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Young Mog Shim
OA10 - Sophisticated TNM Staging System for Lung Cancer (ID 136)
- Event: WCLC 2019
- Type: Oral Session
- Track: Staging
- Presentations: 1
- Now Available
- Moderators:Ke-Neng Chen, Pedro Lopez De Castro
- Coordinates: 9/09/2019, 14:00 - 15:30, Toronto (1985)
OA10.02 - Recommended Change for N Descriptor Proposed by the IASLC: A Validation Study from a Single-Center Experience (Now Available) (ID 2117)
14:00 - 15:30 | Author(s): Young Mog Shim
The International Association for the Study of Lung Cancer (IASLC) recently proposed changes for N descriptor based on the location and number of involved lymph node stations. The aim of our study was to evaluate the discriminatory ability and prognostic performance of the proposed N descriptor in a large independent non-small cell lung cancer (NSCLC) cohort.Method
IASLC proposals include: a classification of N descriptor by combining the present nodal categories and number of involved lymph node stations into: N0; single-station N1 (N1a); multiple-stations N1 (N1b); single-station N2 without N1 involvement (N2a1); single-station N2 with N1 involvement (N2a2); multiple-stations N2 (N2b) and N3. A total of 1128 patients who underwent major pulmonary resection for pathologic N1 or N2 NSCLC between 2004 and 2014 were analyzed in this study. survival analysis was performed using Cox proportional hazard model to assess the prognostic significance of the N descriptor.Result
From 2004 to 2014, 7437 patients were operated on for non-small-cell lung carcinoma (NSCLC). Among those, patients who underwent preoperative treatment for stage IIIA-N2 NSCLC were excluded (N=-698, 9.4%). Patients who were confirmed as pathologic N1 (N=676) or N2 (N=452) after surgery were included in this study. Invasive mediastinal staging (EBUS or mediastinoscopy) was done in 614 patients (54.4%). After surgery, adjuvant treatments were performed in 901 patients (81.7%). The mean total number of dissected lymph node was 25.7 ± 11.0, and the mean number of involved (metastatic) lymph node was 3.0 ± 3.2. The 5-year overall survival rate was 64.7 % in N1a, 57.1% in N1b, 68.0% in N2a1, 50.1% in N2a2, and 46.7% in N2b. Based on our study about the overall survival and recurrence-free survival, N2a1 is not clearly divided into N1a and N1b is not clearly divided with N2a2.
Based on the proposed N stage classification by combining the LN station number with the proposed anatomic location in IASLC, all 5 groups were not clearly identified. According to our analysis, it would be better to classify similar prognostic group as 3 or 4 group to divide the group. The new N classifications should be considered for future revisions of TNM staging system for lung cancer.
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P2.05 - Interventional Diagnostic/Pulmonology (ID 168)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Interventional Diagnostics/Pulmonology
- Presentations: 1
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
P2.05-13 - Impact of Diffusing Capacity for Postoperative Pulmonary Complications in Patients Without Obstructive Pulmonary Disease (ID 2314)
10:15 - 18:15 | Author(s): Young Mog Shim
This study evaluated the impact of diffusing capacity of the lungs for carbon monoxide (DLco) on postoperative pulmonary complications (PPCs) after lung resection in patients without obstructive pulmonary diseaseMethod
We retrospectively reviewed non-small cell lung cancer patients undergoing anatomical lung resection without induction treatment between 2015 and 2016. Of these, 1233 patients without obstructive pulmonary disease were included in the study. We considered the following PPCs as study outcomes: pneumonia, acute respiratory distress syndrome (ARDS), significant atelectasis, empyema, bronchopleural fistula, prolonged air leakage and pneumothorax. The independent effects of DLco on PPCs were evaluated using multivariate logistic regression. Models were adjusted for age, sex, smoking status, comorbidity, histology and type of surgery.Result
Twenty three percentage of patients showed the decrement of pred % of DLco less than 80. A total of 104 patients (8.4%) developed at least one PPC. More PPCs were occurred in the patients with impaired DLco (6.2% vs 15.7%, p<0.001). In multivariable-adjusted analyses, risk of PPC in patients with impaired DLco was more than 2 times [the adjusted odds ratio (aOR)=2.44 (1.58,3.77)] compared to those in patients with preserved DLco. Also, with every 10% decreasing in % pred DLco, the risk of developing PPC was gradually increased. [DLco ≥ 80 vs. 70≤DLco<80, aOR=2.07 (1.22, 3.49); 60≤DLco<70, aOR=2.79 (1.45, 5.36); DLco<60, aOR=4.69 (1.72, 12.75), p<0.001]Conclusion
Patients with impaired DLco had more risk of PPCs after lung resection even without airflow obstruction. Assessment of DLco is necessary for the prediction of PPCs in lung resection surgery for NSCLC.