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Jhingook Kim
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P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- 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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P2.01-57 - Prognostic Implication of Clinical, Imaging, and Pathologic Parameters in N2(+) Stage IIIA Lung Cancer Patients (ID 13564)
16:45 - 18:00 | Author(s): Jhingook Kim
- Abstract
Background
As a comprehensive study of large scale and long-term clinical outcomes from a single institution, we are trying to analyze any predictive or prognostic factors for survival outcomes in N2(+) NSCLC patients. The purpose of this study is to investigate the efficacy of clinical, imaging (CT and PET-CT), and pathologic parameters, as a prognostic factor in N2(+) NSCLC patients undergoing tri-modality therapy.
a9ded1e5ce5d75814730bb4caaf49419 Method
We retrospectively reviewed 160 patients with N2(+) NSCLC patients between January 2008 and June 2014. All patients underwent preoperative concurrent chemoradiotherapy (CCRT) (44-45 Gy in 22-25 fractions concurrent with weekly DP chemotherapy) and surgery. Clinical, imaging (CT and PET-CT), and pathologic parameters were analyzed with respects to outcomes.
4c3880bb027f159e801041b1021e88e8 Result
Overall pathologic down-staging and pathologic complete response following preoperative CCRT were achieved in 66 (41.3%) and 13 patients (8.1%), respectively. The median follow-up durations of all patients was 43 months (2~106 months). The 5-year rates of disease-free survival (DFS) and overall survival (OS) were 33.3% and 53.0%, respectively. Pathologic N down-staging (HR 2.604; 95% CI 1.418-4.779; p value=0.002) was a significant factor for DFS. Histopathology (HR 0.475; 95% CI 0.242-0.930; p =0.030), GTV of nodal lesion(s) on pre-RT CT (HR 1.066; 95% CI 1.029-1.104; p <0.001), type of surgery (HR 2.985; 95% CI 1.114-7.997; p =0.030), and proportion of viable tumor on cross-section area (HR 0.986; 95% CI 0.973-0.999; p =0.034) were significant factors for OS. Neither tumor volume reduction rate (TVRR) nor SUVmax was significant for DFS or OS.
8eea62084ca7e541d918e823422bd82e Conclusion
In patients with N2(+) NSCLC undergoing tri-modality therapy, we proved that none of the imaging parameters correlated with prognosis, except pretreatment nodal volume. We confirmed that patients with adenocarcinoma showed prominently improved survival and pathologic N down-staging was a most important pathologic parameter as a prognosticator.
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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P3.01-81 - Long-Term Outcome of Surgically Resected Unsuspected N2 Lung Adenocarcinoma (ID 14381)
12:00 - 13:30 | Author(s): Jhingook Kim
- Abstract
Background
This study was performed to assess the long-term outcome of lung adenocarcinoma in patients without clinical suspicion of mediastinal lymph node involvement and whose tumors were finally proven to be pathologic N2.
a9ded1e5ce5d75814730bb4caaf49419 Method
This is a retrospective study of a prospective lung cancer database at our institution from January 2004 to December 2014. We retrospectively reviewed the medical records of 299 patients with unsuspected pathologic N2 disease.
4c3880bb027f159e801041b1021e88e8 Result
The median follow-up time was 51.5 months (range, 1.1 to 172.3 months). The median recurrence-free survival (RFS) was 25.3 months and the 1-year, 3-year, and 5-year RFS rates were 78.2%, 41.0%, and 29.5%. The median overall survival (OS) was 75.2 months and the 1-year, 3-year, and 5-year OS rates were 92.6%, 85.9%, and 62.7%, respectively. The most common type of resection was lobectomy (88.6%). Adjuvant therapy was administered in 255 patients (85.3%). N2 involvement was single station without N1 involvement (“skip” metastasis, N2a1) in 73 (24.4%), single station with N1 involvement (N2a2) in 148 (49.5%), and N2 at multiple stations (N2b) in 78 (26.1%). The median RFS and 5-year RFS rate of N2a1 were 42.9 months and 44.8%. The median and 5-year OS and OS rate of N2a1 were 86.2 months and 69.0%. In multivariate analysis, N2a1, low T-stage, and adjuvant therapy were significantly associated with a longer RFS, whereas pneumonectomy was significantly associated with a worse RFS.
8eea62084ca7e541d918e823422bd82e Conclusion
The long-term outcome of unsuspected pN2 group of patients with lung adenocarcinoma was better than expected. Especially the RFS and OS of pN2a1 group of patients were similar to the those of N1 group of patients reported for survival in our group. Therefore, resection of properly staged unsuspected pathologic N2 lung adenocarcinoma is reasonable and should not be avoided if a complete resection without pneumonectomy can be done.
6f8b794f3246b0c1e1780bb4d4d5dc53
