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Akif Turna
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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: 2
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.18-10 - Bilateral Mediastinal Lymphadenectomy Is Associated with Better Survival in Stage IA-IIIB Non-Small Cell Lung Cancer (ID 2695)
08:00 - 18:00 | Presenting Author(s): Akif Turna
- Abstract
Background
Studies have shown that, mediastinal lymph node dissection improves survival in non-small cell lung cancer. However, the role of bilateral lymph node dissection is yet to be elucidated. The aim of this study was to analyze the impact of bilateral mediastinal lymphadenectomy on survival in operable and inoperable non small-cell lung cancer (NSCLC) patients.
Method
Between May Between March 2010 and December 2017, 1344 patients with potentially operable non-small cell lung cancer were evaluated. Of those 560 patients(41.7%) underwent video-assisted mediastinoscopic bilateral mediastinal lymphadenectomy(VAMLA) including removal of upper paratreacheal, lower paratracheal, subcarinal lymph node dissection via cervical incision, As the preference of surgeon, 510 patients(37.9%) underwent mediastinoscopic biopsy before planned operation. Of 1344 patients, 801(59.6%) were found to have no mediastinal lymph nodal involvement after bilateral lymphadenectomy or mediastinoscopy. Of those, 690 patients(51.3%) underwent anatomical lung resection. The patients who had negative VAMLA/mediastinoscopy results underwent anatomic pulmonary resection and systematic lymph node dissection/systematic sampling.
Result
The 5-year survival rate in all patients was 44% for bilateral lymphadenectomy patients and 35.1% for patients who had unilateral mediastinal lymphadenectomy patients(p=0.001). Among the patients who had pulmonary resection (pstage IA-IIIA), The 5-year survival was 88% for BML patients and 61% for patients who had mediastinal lymph node sampling(P=0.02). By multivariable analysis, BML was associated with better survival (odds ratio, 0.64; 95% confidence interval, 0.27-0.83; P=0.02). After propensity matching of two groups, BML provided independently better survival (odds ratio, ; 95% confidence interval, 0.34-0.82; P=0.03)
Conclusion
ML was associated with improved survival in resectable (pIA-IIIA) or non-resectable (pIIIA-IIIB) NSCLC patients.
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EP1.18-23 - Is Salvage Lung Resection Necessary After Definitive Chemoradiation Therapy for Stage IIIA(N2) Non-Small Cell Lung Cancer? (ID 2661)
08:00 - 18:00 | Presenting Author(s): Akif Turna
- Abstract
Background
A combination of platinum-based chemotherapy and definitive radiotherapy is the standard of care for Stage III (N2) NSCLC patients who have single or multiple lymph node metastasis. However, the role of salvage lung resection in patients with residual disease without lymph node metastasis is yet to be identified.
Method
Between January 2011 and December 2018 103 eligible patients who had pathologically proven in two university hospital clinics, stage IIIA/N2 non-small-cell lung cancer and were prospectively recorded. Those in the chemoradiotherapy group received three cycles of neoadjuvant chemotherapy (AUCx2 carboplatin and docetaxel 85 mg/m[2 ] docetaxel) and concurrent radiotherapy with 61.2-64.0 Gy in 34 fractions over 3 weeks followed by surgical resection. Also, a group of patients who had definitive chemoradiotherapy who did not undergo surgery was compared with the surgical group.
Result
A total of 103 patients were analyzed, of whom 75(72.8%) received chemoradiotherapy followed by surgical resection and 28(27.2) had chemoradiotherapy only. Median overall survival was 49 months (95% CI 8.0–58.0) in the chemoradiotherapy + surgery group and 33.0 months (95% CI:7.5–90.4) in the chemotherapy group (p=0.423). One patients died in the surgery group within 30 days(0.9%) after surgery. Complication rate in all patients and the patients who underwent pneumonectomy after chemoradiation were not statistically significantly different compared to those who had undergone resectional surgery without oncological therapy(p=0.321, p=0.08 respectively)
Conclusion
Pulmonary salvage resection after definitive chemoradiotherapy is safe and surgical resection after chemoradiotherapy did not seem to provide better survival in histologically proven N2 stage IIIA non-small cell lung cancer.
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ES23 - Optimal Management of N2 Disease in the Era Of IO (ID 26)
- Event: WCLC 2019
- Type: Educational Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:Alex Martinez-Marti, Hong-Xu Liu
- Coordinates: 9/10/2019, 11:30 - 13:00, Hilton Head (1978)
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ES23.01 - Mediastinoscopy with Invasive Staging: Are They Still Crucial? (Now Available) (ID 3281)
11:30 - 13:00 | Presenting Author(s): Akif Turna
- Abstract
- Presentation
Abstract
There are more multiple treatment strategies for non-small cell lung cancer(NSCLC) that should be selected based on staging of the disease. Nodal status indicates N component of staging and studies invariably show that upfront surgical resection of patients with mediastinal lymph node involvement (i.e., N2 or N3) is not recommended. Evidence suggest that, T1-4N2-3M0-1c patients should firstly receive oncological treatment; otherwise, surgical treatment could be deemed to be futile.
Accordingly, mediastinal lymph node involvement prediction as accurate as possible is recommended before any treatment planning. PET-CT, Endobronchial ultrasonography-transbronchial aspiration (EBUS-TBNA), endoscopic ultrasound-guided-fine-needle aspiration(EUS-FNB) have all inherent limitations. Mediastinoscopy has been defined to be gold standard for preoperative disclosure of mediastinal lymph node metastasis. However, small biopsy material due to being an incisional biopsy, practically low number of explored mediastinal stations (usually median number of 2 or 3) led to approximately 10% of false negativity rate. Also studies showed that, even the fact that, mediastinoscopy has been recommended to be performed in all patients except the patients with non-discrete lymph node involvement or in the patients with peripheral cT1a-cN0M0 patients, a fraction of thoracic surgeons prefer to comply with the published guidelines.
Video-assisted mediastinoscopy lymphadenectomy(VAMLA) was developed to reduce the false negativity rate below statistically non-significant levels (below 5%). It involves dissection of at least 5 lymph nodes stations and some evidence suggest that, VAMLA is associated with better survival rate beyond selection bias phenomenon. Transcervical extended mediastinal lymphadenectomy (TEMLA) is a technically more advanced mediastinal lymph node dissection procedure that is a definition of a resection of lymph nodes from #1-9 bilaterally including aorticopulmonary and anterior mediastinal lymph nodes. The accuracy of TEMLA has been reported to be 98.4%. Taking all those achievements into consideration, VAMLA or TEMLA or at least video-mediastinoscopy should be performed before selecting a therapeutical option in a patient with potentially resectable operable NSCLC.
However, recent advancements in computational science could propose us that, possibly, there is enough information for us to predict mediastinal lymph node positivity without performing any invasive procedure. Artificial Intelligence (AI) is accomplished by computers that use algorithms, pattern matching, rules, deep learning and cognitive computing to approximate conclusions using previously defined analog or digital parameters. AI aimed to mimic the brain’s neural networks. It uses multiple layers of non-linear processing units to teach itself how to understand data classifying the record or making predictions.
In a study, we aimed to evaluate the value of artificial neural network(ANN) for mediastinal nodal metastasis, by using only clinical and radiologic data. In our data set, ANN predicted mediastinal nodal involvement perfectly (AUC:1) in both training and test groups. When we used ‘traditional’ univariate and multivariate analyses, younger age (<65) (AUC:0.59) and higher SUVmax (>2.5)(AUC:0.67) were associated to be mediastinal nodal involvement. ANN prediction was better and it was even more sensitive than VAMLA! However, specificity of ANN resulted to be less than 0.9 in some training analyses.
The major limitations of ANN include its variability, non-transparency and non-consistency. Nevertheless, there is a possibility that, ANN could provide better predictions and it may help us to identify and narrow down the patients who need invasive staging. However, the usage of ANN in medicine has been continuously expanding. Future studies are needed to understand the exact place of ANN in mediastinal staging.
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OA10 - Sophisticated TNM Staging System for Lung Cancer (ID 136)
- Event: WCLC 2019
- Type: Oral Session
- Track: Staging
- Presentations: 1
- Now Available
- Moderators:Ke-Neng Chen, Pedro Lopez De Castro
- Coordinates: 9/09/2019, 14:00 - 15:30, Toronto (1985)
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OA10.08 - Discussant - OA10.05, OA10.06, OA10.07 (Now Available) (ID 3768)
14:00 - 15:30 | Presenting Author(s): Akif Turna
- Abstract
- Presentation
Abstract not provided
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P1.17 - Treatment of Early Stage/Localized Disease (ID 188)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.17-42 - The Importance of Lymphatic and Vascular Invasion in Stage 1 Non-Small Cell Lung Cancer and Definition of a Totally Curable Tumors (ID 2681)
09:45 - 18:00 | Presenting Author(s): Akif Turna
- Abstract
Background
A number of non-anatomic prognostic factors have been reported for resected non-small cell lung carcinoma. Certain histopathologic properties of the tumor such as lymphatic and vascular invasion could help to predict the patients with excellent survival.
Method
A retrospective study was conducted on 550 surgically resected stage 1 non-small cell lung carcinomas, and the following prognostic factors were evaluated in univariate analysis: age, gender, size of tumor, histologic type of tumor, grade of differentiation, lymphatic invasion, vascular invasion, and perineural invasion. The mean follow-up time was 69 months(range;10 to 181 months).
Result
Lymphatic vessel invasion, perineural invasion, blood vessel invasion, size of tumor(i.e.,T1a, T1b, T1c) of the tumor were found to be significant prognostic factors (p=0.001, p=0.006, p<0.001 and p=0.029 respectively). According to multivariate analyses, two factors were selected as prognostic indicators: (1) lymphatic invasion (p=0.027;OR:2.27;95%confidence interval:1.097-4.7), (2) vessel invasion (p =0.013;OR:2.021;95%confidence interval:1.16-3.53). By combining these factors we identified a poor and excellent prognostic subgroups of patients with stage I disease. The patients with 1A1 disease without lymphatic or blood vessel invasion had 100% of 5-year survival
Conclusion
Our study showed that lymphatic vessel and blood vessel invasion of the tumor could be prognostic factors, along with anatomical determinants. The patients with stage 1A1 tumors who had no lymphatic or blood vessel invasion seem to be totally cured by surgical resection.
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P2.03 - Biology (ID 162)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Biology
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.03-51 - Gene Variants and Expressions of Galectin-3 Is Associated with Non Small Cell Lung Cancer and Vascular Invasion of the Tumor (Now Available) (ID 2574)
10:15 - 18:15 | Presenting Author(s): Akif Turna
- Abstract
Background
Galectin-3 is a β-galactoside binding protein and known for its deregulation in cancer. In previous studies, correlations between single nucleotide polymorphisms (SNP) and cancer development have been identified in the context of genetic susceptibility to different types of cancer. However, potential phenotypic variations related to galectin-3 SNPs have not yet been evaluated in non-small cell lung cancer (NSCLC).
Method
In this study, it was aimed to correlate expression levels of gene and protein galectin-3 with genotype and allele distribution of rs4644 and rs4652 SNPs of galectin-3 between NSCLC patients (n=65) and healthy control (n=95) individuals. SNPsrs4644 and rs4652 in galectin-3 were studied using TaqMan Real-Time PCR system. Tissue gene expression levels of galectin-3 for patients was also analysed by Real-Time PCR. Galektin-3 serum levels were measured by ELISA.
Result
There were no significant differences in genotype and allele distribution of SNPs and galectin-3 gene expression levels between the tumor tissues compared to tumor surrounding tissues (p> 0.05); Mean serum level of galectin-3 was significantly higher in patients (26.05 ± 1.77 ng / ml) than that of controls (11.62 ± 1.30 ng/ml) (p <0.0001). The presence of angiolymphatic invasion was statistically significantly associated with AA genotype (p = 0.04). SNP rs4644 AC/CC genotype was found to be associated with higher serum galectin-3 levels in patients compared to that of controls (p<0.0001) while SNP rs4652 with AA / AC genotype was associated with lower serum galectin-3 levels in controls compared to patients (p<0.0001). Serum galectin-3 level has been shown to be statistically significantly associated with of vascular invasion among patients who had AC genotypes for both SNPs rs4644 and rs4652 (p = 0.03; p = 0.019 respectively).
Conclusion
Galectin-3 could be defined as a possible biomarker for NSCLC and it plays a role as surrogate marker for vascular invasion in tumors.
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P2.03-56 - Polymorphism ICAM-1 and Beta-3 Integrin Are Associated with the Development of Non-Small Cell Lung Cancer and the Prognostic Role of ICAM-1 (Now Available) (ID 2615)
10:15 - 18:15 | Presenting Author(s): Akif Turna
- Abstract
Background
Lung cancer is widespread cancer in the worldwide. Non-small cell lung cancer (NSCLC) accounts for 80-85% of all lung cancers. ICAM-1 and β3 integrin have been have been found to be associated with the angiogenesis, tumor growth and metastasis in various tumor types. Our primary aim in this study was to explore gene polymorphisms in ICAM-1 and β3 integrin molecular pathway in NSCLC patients and to clarify whether these values are effective on the etiopathogenesis and prognosis of the disease.
Method
Sixty-nine patients with operable (T1-4N0-1M0) NSCLC patients and 120 healthy individuals between January 2012 and June 2018 were included in the study. The tumor samples were taken after resected specimen. Blood samples of the patients were also collected before surgical resection. ICAM-1 and β3 integrin gene polymorphisms were determined by using PCR-RFLP techniques. Also serum ICAM levels were determined by ELISA method. The stages of the tumor were constructed according to 8th staging system.
Result
There was no statistically significant difference between patient with NSCLC and healthy control groups with regard to β3 Integrin Leu33Pro gene polymorphism(p=0.182). However, in patients with NSCLC, AG genotype frequency and G allele carriers of ICAM K469E variant were found to be higher than the control group and the difference was statistically significant(OR:2,710 95%CI:1,364-5,376; p=0.005). It has been determined that having a G allele increased approximately 2,95 fold the risk of disease and also carrying of AGTC combined genotype increased(OR:2,95 95%CI:1,366-6,373;p=0.049). When patients were evaluated according to tumor stage, serum levels of ICAM-1 gene in early tumor stage was found to be significantly higher than in advanced tumor stage (p=0,013). No significant difference was found between the range of histopathological subtypes and serum ICAM levels (p>0,05). Also, no statistically significant association was found between serum ICAM levels and angiolymphatic invasion (p=0.101, perineural invasion(p=0.054), lymph node metastasis (p=0.585).
Conclusion
ICAM-1 as an intercellular adhesion molecule seems to play an important role in lung carcinogenesis and it might play a role in the invasiveness of the tumor. However, β-3 integrin was not found to be associated with lung cancer development. The role of ICAM-1 in the genesis of lung cancer as well as immune mechanism should be further investigated.
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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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P2.18-16 - VATS Lobectomy and Chest Wall Resection for NSCLC (ID 1034)
10:15 - 18:15 | Author(s): Akif Turna
- Abstract
Background
The classic surgical approach in patients with NSCLC invading the chest wall is lobectomy and chest wall resection by thoracotomy in the majority of patients. However, this approach can be performed by video-assisted thoracoscopic surgery (VATS) or robotic surgery (RATS) as a result of increased experience and technological developments. The aim of this study was to evaluate the feasibility of the technique and its results in patients undergoing lung and chest wall resection by means of minimally invasive surgery.
Method
The data of patients who underwent anatomical lung resection using VATS or RATS for NSCLC in three academic hospitals between 2013-2018 were prospectively recorded and reviewed retrospectively. Fourteen patients, all but three males with a median age of 62 ± 6.0 years, undergoing lung and chest wall resection were included in the study. Surgical results were evaluated.
Result
Neoadjuvant/induction treatment was chemo-radiotherapy in three and chemotherapy in two patients. The preferred surgical technique was RATS in two patients, and multiportal VATS in 10 and uniportal VATS approach in two patients. Upper lobectomy was performed in 11 patients, lower in two patients and upper lobe posterior segmentectomy in one patient. Standard small incision for chest wall resection was performed in four, Hybrid approach in 10 patients. Five patients had one, 6 patients had two, two patients had three and one patient had four ribs resections. Chest wall reconstruction was not necessary in any of the patients. The mean operation time was 96.4 ± 21.8 minutes. Complications were observed in 5 (35.7%) of the patients without mortality. The most common complication was prolonged, >5 days, air leak in four patients (28.6%). Ten patients (71.4%) were classified as T3N0, one patient (7.1%) as T4N0, one patient (7.1%) as T4N1, and two patients (14.1%) as T3N0M1. Surgical margins were reported as tumor-free (R0) in all patients. Adjuvant chemotherapy was given in eight patients (57.1%). The two-year survival rate was 66.8%.
Conclusion
Lobectomy and chest wall resection with minimally invasive surgery is a safe and feasible method in patients with NSCLC with chest wall invasion. Compared with thoracotomy, it provides equivalent oncologic outcomes as well as less postoperative pain, smaller incision, and faster recovery.
