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Masayoshi Inoue



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    P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)

    • 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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      P1.14-11 - The Expression Pattern of Programmed Death-Ligand 1 According to the Pathological Type of Malignant Thymic Epithelial Tumors (ID 12665)

      16:45 - 18:00  |  Author(s): Masayoshi Inoue

      • Abstract
      • Slides

      Background

      Malignant thymic epithelial tumors (TETs) have pathological types ranging from low-grade to high-grade malignancy, while the pattern of PD-L1 expression remains unclear. We investigated PD-L1 expression in TETs and verified the pattern of expression associated with the pathological type.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We examined 66 malignant TETs. Immunohistochemical evaluation of PD-L1 expression was performed using anti-PD-L1 antibody (SP263). We calculated the tumor cell positive rate (Total Proportion Score: TPS) of PD-L1 expression. The discrimination of the tumor region was confirmed by immunostaining with anti-pan-cytokeratin antibody (AE1AE3). PD-L1 expression was examined for each type of histological classification of TETs. We classified a High TPS group (H group) and Low TPS group (L group) using a TPS cut-off value of 25% and examined the correlation with clinical background and prognosis. We classified Type B2, B3, and thymic carcinomas into a high-malignancy group. PD-L1 expression was also digitally analyzed based on Whole Slides Imagings (WSI) for objective analysis as Digital TPS.

      4c3880bb027f159e801041b1021e88e8 Result

      We identified WHO histological types (Type A/AB/B1/B2/B3/metaplastic tumor/thymic carcinomas = 8/19/5/15/6/2/11). In Type A, PD-L1 expression was low in most cases and the median of TPS was 22%. In Type AB, Type A and B regions showed low and high TPS, respectively, and the median was 23%. In Type B1, TPS was low in most cases and the median was 26%. In Type B2, TPS was higher than that in Type B1, and the median was 69%. In Type B3, TPS was high (>50%) in all cases and the median was 86%. The PD-L1 expression of thymic carcinomas ranged from low to high and the median was 28%. Metaplastic tumors showed scanty PD-L1 expression. The High PD-L1 group showed more advanced disease stages according to the Masaoka stage and TMN classification, and the TPS of Type B2 and B3 was significantly higher than that of Type A, AB and B1. The disease-free survival rate was significantly lower in the H group than that in the L group. When we examined the prognosis in high-malignancy group, there were no significant differences in the disease-freel and overall survival rates by TPS. Based on measurements using WSI, Digital TPS correlated with visual TPS (correlation coefficient=0.85,pvalue<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      TETs had the characteristic features of the PD-L1 expression according to histological types. Type B2 and B3 thymomas was higher PD-L1 expression than the other types of TETs.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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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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      P2.15-27 - Lung Volume Change After Lobectomy Estimated by Three-Dimensional Image Analysis System (ID 11961)

      16:45 - 18:00  |  Author(s): Masayoshi Inoue

      • Abstract
      • Slides

      Background

      High-precision three-dimensional (3D) image analysis system has been used for preoperative planning in various fields including thoracic surgery. Such software has made us quite easy to measure lung volume. Change of pulmonary function after surgery has been surveyed in some reports, but there are few reports about lung volume change after surgery.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We conducted a retrospective review of 49 patients who underwent lobectomy between January 2014 and June 2016 at General Hospital of Japan Railway Company. We used 3D image analysis system (SYNAPSE VINCENT, Fujifilm Corp, Tokyo, Japan) to calculate lung volume of each patient from computed tomography (CT) images which were taken twice, before surgery and 6 months after surgery. We estimated lung volume change from the difference between those two values.

      4c3880bb027f159e801041b1021e88e8 Result

      There were 19 right upper lobectomies (RUL), 7 right middle lobectomies (RML), 8 right lower lobectomies (RLL), 5 left upper lobectomies (LUL), and 10 left lower lobectomies (LLL). We performed lobectomies in three different surgical approaches; Thoracotomy (n=5), Hybrid Video-assisted thoracic surgery (VATS) (n=24), Complete VATS (n=20). 7 patients needed pleurodesis after surgery to treat air leakage. The average of total lung volume change was -10.4%. Right lobectomies showed 11.45% decrease of lung volume in average, while left lobectomies showed 5.34% decrease (p=0.18). Decrease ratio seemed to depend on the way of approaches; Thoracotomy was -19.98% and VATS (hybrid and complete) was -8.58% (p=0.12). Volume change of patients who underwent pleurodesis after surgery was -20.37%, while the ratio of the others was -7.84% (p=0.03).

      result.jpg

      8eea62084ca7e541d918e823422bd82e Conclusion

      VATS seemed to be better in the point of lung volume after lobectomy than thoracotomy. Pleurodesis turned out to reduce lung volume significantly. For furthur study, we will compare lung volume with pulmonary function on a lager aomount of data .

      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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      P3.16-47 - Analysis of The Novel Chest Tube (Coaxial Drain) for Lung Cancer Surgery (ID 12882)

      12:00 - 13:30  |  Author(s): Masayoshi Inoue

      • Abstract
      • Slides

      Background

      The chest tube following a thoracic surgery must immediately read a sign of the postoperative abnormal findings and should be safe and effective in draining both air and fluid. The purpose here is to elucidate the efficacy of the novel chest tube (Coaxial Drain)after anatomical pulmonary resection in patients with lung malignant tumor.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      At first, we analyzed the evacuation of air of various chest tubes (TC: Thoracic Catheter, BD: Blake drain, CD: COAXIAL DRAIN). We measured the maximum pressure and the time required for pressure to reduce under 0.2hPa. Additionally, we verified fluid emission amount and evacuation site of various chest tubes. Next, a clinical trial was performed. This study included patients who underwent anatomical pulmonary resection and mediastinal lymph node dissection for lung malignant tumor between September 2017 and April 2018. One chest tube (24Fr.TC or 24Fr.CD) was positioned apically and posteriorly after surgery. We reviewed the postoperative pain, the amount of chest tube drainage and the presence of subcutaneous emphysema. Pain intensity was evaluated by using The Prince Henry Hospital pain scale (PHPS), and satisfaction scores were evaluated by numeric rating scores (NRS).

      4c3880bb027f159e801041b1021e88e8 Result

      The decompression time of TC was the shortest and its time of CD was shorter than BD (BD>CD>TC). The fluid emission amount increased in proportion to the cross-section area of a drain (CD>TC>BD). All cases found no severe pain in this clinical study. There were no significant differences of pain scale between the TC group and the CD group (PHPS; p=0.83, NSR; p=0.78). No significant difference was observed in total drainage and duration of drainage both the groups. Subcutaneous emphysema occurred in 4 of 8 TC patients and 4 of 20 CD patients, indicating no significant difference between the two groups (p=0.172). There were no complications in any patient. All patients recovered and were discharged home. Moreover, all the cases in which Coaxial Drains were used obtained good wound healing at the drain insertion site.

      8eea62084ca7e541d918e823422bd82e Conclusion

      When air leakage occurs, air evacuation with the only BD or TC tends to be insufficient, irrespective of suction conditions. Coaxial Drains have both air inner lumen and liquid duct channels for drainage capability. Therefore, we think Coaxial Drains provide proper drainage of both airs and fluid after pulmonary resection.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.CR - Case Reports (Not CME Accredited Session) (ID 984)

    • 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.CR-31 - A Case of Thymoma with Autoimmune Hepatitis Following Preoperative Chemotherapy (ID 13065)

      12:00 - 13:30  |  Author(s): Masayoshi Inoue

      • Abstract
      • Slides

      Background

      We encountered a case of thymoma with autoimmune hepatitis.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A 63-year-old woman was found to have an abnormal finding on chest radiography during a medical checkup, but did not seek further care. She was referred to our hospital one year later when a bilateral hilar abnormality was again found during a checkup. Chest computed tomography (CT) showed a 4.6 × 3.0 × 5.6 cm mass with calcifications in the anterior mediastinum. The tumor invaded the right lung and middle lobe, in association with a 2.0-cm daughter nodule in the head of the main tumor, with multiple pleural seeding lesions in the right thoracic cavity. Although she was asymptomatic, the anti-acetylcholine receptor antibody level was elevated to 33 nmol/L and the soluble IL-2 receptor antibody was elevated to 1,700 U/mL. The mass was diagnosed with CT-guided biopsy as a type-B2 thymic tumor (cT3N0M1a, c-Stage IV). She underwent induction chemotherapy (ADOC, 2 courses). After chemotherapy, abnormal liver enzyme levels (aspartate aminotransferase: 451 U/L, alanine aminotransferase: 529 U/L) were noted on preoperative examination. She was diagnosed with autoimmune hepatitis based on liver biopsy findings and treated with oral prednisolone 30 mg.

      4c3880bb027f159e801041b1021e88e8 Result

      Surgery was performed after prednisolone dose was gradually decreased to 20 mg. Extended thymectomy and pulmonary wedge resection using median sternotomy were performed. Pleural dissemination was resected using video-assisted thoracoscopic surgery. The pathological findings showed type-B3 thymic carcinoma (pT3N0M1a, p-Stage IV, Masaoka classification IVa). She was placed under observation without any additional treatment. Prednisolone dose has been gradually decreased to 15 mg without exacerbation of liver function. The anti-acetylcholine receptor antibody level decreased after surgery.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Autoimmune diseases in association with thymoma are well known, but reports of autoimmune hepatitis are very rare. Autoimmune hepatitis must be considered when acute liver damage is observed.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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