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Ho Yun Lee
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P1.05 - Interventional Diagnostics/Pulmonology (Not CME Accredited Session) (ID 937)
- 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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P1.05-08 - Spread Through Air Spaces (STAS) in Invasive Mucinous Adenocarcinoma of the Lung: Incidence, Prognostic Impact, and Predictive Factors (ID 13767)
16:45 - 18:00 | Author(s): Ho Yun Lee
- Abstract
Background
Spread through air spaces (STAS) is a recently recognized as a novel negative impact on prognosis in lung adenocarcinoma, however was almost investigated non-mucinous adenocarcinoma. We investigated the incidence of STAS in invasive mucinous adenocarcinoma (IMA) of the lung and whether tumor STAS was a risk factor of disease recurrence even in IMA, and determined clinico-radiologic factors in patients with IMA harboring STAS.
a9ded1e5ce5d75814730bb4caaf49419 Method
We reviewed pathologic specimens and imaging characteristics of primary tumors from 132 consecutive patients who underwent surgical resection for IMA. On pathology, the presence of aerogenous spread (AS), mucin, and STAS were evaluated. Two groups determined by STAS were compared with respect to clinical characteristics as well as CT imaging using the Pearson χ2 test or the Fisher exact test. Multivariate logistic regression was used to explore the clinico-radiologic features that facilitate the detection of STAS in IMA, for which receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance. The relationships between all variables including STAS and survival (overall survival [OS] and disease-free survival [DFS]) were analyzed by using Kaplan–Meier curves and Cox regression analyses.
4c3880bb027f159e801041b1021e88e8 Result
Of 119 patients with full pathologic specimens, STAS was observed in 86 patients (72.3%). On multivariate analysis, IMA patients with STAS were significantly tended to be lobectomy (odds ratio [OR] = 7.120, 95% confidence interval [CI] = 1.184 to 42.825, P value = 0.032), older (OR = 2.979, 95% CI = 1.109 to 8.001, P value = 0.030) and the absence of peripheral GGO on CT (OR =0.376, CI=0.141 to 0.999 , P value = 0.049), where the predictive model for presence of STAS showed discrimination performance with an area under the receiver operating characteristic curve (AUC) of 0.798 (95% CI = 0.711 to 0.884, P value < 0.005). The DFS was lower in patients with STAS compared with in those without STAS, whereas there was no statistically significant difference (P value =0.091). On multivariate analysis for DFS, STAS failed to be an independent predictor, but lymph node metastasis (hazard ratio [HR], 2.505; 95% CI 1.288–11.089, absence of mucin on pathologic specimen (HR, 0.46; 95% CI 0.194–0.985) and CT angiogram sign (HR, 2.872; 95% CI 1.036–7.963) remained independent predictors for disease recurrence.
8eea62084ca7e541d918e823422bd82e Conclusion
IMA with STAS represented older age, absence of peripheral GGO on CT, more frequent lobectomy than limited resection. STAS was associated with reduced DFS, but failed to be a significant prognostic factor.
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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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P1.16-10 - Marginal Features Analyses of Lung Adenocarcinoma for Survival Prediction (ID 12587)
16:45 - 18:00 | Author(s): Ho Yun Lee
- Abstract
Background
Tumor microenvironment is a complex mixture of assorted cells and extra-cellular components which make up an amazingly dynamic area that includes signaling interactions between cancer cells and their surrounding tissue. Tumor microenvironment makes up the peripheral portion of the tumor and major changes in this area has been reported to be associated with a poor prognosis. However, very few studies have investigated the tumor marginal features quantitatively extracted from CT images using a radiomics approach. We aimed to clarify the relationship between tumor marginal features and the micropapillary pattern and correlated with survival.
a9ded1e5ce5d75814730bb4caaf49419 Method
We enrolled 334 patients who underwent complete resection for lung adenocarcinoma. Quantitative histologic subtyping was performed for the whole tumor. Using a radiomics approach, quantitative CT analysis was performed and 82 marginal features were extracted. Clinical variables and marginal features were correlated with survival. Using selected clinical variables and marginal features a prognostic model was calculated with subsequent internal and external validation.
4c3880bb027f159e801041b1021e88e8 Result
Among various subtypes, solid predominant adenocarcinomas had the lowest proportion (6.9%) of combined micropapillary pattern. At univariate analysis, patient age, tumor size, and multiple marginal features (convexity, surface area, compactness, maximum 3D diameter, sphericity, surface-to-volume ratio, mean pixel value, median pixel value, entropy, uniformity, skewness, kurtosis, roundness factor, solidity, and lacunarity)were predictive of survival. At multivariate cox proportional analysis, convexity (P=0.017), kurtosis (P<0.001), and patient age (P=0.006) were identified as being predictive of survival. Ten-fold cross-validation tests demonstrated that our prediction model significantly classified patients according to survival (P<0.001). Although lower than internal validation, the prediction model also worked at external validation.
8eea62084ca7e541d918e823422bd82e Conclusion
Marginal radiomics features of convexity and kurtosis reflect the tumor microenvironment and were predictive of patient survival in lung adenocarcinomas.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- 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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P2.01-10 - Prognostic Impact of Longitudinal Monitoring of Radiomic Features in Patients with Advanced Non-Small Cell Lung Cancer (ID 12877)
16:45 - 18:00 | Author(s): Ho Yun Lee
- Abstract
Background
Tumor growth dynamics varies substantially in non-small cell lung cancer (NSCLC). We aimed to develop novel biomarkers reflecting longitudinal change of radiomic features in NSCLC and evaluate prognostic power of those.
a9ded1e5ce5d75814730bb4caaf49419 Method
Fifty-three patients with advanced NSCLC included in this retrospective study. Measurable lesions on baseline and follow-up computed tomography (CT) were segmented and 23 radiomic features were extracted. All three variables reflecting patterns of longitudinal change were extracted: the area under the curve (AUC), beta value, and AUC2. We constructed models for predicting survival using multivariate cox regression, and identified the performance of these models.
4c3880bb027f159e801041b1021e88e8 Result
In volume, AUC2 showed an excellent correlation with pattern of longitudinal volume change (r = 0.848, p < 0.000), and showed a significant difference in overall survival time (p = 0.035). In multivariate regression analysis, kurtosis of positive pixel values (p < 0.000), and surface area (p = 0.001) on baseline CT, and AUC2 of density (p < 0.000), skewness of positive pixel values (p = 0.003), and entropy at inner (p = 0.001) were found to be associated with overall survival time, and the area under the receiver operating characteristics curves were 0.922, and 0.771 at 1 year, and 3 years of follow-up.
8eea62084ca7e541d918e823422bd82e Conclusion
Longitudinal change of radiomic tumor features would be prognostic biomarkers in patients with advanced NSCLC.
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P2.01-56 - Metastases in Residual PET Uptake of Lymph Nodes After Treatment: Added Value of CT Radiomic Approach for Prediction (ID 12595)
16:45 - 18:00 | Author(s): Ho Yun Lee
- Abstract
Background
Although substantial decrease of FDG uptake on positron emission tomography-computed tomography (PET-CT) holds promise metabolic response, predicting pathologic complete response of lymph nodes still remains challenging. We investigated the potential of CT radiomics features to predict pathologic complete response of lymph nodes showing residual uptake on PET-CT after neoadjuvant concurrent chemoradiotherapy (CCRT) in stage IIIa non-small cell lung cancer (NSCLC).
a9ded1e5ce5d75814730bb4caaf49419 Method
From 2004 through 2013, all consecutive patients who underwent neoadjuvant CCRT for stage IIIa NSCLC, post-treatment PET-CT, and curative operation were included. As for all lymph nodes which showed remaining positive FDG uptake on restaging PET-CT, 161 CT Radiomic features from physical, shape, histogram, texture, regional feature categories were extracted. Positive and negative lymph node metastases were compared with respect to clinicopathologic characteristics as well as CT radiomic features using the Pearson χ2 test or the Fisher exact test Multivariate logistic regression was used to explore the predictive model for the the detection of metastatic lymph nodes, for which receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance.
4c3880bb027f159e801041b1021e88e8 Result
Of 237 patients undergoing neoadjuvant CCRT for stage IIIa NSCLC, 135 patients (56.9%) showed residual PET uptake on 177 lymph nodes after treatment. Among those 177 lymph nodes, 70 lymph nodes were proven to be malignant (39.5%, 70 of 177). On multivariate analysis, metastatic lymph nodes were significantly tended to be more squamous cell carcinoma than adenocarcinoma (odds ratio [OR] = 0.370, 95% confidence interval [CI] = 0.190 to 0.722; reference of adenocarcinoma, P value = 0.004) and higher entropy-GLCM (OR = 1.437, 95% CI = 1.147 to 1.802, P value = 0.002), where the predictive model for metastasis showed discrimination performance with an area under the receiver operating characteristic curve (AUC) of 0.770 (95% CI = 0.700 to 0.839, P value < 0.001).
8eea62084ca7e541d918e823422bd82e Conclusion
Radiomic approach allows for noninvasive detection of lymph node metastases in lymph nodes showing residual PET uptake after treatment in NSCLC patients
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