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Yoshihisa Shimada



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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  |  Author(s): Yoshihisa Shimada

      • 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): Yoshihisa Shimada

      • 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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    P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

    • 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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      P3.01-78 - The Cytology Samples and Plasma Specimens were Feasible for the EGFR Molecular Testing. (ID 12991)

      12:00 - 13:30  |  Author(s): Yoshihisa Shimada

      • Abstract
      • Slides

      Background

      EGFR mutation detection with real-time PCR is standard method to identify eligible patients for EGFR-TKI treatments in daily routine practice. Surgically resected tissues or biopsy specimens are mainly used as the sample materials for testing. However, the biopsy samples sometimes have a certain limitation in their volume and so the cytology specimens are chosen for EGFR testing instead. Plasma has also become an option especially in EGFR-TKI resistant cases in which often have difficulties to obtain the adequate tumor yield. In this study, we evaluated the feasibilities of using cytology samples and plasma specimens for the EGFR molecular testing.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      atients provided written informed consent for use of the samples were participated in this prospective research. Cytology samples were obtained from biopsy and cells were suspended into liquid-based cytology (LBC) media. Tumor contents in the samples were confirmed with Papanicolaou stained slides. Plasma samples were also collected from patients shortly before the tissue biopsy. EGFR mutations in these samples were analyzed by cobas EGFR Mutation Test v2. Also, EGFR testing result of tissue specimens of the patients corresponded were collected from the medical records measured by cobas EGFR Mutation Test v2 as reference.
      The feasibilities of both cytology and plasma specimen were evaluated comparing with the tissue samples.

      4c3880bb027f159e801041b1021e88e8 Result

      One-hundred fifty-eight patients were registered to this study. Among those patients, 77 patients with matched set of samples were enrolled to this study. EGFR mutation rates in tissue, cytology, and plasma were 37.7, 29.9 and 16.9 %, respectively. Overall agreement rate of the cytology specimens and the plasma specimens against the tissue samples were 87.0 and 75.3%, respectively. All eightT790M mutation positive cases were perfectly matched between tissue and cytology specimens.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The results suggested that tissue specimen is the most suitable sample for detecting mutations. Since high specificities were confirmed in both cytology and plasma specimens, the results are reliable as long as the call is positive. Choosing cytology or plasma specimens for EGFR testing can be the considerations for the patients who have difficulties in collecting tissue samples in the real world setting.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.09 - Pathology (Not CME Accredited Session) (ID 975)

    • 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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      P3.09-23 - Accuracy and Reproducibility of Touch Imprint Cytology in Resected Lung Cancer (ID 13092)

      12:00 - 13:30  |  Author(s): Yoshihisa Shimada

      • Abstract
      • Slides

      Background

      With the development of high-resolution computed tomography (CT), small-sized tumors showing ground-glass opacity (GGO) on chest CT images has been more frequently encountered. However, methods such as the transbronchial biopsy and the computed tomography-guided fine-needle aspiration cytology are limited in their ability to diagnose such small lung tumors. We evaluated about the association of the cytological features with the histological examination using the surgically resected specimen.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      169 patients, age between 31–87 years old, who showed radiological signs of peripheral lung tumors less than 3.0cm in diameter on CT images, underwent surgical resection at our institution between 2015 and 2016. The histological examination was performed on surgical specimen, fixed with 10% formalin and stain with Hematoxylin–Eosin. The cytological examination was performed on stamps from surgical material by Papanicolaou staining. The morphological features were compared both histopathogical diagnosis and cytological diagnosis of imprint cyotology derived from the resected specimen. Interobserver reproducibility was assessed by Kappa coefficient providing a measure for agreement beyond chance.

      4c3880bb027f159e801041b1021e88e8 Result

      By histological examination (in the 169 cases), the diagnostic of lung cancer was given with the establishing of the histological type. In 139 cases (82.2%) of the cases diagnosed as adenocarcinoma, in 25 cases (14.8%) squamous cell carcinoma, in 3cases (1.7%) was neuroendocrine tumors, and one case each of adenosquamous carcinoma and pleomorphic carcinoma. There was 86.3% (146 of 169 cases) agreement with a k statisticvalue of 0.65. Obtained kappa values from imprint cytology showed good (from 0.60 to 0.8) for detection of epithelial cell abnormalities indicating high observer diagnostic reproducibility.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This kappa statistic method allows assessment of the diagnostic quality of a respiratory cytology. Imprint cytology for small peripheral lung cancer is a useful method for evaluating tumors. Our data indicate the fact that the cytological examination on stamps from surgical material offers a very high percentage of positive results, close to the histological one. But in the tumor size less than 1.0cm, the establishing of the histological type of lung cancer is more difficult by cytological examination. Despite this, the cytology may be extremely useful in diagnose of the small peripheral tumors. The cytological characteristics of small peripheral adenocarcinoma were little reference to the differentiation at the cellular level. Our findings indicated that the presence of several nucleoli and granular chromatin densely are the factors of adenocarcinoma.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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