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Satoshi Shiono
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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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P1.09-07 - PD-L1 Protein Expression is a Predictor of Benefit from Adjuvant Chemotherapy in Resected Non-Small Cell Lung Carcinoma (ID 11326)
16:45 - 18:00 | Author(s): Satoshi Shiono
- Abstract
Background
Programmed cell death protein 1/programmed cell death ligand 1 (PD-1/PD-L1) are important targets of immunotherapy and its expression has been closely correlated with response and survival benefit from anti-PD-1/PD-L1 immune checkpoint inhibitor therapies in advanced non-small cell lung carcinoma (NSCLC). But it is still unclear whether PD-L1 is a prognostic or a predictive marker of adjuvant chemotherapy. The aim of this study is to examine the prognostic value of PD-L1 protein expression and its predictive role for adjuvant chemotherapy in surgically resected NSCLC.
a9ded1e5ce5d75814730bb4caaf49419 Method
A total of 407 NSCLC were examined. The male:female ratio was 288:119; the age range was between 38 and 85 years of age and the mean age was 68.5 years. Pathological stage’s ratio (I:II:III) was 147:154:106. Adenocarcinoma:Squamous cell carcinoma:Others’ ratio was 251:135:21 in histology. Adjuvant chemotherapy was performed in 173 patients. The follow up duration was from 0.4 months to 168.7 months and the mean duration was 61.9 months. Tissue microarray was constructed and PD-L1 protein expression was analyzed using immunohistochemistry (clone SP263, Ventana Medical Systems. Inc., Tucson, AZ). The PD-L1 staining percentage in tumor cells were classified as follows: Negative, 0%; Weak positive, 1-49%; Strong positive, 50-100%. The score of PD-L1 staining was correlated with clinicopathological backgrounds, molecular features, patient outcome and potential benefit of adjuvant chemotherapy.
4c3880bb027f159e801041b1021e88e8 Result
The score of PD-L1 staining was as follows: Negative, 265 (65%); Weak positive, 82 (20%); Strong positive, 60 (15%). PD-L1 expression status was associated with sex, smoking history, pathological stage, histology, p53 protein expression, MIB-1 labeling index. 5-year overall survival (OS) was as follows: Negative, 63.5%; Weak positive, 62.1%; Strong positive, 54.8% and 5-year recurrence-free survival (RFS) was as follows: Negative, 51.6%; Weak positive, 55%; Strong positive, 42.5%, respectively. These results were not statistically significant. Untreated patients with a strong positive PD-L1 expression had significantly worse OS than patients with a negative PD-L1 expression {hazard ratio (HR)=1.98; 95% CI, 1.21-3.24; p=0.006}. However, patients with a strong positive PD-L1 expression had a significantly better survival benefit from adjuvant chemotherapy (HR=0.43; p=0.03) compared with patients with a negative PD-L1 expression (HR=1.04; p=0.82).
8eea62084ca7e541d918e823422bd82e Conclusion
PD-L1 protein expression is not a prognostic marker, however it is a significant predictive marker of benefit from adjuvant chemotherapy in resected NSCLC.
6f8b794f3246b0c1e1780bb4d4d5dc53
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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): Satoshi Shiono
- Abstract
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.
6f8b794f3246b0c1e1780bb4d4d5dc53
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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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P3.16-03 - Uncommon EGFR Mutations as a Worse Prognostic Factor for Surgically Resected Lung Adenocarcinoma (ID 12338)
12:00 - 13:30 | Author(s): Satoshi Shiono
- Abstract
Background
The characteristics and prognosis of patients with lung adenocarcinoma harboring uncommon epidermal growth factor receptor (EGFR) mutations have not been clarified. Here, we examined whether the presence of uncommon EGFR mutations is a prognostic factor for patients treated surgically.
a9ded1e5ce5d75814730bb4caaf49419 Method
In this multi-institutional retrospective cohort study, clinicopathological data were collected from 1,463 patients who underwent complete surgical resection for lung adenocarcinoma between 2005 and 2012 at five institutions and were examined for EGFR mutation status. Differences in postoperative overall survival (OS) and recurrence-free survival (RFS) according to EGFR mutation status were evaluated.
4c3880bb027f159e801041b1021e88e8 Result
Of 1,031 eligible patients, 500 (48.5%), 497 (48.2%), and 34 (3.3%) had wild-type EGFR (WT), common EGFR mutations (CMs), and uncommon EGFR mutations (UCMs), respectively. In the UCM group, 19 patients had a single mutation, including exon 18 G719X (n = 7), exon 20 T790M (n = 6), or exon 21 L861Q (n = 5), and 15 patients had compound mutations. The clinicopathological characteristics were not significantly different between the CM and UCM groups. The 5-year OS rates in the WT, CM, and UCM groups were 76.3%, 88.6%, and 68.4%, respectively. OS was significantly shorter in the UCM than CM group (p = 0.011), although no significant difference was observed between the UCM and WT groups (p = 0.83). The 5-year RFS rates in the WT, CM, and UCM groups were 63.7%, 75.4%, and 58.1%, respectively. RFS was significantly shorter in the UCM than CM group (p = 0.006), although no significant difference was observed between the UCM and WT groups (p = 0.41). The use of EGFR–tyrosine kinase inhibitors after recurrence did not affect the prognosis with respect to EGFR mutation type. Among those with single mutations in the UCM group, patients harboring T790M were younger, more likely to be males and smokers, and more likely to have a larger tumor size, lymph node metastasis, pleural invasion, and lymphovascular invasion, compared with those harboring G719X or L861Q. T790M was also associated with shorter OS and RFS; the 3-year OS rates were 50.0%, 83.3%, and 100% and the 3-year RFS rates were 16.7%, 71.4%, and 80.0% for patients harboring T790M, G719X, and L861Q, respectively.
8eea62084ca7e541d918e823422bd82e Conclusion
Among patients with surgically resected lung adenocarcinoma, OS and RFS were significantly shorter in those with UCMs compared with CMs, implying that UCMs may be a worse prognostic factor.
6f8b794f3246b0c1e1780bb4d4d5dc53
