 (76.5%) patients, respectively. LSD group included more c-IA and upper lobe tumors relative to SND group, although there was no significant differences in age and preoperative comorbidity. There was no significant difference in postoperative morbidity and mortality between 2 groups. Extended pathological N2 disease outside LSD area was found in 3.2% of the SND group, but recurrences were not different between 2 groups (all recurrences: 22.0% in LSD, 26.9% in SND; local recurrence: 6.1% in LSD, 7.7% in SND; p=0.788). The 5-year overall survival (OS) was 81.5% in LSD and SND in 75.9%. An IPTW–adjusted Cox model showed that LSD did not have a negative prognostic impact and instead was associated with favorable survival (hazard ratio: 0.68, 95% confidence interval: 0.60-0.77).

      8eea62084ca7e541d918e823422bd82e Conclusion

      This retrospective registry study suggested that LSD is an alternative to SND for selected patients with c-stage I or II NSCLC. Future prospective studies are warranted to determine whether LSD is applicable and provides clinical benefit for the general population of patients with cstage I or II NSCLC.

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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • 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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      P1.16-36 - Real-Time Ct Guided Video Assisted Thoracoscopic Partial Resection of Peripheral Small-Sized Lung Tumors. (ID 13502)

      16:45 - 18:00  |  Author(s): Ichiro Yoshino

      • Abstract
      • Slides

      Background

      As pulmonary resection for small and grand-grass opacity (GGO) dominant pulmonary nodules have been increasing, various navigation systems to detect these nodules have been reported. The aim of this study is to evaluate feasibility of real-time CT guided pulmonary resection for impalpable small pulmonary nodules.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From July to November in 2017, 11 patients were eligible for pulmonary resection for lung cancer or malignancy suspected lesions, which was expected to be difficult to detect during operation. These nodules were defined as GGO-dominant (>50%) tumor with a diameter of 3cm or lower (GGO-dominant type), and tumor with a diameter of 2cm or lower, which is located deeper than the diameter of the tumor from visceral pleura (deep solid type). First, we put several surgical clips as first marker on the visceral pleura of the tumor-located lobethrough 3-ports VATS approach. The tumor and the first markers were visualized by cone beam CT, then the second marker was put just on the tumor based on the image. Pulmonary resection was performed according to second marker guided by automated staplers. CT scanning was also performed for confirmation of the complete resection.

      4c3880bb027f159e801041b1021e88e8 Result

      These procedures were performed for 4 men and 7 women (mean age: 58 years (39-71)). Tumors were located in the right upper lobe/right lower lobe/left upper lobe/left lower lobe in 5/2/2/2 patients. Diameters of tumors were 1.5cm or less. Six tumors were GGO-dominant types whereas 5 were solid types located in the deep from the visceral pleura; therefore all tumors couldn’t be detected by video-scopic observation. The average number of cone beam CT scanning is 2.7 times. All patients accomplished macroscopic and microscopic complete resection with no adverse events during perioperative periods.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This feasibility study suggested that cone beam CT was safe and useful guide forvideo assisted thoracoscopic partial resection for impalpable peripheral pulmonary nodules.

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    P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)

    • 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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      P2.15-21 - Post Resection Lung Cancer Surveillance: Comparisons of Practice Between STS, ESTS and JACS Members (ID 12202)

      16:45 - 18:00  |  Author(s): Ichiro Yoshino

      • Abstract
      • Slides

      Background

      We recently investigated contemporary practice in post-resection lung cancer surveillance, between the Society of Thoracic Surgeons (STS) and the European Society of Thoracic Surgeons (ESTS) updating a published STS survey and showed a wide variance of practice.

      In order to understand better the role of socio-demographics on this divergence, we aim to compare these patterns to those of members of the Japanese Association for Chest Surgery(JACS) as well as surveillance attitudes across these regions.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A survey identical to the one conducted in 1995 among STS members was administered via mail or electronically to members of the STS, ESTS and JACS requesting responses from those treating NSCLC. Goodness of fit tests were used to compare profiles of respondents and attitudes toward testing between groups. Multivariable logistic regression was performed to examine for predictors of guideline concordant surveillance with CT.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 2978 STS member (response rate 7.8%, n=234), 1450 ESTS members (response rate 8.4%, n=122) and 272 JACS (response rate 40,8%, n=111) members were surveyed. All three societies reported similar use of history and physical examination for asymptomatic patients (75%vs78%vs73%p=0.52). Rate of guideline-recommended surveillance CT was reported highest among ESTS respondents for stage I patients (22% ESTS, 3% STS and 6% JACS members, p<0.01). However, both JACS and ESTS respondents reported higher rates of use of non-guidelines-recommended tests compared to STS respondents which persisted on adjusted analyses. In particular, JACS and ESTS respondents reported significantly higher use of brain MRI (JACS AOR 13.85 [7.46-25.73] ESTS AOR 2.81 [1.59-4.99], p<0.01), Bone Scan (ESTS AOR 3.00 [1.68-5.36] JACS AOR 5.69 [3.21-10.08], p<0.01) and bronchoscopy for post-resection surveillance (JACS AOR 3.51 [1.99-6.20] ESTS AOR 3.25 [1.83-5.79], p<0.01) compared to STS respondents. Regarding attitudes towards surveillance, more JACS and ESTS members either “agree” or “strongly agree” that routine testing for NSCLC recurrence results in potentially curative treatment (ESTS:86%, STS:70%, JACS:90% p<0.01). Similarly, JACS and ESTS respondents believe that surveillance would identify a curable second primary NSCLC (ESTS:94%, STS:84%, JACS:100% p<0.01) and that current literature documents definitive survival benefits from routine follow-up testing (ESTS:57%, STS:30%, JACS:62% p<0.01).

      8eea62084ca7e541d918e823422bd82e Conclusion

      The Japanese attitude towards surveillance is similar to that of ESTS members potentially highlighting significant differences between European and Asian surgeons compared to STS members and may be the underpinnings of routine use of non-guideline concordant surveillance. These differences clearly highlight the need of better prospective studies and joint recommendations to standardize practice globally.

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    P3.08 - Oligometastatic NSCLC (Not CME Accredited Session) (ID 974)

    • 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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      P3.08-08 - Outcomes of Pulmonary Metastasectomy in Breast Cancer: Prognosis Based on the Metastatic Lung Tumor Study Group of Japan (ID 12242)

      12:00 - 13:30  |  Author(s): Ichiro Yoshino

      • Abstract
      • Slides

      Background

      Although pulmonary metastasectomy is a common treatment in other primary cancers, its role in patients with primary breast cancer is still controversial. The purpose of this study was to analyze a Japanese multi-center database to assess the prognostic factors and indications of metastasectomy in breast cancer.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Data of 387 patients with histologically proven pulmonary metastases from breast cancer have been prospectively enrolled in the Metastatic Lung Tumor Study Group of Japan between December 1982 and March 2017. Those with inadequate information about perioperative data, surgery for biopsy, male or non–epithelial malignancies were excluded. A total of 253 female with invasive breast carcinoma between 1982 and 2017 constituted the study population, and their clinical and prognostic data were retrospectively analyzed.

      4c3880bb027f159e801041b1021e88e8 Result

      The median follow-up period was 5.4 (range, 0–24) years. The mean age of patients was 56 (range, 32–82) years, the median disease-free interval was 4.8 (range, 0–31) years, pulmonary metastasis (215 solitary, 38 multiple) was treated with surgeries, namely, wedge resection (n = 113, 45%), segmentectomy (n = 22, 9%), lobectomy (n = 116, 45%), and pneumonectomy (n = 2, 1%). Nodal metastases were found in 56 (22%) patients. There were 24 (9%) patients with incomplete resection. Additional treatments after metastasectomy were performed in 141 patients (56%). Recurrence after pulmonary metastasectomy developed in 98 of 229 (43%) patients without incomplete resection, namely, intrathoracic lesion (n = 21, 23%), distant metastasis (n = 47, 51%), and unknown (n = 25, 27%). The 5-year and 10-year survival rates after pulmonary metastasectomy were 66% and 52%, respectively, and the median survival period was 10 years. In the univariate analysis, early treatment period (<2001; p = 0.02), short disease-free interval (<3 years; p < 0.01), large tumor size (>2 cm; p < 0.01), surgical procedure (lobectomy and pneumonectomy; p = 0.01), intrathoracic nodal metastasis (p < 0.01), and incomplete resection (p = 0.05) were shown to be associated with poor survival. Multivariate analysis revealed that only short disease-free interval (<3 years; p < 0.01) was significantly worse prognostic factor in 253 patients.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The main poor prognostic factor was disease-free interval (<3 years). However, complete resection of metastases was not a significant prognostic factor. The efficacy of pulmonary metastasectomy in breast cancer is still controversy. For pulmonary metastais from breast cancer, pulmonary metastasectomy is considered to be optional treatment.

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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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      P3.16-09 - High Preoperative D-Dimer Level Predicts Early Recurrence After Surgery for Non-Small Cell Lung Cancer (ID 11928)

      12:00 - 13:30  |  Author(s): Ichiro Yoshino

      • Abstract

      Background

      Carcinoma cells often affect the coagulation and fibrinolysis among cancer patients. Plasma dimerized plasmin fragment D (D-dimer) has been reported as the prognostic marker of various type of malignancies. For non-small cell lung cancer (NSCLC) patients, significance of D-dimer levels still remains unclear.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Two hundreds and thirty five patients with NSCLC who underwent radical surgery between April 2015 and March 2017 were retrospectively reviewed. We divided two groups including 1) high D-dimer (over 1.0ug/mL) group (hDD group, n=47), and 2) normal D-dimer group (nDD group, n=188). The clinical characteristics, tumor CT findings, pathological findings, and clinical outcomes were analyzed.

      4c3880bb027f159e801041b1021e88e8 Result

      The mean D-dimer level was 2.49±2.58 among hDD group. The hDD group had the character of 1) male gender, 2) elder patients, 3) larger tumor size (p=0.0011), 4) pure solid appearance (p=0.0203). The hDD group showed worse overall survival (OS), disease free survival (DFS), and disease specific survival (DSS) than nDD group (Figure 1-A, B, C; log-rank test, p<0.0001, =0.0007, =0.0003, retrospectively) and these findings were also observed only for the p-Stage IA cases. Interestingly patients with grand glass attenuation-dominant nodule were not affected by D-dimer level with favor prognosis. Pathology showed more frequent vessel involvement (v+) in hDD group (p=0.033), but there was no significant difference for histology or histological subtypes of adenocarcinoma.os_dfs_dss2.png

      Figure1:

      Kaplan-Meier survival curves of postoperative overall survival (A), disease free survival (B), and disease specific survival (C) by preoperative D-dimer level.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The preoperative D-dimer level predicts the postoperative early recurrence and poor prognosis in the patients with NSCLC with pure solid appearance on chest CT.

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