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Tie-Hua Rong



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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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      EP1.17-34 - Association Between the Number of Resected Lymph Nodes and Long-Term Survival in N0 Non-Small Cell Lung Cancer: Data from a Chinese Large Cohort (Now Available) (ID 491)

      08:00 - 18:00  |  Author(s): Tie-Hua Rong

      • Abstract
      • Slides

      Background

      We aim to investigate the impact of the numbers of resected total lymph nodes (TLNs) and mediastinal lymph nodes (MLNs) on long-term survival in patients with node-negative (N0) non–small cell lung cancer (NSCLC) using a large cohort.

      Method

      Patients with N0 NSCLC who underwent R0 resection between 2001 and 2014 were included. Scatter plots of hazard ratios (HRs) from Cox proportional hazards model against the numbers of resected TLNs and MLNs were depicted and curves were fit using a LOWESS smoother. Cut-off points for the optimal numbers of resected lymph nodes were further determined by Chow test. KaplanMeier method was used to compare the overall survival (OS) between groups divided by the cut-off points.

      Result

      A total of 2,444 patients were included in this study and adenocarcinoma accounted for most of the cases (adenocarcinoma: 1,522/2,444, 62.3%; squamous-cell carcinoma: 784/2,444, 32.1%; others: 138/2,444, 5.6%). Mean numbers of resected TLNs and MLNs were 19.4 ± 11.0 (median: 17) and 12.1 ± 8.6 (median: 10). Cox regression analysis suggested that the increasing numbers of resected TLNs/MLNs were independent factors favoring OS in adenocarcinoma (TLNs: HR = 0.983, 95% confidence interval [95% CI] 0.971 to 0.996, P < 0.01; MLNs: HR = 0.983, 95% CI 0.968 to 0.999, P = 0.034). Curves of HRs against resected numbers of TLNs/MLNs with Chow test suggested that 17 resected TLNs and 12 resected MLNs were optimal cut-off points for prolonged OS in adenocarcinoma. Furthermore, both the cut-off points were confirmed by OS comparison (5-year OS: 84.2% [≥17 TLNs] vs. 77.9% [<17 TLNs], P = 0.02; 84.4% [≥12 MLNs] vs. 78.9% [<12 MLNs], P = 0.04) and Cox regression model (TLNs: univariate HR = 0.754, 95% CI 0.593 to 0.959, P = 0.021, multivariate HR = 0.712, 95% CI 0.556 to 0.914, P < 0.01; MLNs: univariate HR = 0.769, 95% CI 0.598 to 0.988, P = 0.040, multivariate HR = 0.730, 95% CI 0.560 to 0.952, P = 0.020). However, the numbers of resected TLNs/MLNs were not associated with OS in non-adenocarcinoma (TLNs: HR = 0.998, 95% CI 0.987 to 1.009, P = 0.756; MLNs: HR = 1.000, 95% CI 0.986 to 1.015, P = 0.988).

      Conclusion

      The number of resected lymph nodes associated with OS in N0 lung adenocarcinoma patients. At least 17 TLNs and 12 MLNs are required to be resected to warrant the long-term survival in these patients.

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    OA13 - Ideal Approach to Lung Resection and Novel Perioperative Therapy (ID 146)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
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      OA13.02 - Video-Assisted Thoracoscopic Surgery vs. Thoracotomy for Non-Small Cell Lung Cancer: Survival Outcome of a Randomized Trial (Now Available) (ID 1444)

      11:30 - 13:00  |  Author(s): Tie-Hua Rong

      • Abstract
      • Presentation
      • Slides

      Background

      Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of early-stage non–small cell lung cancer (NSCLC). However, there has not been a robust randomized control trial (RCT) to confirm the non-inferiority of VATS to open lobectomy in term of oncologic efficacy. Therefore, a large multicenter RCT in China was designed and initiated to verify the role of VATS.

      Method

      A phase 3 RCT was undertaken at five thoracic surgery tertiary centers in China. Patients aged 18-75 years old who were diagnosed of clinically early-stage NSCLCs were randomized in a 1:1 ratio into VATS and thoracotomy groups. Radical lobectomy plus hilar and mediastinal lymph node dissection was the standard surgical intervention. The primary end-point of study was 5-year overall survival (OS). The secondary end-points including 5-year disease-free survival (DFS) and cancer relapse rates would also be reported here. Analysis was by intention to treat. This study is registered with the ClinicalTrials.gov, number NCT01102517.

      Result

      A total of 508 patients were recruited between January 2008 and March 2014. The final follow-up for 5-year survival analysis was completed in March 2019. And 432 patients were eligible for analysis (222 cases in VATS group and 210 cases in thoracotomy group). The cancer relapse (recurrence and metastasis) rates were 39.2% in VATS group and 36.7% in thoracotomy group respectively (P=0.621). Patients who received VATS lobectomies had a similar 5-year DFS to those who underwent open surgery (58% versus 62%, P=0.686). Finally, the 5-year OS rates were of no significant difference between VATS and thoracotomy groups (74% versus 71%, P=0.497).fig.jpg

      Conclusion

      The non-inferiority of VATS to thoracotomy lobectomy was confirmed in our RCT in terms of oncologic efficacy for clinically early-stage NSCLCs.

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