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Seiichiro Sugimoto
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EP1.01 - Advanced NSCLC (ID 150)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.01-18 - Clinical Features of Locally Advanced Lung Cancer Patients with Radiation Pneumonitis After Induction Chemoradiotherapy (Now Available) (ID 2199)
08:00 - 18:00 | Author(s): Seiichiro Sugimoto
- Abstract
Background
The therapeutic management of locally advanced non-small cell lung cancer (NSCLC), such as those in the N2-3, bulky N1, or T3-4 stage, remains controversial. Induction chemoradiotherapy (CRT) followed by surgery is one of the potential therapeutic options for locally advanced NSCLC, however, sometimes develops radiation pneumonitis (RP). Severe RP induce remarkable respiratory disfunction, resulting in a delay of next treatment. The purpose of this study is to reveal the clinical features of NSCLC patients with RP after induction CRT.
Method
The clinical data of NSCLC patients who underwent surgical resection of lung cancer after induction CRT between 1999 to 2017 at our institution were analyzed. We compared NSCLC patients who had RP with those who didn’t, regarding patient’s and therapeutic factors, and their prognosis. RP of our cases was defined as RP which occurred between the administration of induction CRT and 30 days after surgery.
Result
A total of 172 data of NSCLC patients who underwent surgical resection of NSCLC of stage IIB–IIIC after induction CRT was collected. Among them, 34 NSCLC patients had RP, and 15 NSCLC patients received steroid therapy in 30 NSCLC patients, able to be assessed retrospectively. Non-smoking status was significantly associated with RP in univariate analysis (p = 0.006) and in multivariate analysis (odds ratio: 3.70, 95% confidence interval: 1.05-13.10, p = 0.042). Duration between completion of RT and surgery was longer in NSCLC patients with RP than those without RP (range [median]: 14-141 [45.5] vs 23-91 [40.0], p = 0.029). Adjuvant therapy was more frequently given to the patients without RP (p = 0.019). No significant difference in overall survival (OS) was observed between the 2 groups.
Conclusion
Non-smoking status was the risk factor of RP of NSCLC patients who received induction CRT followed by surgery. The frequency of adjuvant therapy was more in NSCLC patients without RP than those with RP while OS was not different in the 2 groups.
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EP1.18 - Treatment of Locoregional Disease - NSCLC (ID 208)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.18-08 - Pulmonary Lobectomy and Completion Pneumonectomy for Ipsilateral Lung Cancer After Radical Resection (Now Available) (ID 1218)
08:00 - 18:00 | Author(s): Seiichiro Sugimoto
- Abstract
Background
Ipsilateral reoperation such as lobectomy and completion pneumonectomy after radical resection of lung cancer is a high-risk operation. We evaluated outcomes after these operations in our hospital.
Method
We retrospectively reviewed the records of 27 patients who underwent ipsilateral lobectomy or completion lobectomy for new primary lung cancer or recurrence after pulmonary lobectomy or bi-lobectomy between 1998 and 2017.
Result
9 patients underwent completion lobectomy, of which 4 were right and 5 were left, and 18 patients underwent lobectomy. Mean operative time was 308.7±27.4 minutes, and mean blood loss was 706.9±254.3mL. Blood loss was significantly higher in completion pneumonectomy patients as compared to lobectomy patients, whereas operative time was not different between the operations. There was no perioperative mortality, but intraoperative complications were seen in 4 cases (14.8%), which were 2 pulmonary artery injury, superior venous cava injury and azygos vein injury. Perioperative morbidity was seen in 8 cases (29.6%), and postoperative bronchopleural fistula occurred in one case. Fourteen patients had Pathological stage IA disease, 6 had IB, and 5 stage II or over. As clinical outcome, 5-year overall survival rate was 71.1%.
Conclusion
Pulmonary lobectomy or completion pneumonectomy for ipsilateral lung cancer after radical resection were performed in 27 patients without perioperative mortality. Our results strongly suggests that this strategy is a meaningful option for new or recurrent ipsilateral lung cancer.
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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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MA20.11 - Surgical Treatment for Metastatic Lung Tumors from Sarcomas of Soft Tissue and Bone (Now Available) (ID 2391)
11:30 - 13:00 | Author(s): Seiichiro Sugimoto
- Abstract
- Presentation
Background
Sarcoma is one of the refractory malignant tumors and often develops pulmonary metastasis. The purpose of this study was to evaluate the impact of surgical resection for metastatic lung tumors from sarcomas of soft tissue and bone retrospectively.
Method
Between 2006 and 2015, we had a total of 158 patients with metastatic lung tumors from soft-tissue and bone sarcomas who underwent pulmonary metastasectomy for the first time. In total, 265 surgical procedures were performed in Okayama University Hospital in this period. We analyzed the age, sex, site of primary lesion, histology, extent of primary tumors at the initial diagnosis, extent of pulmonary metastases at the first pulmonary metastasectomy, presence or absence of local recurrence and/or extrapulmonary metastases with or before pulmonary metastases, operative procedures, size of the largest lesions resected, maximum number of the resected tumors, postoperative complications, and the prognosis at the end of 2018.
Result
Average number of resected tumors per intervention was 4.0 (range 1-19). These sarcoma patients consisted of 36 males and 122 females, and their average age was 53.7 years (range 14-88 years). Leiomyosarcoma was the most common histological subtype (n = 92, 58.2%) and uterus was the most common location of the primary disease (n = 71, 44.9%). Operative procedures were composed of 202 partial resections, 35 segmentectomies with or without partial resections, 26 lobectomies with or without partial resections, 1 pneumonectomy, and 1 basal segmental auto-transplantation after pneumonectomy. The postoperative complications were limited, showing that pulmonary metastasectomies for sarcomas are acceptable. Overall 3-year survival after the first pulmonary metastasectomy was 50.6%. In univariate analysis, the survival was significantly better for the group with disease-free interval of more than 2 years from the date of the initial treatment for primary disease until the date of diagnosis for the first pulmonary metastasis, the one who underwent pulmonary resections three times or more, and the one in which size of the largest resected lesion was 20 mm or less. Those factors significant in univariate analysis were all significant in multivariate analysis.
Conclusion
Surgical resections for metastatic lung tumors from sarcomas of soft tissue and bone were performed without major complications, indicating the acceptable feasibility. If disease-free interval is more than 2 years and the size of the largest resected lesion is less than 20 mm, patients may maximally benefit from pulmonary resection. In order to increase the opportunities of pulmonary resections, we should preserve the lung parenchyma as much as possible when performing pulmonary metatstasectomy, resulting in the better survival.
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P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.16-35 - The Prognostic Impact of Sarcopenia on the Clinical Outcome of Thoracic Surgery for Non-Small Cell Lung Cancer in Elderly Patients (ID 1544)
09:45 - 18:00 | Author(s): Seiichiro Sugimoto
- Abstract
Background
The elderly patients who undergo surgery for non-small cell lung cancer (NSCLC) is increasing in Japan whereas they are at high risk for surgery because of weakness of physical strength and increased comorbidity. Skeltal muscle depletion, referred to as sarcopenia, has recently been identified as a risk factor of poor clinical outcomes after surgery in the patients with various malignancies including NSCLC. We investigated the impact of sarcopenia on the clinical outcome of thoracic surgery for NSCLC in elderly patients.
Method
We enrolled 259 patients over 65 years old with NSCLC who underwent pulmonary resection (lobectomy or segmentectomy) without any induction treatment before surgery in our hospital during 2012 to 2015. Sarcopenia was assessed by the psoas muscle mass index (PMI, cm2/m2) using the computed tomography imaging at the third lumbar vertebra level before surgery. Postoperative complications, which were observed within 30days after surgery, were classified according to Clavien-Dindo classification. Overall survival (OS) was evaluated by the Kaplan-Meier method with log-rank test (univariate analyses) and by the cox proportional hazard model (multivariate analyses).
Result
Median age was 73 years old (65 - 92). One hundred fifty-five (60%) patients were male. Two hundred nine (81%) patients were cStage0 or I. Fifty-seven (22%) patients were squamous cell carcinoma (SCC). Postoperative pneumonia, arrhythmia, and delirium were observed in 17 (7%), 35 (14%) and 17 (7%) patients, respectively. Median follow-up was 48.7 months (range 3.0 – 79.6). Using the cutoff values as previously reported, 179 (69%) and 80 (31%) patients were diagnosed as sarcopenic and non-sarcopenic, respectively. Male and ever smoker were significantly more frequent in the sarcopenic patients than the non-sarcopenic patients (P < 0.001 and P = 0.018, respectively). The sarcopenic patients showed the trend of high incidence of Postoperative complications, however, there was no significant difference in OS between the sarcopenic and non-sarcopenic patients. Next, we performed the subgroup analysis to elucidate the prognostic factors only in the elderly sarcopenic patients. Among 179 sarcopenic patients, multivariate analysis including statistically significant factors in the univariate analysis revealed that the patients with restrictive lung disease, advanced cStage, postoperative pneumonia and delirium were inferior in OS [Hazard Ratio, 11.1, 3.6, 5.3 and 4.6; 95% confidence interval, 1.6 to 68.1, 1.1 to 13.0, 1.4 to 20.0 and 1.1 to 16.5; P= 0.011, 0.037, 0.017 and 0.041], suggesting the importance of the intensive perioperative management to avoid complications.
Conclusion
Perioperative complications are significantly associated with the prognosis of the sarcopenic elderly patients with NSCLC. Intensive perioperative management is mandatory for NSCLC patients with sarcopenia to improve the clinical outcome after thoracic surgery.
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-82 - Lung Cancer in Lung Transplant Recipients (Now Available) (ID 2334)
10:15 - 18:15 | Author(s): Seiichiro Sugimoto
- Abstract
Background
Long-term immunosuppression is considered to increase the chance of developing malignancy, which is one of the leading causes of death after organ transplantation. Lung cancer in lung transplant recipients can originate from de-novo occurrence, transplanted donor’s lung and progression/recurrence of the recipient’s lung cancer. We conducted a survey of lung cancer in lung transplant recipients in our institution and report the case series.
Method
All 189 recipients who underwent lung transplantation (97 brain-dead donor lung transplantation, 90 living donor lobar lung transplantation, 2 hybrid lung transplantation) since October 1998 until December 2018 at Okayama University Hospital were retrospectively reviewed.
Result
Lung cancer was diagnosed in 4/189 (2.1%) of 16/189 (8.5%) all malignant diseases, in lung transplant recipients with a median follow-up of 4.5 years. Whereas de novo lung cancer occurred in one patient, patient-baring lung cancer was histologically detected in resected lung in three patients, leading to progression after transplantation in the two recipients. One recipient who had a previous history of lung cancer with over 5-year disease free period, experienced no recurrence afterword. All three recipients who had advanced lung cancer died relatively early from the diagnosis of lung cancer, regardless of cancer treatment.
Lung cancer in lung transplant recipients could be difficult to detect by radiological screening and biopsy due to severely deteriorated lung condition, especially in idiopathic interstitial pneumonitis. Additionally, recipients with advanced lung cancer seem to have poor prognosis.
Case Underlying disease Occurrence LTx - Lung cancer Degree of progression Treatment/Prognosis #1 LAM De novo 10 years Chest wall invasion Right pneumonectomy (10 months)→chemotherapy (9 months)→death #2 IIP Resected recipient’s lung 15 months Mediastinal lymph-nodes Lymph-node resection (10 months) →death #3 IIP Resected recipient’s lung 3 months Pleural Dissemination chemotherapy (6 months)→death #4 BO Resected recipient’s lung nil nil nil
LAM: lymphoangioleiomyomatosis IIP: idiopathic interstitial pneumonitis BO: bronchiolitis obliterans LTx: lung transplant
Conclusion
Lung cancer in lung recipients should be screened carefully ever since listing for transplantation.
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P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-12 - Prognostic Nutrition Index Affects Prognosis of Trimodality Therapy for Locally Advanced Lung Cancer with High T Factor (Now Available) (ID 1644)
10:15 - 18:15 | Author(s): Seiichiro Sugimoto
- Abstract
Background
Pretreatment nutritional status critically affects the clinical outcomes. Induction chemoradiotherapy (iCRT) followed by surgery (trimodality therapy) is a high-invasive treatment option for patients with locally advanced non-small cell lung cancer (LA-NSCLC). LA-NSCLC is a heterogeneous disease. Direct invasion into the surrounding structures easily promotes the invasion-related symptoms which inpair quality of life, but lymph node metastasis rarely causes its related symptoms until the bulky metastatic lymph nodes invade the surrounding structures. These differences of disease extent are expected to affect not only clinical outcome of treatment but also nutritional condition before initiation of treatment. While the prognostic nutritional index (PNI) is known to be correlated with the clinical outcomes after surgery in patients with early NSCLC, the significance of the PNI in LA-NSCLC patients undergoing trimodality therapy has not yet been well examined. In this study, we investigated the clinical impact of PNI in the LA-NSCLC patients who underwent iCRT followed by surgery considering the heterogeneity of disease extent.
Method
We enrolled 127 patients who received trimodality therapy at our institution between 1999 and 2016. The PNI was examined at all three time-points in the patients: before iCRT, before surgery, and after surgery.
Result
Fifty-five and 72 patients were diagnosed as clinical T1/2 (cT1/2) and cT3/4 diseases, respectively, and, 42 and 85 patients were cN0/1 and cN2/3, respectively. The PNI significantly decreased as the treatment progressed among all 127 patients. Patients with cT3/4 disease showed significantly lower PNI values before and after surgery than those with cT1/2 disease. By contrast, the PNIs were equivalent at all time-points between patients with cN2/3 and cN0/1 disease. We performed receiver-operating characteristic curve analysis to determine the cutoff the pre-iCRT PNI for overall survival (OS) in all (n = 127), cT3/4 (n = 72) and cN2/3 patients. The ROC curve analyses indicated that a significant cutoff was identified only in cT3/4 patients. Univariate and multivariate analyses revealed that high pre-iCRT PNI values were significantly correlated with better survival in cT3/4 patients. By contrast, the prognostic impact of pre-iCRT PNI values could not be observed in cN2/3 patients
Conclusion
The nutritional status deteriorates as the treatment progresses during trimodality therapy. Intensive perioperative nutritional intervention is required especially for cT3/4 LA-NSCLC patients receiving trimodality therapy.
