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Yojiro Makino



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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: 2
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-15 - Evaluation of Emphysema Severity by 3D-CT for Predicting Postoperative Respiratory Complications and Prognosis of Lung Cancer (ID 12953)

      16:45 - 18:00  |  Presenting Author(s): Yojiro Makino

      • Abstract
      • Slides

      Background

      Emphysema is one of the main causes of respiratory complications and perioperative mortality and morbidity in lung cancer patients. We have used 3D-CT for depicting emphysematous areas as low attenuation areas (LAAs) and visual scores based on Goddard classification (Goddard score: GS). This study aimed to investigate the effectiveness of the 3D-CT function analysis of emphysema severity and its association with respiratory complications and prognostic outcomes.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The study included 504 patients who underwent preoperative 3D-CT for surgical simulation followed by resection for lung cancer from October 2010 to March 2015. GS and LAA% (LAA / total lung volume) were measured using 3D-CT data. We studied the relationship between the development of postoperative respiratory complications/ overall survival (OS) and independent variables including age, sex, forced expiratory volume in 1 second as percent forced vital capacity (FEV1%), histology, smoking status, surgical procedure, GS, and LAA%.

      4c3880bb027f159e801041b1021e88e8 Result

      Postoperative respiratory complications were observed in 69 patients (13.6%). These included prolonged air leakage > 7 days (n = 22), pneumonia (n = 13), bronchial fistula (n = 4), atelectasis (n = 5), pulmonary fibrosis (n = 3), empyema (n = 5), recurrent nerve paralysis (n = 2), chylothorax (n = 5), pleural effusion (n = 3) and other respiratory-related adverse events (n = 7). The ROC curves for respiratory complications determined using the GS and LAA% dichotomized at each cut-off level (1 and 0.7%, respectively) showed that the events were observed in 32% of the patients with GS ≥ 1 and in 25% of the patients with LAA% ≥ 0.7. On multivariate analyses, the GS or LAA% was significantly correlated with postoperative respiratory complications (p < 0.001 and p = 0.016, respectively). Univariate and multivariate analysis using the Cox regression model for prognosis also showed GS was significantly associated with unfavorable OS among 362 patients with pathological Stage I NSCLC patients (p = 0.039). Five-year OS rates in these patients with or without emphysema were 84.0% and 94.1%, respectively (p < 0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Preoperative measurement of GS and LAA% using 3D-CT in patients with lung cancer, particularly with the coexistence of emphysema, was beneficial for predicting postoperative respiratory complications and prognosis in lung cancer patients.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P1.16-17 - The Role of Quantitative Metabolic Metrics on FDG-PET/CT in Predicting Pathological Invasive Factors in cN0 Lung Adenocarcinoma (ID 13195)

      16:45 - 18:00  |  Author(s): Yojiro Makino

      • Abstract
      • Slides

      Background

      Growing evidence suggests that FDG-PET/CT has greatly contributed the preoperative investigation of early-stage lung cancer. The maximum standardized uptake values (SUVmax) of the primary lesion is widely reported to be associated with prognosis in NSCLC while other metabolic metrics, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have been explored as a measure of metabolic tumor burden in recent years. The purpose of this study is to investigate the role of quantitative metabolic metrics in predicting the incidence of pathological invasive factors including microscopic vascular invasion, pleural invasion, and lymph node metastasis in cN0 lung adenocarcinoma.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We examined 265 patients with clinical stage 0-II(cN0) adenocarcinoma. Pre-operative PET/CT and subsequent complete resection was performed for all the patients during the period from August 2012 to July 2017. The maximum tumor and solid-part diameter on HRCT and the three metabolic metrics on PET/CT measured by the SYNAPSE VINCENT (Fujifilm Medical, Tokyo, Japan) as the volume viewer softwarewere observed. In the current study, MTV was defined as the total tumor volume with an SUV > 2.5 while TLG was calculated as meanSUV x MTV. We assessed the relationship between these parameters and the incidence of pathological invasive factors.

      4c3880bb027f159e801041b1021e88e8 Result

      Among 265 patients, 18 (7%) patients were clinically staged as 0, 205 (77%) as IA, 32 (12%) as IB, and 10 (4%) as II, respectively. Pathological vascular invasion, pleural invasion, and lymph node metastasis were found in 100 (38%), 53 (20%), and 45 (17%) patients, respectively. SUVmax, MTV, and TLG were dichotomized at cut-off level by the receiver operating characteristic (ROC) curves for pathological invasive factors (SUVmax of 4.4, MTV of 0.75mm3, and TLG of 2.6, respectively). ROC curve yielded area under the curve values of 0.812, 0.915, and 0.882 for SUVmax, MTV, and TLG, respectively. Univariate analysis showed that SUVmax (Hazard Ratio (HR), 27.185; p<0.001), MTV (HR, 24.580; p<0.001), TLG (HR, 24.580; p<0.001), maximum tumor size (HR, 2.495; p<0.001), solid-tumor size (HR, 7.830; p<0.001), c-stage (HR, 14.418; p<0.001), and sex (HR, 1.882; p=0.013) were significantly associated with the incidence of pathological invasive factors. Multivariate analysis showed that SUVmax was the independent predictor (HR, 7.006; p=0.001). The frequency of pathological invasive factors of patients with SUVmax > 4.4, MTV > 0.75mm3, and TLG > 2.6 were 82%, 84%, and 84%, respectively.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In cN0 early-stage lung adenocarcinoma, the measurement of SUVmax, MTV, and TLG on FDG-PET/CT was beneficial for the prediction of pathological invasive factors.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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