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Carlos Alfredo Fraile Olivero



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    EP1.03 - Biology (ID 193)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Biology
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.03-04 - Analysis of Post-Surgical Systemic Inflammatory Indexes After Non-Small Cell Lung Cancer Surgical Intervention (ID 1135)

      08:00 - 18:00  |  Author(s): Carlos Alfredo Fraile Olivero

      • Abstract
      • Slides

      Background

      High NSCLC´s mortality rates pushes the research of new prognostic indexes further tan TNM staging and could help in better treatment´s selection. Neutrophil-Lymphocyte Ratio (NLR) preoperatively determined has demonstrated its relation with the immunologic status of the patient prior to the intervention and its capacity of “beating” tumor growing and its prognostic influence.

      OBJECTIVE: Evaluate the prognosis influence of NLR, Lymphocyte-Monocyte Ratio (LMR) and Platelet-Lymphocyte Ratio (PLR) in patients who underwent surgery for NSCLC with R0 resection and abscence of neoadjuvant treatment in peripheric blood determinations after surgery.

      Method

      A retrospective review of all consecutive patients operated on stage I to IIIA NSCLC from may 2014 – october 2018, completely resected and with no neoadjuvant treatment. Patients with previous oncologic history, haematologic neoplasms, perioperatory blood transfussion, perioperative infections or corticosteroids treatment were excluded. Peripheral blood determinations were taken during the first 6-months follow-up period.

      NLR, LMR and PLR were calculated.

      A descriptive analysis of demographic, tumor and surgical details is done.
      Overall survival (OS) was calculated since the date of surgery to date of death or last follow-up date. Disease-free survival (DFS) was calculated since the date of surgery to the date of recurrence. The discrimination capacity of the ratios was assessed with the calculation of the area under the ROC curve [AUC (CI 95%)].

      The relationship among relevant clinico-pathological variables, DFS and OS was calculated. Analysis of recurrence risk factors with univariate and multivariate binary logistic regression (LR) OR(95%CI) was performed.

      Result

      86 patients were included in the analysis. Median follow-up time was 45.7 months. Median OS and DFS were 27 and 24 months respectively. The AUC values of NLR [0.59(0,44-0,74)] and PLR [0,61(0,45-0,76] were not statistically significant, but value of LMR was significant with [0,70(0,57-0,83)].

      The LR model found as factors associated with a higher probability of recurrence adjusted by sex and age: the value of LMR with OR=0,38 (0,20-0,73) and a higher stage than the OR=11,3 (1,89-67.5).

      Conclusion

      Conversely to other publications, in our study the results showed the only relationship between LMR, tumor stage and risk of recurrence.

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      EP1.03-21 - Circulating Tumor Cells Isolation Is Not a Useful Prognostic Tool for Non-Small Cell Lung Cancer Patients Candidates to Surgical Treatment (ID 1271)

      08:00 - 18:00  |  Author(s): Carlos Alfredo Fraile Olivero

      • Abstract
      • Slides

      Background

      It is well known that prognostic stratification according to TNM classification of non-small cell lung cancer (NSCLC) patients is somehow imprecise as there exist notable differences among patients endorsed in the same staging. Because of this it is mandatory to find complementary tools to reach a more accurate classification in order to the best selection of treatments for every patient. The presence of circulating tumor cells (CTC) in periferic blood samples has showed worse prognosis in other primary tumors. The aim of this study is analyzing the impact of CTC on disease free survival (DFS) and overall survival (OS).

      Method

      Periferic blood samples from 28 patients diagnosed with NSCLC in early stages candidates for surgical treatment were obtained. Study period was from June 2011 to October 2013. Blood samples were obtained at least at three different moments: before surgery (S1), one year after the operation (S2) and the last one 2 years after the operation (S3). Blood samples were analyzed by CellSearch method.

      Probability of survival was calculated following the Kaplan-Meier method; differences in survival were examined by the Long-Rank test.

      Result

      Median OS was 34 months and DFS was 11 months. There was no statistically significant differences among patients with or without CTC in S1, S2 and/or S3. When CTC were present, no relationship was observed between the variations in the number of CTCs among the different blood samples and the OS and DFS.

      Conclusion

      In our study, the presence of CTCs in any of the blood samples obtained during the follow-up showed no relationship with OS and DFS. The same results were observed in relation to variations of CTCs' count.

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    MA16 - Prioritizing Use of Technology to Improve Survival of Lung Cancer Subgroups and Outcomes with Chemotherapy and Surgery (ID 142)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      MA16.07 - Implementation of a Smartphone App to Face Postoperative Period in Patients with NSCLC Undergoing Lung Resection Surgery (Now Available) (ID 1028)

      15:45 - 17:15  |  Presenting Author(s): Carlos Alfredo Fraile Olivero

      • Abstract
      • Presentation
      • Slides

      Background

      Preoperative patient education and counseling helps to set expectations about surgical procedure and to prepare for it. Thoracic surgery procedures are related to postoperative complications and strategies to reduce them begin prior to surgery. Lung expansion maneuvers, the importance of early ambulation and pain control are best taught before the procedure. The aim of this prospective study was to implement the use of a smartphone application in a cohort of patients undergoing lung resection surgery and describe their feedback results.

      Method

      We created a Smartphone application as a multidisciplinary tool including: peri-operative medical advice (stop smoking, mouth health, early mobilization and pain control) (Fig1), ten chest physical exercises (with animated images) and programmable Smartphone daily notifications. Complete information to download, set up and interaction with the software was given to patients. A Multiple-Choice-Question survey was applied to patients at the moment of hospital discharge in order to evaluate their experience. This prospective and observational study included clinical data and results of surveys applied.

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      Result

      A total of 68 patients interacted with the application before surgery and answered the survey after the procedure. Median age was 66.5 years and 67.6% were males. Of them, 51 patients (75%) considered the content “very compressible”. 54 patients (79.4%) considered “positive” the contribution of the application to face the postoperative period. Additionally, 31 patients (45.6%) deemed “appropriate” the quantity of time and physical effort needed to complete the interaction with the tool and reach the goals.

      Conclusion

      This is the first smartphone application created by thoracic surgeons to improve patient´s education and helps them to prepare for surgery. This new technological tool was successfully implemented in our thoracic surgery department. For patients, it is easy to download, setup and contents comprehensible information that contributes to face positively the postoperative period with an adequate physical effort and quantity of time.

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    P1.03 - Biology (ID 161)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Biology
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.03-43 - Preoperative Prognostic Value of Immune-Inflammation Index in Patients with Operable Non-Small Cell Lung Cancer (Now Available) (ID 50)

      09:45 - 18:00  |  Presenting Author(s): Carlos Alfredo Fraile Olivero

      • Abstract
      • Slides

      Background

      There is increasing evidence that the systemic immune-inflammation response is correlated with clinical outcomes in diverse solid tumors. The aim of the study was to determine preoperative values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR), and to analyze their impact on histologic outcomes and prognosis in patients with operable non-small cell lung cancer (NSCLC).

      Method

      Retrospective study of patients diagnosed of stage I-IIIA NSCLC (7th edition TNM) between May 2014 and October 2018. Exclusion criteria included neoadyuvant therapy, R1-R2 resection, previous autoimmune or hematological disorders, active pre- or postoperative infection, steroid therapy, perioperative blood transfusion and previous history of malignancy other than NSCLC. The NRL, PLR and LMR were calculated by means of a peripherical blood sample 4 weeks prior to surgery. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for above mentioned ratios. The association between NRL, PLR and LMR, and histological outcomes, recurrence, disease free interval (DFI) and overall survival were analyzed.

      Result

      Eighty-six patients who underwent surgery for NSCLC were included in this retrospective analysis (51% males, median age 69,5 years). Mean follow-up was 45,7 months. Median overall survival and DFI were 27 and 24 months respectively. There was no statistically significant association between PLR, MLR, and histological variables, DFI or overall survival. The optimal cut-off value was 1.90 for NLR. In our series, INR values superior to 1.90 showed a significantly higher recurrence rate (23.6% vs. 5.5%, p=0.04) (Fig. 1) and a decreased overall survival (90% vs. 97%, p=0.031).

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      Conclusion

      This study demonstrated that NLR is an independent poor outcome marker for patients with I-IIIA NSCLC who underwent surgery. In our series NLR (cut off value >1.90) could be used preoperatively as a valuable prognostic marker for disease free interval and overall survival.

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      P1.03-45 - Circulating Tumor Cells' Clearance in Blood Samples After Chemotherapy: A Good Prognostic Factor for OS in Advanced NSCLC (ID 1277)

      09:45 - 18:00  |  Author(s): Carlos Alfredo Fraile Olivero

      • Abstract
      • Slides

      Background

      The poor prognosis of patients diagnosed with non-small cell lung cancer (NSCLC) patients in advanced stages requires a close monitoring of treatment´s response in order to plan early changes when necessary. The presence of circulating tumor cells (CTC) in periferic blood samples has showed worse prognosis in different tumors.

      The aim of the study is analyzing the relationship between the presence of CTCs in periferic blood samples and overall survival (OS) and progression-free interval (PFS) in advanced stages of NSCLC patients.

      Method

      Periferic blood samples were obtained from 25 patients diagnosed with NSCLC in advanced stages from April of 2010 to January of 2013 suitable for chemotherapy treatments. One blood sample was taken before treatment (S1) and the other one, after one cycle of chemotherapy (S2). Blood samples were analyzed by CellSearch method.

      Probability of survival was calculated following the Kaplan-Meier method; differences in survival were examined by the Long-Rank test.

      Result

      Median OS and PFS were 10 months and 6 months respectively.

      OS was 6 months in patients with isolation of CTC in S1 vs 11 months in those with no isolation of CTC; no statistical differences (p=0.978).

      OS was longer in those patients in whom there was no isolation of CTC in S2 compared to those in whom CTC were isolated (19 months vs 5 months; p=0.006). Contrary to this, no difference was observed considering PFS with a median of 6.5 months in patients without CTCs in their S2 and 6 months with CTCs present.

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      Conclusion

      In our study, patients with CTC´s isolation in S2 had a worse prognostic, median of 14 months OS, compared to those in whom there were no CTC isolation.

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    P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-42 - The Use of a Smartphone Application Improves Postoperative Outcomes in Patients Undergoing Lung Cancer Resection (Now Available) (ID 1462)

      10:15 - 18:15  |  Presenting Author(s): Carlos Alfredo Fraile Olivero

      • Abstract
      • Slides

      Background

      For early stages of lung cancer, complete surgical resection with curative intent for patients who are surgical candidates remains the most effective treatment. However, thoracic surgery procedures are related to postoperative pulmonary complications which increase the morbidity and mortality. Preoperative pulmonary rehabilitation programs improve postoperative outcomes. This study aims to evaluate the role of a smartphone application to improve pulmonary rehabilitation in a group patients scheduled for lung cancer resection.

      Method

      A Smartphone application containing peri-operative medical advice (stop smoking, mouth health, early mobilization and pain control) and ten chest physical exercises (aerobic exercise, inspiratory muscle strength and secretion mobilization technique) was created. This prospective and no randomized study was developed between January 2017 and December 2018. All patients scheduled for surgery were asked to participate. A group of 68 patients used and interacted with the software before and after the surgery. The control group (114 patients) received classical information and education by the Department of Physical Medicine and Rehabilitation. Clinical-pathological variables, incidence of postoperative pulmonary complications, duration of chest drainage, length of hospital stay and 30 days mortality rate were recorded and analyzed.

      Result

      Postoperative pulmonary complications were developed 17.6% in the intervention group and 33.3% in the control group (P=0.02). The length of hospital stay was shorter in the intervention group (median 3±4.09d vs. 5±6.87d P=0.001). No differences were found in duration of chest drainage or 30 day mortality compared with control group.

      Conclusion

      This new technological resource created by thoracic surgeons demonstrates that preoperative rehabilitation program and patient education improve postoperative outcomes in patients undergoing lung cancer resection, decreasing the incidence of postoperative pulmonary complications and length of hospital stay.

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