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Yugo Tanaka



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    EP1.12 - Small Cell Lung Cancer/NET (ID 202)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.12-17 - Neuroendocrine Marker Staining Pattern Categorization of Small-Sized Pulmonary Large Cell Neuroendocrine Carcinoma (Now Available) (ID 677)

      08:00 - 18:00  |  Author(s): Yugo Tanaka

      • Abstract
      • Slides

      Background

      Pulmonary large cell neuroendocrine carcinoma (LCNEC) is categorized as high-grade neuroendocrine carcinoma and is known to be associated with shorter survival than that of other non-small cell lung cancers.

      Radical therapies for these tumors are considered to have limited applicability to small-sized cases because of their rapid growth and early metastasis.

      The study aim was to identify subgroups with good or bad prognosis in patients with small-sized LCNEC (sLCNEC) that were based on immunostaining patterns with neuroendocrine markers.

      Method

      From January 2001 to December 2017, of all patients with surgically resected LCNEC, we selected patients whose pathological tumor sizes were ≤30 mm in diameter (defined as small-sized tumors) and who underwent complete anatomical resection with hilar and mediastinal lymphadenectomy. We classified patients with sLCNEC into 2 subgroups based on immunostaining patterns with 3 neuroendocrine makers (chromogranin A, synaptophysin, and neural-cell adhesion molecule).

      Result

      Forty-eight patients with sLCNEC were enrolled in this study. Of 48 patients with sLCNEC, 21 were categorized as the small-sized triple-positive group (sTP), whose patients were positive for the 3 neuroendocrine markers, and 27 patients were categorized as the small-sized non-triple-positive group (sNTP), whose patients were not positive for all 3 neuroendocrine markers. Table 1 shows cliniopathological characteristics among sNTP and sTP. The percentage of lymph node metastasis was significantly lower in sNTP than in sTP (11% and 48%, respectively, P< 0.01). There was no significant difference in overall survival, but recurrence-free survival (RFS) and tumor-specific survival (TSS) were significantly poorer in sTP than in sNTP (Fig 1). Multivariate analysis using 6 clinical factors (age, sex, surgical procedure, pN status, histology, and adjuvant chemotherapy) revealed that sTP were independent prognostic factors for poorer RFS and TSS than those of sNTP.

      table 1.jpgfig 1.jpg

      Conclusion

      The sNTP subgroup had good prognosis and the sTP subgroup had poor prognosis.

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    MA18 - Advances in Diagnosis of Common Types of NSCLC (ID 145)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Pathology
    • Presentations: 1
    • Now Available
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      MA18.10 - Multicenter Study of Intraoperative Rapid IHC for Undiagnosed Pulmonary Tumor Using Non-Contact Alternating-Current Electric-Field Mixing (Now Available) (ID 37)

      11:30 - 13:00  |  Author(s): Yugo Tanaka

      • Abstract
      • Presentation
      • Slides

      Background

      It is widely recognized that pathology is the most important factor for staging and selecting effective chemotherapy for patients with cancer. Immunohistochemistry (IHC) is a reliable screening method, but intra-operative diagnosis by frozen section with IHC is not possible because IHC takes approximately 6 hours. Our aim was to evaluate the clinical utility reliability and sensitivity of a novel intraoperative rapid-IHC by taking advantage of the non-contact mixing effect in microdroplets subjected to an alternating current (AC) electric field.

      Method

      With the new device we have developed, we apply a high-voltage, low-frequency AC electric field to the sections. The antibody is mixed within the microdroplet as the voltage is switched on and off at specific intervals (Figure 1). The resultant coulomb force stirs the diluted solution on the sections, which increases the opportunity for contact. This rapid-IHC enables rapid detection of target cells in frozen sections and can provide a surgeon with an intraoperative diagnosis within 20 min. We will recruit total 150 patients with undiagnosed pulmonary tumor until December 2022.

      wclc fig.1.jpg

      Result

      We enrolled 60 patients for now (the achievement rate is 40.0%). The rate of agreement between rapid-IHC and final pathological diagnosis was 95%. In contrast, the rate of agreement between conventional H&E stain and final pathological diagnosis was 83.3%. When diagnosing pulmonary tumor intraoperatively based on rapid-IHC, we achieved a higher performance level than was achieved using H&E stain alone.

      Conclusion

      We have shown that the rapid-IHC can be used as a clinical tool for prompt diagnosis in pulmonary tumor samples. Our method will help pathologists and surgeons when diagnosing intraoperatively.

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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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      P2.17-05 - Feasibility Study of Adjuvant Chemotherapy with Carboplatin and Nab-Paclitaxel for Completely Resected NSCLC (ID 421)

      10:15 - 18:15  |  Author(s): Yugo Tanaka

      • Abstract
      • Slides

      Background

      Cisplatin-based regimen is the standard adjuvant chemotherapy for patients with completely resected stage II or III non-small cell lung cancer (NSCLC). However, the patients unfit for cisplatin-based chemotherapy due to old age or renal impairment recently increased. This phase II study was conducted to evaluate the tolerability and efficacy of carboplatin and nab-paclitaxel as adjuvant chemotherapy.

      Method

      Patients with completely resected stage II to IIIA NSCLC enrolled. Eligible patients received postoperative adjuvant chemotherapy with 4 cycles carboplatin (area under the curve=5, on day1) and nab-paclitaxel (100 mg/m2, on days 1, 8 and 15) administered every 4 weeks. The primary endpoint was to evaluate the completion rate of 4 cycles of chemotherapy. We assumed completion rate of 50% would be the lower limit.

      Result

      From Jan 1, 2014 to Jan 31, 2019, 21 patients were enrolled, but two patients were excluded. Two patients of them are on protocol chemotherapy at data cutoff point. Median age of the 17 patients was 73 years (ranging from 53 to 80 years). Four of 17 patients (23.5%) were at stage IIA, 3 (17.6%) were at stage IIB, and 10 (58.8%) were at stage IIIA. Eleven (64.7%) had adenocarcinoma and 6 (35.3%) had squamous cell carcinoma. The most reasons of unfit for cisplatin regimen were old age (≥70 years old, n=14) and renal impairment (n=7). Ten of 17 patients (58.8 (32.9-81.6) %) completed four cycles of regimen. The reasons for discontinuation of the chemotherapy were febrile neutropenia (n=2), neutropenia (n=1), empyema (n=1), drug-induced pneumonitis (n=1), renal failure (n=1), and patient refusal due to fatigue (n=1). Three of 10 patients who completed four cycles needed dose reduction due to grade 4 neutropenia. Nab-paclitaxel on day 15 was omitted in 39 of 49 cycles (79.6%) because of grade 3 or 4 neutropenia. The most common grade 3 or 4 adverse event was neutropenia (n=14, 82.4%), followed by anemia (n=3, 17.6%). Febrile neutropenia, grade 3 pneumonitis, grade 1 peripheral sensory neuropathy were observed in 11.8%, 5.9%, 35.3% of the 17 patients respectively. The median time to disease recurrence was 24.4 (10.8-37.5) months.

      Conclusion

      Carboplatin and nab-paclitaxel as adjuvant chemotherapy for NSCLC unfit for cisplatin was not tolerable. Dose reduction should be considered in further study of adjuvant chemotherapy.

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