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Munetaka Masuda
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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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EP1.01-100 - Evaluation of the Clinicopathological Features of Patients in Whom Residual Carcinoma in Bronchial Stump After Surgery for Lung Cancer (Now Available) (ID 372)
08:00 - 18:00 | Author(s): Munetaka Masuda
- Abstract
Background
Operation for lung cancer should be carried out with no residual carcinoma at bronchial stump. Rarely, we encounter unexpected microscopic residual carcinoma at surgical bronchial stump after surgery. Additional therapy for these patients is still controversial.
Method
From January, 2008 to December, 2018, 812 consecutive patients with non-small lung cancer underwent surgery (99 of segmentectomy, 694 of lobectomy, and 19 of pneumonectomy) in our institution. Among them, there were 7 cases (0.9%) which had bronchial stump with residual cancer cells. We investigated the clinicopathological characteristics and outcomes of these patients retrospectively.
Result
The procedures for the 7 cases consist of 5 lobectomy, 1 segmentectomy, and 1 pneumonectomy. In 3 cases, frozen diagnosis were done and in 2 of 3 cases additional resection were done. Histologically, there were 4 case of adenocarcinomas and 2 of squamous cell carcinomas, and 1 of adenosquamous cell carcinoma. 3 cases were stage ⅢB(pT4N2M0, pT3N2M0), and 3 cases were ⅢA (pT2bN2M0, pT4N1M0), 1 case was stage ⅡB (pT1bN1M0) respectively. All cases had lymphatic invasion microscopically.
6 cases developed recurrence or distant metastasis. 2 had local recurrence at bronchial stump and 4 had distant metastasis (1 was in brain, 1 was at lymph nodes, 1 was at vertebrae, 1 was at bilateral lungs).
5 cases were received postoperative additional therapies. 4 cases were received cytotoxic chemotherapy only, and another case was recieved cytotoxic chemotherapy and TKI. None of them were received radiotherapy for bronchial stump. 5 cases passed away because of cancer progression and 1 case was because chronic heart failier. Another case is alive with lung metastases taking TKI therapy.
In all cases, preoperative CT scan didn’t show bronchial wall thickning, and preoperative bronchoscopic findings showed normal bronchial mucosa.
Conclusion
In surgical cases of non-small cell lung cancer, 1.2% had microscopic residual cancer at surgical bronchial stump. Our study revealed that such cases tended to have a relapse as distant metastasis rather than local recurrence. Preoperative evaluation whether bronchial invasion exists or not is difficult and post-operative additional treatment strategy is still uncertain. In postoperative follow-up, systemic survey for not only local region but distant organs is necessary.
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EP1.09 - Pathology (ID 199)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Pathology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.09-09 - Surgical Cases of Pulmonary Pleomorphic Carcinoma at Our Institution (Now Available) (ID 1254)
08:00 - 18:00 | Author(s): Munetaka Masuda
- Abstract
Background
Pulmonary pleomorphic carcinoma (PC) is rare with an incidence of 0.1% to 0.4% of all lung cancers. Because of its rarity, its exact characteristics are still unknown and standard treatment strategies have not been established.
Method
The clinical features and prognosis of 19 surgical cases (1.5%) with PC among 1,247 cases of all resected lung carcinoma from August 2007 to September 2018 at Kanagawa Cardiovascular and Respiratory Center were retrospectively analyzed.
Result
A total of 19 cases, 16 males (84.2 %) and 3 females (15.8 %) with a median age of 71±9.4 (range: 52-83) years was included in the analysis.
The median of the brinkman index was 1060±662.8 (0-3000). Coexisting lung diseases included 1 case of chronic obstructive pulmonary disease (COPD) and 5 cases of interstitial pneumonias (IP). Tumors were located in the upper lobes in 10 cases and in the lower lobes in 9 cases. The median size of the tumors was 28 ± 22.9 (10-100) mm in diameter.
The surgeries comprised 5 wedge resections, 2 segmentectomies, and 12 lobectomies, including 3 combined wedge resections, 2 combined angioplasties, and 1 double sleeve lobectomy.
The epithelial components of PC were 11 adenocarcinomas, 5 squamous cell carcinomas (SQC), and 3 large cell carcinomas. There were 9 cases in stage I (IA1: 3, IA2: 3, IA3: 2, IB: 1), 4 in stage II (IIA: 2, IIB: 2), and 6 in stage III (IIIA: 5, IIIB: 1).
All of the cases were followed-up, and the median follow-up period was 1124 ± 1066 (195-3845) days. After 5 years, 11 cases were alive (including 2 relapsed cases) and 8 cases had died (6 died from PC). The overall survival rate was 50.3% at 5 years in all cases.
In univariate analysis, PC with both a SQC component and lymph node metastasis had a poor prognosis with a significant difference in the 3-year survival rate (component; SQC vs non SQC: 26.3% vs 73.7%, p=0.024) and in the 5-year survival rate (lymph node metastasis; positive vs negative: 36.8% vs 73.2%, p=0.026).
In multivariate analysis, a SQC component (p=0.011) and lymph node metastasis (p=0.016) were independent prognostic factors indicating a poor OS. On the other hand, 8 of the 9 cases with a non SQC component and no lymph node metastasis were still alive.
Conclusion
We found that PC generally had a poor prognosis even in surgical cases. A SQC component and lymph node metastasis were prognostic factors indicating a poor overall survival.
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P1.18 - Treatment of Locoregional Disease - NSCLC (ID 190)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.18-20 - The Relationship Between the Recurrence Timing and Inflammation-Based Prognostic Scores in Resected Non-Small-Cell Lung Cancer (ID 757)
09:45 - 18:00 | Author(s): Munetaka Masuda
- Abstract
Background
Several inflammatory markers are reported to be useful in predicting the surgical outcomes in patients with various cancers. We evaluated the influence of inflammation-based prognostic scores on the postoperative recurrence timing using survival curves and hazard curves for non-small cell lung cancer (NSCLC) patients.
Method
Total 356 patients with NSCLC who underwent pulmonary resection were retrospectively studied. The study subjects included 217 males and 139 females with a mean age of 70.0 years at the time of the surgery. We divided the population as per the Glasgow prognostic score (GPS), modified GPS, neutrophil-to-lymphocyte ratio (NLR, cut-off: low ≤ 3.75 and high > 3.75), platelet-to-lymphocyte ratio[A1] (low ≤ 200 and high > 200), and C-reactive protein-to-albumin ratio (CAR, low ≤ 0.028 and high > 0.028). Hazard curves and changes in the hazards [A2] over time were evaluated.
Result
GPS, mGPS, high NLR, and high CAR were significantly associated with poor recurrence-free survival (RFS) in the univariate analysis. Multivariate analysis revealed that only mGPS (Hazard ratio [HR]: 1.569, 95% confidence interval [CI] 1.149–2.144, p = 0.005) and high CAR (HR: 1.751, 95%CI 1.002–3.061, p = 0.049) remained independently associated with RFS. The resulting hazard curves indicated that the recurrence risk pattern correlated with inflammation, with an early sharp peak within a year of surgery for patients with mGPS 2 or a high CAR and some late gentle humps [A1] for patients with mGPS 0 or a low CAR.
Conclusion
Patients with mGPS 2 or a high CAR have a high risk of early recurrence in resected NSCLC. These findings are useful for postoperative follow-up strategy, allowing the identification of patients who would specifically obtain a clinical benefit from intensive surveillance.
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P2.05 - Interventional Diagnostic/Pulmonology (ID 168)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Interventional Diagnostics/Pulmonology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.05-05 - Availability of Four Dimensional Computed Tomography (4DCT) for Lung Cancer (Now Available) (ID 435)
10:15 - 18:15 | Author(s): Munetaka Masuda
- Abstract
Background
Four-dimensional computed tomography (4DCT) imaging is a new form of chest CT that can detect continuous movement of the airways and lungs under free breathing conditions. This method is likely to be used increasingly to evaluate pulmonary function or predict intraoperative adhesion or tumor invasion.
Method
A total of 31 cases that underwent 4DCT at the Kanagawa Cardiovascular Respiratory Center from October 2017 to February 2019 were reviewed. Dynamic ventilatory scans were performed using a 320-row multi detector CT (Aquilion ONE GENESIS, Canon Medical Systems, Otawara, Tochigi, Japan). The frame rate was 0.25sec/volume and the total estimated radiation exposure was 3.9 mSV. In surgical cases of lung cancer, the 4DCT findings were compared with the intraoperative assessment. We obtained 2 sets (upper lung region and lower region) of 4DCT covering the whole lung. These volume sets were connected and evaluated using imaging processing software. Intrathoracic adhesion and tumor invasion were defined by the differential movement between the tumor and adjacent structures, and laterality of the respiratory motion.
Result
There were 16 cases of non-neoplastic diseases, such as non-tuberculous mycobacteriosis, giant bulla and lung sequestration. The 15 neoplastic diseases included 2 solitary fibrous tumors and 13 lung cancers. Among them, 12 cases in the lung cancer group underwent surgical procedures and were able to be evaluated. The purposes of the preoperative 4DCT were as follows: evaluation of tumor invasion (n=8), reoperation cases (n=2), medical history of tuberculous mycobacteriosis (n=2) and suspicion of intrathoracic adhesion on chest X-ray (n=1). Adjacent structures were the descending aorta (n=2), pulmonary artery (n=1), subclavian artery (n=1) and chest wall (n=5). The surgical procedures included 10 lobectomies, 1 wedge resection and 1 open lung biopsy. The 4DCT findings were comparable with the intraoperative findings in eleven cases; intraoperative adhesions were noted at the same locations and there were no signs of direct tumor invasion to vital structures, as indicated by 4DCT. In only one case of suspected invasion of the subclavian artery, was unexpected adhesion to the upper mediastinum observed during surgery. As the motion of the apical region was restricted in all cases, we were not able to evaluate apical adhesion.
Conclusion
The intraoperative findings supported those of 4DCT in 11/12cases. 4DCT of the whole lung was an useful and reliable tool for the preoperative assessment and determination of the surgical indication for lung cancers.
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P2.10 - Prevention and Tobacco Control (ID 176)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Prevention and Tobacco Control
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.10-12 - Clinicopathological Analysis of the Lung Cancer Patients Who Have History of Asbestos Exposure (Now Available) (ID 437)
10:15 - 18:15 | Author(s): Munetaka Masuda
- Abstract
Background
Because of the delayed cessation of the asbestos use in industry, the malignant pleural mesothelioma patients are increasing in Japan. Simultaneously, lung cancer patients, who have history of asbestos exposure, is increasing in our hospital.
Method
We analyzed the characteristics of the lung cancer with the history of asbestos exposure. This study enrolled 1216 patients operated on in our department with a diagnosis of lung cancer since January 2003 to March 2018. Among them, 153 patients (12.6%) had the history of asbestos exposure.
Result
The patients were 145 men and 8 women, the age were 47 to 83 (mean 70) years old, shipyard workers were 22 men. 64 patients pointed out by the regular medical checkup, 61 were in the middle of detailed examination for other disease, 10 had hemoptysis, and 9 patients were suffering from cough. The affected sites were right 92, left 61.
The operative procedures were pneumonectomy 2, lobectomy 116, segmentectomy 8 and wedge resection 21. Postoperative complications were 49 episodes in total, such as bronchopleural fistula, pneumonia, ALI. 30 days mortality was 3cases (0.02%).
The histology were adenocarcinoma 87, Squamous cell carcinoma 49, adenosquamous cell carcinoma 5, small cell carcinoma 4, Large cell carcinoma 2, and LCNEC 4. The postsurgical stage (UICC ver,6, UICCver.7) were StageⅠA(33%,33%),ⅠB(29%,33%),ⅡA (7.8%,5.8%),ⅡB(9.8%,8.1%),ⅢA(3.9%,17.4%),ⅢB(5.9%,0%),Ⅳ(2.0%,1.2%), respectively. Over all 5 years survival rate was 62.1%.
Asbestos bodies count (by Smith method) were analyzed for 51 cases. The numbers were 3 to 718041 AB/g dry lung.
Conclusion
The characteristics of the lung cancer patients who have history of asbestos exposure were not unique, and no very special issues, in the aspects of symptom, histology and prognosis.
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P2.15 - Thymoma/Other Thoracic Malignancies (ID 185)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.15-09 - Clinical Features and Prognosis of Primary Tracheal Cancer at Our Institution’s Experience (ID 537)
10:15 - 18:15 | Author(s): Munetaka Masuda
- Abstract
Background
Primary tracheal cancer (PTC) is rare. Although histological components of the trachea are similar to that of the lung, the reason for its low incidence is still unknown. Because of its rarity, there are no standard treatment strategies.
Method
PTC is not clearly defined. We defined it as a primary malignant neoplasm arising from the sub vocal cord region to the bilateral main bronchi via the bifurcation. The clinical features and prognosis of patients with PTC from 1999 to 2018 at the Kanagawa Cardiovascular and Respiratory Center were analyzed.
Result
A total of nine cases, 4 males and 5 females with the median age of 62 years (range:29-81), were included in this study. The clinical symptoms were 3 patients with a cough, 2 with expiratory noise, 2 with hemoptysis, 1 with wheezing, and 1 PTC was detected on screening computed tomography. The tumors were located at upper trachea region in 4 cases, at the lower in 4 cases, and at main right bronchus in 1 case (upper tracheal region is defined as the sub vocal cord area to the lower end of the thyroid and lower tracheal region is defined as the lower end of thyroid to the bifurcation). The histopathological types were 5 (55.6%) adenoid cystic carcinomas (ACC), 2 (22.2%) mucoepidermoid carcinomas, and 2 (22.2%) squamous cell carcinomas. Five patients (55.6%) received radical surgeries and 2 patients (22.2%) who had distant metastasis received palliative surgeries. The remaining 2 (22.2%) patients received tracheal stenting. The postoperative adjuvant therapies included 2 cases with irradiation, and 1 case with chemotherapy. The 2 tracheal stenting cases received full dose irradiation therapy (including case with concurrent chemotherapy) and the 2 cases with palliative surgery also received adjuvant irradiation and chemotherapy, respectively. The overall survival rate was 55.6% at 5 years in all cases. The ACC group tended to have a better prognosis compared to that of the non-ACC group, having the 5-year survival rate was 80.0% vs 25.0%, respectively. In the ACC group, only 1 case (20.0%) died from ACC. The overall survival rate of the radical surgery group and the non-radical group was 60.0% vs 50.0% at 5 years, respectively.
Conclusion
We found that PTC generally had a poor prognosis. Among the different types of PTC, ACC had a better prognosis than the other histopathological types. Complete resection achieved a better prognosis, especially in ACC.
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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
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-17 - Outcome of Surgical Treatment for Clinical N1 Non-Small Cell Lung Cancer (ID 1224)
10:15 - 18:15 | Author(s): Munetaka Masuda
- Abstract
Background
Main stem treatment for clinical N1 NSCLC is surgery, but it is sometimes difficult to perform because tumor or metastatic lymph-node invade hilar structures. Nowadays, treatment outcome has been improved. This study aims to reconsider the surgical outcome of N1 NSCLC.
Method
The data of 337 cases who underwent at least lobectomy and lymph node dissection for NSCLC from 2000 to 2014 was retrospectively reviewed. The factors which may have impact for survival and treatment related death (TRD) were examined.
Result
Median follow up period was 51.7 months. 337 cases were 15.3% of all lobectomy and pneumonectomy performed in this period. 248 males and 89 females, average age was 67.1. Lobectomy was 309 including 15 bronchoplasty and pneumonectomy was 28. Mean operative time was 212 minutes, blood loss was 110g. TRD was noted in 6 (1.8%); 3 interstitial pneumonia, 2 myocardial infarction and a stroke, 4 cases (1.2%) died within 30 day after surgery.During this time, TRD of clinical N0 was 8 case (0.46%) and N2 was a case (0.82%). TRD of N1 was significantly frequent (p=0.026). Pathologically, N0 was 152 cases (45.1%), N1 was 116 (34.4%) and N2 (20.5%); pathological accuracy of N1 was only one third. 5 year survival rate of clinical N1 was 59.3%, 83.6% in N0 and 54.1% of N2. In histology, adenocarcinoma was 184, 113 squamous, 8 large, 7 adenosquamous and 25 other. Induction therapy, blood loss and pathological N status had negative impact for survival. On the other hand, operative time and right side had negative impact for TRD.
Conclusion
The outcome of clinical N1 has been improved compared with historical report, but the accuracy of clinical N1 is not satisfied one. TRD rate in N1 was relatively high, surgery for N1 NSCLC should be performed by certified thoracic surgeons.
