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Dariusz Adam Dziedzic



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    EP1.17 - Treatment of Early Stage/Localized Disease (ID 207)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.17-29 - Evaluation of the Influence of Removed Lymph Nodes during VATS-Lobectomy in the Group of Patients with Early Stage of NSCLC on Long-Term Results (Now Available) (ID 311)

      08:00 - 18:00  |  Presenting Author(s): Dariusz Adam Dziedzic

      • Abstract
      • Slides

      Background

      Numerous controversies are caused by the smaller number of acquired lymph nodes (LN) during VATS-lobectomy (VATS-L) compared to the classic thoracotomy (TORA-L) and the potential impact on long-term results of treatment in the oncological aspect. The aim of the study was to determine the number of LN removed during VATS-L and compare it to TORA-L in the group of patients with pT1N0 stage and to determine distant experiences in both groups.

      Method

      The study was based on data from the National Registry of Lung Cancer. In the first stage, the number of removed nodes in the whole group was analyzed with the cN0 feature including 18199 TORA-L and 2685 VATS-L in stages I and II. In the next stage, in the group of patients in the pN0 stage (9864-TORA-L and 2001-VATS-L), the differences in the number of removed nodes in particular types of lobectomy were determined using the Mann-Whitney test and correlated with the survival curves using the log-rang test

      Result

      In the entire examined group, the median of removed nodes was higher in the TORA-L 13 group compared to VATS-L-10 (p <0.0001). In the TORA-L group, the change in grade from N0 to N1 and N2 was found in 11.1% and 7.7% of patients respectively, and in the VATS-L group in 8.8% and 5.7% (p <0.001). In the group of patients with pT1N0, the median of removed nodes for TORA-L and VATS-L were respectively 11 and 9 (p <0.001). The biggest differences concerned the nodes of the groups: 2L, 3, 4L, 7 and 8. In the division into individual lobectomy types, the differences of the removed LN were related to the groups: LDL-2L, 5,6,7,8; LDP-3, LGL-2L, 4L, 8.9; LGP-3, 4R, 7,8,12. 3- and 5-year survivors in the VATS-L group were 84% and 77%, respectively, and were significantly better in comparison to TORA-L: 76% and 67% (p <0.001).

      Conclusion

      The long-term results in the early-stage NSCLC in the group of patients treated with VATS are significantly better than in the group treated classically despite the smaller number of removed lymph nodes during the operation. In the absence of the possibility to clearly determine the required number of lymph nodes, lymphadenectomy during VATS-lobectomy should meet the same criteria as for thoracotomy.

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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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      MA01.07 - Prognostic Factors of Surgical Treatment in Non-Small Cell Lung Cancer (NSCLC) Patients in Oligometastatic Stage-M1b of Disease (Now Available) (ID 312)

      10:30 - 12:00  |  Presenting Author(s): Dariusz Adam Dziedzic

      • Abstract
      • Presentation
      • Slides

      Background

      Non-small cell lung cancer in stage IV is rarely the subject of surgical treatment. Most cases are considered as inoperable and qualified for palliative treatment. Long-term results in this group of patients are poor despite systemic oncological treatment. A special group of patients are patients with a single metastasis beyond the lung (grade M1b), in which in some cases surgery may significantly improve the prognosis. The aim of the study was to determine the prognostic factors of surgical treatment of non-small cell lung cancer in stage IVA with a single distant metastasis (oligometastatic stage-M1b)

      Method

      A retrospective study was based on data from the National Register of Cancer of the Lung conducted by the Polish Group of Lung Cancer. The study included 387 patients (242 men and 145 women) between 41 and 87 years of age (median 60.4 +/- 8.4 years) with established NSCLC and single synchronous metastasis most often to: second lung (55.5%), brain (24.8%) and adrenal glands (14.5%). All patients underwent resection of the pulmonary parenchyma and resection of the metastatic focus. The size of the primary tumor was respectively: 1-2 cm in 16.0%, 2-3 cm in 26.4%, 3-5 cm in 23.5%, 5-7 cm in 12.4% 7-10 cm in 14 , 0% and over 10cm in 7.8%. The features of N0, N1, and N2 were diagnosed in 69.8%, 15.5% and 14.7% of patients respectively. Radical oncology R0, R1 and R2 were obtained in 96.1%, 2.1% and 1.8% of cases respectively. Anatomical resection was performed in 70% and minor resection in 30% of patients. Preoperative chemotherapy was used in 7.5% of cases, and postoperative in 21.2% of patients.

      Result

      The 5-year survival in the entire M1b group was 27.3%. Multivariate analysis showed that the negative prognostic factors were male gender (HR = 1.56, 95% CI-1.16-2.1, P <0.003), age> 50 (HR = 1.39, 95% CI-0.87-2.22, P <0.002), tumor size (HR = 34.32, 95% CI-2.39-7.82, P <0.001), feature N1 (HR = 1.53, 95% CI-1.02-2.29, P <0.04) and the N2 trait (HR = 2.71; 95% CI -1.8-4.06, P <0.001). Patients undergoing anatomical resection vs lower (HR = 0.5, 95% CI-0.35-0.72, P <0.001) and postoperative preoperative chemotherapy (HR = 0.69, 95% CI-0.48-0.97, P <0.034) have better prognosis. The number of lymph nodes removed during the procedure is also significantly affected - 5-year survival at 1-5 removed nodes was 24.6%, and in the case of 6-10 nodes 32.4%.

      Conclusion

      Surgical treatment of NSCLC in the M1b stage in a selected group of patients allows for the improvement of long-term results. Negative prognostic factors are gender, age, tumor size and metastases to lymph nodes. The scope of resection in this group of patients should be the same as in the lower stages with the predominance of anatomical resection and mediastinal lymphadenectomy. Post-operative chemotherapy may have a beneficial effect on long-term results.

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