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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

  • 26754

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    P1.16-44 - Minute Ventilation-To-Carbon Dioxide Slope is Associated with Early and Long Term Survivals Following Anatomical Pulmonary Resection (ID 12415)

    16:45 - 18:00  |  Author(s): Takeshi Nagayasu
    • Abstract
    • Slides

    Background
    

    The aim of study was to identify that ventilation-to-carbon dioxide output (VE/V CO2) slope obtained from cardiopulmonary exercise test (CPET) was an independent prognostic factor of short and long term survival after lobectomy or segmentectomy.The aim of study was to identify that ventilation-to-carbon dioxide output (VE/V CO2) slope obtained from cardiopulmonary exercise test (CPET) was an independent prognostic factor of short and long term survival after lobectomy or segmentectomy.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    974 patients including lobectomy (n=887) or segmentectomy (n=87) were performed from April 2014 to March 2018. 209 (22%) underwent CPET, and pulmonary function and several clinical factors including age, sex, performance status and comorbidities were retrospectively investigated to identify the prognostic factors with a multivariable Cox regression analysis.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Among patients with CPET, 95 patients (46%) had VO2max<15 mL/kg/min. Compared to patients with higher VO2max, they had similar cardiopulmonary complication rates (32% vs. 29%, p=0.68) and 90 day mortality (9.5% vs. 6.2%, p=0.43). 172 patients had measured VE/V CO2. The incidence of cardiopulmonary complications in patients with VE/V CO2 slope >40 was 37% (19 of 51) vs. 27% (33 of 121) in those with lower slope values (p=0.19). However, 90-day mortality in patients with high VE/V CO2 slope (n=8) was 3-fold higher (16% vs. 5.0%) compared to those with lower (n=6) values (p=0.03). Cox regression analysis showed that higher VE/V CO2 values were significantly associated with poorer 2-year survival (HR 1.07, 95% CI 1.01-1.13, p=0.009)

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    We found VE/V CO2 slope was associated with increased 90-day mortality and poorer 2-year survival in patients submitted to anatomical pulmonary resection for non-small cell lung cancer. These findings may assist the multidisciplinary team in selecting the most appropriate radical treatment in high-risk patients.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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    P1.16-59 - A Phase II Study of Adjuvant Chemotherapy with Tegafur-Uracil for Vessel Invasion Positive Stage IA Non-Small Cell Lung Cancer (LOGIK0602) (ID 12111)

    16:45 - 18:00  |  Author(s): Takeshi Nagayasu
    • Abstract

    Background
    

    Vessel invasion, which includes vascular or lymphatic invasions, is a representative prognostic factor in lung cancer therapy. Even in the patients with resected stage IA non-small cell lung cancer (NSCLC), vessel invasion is a significant poor prognostic factor. The pathological analysis of 322 cases of resected stage IA NSCLC in Oita Prefectural Hospital revealed that the 5-yr overall survival rate was 71.8% in the vessel invasion-positive group and significantly worse than the 89.6% in the vessel invasion-negative group. Interestingly, the 5-yr overall survival rate of the oral tegafur-uracil adjuvant chemotherapy group was 93.3% and significantly better than the 66.6% of the untreated group. Tegafur-uracil is known to affect vascular endothelial growth factor overexpressing tumours. Therefore, to estimate the positive effect of adjuvant tegafur-uracil in patients with vessel invasion-positive stage IA NSCLC, we conducted a multi-center single-arm phase II study (LOGIK0602).

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    The patients with completely resected vessel invasion-positive stage IA NSCLC were registered at the Lung Oncology Group in Kyushu (LOGIK). Vessel invasion was diagnosed by two of the three pathologists. Adjuvant chemotherapy consisted of 2 years of oral tegafur-uracil at 250 mg/m²/day. Fifty-five patients from 7 institutions were enrolled from June 2007 to September 2012. The primary endpoint was the 5-yr overall survival rate. Secondary endpoints were the rate of accomplishment of scheduled adjuvant chemotherapy, incidence and grade of adverse reactions, 3-yr overall and relapse-free survival rates, and 5-yr relapse-free survival rate.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Among the 52 eligible patients, 16 (30.8%) discontinued tegafur-uracil administration and 36 (69.2%) completed the treatment course. The observation period was calculated as 562 to 3107 days and median observation period as 1947 days using the reverse Kaplan-Meier method. There were 39 male and 13 female patients. The 3-yr and 5-yr overall survival rates were 96.2% and 94.2% respectively, which were obviously better than the historical data of 28% to 78.7% in 8 reports. The 3-yr and 5-yr relapse-free survival rates were 92.3% and 88.5%, respectively. Eighteen adverse reactions were observed including 4 cases of grade 3 hepatic function disorder (7.7%) and 5 cases of grade 2 anorexia (9.6%). No grade 4 adverse effect was encountered. Five recurrences were observed including 1 distant metastasis (adrenal) and 4 local recurrences (lung: 2, lymph node: 2).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    A 2-year course of oral tegafur-uracil administration is feasible and might have a significant benefit in the adjuvant treatment of vessel invasion-positive stage IA NSCLC.

    6f8b794f3246b0c1e1780bb4d4d5dc53