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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
- Presentations: 1
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
P1.16-33 - Occult Lymph Node Metastases in Early Stage NSCLC Patients: Where Do We Stand Now? A Proposal for a Preoperative Risk Model (ID 11974)
16:45 - 18:00 | Author(s): Massimo Ippoliti
Notwithstanding mediastinal lymphadenectomy is a cornerstone of surgical management of primary lung tumors, results and evidences are still debated for clinical stage I disease. In this aspect, current guidelines appear conflicting, as being both radical lymph node dissection and systematic node sampling equally advocated by several Authors. However, though lymphadenectomies are not risk-free procedures, N-status is an undoubted and significant prognostic factor in NSCLC patients. For these reasons, the adoption of a preoperative predictive non-invasive model should be clinically useful to stratify patients according to risk of lymphatic metastases.a9ded1e5ce5d75814730bb4caaf49419 Method
A multicentre retrospective study from January 2014 to June 2017 enrolling 2502 early stage NSCLC patients (up to cIB disease) with a mean age of 67.35 ± 8.89 years was conducted by analysing demographic, radiological and pathological features and correlating themselves to pN+ disease through a bivariate analysis, relative risk estimation and Receiver Operative Curves estimation. Diagnostic performance of a derived risk coefficient (RC = Σ factors) was finally evaluated.4c3880bb027f159e801041b1021e88e8 Result
With a mean Charlson’s Comorbidity Score of 4.34 ± 1.80 and an excellent ECOG Status (ECOG 0-1) in 98.1%, 66.2% presented a very early stage disease (cT1a/b N0 M0) with predominant solid nodule density at chest CT (n. 1992 – 79.6%) and a mean SUVmax of 4.37± 4.95. Each patient underwent a R0 video-assisted thoracoscopic lobectomy with a radical node dissection in 69.9% and a systematic lymph node sampling in remaining cases. Concerning with histology, primary pulmonary invasive adenocarcinoma was the predominant pattern (n. 1417 56.6%) and a cumulative incidence of occult hilar-mediastinal lymph node metastases of 8.8% was reported. At bivariate analysis and relative risk estimation, male gender (p=0.033), clinical T-stage (p=0.000), nodule diameter (p=0.000), nodule density (p=0.005), the presence of visceral pleura or bronchial invasion (p=0.000) and a SUV max >3.5 (p=0.001) significantly correlated with pN+ disease. By deriving a risk coefficient function and adopting it to general population through a ROC curve, a RC > 58 presented a not negligible predictive value (sensibility: 82.73%, specificity 74.36%, PPV 23.73%, NPV 97.81%).8eea62084ca7e541d918e823422bd82e Conclusion
Although a prospective study is needed, a preoperative clinically easily reproducible predictive model for early stage NSCLC patients should represent a useful tool for a proper stratification of pN+ high risk patients. In particular, by considering its high negative predictive value, the aforementioned risk coefficient could allow to discriminate low risk cohort patients amenable to limited lymph node assessment rather than radical dissections with their fearsome related risks.
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