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Shuichi Shinohara



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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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      P1.16-52 - Long-Term Impact of Postoperative Complications Following Lung Resection Among Patients with Non-Small Cell Lung Cancer (ID 13657)

      16:45 - 18:00  |  Presenting Author(s): Shuichi Shinohara

      • Abstract
      • Slides

      Background

      Postoperative complications following lung resection are fatal and common. The immediate effects of postoperative complications are clearly associated with poor prognosis; however, the long-term effects remain unclear. The aim of this study was to investigate the long-term effect of postoperative complications in patients with non-small cell lung cancer following lung resection.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This investigation was designed as a retrospective cohort study including 345 consecutive patients with non-small cell lung cancer who underwent lung resection as the curative surgery at a single institution between 2007 and 2016. Three patients who had surgery related deaths which is defined as the event within hospital stay or within 30days after surgery was excluded. Postoperative complications were graded according to the Clavien-Dindo classification. Postoperative complications included a grade of greater than and equal to 2. We devided two groups among patients with complications(n=109) and without complications (n=233), and evaluate the deta between two groups. Clinical characteristics, pathological features, and causes of death were analysed. Survival analysis was conducted by the Kaplan-Meier method. Prognostic factors were analysed by a Cox proportional hazard model.

      4c3880bb027f159e801041b1021e88e8 Result

      Throughout the study, 253 patients (74.0%) survived and 89 died (26.0%). The median length of follow-up was 51.8 months. Postoperative complications were observed in 109 patients (31.9%). Operation time, smoking index (pack-year), the rate of COPD, and lymphatic invasion were significantly higher in patients with complications than those withtout complications (p=0.001, <0.001, <0.001 and 0.02, respectively). FEV1.0% was lower in the complications group (p <0.001). In comparison to an absence of complications, the presence of complications resulted in worse 5-year overall survival (68.3% vs. 79.5%; p=0.001), worse recurrence-free survival (48.4% vs. 71.0%; p<0.001), and worse cause-specific survival (84.4% vs. 90.5%; p=0.003). There are no significant differences between two groups in concerning non-cause-specific survival (81.0% vs. 94.7%; p=0.095). Patients with complications had higher rates of lung cancer death (15.6% vs. 9.0%; p=0.030). The 5-year overall survival in patients with pulmonary complications tended to be poorer than among those without them, although the difference was not significant (64.2% vs. 70.4%; p=0.072). The Cox proportional hazards model for OS adjusted for age, sex, pathological staging, Charlson comorbdity index, COPD, vascular invasion, lymphatic invasion, pleural invasion, CEA ≥5 ng/ml, and lobectomy showed that postoperative complications are associated with a poorer overall survival (hazard ratio 1.78; 95%CI=1.15–2.19; p =0.010).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our findings indicate that postoperative complications were associated with poor overall survival due to the increase in cause-specific deaths.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.16-10 - Prognostic Impact of Postoperative C-Reactive Protein for Non-Small Cell Lung Cancer Following Lobectomy (ID 13316)

      16:45 - 18:00  |  Presenting Author(s): Shuichi Shinohara

      • Abstract
      • Slides

      Background

      C-reactive protein (CRP) is suggested to be associated with cancer progression; however, the prognostic impact of elevated CRP on postoperative course are not highlighted. We investigated whether the peak level of postoperative CRP could serve as a prognostic marker in patients with non-small cell lung cancer who underwent lobectomy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed 198 consecutive patients with non-small cell lung cancer who underwent lobectomy at a single institution between April 2007 and March 2015. Patients with infection before surgery, missing CRP data, induction therapy, postoperative infectious complications, and non-curative resection were excluded. CRP was measured on postoperative days 1, 3, and 5. Patients were equally divided into two groups according to the median of CRP on postoperative day 3 (CRP3); the high and low CRP3 groups (n=99, respectively).Survival analysis for OS and recurrence-free survival (RFS) was conducted with the Kaplan-Meier method, and the estimates were compared with the log-rank test. A Cox proportional hazards model was used for multivariate analysis to evaluate prognostic factor for OS.Baseline variables with p<0.10 in the univariate analysis were included in the multivariate analysis.

      4c3880bb027f159e801041b1021e88e8 Result

      In this study, 148 patients (74.7%) were alive and 50 had deceased (25.3%). The median length of follow-up for all cases was 61.3 months (IQR=42.6–85.8). Pathological staging were significantly higher in the high CRP3 group (p=0.003). There were no significant differences in 30-day mortality, 90-day mortality, and postoperative complications between two groups. Five-year overall survival (OS) was significantly higher in the high CRP3 group than the low CRP3 (75.3% vs. 86.5%; P=0.016), as was the 5-year recurrence-free survival (62.7% vs. 73.0%; P=0.016).Among the pathological stage I patients, the 5-year OS of the high CRP3 group was higher than that of low CRP3 group (80.5% [95%CI=66.8–88.2] vs. 90.3% [95%CI=78.0–95.9]; p=0.023). This was also same for the pathological stage II and III patients (61.2% [95%CI=38.8–77.5] vs. 81.0% [95% CI=63.9–90.6]; p=0.045). A Cox hazard proportional model for OS adjusted for age, sex, smoking history, pathological staging, and Glasgow prognostic score revealed high CRP3 was associated with a favorable prognosis (hazard ratio, 0.36; 95%CI=0.20–0.65; P<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our findings indicate that high CRP3 may be a favorable prognostic predictor in patients with non-small cell lung cancer following lobectomy. Evaluating the change in postoperative CRP levels should be considered as a prognostic marker of OS.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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