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Yukihiro Yoshida



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    EP1.18 - Treatment of Locoregional Disease - NSCLC (ID 208)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.18-03 - Outcome of Surgical Resection for Invasive Mucinous Adenocarcinoma: Experience at a Single Institution (Now Available) (ID 2105)

      08:00 - 18:00  |  Author(s): Yukihiro Yoshida

      • Abstract
      • Slides

      Background

      Invasive mucinous adenocarcinomas are new histological type which was determined by WHO classification 4thedition. The aim of this study was to investigate the outcome of surgical treatment for the patients with invasive mucinous adenocarcinoma who underwent surgery in our institution.

      Method

      Between 2010 and 2013, We identified 68 patients with invasive mucinous adenocarcinoma who underwent surgical resection. We measured the distance of tumor cell size and mucinous size, and their clinical and pathological data were retrospectively reviewed. Overall survival (OS) rates were compared using a log-rank test and survival curves were plotted using the Kaplan–Meier method.

      Result

      Participants comprised 31 men and 37 women, ranging in age from 46 to 83 years (median, 67 years). Median observation period in the survivors was 5.1 years. T classification of group oftumor cell size was T1/T2/T3,4=42/17/9 cases, and group of mucinous size was T1/T2/T3,4=38/17/13 cases. The 5-year overall survival rate for group oftumor cell sizewere T1/T2/T3,4=94.3/88.3/60.5%, and group of mucinous size were MS:T1/T2/T3,4=94.1/85.7/70.0%(5Y-OS tumor cell size / mucinous size : p=0.02/p=0.147, 5Y-RFS tumor cell size / mucinous size : p=0.04/p=0.237).

      Conclusion

      Our result indicated that to determine T classification, we should measure the distance of tumor cell size instead of mucinous size.

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    MA08 - Pawing the Way to Improve Outcomes in Stage III NSCLC (ID 127)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
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      MA08.06 - Perioperative Outcomes of Lung Cancer Patients with Interstitial Pneumonia (Now Available) (ID 1372)

      15:15 - 16:45  |  Author(s): Yukihiro Yoshida

      • Abstract
      • Presentation
      • Slides

      Background

      Interstitial lung disease is mostly found in elderly male smokers who also have relatively high risks of developing lung cancer. For these patients, modality to treat malignancy is limited to prevent acute exacerbation of interstitial pneumonia. We analyzed the perioperative outcomes of this group of patients with both interstitial pneumonitis and resectable lung cancer with curative intent.

      Method

      We retrieved the characteristics and medical courses of consecutive patients who had undergone pulmonary resections from medical records. In this analysis, usual interstitial pneumonia (UIP) was characterized by the presence of basal predominant, subpleural reticular abnormalities with traction bronchiectasis and honeycomb cysts detected in bilateral lung field on chest computed tomography preoperatively. Pathological findings on surgical specimen were used confirmation of diagnosis. The incidence and outcomes of acute exacerbation within 30 days from operation were analysed.

      Result

      From 2015 to 2017, there were 1,477 patients who underwent pulmonary resection for primary lung cancer at our institute. Among them there were 81 (5.5%) patients diagnosed as UIP by specific findings on chest computed tomography. Of 81 patients evaluated, 68 (84.0 %) were men, the median age was 73 years (range, 55-88). For Eastern Cooperative Oncology Group (ECOG) performance status, all 81 patients were categorized in status 0. Seventy-four patients (91.4%) underwent lobectomy, 1 (1.2%) bi-lobectomy, 2 (2.5%) segmentectomy and 4 (4.9%) wide wedge resections for primary lung cancer. The mean duration of surgery was 129 mins (range, 54-316), and mean value for blood loss was 36.5 ml (range, 0-396). A complete resection (R0) was achieved in 79 cases (97.5%). Postoperative complications were observed in 19 patients (23.5%) including prolonged air leakage (n=4, 4.9%), late onset of air leakage (n=3, 3.7%), surgical site infection, chylothorax and cerebral infarction. Nine patients (11.1%) manifested acute exacerbation of interstitial pneumonia within 30 days after surgery. There were 3 post-operative deaths (3.7%) within 30 days after surgery. Two deaths (2.5%) were due to acute exacerbation of interstitial pneumonia and 1 (1.2%) case of SAH on 1POD.

      Conclusion

      Pulmonary resection for patients with interstitial lung disease led to 9 (11.1%) cases of acute exacerbation within 30 days from surgery. Mortality related to acute exacerbation was found only 2 cases (2.5%) at our hospital, which was tolerable postoperative outcome for pulmonary resection for lung cancer with curative intent.

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    P1.11 - Screening and Early Detection (ID 177)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.11-10 - Serum MicroRNA Biomarkers for Screening of Resectable Lung Cancer (ID 2253)

      09:45 - 18:00  |  Author(s): Yukihiro Yoshida

      • Abstract

      Background

      An accurate early screening method for lung cancer would be a powerful tool for decreasing lung cancer–related mortality. Computed tomography (CT) scanning is an effective method for lung cancer screening in high-risk populations. However, screening by CT scan has a limitation of low specificity (61%) for detection of lung cancer, resulting in unnecessary follow-up CT scans or invasive lung biopsies. In this study, we investigated the diagnostic potential of serum microRNAs (miRNAs) for detection of resectable lung cancer.

      Method

      Using the 3D-Gene® miRNA Labeling kit and the 3D-Gene® Human miRNA Oligo Chip (Toray Industries), we generated comprehensive miRNA profiles (expression levels of 2588 miRNAs) from 3744 serum samples obtained from 1566 patients with resectable lung cancer and 2178 participants with no cancer. We created a reliable diagnostic model for resectable lung cancer based on the combined expression levels of two miRNAs in the discovery set (208 lung cancer patients, 208 non-cancer participants). We then confirmed the diagnostic performance of the model in the validation set (1358 lung cancer patients, 1970 non-cancer participants).

      Result

      The combination of miR-A and miR-B yielded the best discrimination in the discovery set (AUC, 99.3; sensitivity, 99.0%; specificity, 99.0%). We then confirmed the diagnostic performance of the model in the validation set, and showed that the model was accurate (AUC, 0.973; sensitivity, 95.0%; specificity, 99.0%). According to univariable logistic regression analysis, the odds ratio of the diagnostic model for the presence of lung cancer was 21.76 (95% confidence interval [CI], 15.98–29.63). The diagnostic index exhibited high performance for all pathological stages (IA, 96.1%; IB, 93.7%; IIA, 97.3%; IIB, 96.7%; IIIA, 90.2%; IIIB, 83.3%; IV, 100%), and histological types (adenocarcinoma, 95.1%; squamous cell carcinoma, 94.2%; small-cell lung cancer, 90.9%).

      Conclusion

      A comprehensive analysis of serum levels of 2588 miRNAs in 1566 patients with lung cancer and 2178 non-cancer participants identified a combination of two miRNAs that could reliably detect resectable lung cancer. This study was the largest of its kind performed to date, and the results confirm that evaluation of serum miRNAs is an effective method for detection of resectable lung cancer. The high sensitivity and specificity of this screening model could help to decrease lung cancer–related mortality, as well as the number of unnecessary follow-up CT scans and invasive lung biopsies.

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    P1.17 - Treatment of Early Stage/Localized Disease (ID 188)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.17-37 - Minimally Invasive Open Surgery (MIOS) for Clinical Stage I Lung Cancer: Perioperative Outcomes in Recent 5 Years (ID 1638)

      09:45 - 18:00  |  Author(s): Yukihiro Yoshida

      • Abstract

      Background

      Many thoracic surgeons have tried to make lung cancer surgery less invasive. Although several minimally invasive procedures for lung cancer surgery have been proposed, it has been controversial which procedure is the most optimal. Since around 2010, minimally invasive open surgery (MIOS) has been adopted for lung cancer surgery at our institute. MIOS was performed with direct vision and thoracoscopic vision through a 2-cm port and a muscle-sparing mini-thoracotomy (incision, 6-8 cm in the fourth or fifth intercostal space at the anterior or posterior axillary line). The objective of this study was to evaluate MIOS in terms of perioperative outcomes in recent 5 years.

      Method

      Between 2013 and 2017, 2404 patients underwent pulmonary resection for lung cancer at National Cancer Center Hospital, Tokyo, Japan. Among them, 1930 patients with clinical stage I lung cancer were included in this study. We investigated several perioperative factors according to the type of pulmonary resection: lobectomy, segmentectomy and wedge resection.

      Result

      The patients consisted of 993 men (51.5%) and 937 women (48.5%) with a median age of 69 years (range: 32-90 years). Lobectomy was performed in 1288 patients (66.7%), segmentectomy in 397 (20.6%), and wide wedge resection in 245 (12.7%). Median blood loss was 32 ml (range: 1-1489 ml) for lobectomy, 20 ml (range: 1-435 ml) for segmentectomy, and 4 ml (range: 1-177 ml) for wedge resection. Median operative time was 122 min (range: 45-293 min) for lobectomy, 115 min (range: 69-211 min) for segmentectomy, and 66 min (range: 29-177 min) for wedge resection. Median length of post-operative hospital stay was 4 days (range: 1-57 days) for lobectomy, 4 days (range: 2-20 days) for segmentectomy, and 3 days (range: 2-24 days) for wedge resection. There were no operative deaths. The morbidity rate was 11.8% for lobectomy, 7.3% for segmentectomy, and 4.1% for wedge resection. The 30-day mortality rate was 0.16% for lobectomy, 0.25% for segmentectomy, and 0% for wedge resection.

      Conclusion

      MIOS for clinical stage I lung cancer is a technically safe and feasible procedure with a low complication rate and a shorter hospital stay. The oncological outcomes with a longer follow-up need to be investigated.