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Sehoon Choi



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    MA01 - Oligometastatic Disease (ID 114)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Now Available
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      MA01.05 - Progress of Accompanying GGN Beyond Pulmonary Resection for Non-Small Cell Lung Cancer (Now Available) (ID 1525)

      10:30 - 12:00  |  Author(s): Sehoon Choi

      • Abstract
      • Presentation
      • Slides

      Background

      The aim of this retrospective study was to review the natural course of synchronous ground-glass nodule (GGN), which was left after the curative resection of non-small cell lung cancer (NSCLC) in other lobe.

      Method

      Between 2008 and 2017, a prospectively collected retrospective data of 2276 patients who underwent curative resection for NSCLC was reviewed. Among them, GGN was detected in 126 patients beside resected lung. Defined by high-resolution computed tomography (HRCT) or thin-section of computed tomography (CT), twenty patients with nearly solid nodule or GGN with higher CT ratio (> 0.75) was excluded, thereafter the data of 98 patients (4.3%) was included in the study. Demographic data of patients including age, gender, and smoking history were collected for analysis. In addition, risk factor including characteristics of GGN, histopathology and staging of resected tumor, adjuvant treatment, and any other medical history were evaluated for risk factor analysis.

      Result

      Median duration of follow-up was 36 months (range; 11 – 120). The size of GGN has been decreased in 10 patients (10.2%), stationary 48 patients (50.0%), while an increasing in size of GGN was observed in 40 patients (40.8%). Among them, five patients were recommended reoperation (12.5%), and the other 35 patients were in clinical observation (87.5%). In mutivariate analysis, existence of solid component, smoking history, and multiple GGNs in one lobe were independent prognostic factor.

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      Conclusion

      During the follow-up, 40.8% of GGN showed a growth in size, emphasizing that patients with part-solid GGN and with smoking history should be in careful observation.

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    MA02 - Miscellaneous Topics in the Management of Early Stage Lung Cancer (ID 116)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
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      MA02.10 - Different Prognostic Impact of Lymphovascular Invasion Between Lobectomy and Sublobar Resection in Stage IA Non-Small Cell Lung Cancer: A Propensity Score–Matched Analysis (Now Available) (ID 2905)

      10:30 - 12:00  |  Author(s): Sehoon Choi

      • Abstract
      • Presentation
      • Slides

      Background

      Lymphovascular invasion (LVI) has been reported as a risk factor in patients with stage I Non-Small Cell Lung Cancer (NSCLC). Although lobectomy is a standard treatment, sublobar resection may be performed in patients with stage IA NSCLC. This study aimed to evaluate the prognostic effect of LVI in stage IA patients who underwent lobectomy and sublobar resection.

      Method

      We retrospectively reviewed data from 2134 patients with stage IA NSCLC from 2007 to 2016. By using the Cox proportional hazard regression model, we calculated the prognostic impact of LVI quantitatively. To reduce the effects of observed confounding between LVI-positive and negative patients, propensity score matching (PSM) was applied in patients with lobectomy and sublobar resection, respectively.

      Result

      Among patients with stage IA NSCLC (n=2134), 184 (8.6%) were pathologically diagnosed with LVI, which were 144 (8.9%) in lobectomy group (n=1614) and 40 (7.7%) in sublobar resection group (n=520). In multivariable analysis, LVI was a significant risk factor for both overall survival (OS) and recurrence-free survival (RFS) (OS: hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.39–2.96; p < .001; RFS: HR, 2.31; 95% CI, 1.68–3.17; p < .001). After PSM, the prognostic impact of LVI was shown much greater in patients with sublobar resection (HR = 1.77 and 2.51 for OS and RFS) than those with lobectomy (HR = 4.93 and 4.25 for OS and RFS).

      Conclusion

      The presence of LVI significantly affected OS and RFS in stage IA NSCLC patients. Survival outcomes were more affected by the presence of LVI in patients with sublobar resection than those with lobectomy. Subsequent completion lobectomy could be considered in patients diagnosed with LVI after sublobar resection.

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    P1.01 - Advanced NSCLC (ID 158)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.01-123 - Recent Clinical Outcomes of Upfront Surgery Followed by Adjuvant Therapy for Resectable Pathological N2 Non-Small Cell Lung Cancer (ID 323)

      09:45 - 18:00  |  Author(s): Sehoon Choi

      • Abstract

      Background

      Although definitive treatment with chemoradiotherapy is standard for non-small cell lung cancer (NSCLC) with N2 disease, surgery still has a role in improving the prognosis of patients with resectable tumors. In this study, we evaluated the recent clinical outcomes of upfront surgery followed by adjuvant treatment in pathological N2 (pN2) disease.

      Method

      We performed a retrospective analysis of clinical outcomes in patients with pN2 disease who underwent surgery as first-line therapy. Multivariate Cox regression analysis was used to identify the significant factors for overall survival (OS) and recurrence-free survival (RFS).

      Result

      From 2004 to 2015, a total of 706 patients who underwent complete anatomical resection were enrolled in this study. With a median follow-up of 40 months, the median OS and RFS times were 52 and 23 months and 5-year OS and RFS were 44.7% and 33.8%. The patients’ clinical N stages were: cN0, 308 (43.6%); cN1, 123 (17.4%), and cN2, 275 (39.0%). Adjuvant chemotherapy, radiotherapy, and chemoradiotherapy were administered in 169 (23.9%), 115 (17.4%), and 299 patients (42.4%), respectively. According to subdivided pN2 descriptors, median OS time was 80, 53, and 37 months in patients with pN2a1, pN2a2, and pN2b, respectively. Patients with clinical N0-N1, so-called occult N2 disease, showed better prognosis than those with clinical N2 (P value = 0.018 for OS and 0.022 for RFS). Adjuvant chemotherapy was a significant prognostic factor for both OS and FFR (P value < 0.001 for OS and RFS).

      Conclusion

      Recent upfront surgery followed by adjuvant therapy in patients with N2 NSCLC showed favorable outcomes compared to those reported in previous studies. Adjuvant chemotherapy is essential for improving the prognosis in patients undergoing upfront surgery for N2 disease.

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    P1.14 - Targeted Therapy (ID 182)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.14-45 - Surgical Outcome of Non-Small Cell Lung Cancer with Clinical Single Zone N2 in Aortopulmonary Zone (LN#5 and LN#6) (Now Available) (ID 1550)

      09:45 - 18:00  |  Author(s): Sehoon Choi

      • Abstract
      • Slides

      Background

      Current staging work-up methodology could not exactly reflect clinical nodal status of aortopulmonary zone (AP zone) without invasive diagnostic tools. The aim of the study is to evaluate the surgical outcome of single zone clinical N2 in AP zone (LN #5 or #6).

      Method

      Between 2009 and 2018, a retrospective data of 7488 patients was reviewed. Patients were included when only lymph nodes in AP zone was suspected to be metastasized based on the results of computed tomography (CT), positron emission tomography (PET-CT) and endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA). Patients were excluded when metastasis was detected by EBUS-TBNA in other mediastinal lymph node zones. Clinicopathologic variables such as pathologic subtype, differentiation and nodal status were evaluated to identify prognostic factors for survival rate and disease-free survival rate (DFS).

      Result

      Ninety-five patients were included, and median duration of follow-up was 35 months (IQR; 20 – 50). Eighty-four patients underwent upfront surgery, and their pathologic nodal staging was pN0 in 20 patients (23.8%), pN1 in 7 (8.3%), pN2a in 40 (47.6%) and pN2b in 17 (20.2%). Overall 5-year survival and 5-year DFS rate was 55.9% 54.5%, respectively. There was no survival difference between patients with pN0-1, pN2a and pN2b (p = 0.345, figure). Neither pathologic N2 nor N2b was not a risk factor for overall survival rate (p = 0.418, 0.159, respectively) and DFS (p = 0.606, 0.650, respectively). In univariate analysis, there was no other significant clinicopathologic factors for survival and DFS. Eleven patients with neoadjuvant treatment showed a similar 5-year survival rate (43.6%) compared with patients with upfront surgery.figure ver. 2.1.png

      Conclusion

      Current work-up without invasive tools for cN2a in AP zone showed relatively high false-positive rate (32.1%). However, surgical outcome of cN2a in aortopulmonary zone was comparable. Upfront surgery should be considered in highly selected patients.

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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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      P2.17-09 - Preoperative Risk Factors of Potential Failure for Lobe-Specific Nodal Dissection in Clinical Early Stage (I-IIA) Non-Small Cell Lung Cancer (ID 1834)

      10:15 - 18:15  |  Author(s): Sehoon Choi

      • Abstract

      Background

      Clinical early stage (I-IIA) non-small cell lung cancer (NSCLC) is treated with pulmonary resection and systematic nodal dissection (SND) or lobe-specific nodal dissection. The aim of this study was to identify the preoperative risk factors for potential failure of lobe-specific nodal dissection in clinical early stage NSCLC.

      Method

      A retrospective review was carried out on patients who underwent pulmonary lobectomy and SND for clinical early stage (I-IIA) NSCLC. Patients with computed tomography and positron emission tomography were included, whereas patients with invasive mediastinal staging and right middle lobe tumor were excluded. Lobe-specific nodal dissection failure was defined as unexpected metastasis at inferior mediastinal nodes (stations 7, 8, and 9) for both upper lobe tumors and at superior mediastinal nodes (stations 2R and 4R for right upper lobe tumors and stations 4L, 5 and 6 for left upper lobe tumors) for both lower lobe tumors. The incidence of pN2 disease following the tumor location and the factors for the failure of lobe-specific nodal dissection were analyzed.

      Result

      From July 2005 to May 2017, 2130 patients were included in this study. Overall, 12.5% (266/2130) of the patients had pN2 disease. Among them, 33.2% (78/266) of pN2 patients showed potential failure of lobe-specific nodal dissection. Lobe-specific nodal dissection failure was shown in 49 of 764 (6.4%), 21 of 468 (4.5%), 2 of 534 (0.4%), and 6 of 364 (1.6%) cases in right upper lobe, right lower lobe, left upper lobe and left lower lobe, respectively. At multivariable analysis, female (OR: 1.86; 95% CI 1.14-3.03; p = 0.012), right upper lobe tumor (OR: 20.98; 95% CI 5.05-87.08; p < 0.001), right lower lobe tumor (OR:14.81; CI 3.43-63.97; p < 0.001), higher SUVmax ( ≥ 4.75) (OR: 5.51; 95% CI 3.18-9.55; p < 0.001), and adenocarcinoma histology (OR: 8.89; 95% CI 2.11-37.42; p = 0.003) were significant risk factors for the failure of lobe-specific nodal dissection

      Conclusion

      Lobe specific nodal dissection revealed a considerable failure rate in clinical early stage NSCLC. Lobe-specific SND should be performed cautiously in clinical early stage NSCLC, especially in patients with female sex, right sided tumor, higher SUVmax (≥ 4.75) and adenocarcinoma histology.