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Haruhiko Masuda



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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  |  Presenting Author(s): Haruhiko Masuda

      • Abstract
      • Slides

      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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    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): Haruhiko Masuda

      • Abstract
      • Slides

      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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    P2.15 - 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): Haruhiko Masuda

      • Abstract
      • Slides

      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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