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Ricardo Mingarini Terra



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    MS11 - Addressing Challenges with Surgical Resection of Lung Cancer (ID 74)

    • Event: WCLC 2019
    • Type: Mini Symposium
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      MS11.01 - Neoadjuvant Chemotherapy or Neoadjuvant Chemoradiation for Potentially Resectable Nsclc - a Surgeon's Perspective (Now Available) (ID 3500)

      15:45 - 17:30  |  Presenting Author(s): Ricardo Mingarini Terra

      • Abstract
      • Presentation
      • Slides

      Abstract

      Early studies of neoadjuvant therapy compared chemotherapy alone to surgery alone. Later, the Intergroup 0139 study utilized concurrent chemotherapy and radiation as its induction strategy, and this was the basis for adding radiation in the neoadjuvant strategy. Both strategies, neoadjuvant chemotherapy and neoadjuvant chemoradiation are considered alternatives for patients with stage IIIA non-small cell lung cancer deemed operable.

      However, the toxicity of combined chemotherapy and radiation is significant. Radiotherapy has an inflammatory effect that leads to a more difficult surgical procedure and increases the number of postoperative complications. Moreover, studies comparing both strategies failed to demonstrate superiority of any of the two strategies in terms of overall survival.

      On top of that, due to the limited number of radiotherapy clinics in emerging countries, radiotherapy schedules might delay the beginning of the patient’s treatment. This is also an issue to be considered when offering neoadjuvant chemoradiation.

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    P1.10 - Prevention and Tobacco Control (ID 175)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Prevention and Tobacco Control
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.10-10 - Social Vulnerability and Survival in Lung Cancer in Emerging Country (Now Available) (ID 2335)

      09:45 - 18:00  |  Presenting Author(s): Ricardo Mingarini Terra

      • Abstract
      • Slides

      Background

      The association between lung cancer and socioeconomic conditions has been reported more frequently in the last years. Demographical and epidemiological characteristics have changed over time, and these changes are observed mainly in big metropolitan areas of emerging countries with high inequalities scores. Our objective was to analyze the impact of social vulnerability in lung cancer survival in a big urban area of an emerging country.

      Method

      We retrieved data from a local cancer database (RHC) including sociodemographic (Paulista Index of social vulnerability-IPVS and educational level), clinical (tumor characteristics, treatment) and survival data. We used median and interquartile range to show the descriptive results, frequencies and proportions to categorical variables. The survival curve was calculated by Kaplan-Meier and Log-rank.

      Result

      8631 patients were diagnosed with lung cancer between 2000 to 2013 and registered in the RHC database. In our population we found a predominance of men (61%), mean age 63 years (SD±11.4), and 52.5% of them were living in areas with low social vulnerability (Index 2). The most frequent histological type was adenocarcinoma (39%), and most patients were at clinical stage IV at diagnosis (56%); 31.4% received chemotherapy and 24.5%, chemotherapy+radiotherapy as a definitive treatment. The mean time from diagnosis to definitive treatment was 44 days (SD±93). The overall survival was 10 months (4-23). When adjusted for clinical stage, the probability of survival was better for patients living in areas of low social vulnerability (p<0.000) and for those who had completed >12 years of schooling (p<0.000).survival curves.png

      Conclusion

      Social vulnerability and years of schooling are directly related with survival in lung cancer, even when adjusted for clinical stage. Our results highlight the impact of inequality in health outcomes.

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    P2.13 - Staging (ID 315)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Staging
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.13-09 - The Impact of the 8th Edition of IASLC Staging in Patients Who Underwent Surgical Treatment of Lung Cancer (Now Available) (ID 2329)

      10:15 - 18:15  |  Author(s): Ricardo Mingarini Terra

      • Abstract
      • Slides

      Background

      TNM cancer staging main function is to unify the language of patient´s evaluation. It is supposed to be a global initiative, however participation of latin american patients in the IASLC database is limited and the performance of staging in such a population is unknown.Our study aims to describe the performance of TNM 7th and 8th editions in predicting survival of patients with lung cancer who underwent surgical treatment in a latin american country.

      Method

      This is a retrospective study conducted in a Oncologic hospital of São Paulo, Brazil. We selected the patients who underwent surgical treatment of lung cancer between January 2011 and December 2015. Clinical data was obtained from the institutional database including exactly the same variables as the IASLC database. Patients were classified according to the TNM clinical and pathological staging system, both in 7th and 8th editions. Then we performed a survival analysis in 36 months according to each classification using the Kaplan–Meier method. A Cox regression was made with the clinical and pathological staging as variables, in order to determine which classification was more precise in risk prediction.

      Result

      The mean age was 63,9 (±11.6), female predominance (53%), and strong association with current or former smoking (74%). The most common histological type was invasive adenocarcinoma (54%) followed by squamous cell carcinoma (22%). Both TNM classifications stratified risk adequately as demonstrated in Image 1.

      curvas iaslc abstract.jpg

      According to the Cox regression, TNM 8th edition had a better performance in survival prediction.

      Clinical 7th ed (LL=-329.14095; LR=6.29) versus Clinical 8th ed (LL=-25.91923; LR=12.73). Pathological 7th ed (LL=-318.82608; LR=26.92) versus Pathological 8th ed (LL=-315.19067; LR=34.19).

      Conclusion

      TNM 7th and 8th editions predicted adequately survival in patients of a Latin American country, suggesting that these classifications are generalizable for such a population. 8th edition had a better performance when compared to 7th edition.

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      P2.13-10 - Lymph Node Upstaging Evaluation After Robotic Resection for NSCLC in Brazil (Now Available) (ID 934)

      10:15 - 18:15  |  Presenting Author(s): Ricardo Mingarini Terra

      • Abstract
      • Slides

      Background

      An adequate lymph node staging plays a key role in the management of Non-Small Cell Lung Cancer (NSCLC) having great value in determining the necessity for adjuvant therapy. Inasmuch as the development of surgical robotic devices and robotic lobectomy is prominent, it is important to study if the robotic approach is capable of yielding the same or better lymph node staging as open or video assisted technique(VATS).The prevalence of nodal upstaging has been used as an adequate evaluation of the completeness of lymphadenectomy. The aim of this study was to determine the prevalence of lymph node upstaging in patients treated for NSCLC using robotic approach during the initial adoption of this method in Brazil.

      Method

      It was a descriptive analysis with retrospective collection of data from patients submitted to treatment for NSCLC with curative intention using robotic technique in different centers in Brazil. All data regarding demographics in addition to clinical and pathological details about nodal staging were collected. Patients with incomplete records about staging were excluded.

      Result

      We included 172 patients operated on from January 2015 to March 2019 . The average age was 65.7 years, 87 were female and 85 male. The most frequent histologic types were adenocarcinoma with 131(75.7%) cases , carcinoid tumors with 22(12.7%) cases followed by 17(9.8%) squamous carcinomas , 2 (1.1%) large cell carcinomas and 1 (0.5%) adenosquamous carcinoma. One of the patients had 2 tumors with different histotypes (large cell carcinoma and adenocarcinoma). The most frequent stage was IA both in clinical (118,68.6%) and pathological (114, 66.2%) and the average tumor size was 20mm. There was upstaging in 34 (19.7%) cases and down staging in 30( 17.4 %) cases. Lobectomy was the most frequent type of resection with 140 cases. On average 11.9 lymph nodes were resected and 5.8 node categories were addressed. Nodal upstaging occurred in 17 cases (9.8%) of which 8(4.6%) were N1-2 upstaging 6(3.4%) N0-1 upstaging and 3(1.7%) N1-2 upstaging. The incidence of nodal upstaging found was comparable with others studies.

      Conclusion

      In our experience , the treatment for NSCLC using the robotic approach was able to perform an adequate lymphadenectomy with prevalence rate comparable to previous data in literature.

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    P2.17 - Treatment of Early Stage/Localized Disease (ID 189)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.17-27 - Evaluation of Mediastinal Lymphadenectomy Quality in Patients Operated for NSCLC from the Paulista Lung Cancer Registry (PLCR) (ID 2352)

      10:15 - 18:15  |  Author(s): Ricardo Mingarini Terra

      • Abstract
      • Slides

      Background

      To describe the quality of mediastinal lymphadenectomy in patients operated on for NSCLC considering the resectability criteria proposed by IASLC in 2005 and to evaluate the impact of the definition of complete, uncertain and incomplete resection in overall survival and disease free survival in 5 years.

      Method

      Retrospective data from patients operated on for NSCLC between Jan/ 2002 and Dec/2018 in 4 institutions in the state of São Paulo were extracted from a prospective database, the Paulista Lung Cancer Registry (PLCR). Complete resection was defined by the absence of gross and microscopic residual disease, systematic lymph node dissection, and negativity of the highest mediastinal lymph node removed. Uncertain resection was defined by free resection margins, but with less rigorous lymph node evaluation than systematic dissection and/or positivity of the highest mediastinal lymph node removed. Incomplete resection was defined by the presence of gorss or microscopic residual disease. Patient follow-up was updated until Jan/2019. Overall survival was analyzed by the Kaplan-Meier method, Log rank test and Cox proportional regression.

      Result

      A total of 663 patients were identified. Mean age was 65.64 years, 338 men(50.9%). The predominant histological type was adenocarcinoma(n = 466, 70.2%), followed by squamous cell carcinoma(n = 162, 24.4%). Lobectomy was the most commonly performed procedure(n = 576, 86.8%), followed by segmentectomy and pneumonectomy(n = 40, 6.0% and n = 34, 5.1%, respectively). There was 388 patientes(59.81%) classified as stage I, 146(23.1%) stage II, 97(15.3%) stage III and 11(1.74%) stage IV. Resection was complete in 374 cases (56.4%), uncertain in 252 cases(38.0%) and incomplete in 37 cases(5.5%). Mediastinal lymphadenectomy was adequate in 421 cases (63.4%) and inadequate in 242 (36.5%). Reasons for inadequate lymphadenectomy were: no nodal station sampling (n = 30, 4.5%), no station 7 sampling (n = 103, 15.5%) and sampling of less than 3 mediastinal stations (n ​​= 109 , 16.4%). The highest mediastinal lymph node removed was positive in 45 cases (6.7%). Surgical margins were positive in 37 cases (5.5%). The median follow-up was 19.5 months (IQR 7.4 - 42.5), and 5 years follow-up was completed in in 15.5%. During follow-up, 133 (20.4%) patients had recurrence of the disease. Median disease-free survival was 64 months in the general group and 84.0, 58.6 and 31.5 months in the complete, uncertain and incomplete resection groups, respectively (log rank p = 0.15). Median overall survival in the complete resection group was 98.3 months, in the uncertain resection group it was 64 months. The incomplete resection group did not reach the median. There was no statistical difference in survival between groups (log rank p = 0.22).

      Conclusion

      The analysis showed a high prevalence of uncertain resection, but comparable to other studies already published. This demonstrates that lymphadenectomy is not being performed according to IASLC recommendations. However, in this study, there was no impact on overall survival and disease-free survival at 5 years, which may be due to the small sample size and the short follow-up time of the vast majority of patients included in the PLCR.

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