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Takahiko Sakamoto



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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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      EP1.16-21 - Frequencies and Prognosis of Non-Small Cell Lung Cancers Complicated with Synchronous/Metachronous Multiple Primary Cancers (Now Available) (ID 1653)

      08:00 - 18:00  |  Author(s): Takahiko Sakamoto

      • Abstract
      • Slides

      Background

      Recently, opportunities to diagnose multiple primary cancers have been increasing due to the progress of diagnostic technology, resulting in the difficulty in treatment decisions. Therefore, we examined the frequencies, background, and prognosis of non-small cell lung cancers (NSCLC) complicated with synchronous/metachronous multiple primary cancers.

      Method

      Between 2013 and 2017, we retrospectively examined the medical charts in patients with NSCLC who had never experienced cancers before. We classified such NSCLC patients into the following three groups: (1) single primary NSCLC group (SPN), showing no other cancers during the follow-up period, (2) synchronous NSCLC group (SN), showing other cancers diagnosed within 2 months from the first NSCLC diagnosis, and (3) metachronous NSCLC group (MN), showing other cancers diagnosed after 3 months or more from the first NSCLC diagnosis.

      Result

      Among 1350 cases enrolled, the frequencies of SPN, SN, and MN groups were 88.6% (1196 cases), 8.3% (112 cases), and 3.1% (42 cases), respectively. Background factors such as age, sex, performance status, smoking history, clinical stage, EGFR mutation, EML4-ALK fusion gene, ROS-1 gene, PD-L1 expression, and the number of affected cancers were adjusted using Cox proportional hazards model analysis. In SN group, NSCLC (32 cases), colon cancer (20 cases), and gastric cancer (12 cases) were commonly observed. Similarly, in MN group, NSCLC (17 cases), colon cancer (4 cases), and gastric cancer (4 cases) were commonly observed. The median survival times of SPN, SN, and MN groups were 24.0 months, 42.1 months, and not reached, respectively (p < 0.001). Regarding the prognostic factors, the hazard ratios [HR] of SN and MN groups toward SPN group were 0.98 (95% confidence interval [CI]; 0.71 to 1.36, p = 0.91) and 0.38 (95% CI; 0.22 to 0.66, p < 0.001), respectively. The other prognostic factors were 75 years old or older (HR; 1.46, 95% CI; 1.24 to 1.72, p < 0.001), male (HR; 1.56, 95% CI; 1.26 to 1.94, p < 0.001), performance status 3-4 (HR; 3.88, 95% CI; 3.09-4.82, p < 0.001), smoking history (HR; 1.44, 95% CI; 1.12 to 1.84, p = 0.01), and clinical stage IIIB-IV NSCLC (HR; 4.37, 95% CI; 3.62 to 5.30, p < 0.001).

      Conclusion

      In patients with NSCLC who had never experienced cancers before, synchronous/metachronous multiple primary cancers could be often observed. However, their coexistence might not adversely affect the prognosis of firstly diagnosed NSCLC.

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    P1.01 - Advanced NSCLC (ID 158)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.01-75 - Prognostic Impact of Neutrophil-to-Lymphocyte Ratio (NLR) for Advanced Non-Small Cell Lung Cancer (ID 2851)

      09:45 - 18:00  |  Author(s): Takahiko Sakamoto

      • Abstract

      Background

      Recently, the neutrophil-lymphocyte ratio (NLR) has been attracting attention as a prognostic factor for advanced non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs). However, other chemotherapies have not been well reviewed about the usefulness of NLR. Therefore, we retrospectively examined whether NLR at the start of first-line chemotherapy, including cytotoxic anticancer drugs and molecular-targeted drugs, could be a useful biomarker for overall survival (OS).

      Method

      We examined advanced NSCLC patients, including recurrent cases after surgery or radiotherapy, who received first-line chemotherapy at our institution between 2008-2018. Patients were divided into two groups according to gene expression (EGFR/ALK mutant type [mt] and wild type [wt]) to differentiate the therapeutic effects of first-line chemotherapies. Furthermore, only patients treated with molecular-targeted drugs as first-line therapy were included in the mt group, whereas only patients treated with cytotoxic anticancer drugs as first-line therapy were included in the wt group. Blood test to measure NLR was performed within 3 days prior to the initiation of first-line chemotherapy. According to the levels of NLR (NLR < 5 or NLR ≥ 5), OS curves between NLR-low and NLR-high subgroups were compared using log-rank test in the mt and wt groups, respectively. To evaluate the prognostic impact of NLR, background factors such as age, sex, performance status, smoking history, clinical stage, and LDH were adjusted using multivariate Cox proportional hazards model analysis.

      Result

      1113 cases were reviewed, 276 cases of which met the eligibility criteria, including 90 cases (32.6%) in the mt group and 186 cases (67.4%) in the wt group. In the mt group, median survival times (MSTs) of NLR-low and NLR-high subgroups were 37.2 months and 18.1 months, respectively (p < 0.001). Similarly, in the wt group, MSTs of NLR-low and NLR-high subgroups were 16.2 months and 6.3 months, respectively (p < 0.001). On the other hand, significantly independent factors for worse OS in the mt group were NLR-high (hazard ratio [HR]; 3.54, 95% confidence interval [CI]; 1.96 to 6.38, p < 0.001), LDH-high (HR; 2.31, 95% CI; 1.30 to 4.11, p = 0.004), and poor performance status (HR; 3.58, 95% CI; 1.98 to 6.48, p < 0.001). Similarly, significantly independent factors for worse OS in the wt group were NLR-high (HR; 2.10, 95% CI; 1.40 to 3.14, p < 0.001), LDH-high (HR; 1.57, 95% CI; 1.11 to 2.22, p = 0.009), and poor performance status (HR; 2.17, 95% CI; 1.48 to 3.20, p < 0.001).

      Conclusion

      The low levels of NLR at the start of first-line chemotherapy might be associated with better OS regardless of the types of anticancer drugs.