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Mikio Okazaki
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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): Mikio Okazaki
- 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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EP1.04 - Immuno-oncology (ID 194)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.04-27 - Expression Analysis of Programmed Death-Ligand (PD-L) 1 in Large Cell Neuroendocrine Carcinoma (Now Available) (ID 3112)
08:00 - 18:00 | Author(s): Mikio Okazaki
- Abstract
Background
Programmed death (PD)-1/PD-ligand-1 (PD-L1) signaling is main target of immune-checkpoint therapy for lung cancer. Since PD-L1 expression level is known as an important indicator for patient selection of PD-1/PD-L1 blockade therapy, immunohistochemical analysis using anti-PD-L1 antibody were largely performed in various lung cancer tissues. However, there was few evidences regarding expression pattern of PD-L1 in large cell neuroendocrine carcinoma (LCNEC). In this study, we aimed to clarify the tissue distribution of PD-L1, and gene expression pattern between PD-L1-positive and negative cells in LCNEC.
Method
Lung cancer tissues were derived from patients with LCNEC (n=10) and adenocarcinoma (n=8). All tissues were stained with anti-PD-L1 (SP142, Ventana/Roche), CD8 (T lymphocytes), and PD1 antibody using OptiView DAB IHC systems. To investigate the molecular mechanism of overexpression of PD-L1 in LCNEC, we have also performed microarray analysis of PD-L1-positive and -negative cancer cells in the identical LCNEC patient.
Result
From immunohistochemical staining data, while 25% of adenocarcinoma were PD-L1 positive, 80% of LCNEC were strongly stained by anti-PD-L1 antibody. Invasion of PD-1-positive lymphocytes were also seen around PD-L1 positive lung cancer cells. Microarray data showed that antigen-presenting related genes were dominantly up-regulated in the PD-L1-positive cells.
Conclusion
Our data concluded that the patients with LCNEC might be targets for immune-checkpoint therapy using anti-PD-1 neutralizing antibody.
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EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.16-41 - Lung Lobectomy for Elderly Patients Over 85 Years Old Is a Risk of a Complication and Long-Term Hospitalization Compared with Sublobar Resection (Now Available) (ID 1360)
08:00 - 18:00 | Author(s): Mikio Okazaki
- Abstract
Background
The increased number of elderly patients with non-small lung cancer underwent lung resection, though the clinical outcome has remained unclear. In this study, we reviewed the postoperative complications and clinical outcome after lung resection in elderly patients over 85 years old with lung cancer, defied as “very elderly patients”.
Method
Among patients who underwent lung surgery for non-small cell lung cancer (NSCLC from 2012 to 2019 in our institute, a total 24 patients were enrolled for this retrospective study.
Result
During the study period, 24 elderly patients (mean age, 87.3) underwent lung resection, consisting of 14 female and 11 male, 19 adenocarcinomas and 5 non-adenocarcinomas, and 19 c-Stage 0: 1, IA: 16, IB: 3, IIA: 2, IIB: 1, IIIA:1[KS1] (based on UICC 7th edition), and 12 sublobar surgery (6 wedge resections and 6 segmentectomies) and 12 lobectomy. Perioperative complications were observed in 8 patients, and the average hospitalization days are 23.4 days. Next, patients were Stratified by the surgical procedure . The clinical stage is, in limited resection group,cStage 0: 1, 1A: 8, 1B: 3, otherwise in lobectomy group, cStage1A: 8, 1B: 0, 2A: 2, 2B: 1, 3A:1[KS2] . The procedures underwent complete video assisted thoracic surgery are 6 in sublobar resection, 3 in lobectomy. Average operation time is 168 minutes in limited resection, 207 minutes in lobectomy, and blood loss is 48.8 ml and 67.5 ml, respectively. No perioperative mortality was observed within 30 days after surgery. There are more complications in lobectomy group than in limited resection group (50.0%, 25.0%), although the p value was not significant ( p = 0.22). [KS3] The patients need HOT after surgery is one in limited resection, two in lobectomy. Especially the frequency of onset of arrhythmia requiring treatment is high, 33.3%, in lobectomy group and one case needs implanting a pacemaker. On the other a patient in lobectomy group onsets appendicitis after thoracic surgery and the patient is proceeded appendectomy. The average hospitalization days in lobectomy group, 32.5 days, are longer than in limited resection group, 14.3 days.( p = 0.20)
Conclusion
Lung lobectomy in very elderly patients is associated with postoperative complications and prolonged hospitalization compared with sublobar surgery.
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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 | Presenting Author(s): Mikio Okazaki
- 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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P2.08 - Oligometastatic NSCLC (ID 172)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Oligometastatic NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.08-03 - Clinical Outcome of Patients with Recurrent Non-Small Cell Lung Cancer After Trimodality Therapy (ID 2569)
10:15 - 18:15 | Author(s): Mikio Okazaki
- Abstract
Background
Trimodality therapy, consisting of induction chemoradiotherapy (CRT) followed by surgery, is a potential treatment option for patients with locally advanced (LA) non-small cell lung cancer (NSCLC), such as N2-3, bulky N1, or T3-4 stage disease. However, even after completing this intensive treatment, postoperative recurrence will develop in a subset of patients. Patients with distant metastatic recurrences are generally considered to have systemic disease, which is regarded as incurable. Nevertheless, some patients have a relatively good prognosis following this treatment, even after postoperative recurrence.
Method
We analyzed the records of 182 patients with LA-NSCLC who were treated with trimodality therapy between 1999 and 2017 to review the clinical course of those patients and to identify the factors associated with favorable clinical outcome after recurrence. In this study, oligometastasis was defined as one to three metastatic lesions in the brain, or an isolated extracranial metastatic lesion.
Result
In 182 patients patients who underwent trimodality therapy for LA-NSCLC, the median follow-up period after the beginning of CRT was 50 months, the median age was 61 years (range, 31–78 years), and Recurrence developed after trimodality therapy in 65 patients (35.7%). The median recurrence-free interval, being the period between the administration of trimodality therapy for the primary tumor and initial recurrence, was 11 months (range, 4.1–73.9 months). Of the 62 of these patients able to be assessed retrospectively, The brain was the most frequent location of recurrence (31%), followed by the lung (27%), lymph nodes (24%), and bone (15%). Twenty-eight had oligometastatic recurrence and 30 underwent local treatment with curative intent. Local treatment was most frequently given to patients with oligometastatic recurrence (P < 0.001). The median post-recurrence survival (PRS) was 15.1 months, and the 2-year PRS rate was 57%. Patients who received local treatment showed better PRS (P = 0.004). The presence of liver metastasis (P = 0.003), bone metastasis (P = 0.034), or dissemination (P < 0.0001) were associated with worse PRS.
Conclusion
The survival of patients who received aggressive local treatment for postoperative recurrence after trimodality therapy for LA-NSCLC was better than that of patients who did not.
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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): Mikio Okazaki
- 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.
