Virtual Library
Start Your Search
Mitsuhiro Isaka
Author of
-
+
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: 2
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
-
+
P1.17-12 - Osteogenic and Brain Metastases After Resection of NSCLC: Implications for the Use of FDG-PET and Brain MRI in Postoperative Surveillance (Now Available) (ID 973)
09:45 - 18:00 | Author(s): Mitsuhiro Isaka
- Abstract
Background
In several guidelines for lung cancer treatment, routine use of FDG-PET and brain MRI have not been recommend due to their insufficient evidence of survival benefits for resected NSCLC. In clinical practice, not a small portion of patients experience metastases in osteogenic and/or brain at the initial recurrence after surgery, which routine chest CT hardly diagnose them. In this retrospective study, we aimed to propose the candidates for surveillance using FDG-PET and brain MRI to diagnose OM/BM.
Method
We retrospectively enrolled 1099 patients who underwent pulmonary resections of lobectomy or more for NSCLC between 2002 and 2013. From medical records, clinicopathological data were collected and reviewed. Surveillance by using FDG-PET and brain MRI were basically performed at patients’ complaint of symptoms and/or detection of other metastatic disease. Clinicopathological factors associated with osteogenic metastases (OM) and/ or brain metastases (BM) were investigated by univariate and multivariate analyses.
Result
We included 1055 patients with lobectomies and 44 patients with pneumonectomies. Nine hundred thirty-three patients (88.4%) received mediastinal and hilar lymphnodes dissection. Seven hundred twenty-one patients had adenocarcinoma histology, 274 had squamous cell carcinoma histology. The prevalence of pStage was as following; pIA: 265 (25.1%), pIB: 348(33.0%), pIIA: 185(17.5%), pIIB: 105 (10.0%), pIIIA: 193 (18.3%), pIIIB: 3 (0.3%) (TNM 7th edition). Postoperative recurrence were identified in 344 patients (32.6%), OM or/and BM were observed in 115 patients (10.9%) as the initial recurrence. OM were diagnosed in 56 patients (5.6%). In the initial year after resection, 41.1% of OM were diagnosed, and 82% in the 2 years. BM were identified as the initial recurrence in 72 patients (6.6%). In the initial year, 44.1% of BM were diagnosed, and 78.9% in the 2 years. Multivariate analyses following univariate analyses revealed higher preoperative serum CEA level than 5ng/ml and presence of pathological nodal metastases were significantly associated with both postoperative OM and BM (p=0.011,<0.001 in OM, p=0.044, <0.001 in BM). Prevalence of OM and/or BM was 24.6% in patients with high serum CEA and nodal metastases. Postrecurrence survival of asymptomatic patients were better than those of symptomatic patients in both OM and BM groups (p=0.009 and 0.29, respectively)
Conclusion
Preoperative high serum CEA level and pathological nodal spread were closely associated with OM and BM after resection of NSCLC. Most of those events developed in 2 years after resections. Under the patient selections, efficacies of the use of FDG-PET and brain MRI are worthy to be evaluate in respect to earlier detections, maintenance of QOL and survival outcomes.
-
+
P1.17-36 - Analyses of Segmental and Intrapulmonary Lymph Node Metastases of Small-Sized Peripheral Solid Predominant Non-Small Cell Lung Cancer (NSCLC) (ID 1571)
09:45 - 18:00 | Author(s): Mitsuhiro Isaka
- Abstract
Background
Currently, randomized clinical trials to evaluate segmentectomy compared with lobectomy for peripheral small size non-small cell lung cancer (NSCLC) are ongoing, and the results are expected. The extent of lymph node dissection in intentional segmentectomy has not been clarified. The purpose of this study was to retrospectively investigate the pattern of segmental and intrapulmonary metastasis in intentional segmentectomy.
Method
We reviewed the records of patients who underwent lobectomies and systematic lymph node dissections for small(≦2cm) peripheral solid-predominant and clinical/surgical N0 NSCLC from 2002 to 2018. Among them, a total of 239 patients whose primary nodules was located in the outer third peripheral lung field and consolidation-tumor ratio (CTR) >0.5 on thin-section computed tomography (TSCT); who could be candidates for intentional segmentectomy were enrolled in this study. We analyzed the clinical and radiological factors, which may predict nodal metastases, and the distribution patterns of lymph node metastases.
Result
Of all patients, 33 (14%) had lymph node metastases (pN1:15, pN2:18). Segmental lymph node metastases (# 13) were observed in 4 cases(1.7%), and there were no metastasis of #13 in adjacent segment. #12 lymph node metastases were in 18 cases (7.5%), and # 11 lymph node metastases in 12 cases (5.0%), respectively. Skip N2 metastases were in 7 cases (2.9%), and all were in the range of regional lymphatic resection.
Conclusion
Solid-predominant NSCLC may have 14% lymph node metastasisa even with clinical and surgical N0. It may not be necessary to examined outside tumor-bearing segmental lymph nodes. However, there should be adequate lymph node sampling and intraoperative frozen section. In particular, intraoperative sampling of # 11 and # 12 is useful for selection of lobectomy convert cases.
-
+
P2.04 - Immuno-oncology (ID 167)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
-
+
P2.04-41 - Clinical and Immunological Factors Associated with Mutation Burden in Non-Small Cell Lung Cancer (ID 1313)
10:15 - 18:15 | Author(s): Mitsuhiro Isaka
- Abstract
Background
It is unclear whether factors including clinical and immune microenvironment (IME) are associated with tumor mutation burden (TMB) in patients with non-small cell lung cancer (NSCLC). We aimed to develop a prediction model to identify the association between these factors and TMB in patients with NSCLC.
Method
We assessed somatic mutation burden in surgical tumor specimens with whole exome sequencing (WES) using an ion torrent proton platform (Thermo Fisher Scientific). The IME profiles including PD-L1 tumor proportion score (TPS), stromal CD8 tumor infiltrating T cell (TIL) density, and stromal Foxp3 TIL were quantified by digital pathology using a machine learning algorithm. To detect factors associated with TMB, factors including clinical and IME were assessed using a multipul regression model. Two hundred NSCLC patients, for whom both WES and clinical data from Project HOPE (High-Tech-Omics-based Patient Evaluation) were available, excluding those with low tumor purity (less than 20%), were assessed in this study.
Result
Out of 250 NSCLC patients with tumors surgically resected between September 2014 and September 2015, we analyzed tumors from 200 patients. Patient background: median age (range) 70 (39-87), male 37.5%, smoker 27.5%, pathological stage (p-stage) (I/ II/ III) 63.5/22.5/14.0% respectively, histological type (Ad/Sq) 77.0/23.0%, primary tumor location (upper/lower) 58.5/41.5%, median standardized uptake value (SUV) 7.5 (0.86-29.8), median serum CEA level (range) 3.4 ng/ml (0.5-144.3), median serum CYFRA 21-1 level 1.2 ng/ml (1.0-38.0), median TMB 2.19/ Mb (0.12-64.38), median PD-L1 TPS 15.1% (0.09-77.4), median stromal CD8 TIL 582.1/mm2 (120.0-4967.6), and median stromal Foxp3 TIL 183.7/mm2 (6.3-544.0).
In simple regression analysis, gender (male/female), smoking status (yes/no), p-stage (I/II,III,IV), age (< 70, ≥70), primary tumor location (lower/upper), serum CEA level (low [< 5.0ng/ml], high [≥ 5.0 ng/ml]), serum CYFRA level (low [< 3.5ng/ml], high [≥3.5 ng/ml]), and actionable mutation status (Mt+/Mt-) were favorable prognostic factors (p < .0001, p = .0001, p = .072, p = .027, p = .045, p = .002, p = .009, and p = .069 respectively).
Multiple regression analysis identified five factors [smoking status: smoker, age: less than 70, primary tumor location: lower, serum CEA level (greater than 5ng/ml), and serum CYFRA level (greater than 3.5ng/ml)] associated with higher TMB (p = .002, p = .045, p = .03, p = .046 and p = .016 respectively).
Conclusion
IME factors did not associate with tumor mutation burden. However, along with smoking, lower primary location, elevated CEA and CYFRA level may be independent predictors of high TMB.
