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Sakae Okumura



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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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      P1.11-07 - Utility of the Maximum CT Value in Predicting Invasiveness of Pure GGNs (ID 12197)

      16:45 - 18:00  |  Author(s): Sakae Okumura

      • Abstract
      • Slides

      Background

      In the current TNM classification of lung cancer, the pulmonary lesions presenting pure ground-glass nodules (GGNs) without solid component are classified as cTis tumor. However, some of them are pathologically diagnosed as invasive adenocarcinomas. This study aimed to predict the histological invasiveness using the computed tomography (CT) value in pure GGN lesions.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      138 patients underwent resection of pure GGNs between 2011 and 2016. The maximum diameter and CT value were measured using a computer graphics support system. We selected the axial section which showed the densest component of each GGN. The CT value was measured separately in several areas excluding portions of apparent vessels and bronchi manually. We analyzed the correlation between the CT value of pure GGNs and the histological diagnosis, such as atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (Ad).

      4c3880bb027f159e801041b1021e88e8 Result

      The number of the patients with AAH, AIS, MIA and Ad was 6, 81, 45 and 6, respectively. 37% of the pure GGN lesions contained histologically invasive component and 4% of them were diagnosed as Ad. One tumor of Ad had lymphatic invasion, while there was no case with vascular invasion. 37 lobectomies, 38 segmentectomies and 63 wedge resections were performed and there was no recurrence. In comparison between the preinvasive lesions (AAH and AIS) and the invasive lesions (MIA and Ad), the latter was significantly correlated with the higher age of the patients (60 ± 9 years vs 67 ± 7 years), the larger total size (12 ± 5 mm vs 16 ± 5 mm), the higher maximum CT value (-388 ± 125 HU vs -208 ± 129 HU) and the presence of pleural indentation (odds ratio, 2.8).

      When the cut-off point of the maximum CT value in predicting histological invasiveness was set at -300 HU using the ROC curve analysis, the sensitivity, specificity, positive predictive value and negative predictive value were 80%, 77%, 67% and 87%, respectively. The 100% of Ad and the 78% of MIA were correctly estimated.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Invasive adenocarcinoma and MIA accounted for 4% and 33% of the pure GGN lesions, respectively. The maximum CT value was correlated with the pathological diagnosis. It may be useful as a predictor of histological invasiveness. The threshold at -300 HU can be the basis of the computer-aided automatic diagnosis.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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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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      P1.16-43 - Analyses of Long-Term Outcomes and Prognostic Factors in Surgically Resected ALK-Rearranged Lung Adenocarcinoma (ID 12721)

      16:45 - 18:00  |  Author(s): Sakae Okumura

      • Abstract
      • Slides

      Background

      Anaplastic lymphoma kinase (ALK)-rearrangement (ALK+) in lung cancer has made an epoch in the molecular classification. Specific inhibitors of the kinase activity of ALK have been developed as therapeutic drugs for lung cancer with ALK+. Long-term outcomes and prognostic factors, however, in surgically resected cases are unclear. We evaluated the survival rate, and investigated association between prognosis of surgically resected lung adenocarcinoma (AC) with ALK+ and clinicopathological features.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From 1996 to 2013, clinical data of 62 AC patients with ALK+ were retrospectively analyzed. The median follow up time was 73 months. Relationships between the patients’ clinicopathological features (i.e. age, gender, smoking history, operative procedure, administration of adjuvant therapy, tumor size, c-stage, p-stage, pleural invasion, Ly/V invasion, intrapulmonary metastasis, histologic predominant subtypes, and histologic grade), and their recurrence-free survival (RFS), post-recurrence survival (PRS) and overall survival (OS) rates were assessed.

      4c3880bb027f159e801041b1021e88e8 Result

      The 5-year RFS and OS were 69% and 92%, respectively. For OS, advanced p-stage (IIIA and IV) and pleural invasion were independent poor prognostic factors in multivariate analyses, but 5-year OS for even Stage IIIA was 85%, nevertheless (Figure).figure. os for each stages..jpg

      20 patients had recurrence. 8 of the 20 patients were treated with ALK-tyrosine kinase inhibitors (TKIs), and 12 were without. The median PRS was 54 months. Patients treated with AKL-TKIs had longer PRS and OS than without (65 vs. 38 months, p=0.01, and 80 vs. 74 months, p=0.04, respectively).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Long-term outcomes in surgically resected ALK+ AC were excellent even so advanced stage. ALK-TKIs are certainly effective for post-recurrence status. For the resectable ALK+ AC treatment strategy, ALK-TKIs might play an important role.

      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): Sakae Okumura

      • 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.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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