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Paulo De Sousa
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MA20 - Thymic Tumors: From Molecular to Clinical Results and New Challenges in Other Rare Thoracic Tumors (ID 149)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Now Available
- Moderators:Kazuya Kondo, Edith Michelle Marom
- Coordinates: 9/10/2019, 11:30 - 13:00, San Francisco (2009)
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MA20.06 - Neutrophil to Lymphocyte Ratio Is an Independent Prognostic Predictor in Thymoma (Now Available) (ID 1637)
11:30 - 13:00 | Presenting Author(s): Paulo De Sousa
- Abstract
- Presentation
Background
Thymoma is the most common primary neoplasm of the anterior mediastinum in adults and conventional prognostic factors include Masaoka Stage, WHO histology and completeness of resection. Little is known of preoperative peripheral neutrophil-to-lymphocyte ratio (NLR) as an independent additional discriminator of prognosis.
Method
We performed an international multicentre retrospective cohort study (UK Health Research Reference 19/HRA/0440 and EU internal approval reference xxxxxx). We included patients who underwent complete resection for thymoma and data was acquired through patient medical records with follow up data obtained through national database and hospital records. NLR calculated on pre-operation bloods results.
Result
From July 1987 to December 2017, 433 patients underwent surgery for thymoma. The majority were male 228(53%) with a mean age (SD) of 55(15) years. The surgical approach was sternotomy in 335 patients (77%), thoracotomy in 23(5%) and VATS in 75(17%). The WHO classification was type A 63(15%), AB 126(29%), B1 98(23%), B2 55(13%) and B3 86(20%) patients. The Masaoka-Koga stage was I in 135(33%) II in 194(47%), III in 54 (13%) and IV in 31(7%) patients.
Median (IQR) follow-up time was 86 (30 to 152) months with a 5 and 10-year survival of 88% and 79% respectively. The median NLR was 2.1 (1.5 to 3.1), when split into three groups (NLR < 1.4, NLR between 1.4 and 2.3 and NLR > 2.3), higher NLR was associated with poorer survival (log rank P<0.001) that persisted on Cox regression after adjustment for WHO grade and Masaoka stage with a HR of 1.69 (95% CI 1.20 to 2.39; P=0.002).
Conclusion
Pre-operative NLR is a simple, low cost biomarker that can stratify risk of death independent to WHO grade and Masaoka stage in patients undergoing surgery for thymoma.
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P1.13 - Staging (ID 181)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Staging
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.13-11 - An Audit on IASLC Compliance of Lymph Nodes Dissection and Impact on Survival After Surgery for Non-Small Cell Lung Cancer (ID 196)
09:45 - 18:00 | Author(s): Paulo De Sousa
- Abstract
Background
The IASLC proposed minimal criteria for 6 nodes / stations to ascertain certainty status of complete (R0) resection after lung cancer surgery and in 2017, Edwards et al presented that failure of compliance leading to R0 (un) status was associated with poorer survival.
The aims of this audit are to assess compliance of the IASLC recommendations on lymph node staging and determine the impact of R0 (un) status on prognosis in an independent cohort.
Method
We included patients who underwent lobectomy or pneumonectomy for primary lung cancer. Data was obtained from electronic records and survival status obtained from NHS Spine.
Result
From January 2010 to December 2017, 2,521 patients underwent lung resection for primary lung cancer staged using TNM7. The mean age (SD) was 67 (10) and 1,235 (49%) were men, the primary diagnoses were either adenocarcinoma or squamous carcinoma in 2,057 (82%).
The IASLC compliance with 6 node / stations was 627 (25%) and when sub-carinal station was mandatory it was 608 (24%). After exclusions, we were left with 1,859 patients and on adjustment of T and N category, there was no difference between IASLC non-compliance R0 (un) on overall survival with a hazard ratio of 0.95 (95% CI 0.74 to 1.21; P=0.657) compared to R0 compliant.
After adjusting for T and N category there was no significant difference in total lymph nodes stations harvested with a HR 1.01 (0.97 to 1.04, P=0.712) or number of positive stations HR 1.04 (0.92 to 1.16; P=0.543) in survival.
Conclusion
Independent validation of R0 (un) status did not concur with poorer survival. The designation carries uncertainty and likely to be influenced by the extent of N2 dissection. When adjusted for stage, there was no difference on number of stations harvested nor the total number of positive stations on survival.
