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Richard John Finley

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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: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-34 - The Impact of Pathology, Staging and Operative Resection on Survival and CT Evidence of Recurrence of Early NSCLC (ID 12616)

      16:45 - 18:00  |  Presenting Author(s): Richard John Finley

      • Abstract


      The purpose of this study is to determine the impact of histopathology, staging and extent of operative resection on survival and CT evidence of recurrence of early NSCLC excised with VATS wedge resection guided by preoperative CT-guided microcoil localization (CTML) and intra-operative fluoroscopic guidance.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Between April 2003, to June 2012, 106 of 154 patients who underwent CTML and VATS resection of suspicious pulmonary nodules were found to have NSCLC. Serial chest CTs of the 106 patients with confirmed NSCLC were reviewed by 2 chest radiologists for development of recurrence of the original cancer at the resection margin, lung or mediastinum and the development of new primary lung cancer. 53 patients underwent CTML and VATS resection alone and 53 had CTML, VATS diagnostic resection followed by VATS therapeutic lobectomy. An experienced chest pathologist determined pathologic resection margins, histological subtype and staging.

      4c3880bb027f159e801041b1021e88e8 Result

      The male/female ratio was 47/59. Median age was 63 (34-81) years. Smoking history obtained in 91/106. Median follow-up was 82 (32-136) months. Histology consisted of 99 adenocarcinomas and 7 squamous carcinomas. Staging (AJCC 8th edition) was Stage 0 (11), IA1 (77), IA2 (2), IA3 (3) IB (8), IIB (4) & IV (1). Both surgical groups were similar for demographics, tumor characteristics, histopathology and stage at surgery; there was no 90-day mortality. Multivariate analysis showed adverse effects on: 1) Local recurrence of cancer (n=3) by positive resection margin (n=2) ***. 2) Any recurrence of original cancer (n=10) by lymph node stage ***, positive resection margin ***, visceral pleural invasion (VPI) *** but not age, gender, smoking history, nodule shape on CT, histopathology, tumor invasive size, STAS, lymphovascular invasion or extent of resection. 3) Development of a new primary NSCLC (n=19) by wedge resection alone* (12/19). The new primary was resected in 13/19 patients. 4) Disease free survival at 3 (89%), 5 (74%) & 9 years (61%) by a positive resection margin ***, VPI **, lymph node stage*, or wedge resection alone *. Overall 5-year survival was 85%. (p<.05 *,p<.01 **, p<.001***)

      8eea62084ca7e541d918e823422bd82e Conclusion

      In patients with early NSCLC, CTML accurately identifies the cancer margins resulting in a low radiologic local recurrence rate of 3%. Ten patients had recurrence of their original cancer associated with lymph node involvement, positive resection margin, and VPI. Second primary lung cancers are prevalent in long-term survivors, particularly if treated with wedge resection. Completion therapeutic lobectomy following diagnostic wedge resection of NSLC improves disease-free survival.