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Clemens Aigner



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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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      P1.14-21 - Circulating Biomarkers in Thymic Epithelial Tumors (ID 13914)

      16:45 - 18:00  |  Presenting Author(s): Clemens Aigner

      • Abstract

      Background

      Thymic epithelial tumors are the most common mediastinal tumors. Surgery is the mainstay of treatment and complete resection provides the best survival rate. Nevertheless, advanced tumors may require multimodal therapy and additional prognostic factors beyond tumor stage and histological classification might help to risk-stratify patients and personalize the treatment course.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Between 1999 and 2017 202 patients with thymic epithelial tumors were operated in our center. The preoperative C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels as well as clinical follow-up were retrospectively collected and the association of circulating biomarkers with clinicopathological parameters and their impact on overall survival was analyzed.

      4c3880bb027f159e801041b1021e88e8 Result

      115 male and 87 female patients were included in the study with 59.5 (±13.1) years mean age at the time of operation. 30 patients (including 12 male patients) suffered from myasthenia gravis. Thymic carcinoma was associated with high CRP (> 1mg/dl) when compared to thymoma cases (34% vs 12%, p=0.001). While LDH levels did not show such association, there was a strong tendency for increased mean LDH levels in Masaoka 4 patients (252.5±18.9 vs 220.5±6.1, p=0.063). Overall survival was analyzed in the thymic carcinoma subcohort. 90% of the patients were treated in a multimodal approach and received chemo- and/or radiotherapy in adjuvant or neoadjuvant setting. Median overall survival was 11.3 years. The Masaoka stage (1-3 versus 4) was a significant prognostic factor (HR 0.23, 95%CI 0.07 to 0.77, p=0.017). Elevated CRP (> 1mg/dl) did not show prognostic power for overall survival (HR 0.82, 95%CI 0.77 to 1.33, p=0.76). In contrast increased preoperative LDH level (>200 U/L) resulted in poorer outcome (HR 0.32, 95%CI 0.09 to 1.13, p=0.076).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Circulating biomarkers show association with advanced disease stage in thymic epithelial tumors. Importantly, preoperative LDH levels carry prognostic information in thymic carcinoma and could be used to risk stratify surgically treated patients in multimodal treatment settings.

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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: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.01-45 - Mutational and Inflammatory Biomarkers for Lung Cancer Patients with Pleural Effusions (ID 13884)

      16:45 - 18:00  |  Author(s): Clemens Aigner

      • Abstract
      • Slides

      Background

      Pleural effusion is often associated with the progression of lung cancer and the treatment options for patients with malignant pleural effusions are rather limited. The estimation of prognosis remains to be challenging and personalized therapeutic strategies require a set of validated biomarkers.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      87 lung adenocarcinoma, 27 squamous cell carcinoma and 8 neuroendocrine carcinoma patients with pleural effusions were treated in our department between July 2016 and April 2018. Preoperative C-reactive protein and white blood cell count was collected and their association with clinicopathological parameters and overall survival was calculated. KRAS, EGFR and ALK mutational status was available in advanced lung adenocarcinoma cases. The association of oncogenic mutations with the malignancy of effusion was also analyzed.

      4c3880bb027f159e801041b1021e88e8 Result

      39 of the 122 patients had malignant pleural effusions (32%). 64 patients had TNM stage IV disease. Importantly, high CRP (>5 mg/dl, HR: 14.7, CI95% 2.9-73, p=0.0011) but not high WBC (>9000 cells per microliter) was a strong predictor of shorter survival in lung cancer patients with pleural effusions. High CRP remained a significant prognosticator in lung cancer patients with benign effusions (HR: 21.5, CI95% 1.9-242, p=0.013). KRAS mutation was identified in 28% of the lung adenocarcinoma cases. There was a tendency for lower KRAS mutation incidence in the MPE subcohort when compared to BPE cases (16.6% vs 34.6%, p=0.15). Interestingly, 22% of patients had EGFR mutation and EGFR mutations were more frequent in lung cancer patients with malignant effusions when compared to benign effusions (OR 4.8, CI95% 1.2-19.9, p=0.029).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Oncogenic driver mutations may impact the development of malignant effusions in lung adenocarcinoma patients. Furthermore, our study indicates that the routinely available, circulating preoperative C-reactive protein level carries prognostic information. These findings suggest that oncogenic mutations and inflammatory biomarkers can further personalize therapeutic decisions and can contribute to the risk stratification of lung cancer patients with pleural effusions.

      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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      P3.16-30 - The Impact of the Surgical Approach on Lymph Node Upstaging in Curative Intent Lung Cancer Surgery (ID 13926)

      12:00 - 13:30  |  Author(s): Clemens Aigner

      • Abstract

      Background

      Radical mediastinal lymphadenectomy is an essential part of lung cancer surgery. The purpose of preoperative mediastinal staging is to identify patients who benefit from induction treatment. However, even in early stage lung cancer some patients present with N1 or N2 disease only intra- or even post-operatively. Accordingly, this study aims to evaluate the impact of different surgical approaches and tumor size on the rate of nodal upstaging.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We performed an analysis of our prospectively collected database from January 2016 (for robotic assisted surgery January 2015) to March 2018 and nodal upstaging with regard to surgical approach and T status in all patients with early stage T1/T2 NSCLC undergoing primary resection with curative intent.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 452 T1 or T2 stage NSCLC patients were operated with curative intention. Upstaging occurred in 65 cases (14.4%), from which 43 (9.5%) patients had pN1 and 22 (4.9%) had pN2 disease. Staging was performed according to ESTS guidelines. 366 patients (81%) were preoperatively evaluated by PET/CT and/or EBUS. 293 patients received PET/CT and 169 of them had an additional EBUS. 73 patients received EBUS based on conventional staging without PET/CT. There was a significant difference (p=0.01) in upstaging between T1 and T2 tumors (10.5% (7%N1/3.5%N2) and 19.4% (12.8%N1/6.6%N2), respectively). A stratification based on the surgical approach is shown in Table 1.

      table1.jpg

      8eea62084ca7e541d918e823422bd82e Conclusion

      Irrespective of the surgical approach the rate of N1 upstaging is significantly higher in patients with T2 tumors compared to T1 tumors. The rate of mediastinal upstaging is comparable in both groups. The distribution between T1 and T2 tumors needs to be taken into account when analyzing upstaging rates in primary lung cancer surgery.

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