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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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    P2.16-30 - Surgical Strategy for Clinical Stage IA Non-Small Cell Lung Cancer Patients with Risk Factors of Pathological Invasion and/or Metastasis (ID 12662)

    16:45 - 18:00  |  Author(s): Masaya Nakamura
    • Abstract
    • Slides

    Background
    

    Because pathological metastasis and involvement are thought to be associated with postoperative recurrence and poor outcomes in non-small cell lung cancer (NSCLC) patients, limited resection for high risk patients of pathological metastasis and involvement is controversial. The aim of this study was to examine a postoperative locoregional control in these patients.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We retrospectively reviewed completely resected clinical stage IA NSCLC patients on the 8th edition of the TNM classification (solid tumor component size of ≤3 cm on computed tomography; CT). The pathological metastasis and/or involvement was defined that pleural involvement, pulmonary metastasis, lymph node metastasis, and/or lymphovascular involvement were identified on pathological examination. To identify predictors for the pathological metastasis and/or involvement, demographic and clinical factors were analyzed by a univariate analysis and multivariate logistic regression analysis. For the significant factors, optimal cutoff points were determined with a receiver operating characteristic analysis. Locoregional recurrence-free probabilities were calculated using the Kaplan-Meier method in patients with/without the identified predictors, and were compared between patients who underwent limited resection and lobectomy by the log-rank test.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Of the 286 eligible patients, pleural involvement, pulmonary metastasis, lymph node metastasis, lymphatic permeation, and vascular invasion were identified in 43 (15%), 5 (2%), 11 (4%), 15 (5%), and 32 patients (11%), respectively, and in total, 73 patients (26%) developed the pathological metastasis and/or involvement. Univariate and multivariate logistic regression analysis revealed solid tumor component size on CT (OR: 1.090) and consolidation/tumor ratio on CT (CTR; OR: 1.043) as significant predictors. The optimal cutoff points were determined as 1.7 cm and 86% for solid component size and CTR, respectively, and 47 of the 97 patients (48%) with >1.7 cm of solid component size and >86% of CTR developed the pathological metastasis and/or involvement. In the 97 patients, the 3-year locoregional recurrence-free probabilities were 70% versus 84% in patients who underwent limited resection (n = 21) and lobectomy (n = 76), respectively (p = 0.0963), whereas in 104 patients with ≤1.7 cm of solid component size and ≤86% of CTR, the 3-year locoregional recurrence-free probabilities were 95% versus 97% in patients who underwent limited resection (n = 52) and lobectomy (n = 52), respectively (p = 0.8622).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    An indication for limited resection may be decided with caution in clinical stage IA patients with the predictors of the pathological metastasis and/or involvement because of relatively higher incidence of postoperative locoregional recurrence after limited resection when compared with lobectomy.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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