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Hiroyuki Ito
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P2.09 - Pathology (Not CME Accredited Session) (ID 958)
- 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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P2.09-27 - Prognostic Significance of Vascular Invasion in Pathological Stage IA Lung Adenocarcinoma According to the 8th Edition of the TNM Classification (ID 12718)
16:45 - 18:00 | Author(s): Hiroyuki Ito
- Abstract
Background
Vascular invasion, including blood vessel invasion (v) and lymphatic vessel invasion (ly), is not a prognostic factor according to the 8th Edition of the Tumor-node-metastasis (TNM) Classification, and the prognostic impact of vascular invasion remains unclear. We reported the prognostic significance of vascular invasion classified according to the previous 7th Edition in patients with stage I non-small cell lung cancer (Diagn Pathol. 2015;10:17). The aim of the present study was to clarify whether vascular invasion classified in the 8th Edition has a prognostic impact on patients with pathological stage IA lung adenocarcinoma and should thus be adopted as an upstaging factor.
a9ded1e5ce5d75814730bb4caaf49419 Method
We reviewed 314 patients with pathological IA (T1a-1bN0 according to the UICC-TNM Classification of Malignant Tumours, 7th Edition) lung adenocarcinoma completely resected between 2000 and 2005. We excluded patients with mucinous adenocarcinoma. The pathological invasive size was measured on the maximal cut surface of the primary tumor, stained with hematoxylin-eosin (HE) and elastica van Gieson (EVG), in all cases. We evaluated blood vessel invasion using specimens stained with HE and EVG, and lymphatic vessel invasion using specimens stained with HE and anti-podoplanin antibody. Blood vessel invasion and lymphatic vessel invasion together represented tumor vessel invasion (TVI). Survival curves were plotted using the Kaplan–Meier method, and the statistical significance of differences between the groups was determined by the log-rank test.
4c3880bb027f159e801041b1021e88e8 Result
The patients were stratified according to the 8th edition into Tis (N = 46), T1mi (N = 69), T1a (N = 82), T1b (N = 99), T1c (N = 18). The median follow-up period was 98.0 months. The recurrence-free survival rate at 5 years was 100%, 100%, 88.9%, 94.7%, 80.3%, 66.7%, and 66.7% in stage 0, IA1(TVI-), IA1(TVI+), IA2(TVI-), IA2(TVI+), IA3(TVI-), and IA3(TVI+), respectively. The lung cancer-specific survival rate at 5 years was 100%, 100%, 88.9%, 98.2%, 87.4%, 66.7%, and 66.7% in stage 0, IA1(TVI-), IA1(TVI+), IA2(TVI-), IA2(TVI+), IA3(TVI-) and IA3(TVI+), respectively. The presence of TVI was a poor prognostic factor in stage IA1 and IA2, but not in stage IA3.
8eea62084ca7e541d918e823422bd82e Conclusion
TVI is a prognostic factor in patients with lung adenocarcinoma measuring 20 mm or less in the pathological invasive size. Stage IA1 lung adenocarcinoma without TVI can possibly be classified as minimally invasive, because patients with stage IA1 lung adenocarcinoma have 100% recurrence-free survival and lung cancer-specific survival.
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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P2.16-35 - Analysis of Pre and Intra Operative Factors Related to the Operation Time of Lobectomy in VATS: Is the Shape of Thoracic Cavity a Predictive Factor? (ID 12917)
16:45 - 18:00 | Author(s): Hiroyuki Ito
- Abstract
Background
Video-assisted thoracoscopic surgery (VATS) to treat lung cancer is less invasive than thoracotomy. However, prolongation of the operation time can make VATS more invasive. An understanding of the preoperative factors of patients scheduled to undergo VATS may help us decide the operative approach and select patients for training young surgeons. We investigated preoperative and intraoperative factors related to prolongation of the operation time required to thoracoscopically perform lobectomy with mediastinal lymph node dissection for lung cancer.
a9ded1e5ce5d75814730bb4caaf49419 Method
We reviewed all 166 patients who had undergone VATS lobectomy with mediastinal lymph node dissection for lung cancer between April 2013 and September 2016 in our hospital. The depth and width of the thoracic cavity was measured on preoperative computed tomographic scans. Preoperative and intraoperative factors were entered in multiple regression analysis to identify independent predictors of a prolonged operation time. We analyzed the relation between the numbers of factors related to a prolonged operation time and the operation time by one-way ANOVA.
4c3880bb027f159e801041b1021e88e8 Result
The average operation time was 175 minutes. On univariate analysis, the shape of the thoracic cavity was not associated with operation time. On multivariate analysis, smoking index (>600), location of the resected lobe (right middle and left upper lobes), clinical lymph-node metastasis, massive adhesion in thoracic cavity, and the number of autosutures for lobe division (3 or more) were independent factors related to a prolonged operation time. The presence of more factors was related to a longer operation time (p<0.001; no factor: 153 min, one factor: 163 min, two factors: 194 min, three factors: 219 min, and four factors: 222 min).
8eea62084ca7e541d918e823422bd82e Conclusion
The shape of the thoracic cavity was not associated with operation time. We identified 5 predictors of a prolonged operation time. Our findings may be useful for deciding the operative approach and selecting patients suitable for training of surgeons.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)
- 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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P3.16-11 - Pattern of Recurrence of Completely Resected Lung Adenocarcinoma Varies According to EGFR Mutation Status (ID 12326)
12:00 - 13:30 | Author(s): Hiroyuki Ito
- Abstract
Background
The prognostic significance of epidermal growth factor receptor (EGFR) mutations in resectable lung adenocarcinoma is not well defined. We evaluated the influence of EGFR mutation status on postoperative recurrence timing with the use of event dynamics.
a9ded1e5ce5d75814730bb4caaf49419 Method
A total of 644 patients with lung adenocarcinoma who underwent complete resection and examined for EGFR mutation status between 2008 and 2015 were studied. Disease-free survival (DFS) were calculated using the Kaplan-Meier method and compared between EGFR mutation-positive patients (n=322) and EGFR wild-type patients (n=322). Event dynamics, based on the hazard rate, were evaluated and only first events (distant metastases or local recurrence) were considered.
4c3880bb027f159e801041b1021e88e8 Result
There was no statistical significance in recurrence rate (9.9% versus 14.6%; p=0.09) between EGFR mutation-positive patients and EGFR wild-type patients. In patients with pathological stage I, DFS was significantly better in the EGFR mutant group than the wild-type group (p=0.009), whereas the EGFR mutant group had an inferior DFS compared with the wild-type group among patients with pathological stage II or higher (p=0.110). The resulting hazard rate curves indicated that the recurrence risk pattern was definitely correlated with EGFR mutation status, with an early highest peak during the first year for EGFR wild-type patients and a late maximum peak in the fifth year for EGFR mutation-positive patients.
8eea62084ca7e541d918e823422bd82e Conclusion
The prognostic value of EGFR mutations appears to be different according to pathological stage in completely resected adenocarcinoma. The hazard and the peak times of recurrence differ considerably between EGFR-mutant and wild-type patients.
6f8b794f3246b0c1e1780bb4d4d5dc53
