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Filippo Lococo
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P1.06 - Mesothelioma (ID 169)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Mesothelioma
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.06-10 - 18F-FDG PET/CT in Malignant Pleural Mesothelioma: Diagnostic/Prognostic Performance and Correlation with Pathological Results (Now Available) (ID 695)
09:45 - 18:00 | Presenting Author(s): Filippo Lococo
- Abstract
Background
While the role of 18F-FDG-PET/CT-scan in the staging of malignant pleural mesothelioma (MPM) is almost validated, the diagnostic and prognostic performance of this tool is not clearly established. The aims of this study were: 1) to evaluate the detection rate of 18F-FDG PET/CT-scan and identify possible factors causing false-negative (FN) results 2) to explore the relationship between radiometabolic findings, pathological features and survival results.
Method
From 01/09 to 07/18, among all 210 MPM-patients observed and treated in 2 high-volume Institutions, we retrieved the clinical, radiometabolic and pathological aspects of 141 cases who underwent 18F-FDG PET/CT-scan during the diagnostic work-up examination. The Fisher-test was used to test dissimilarities in the prevalence of categorical variables and Cox-model to evaluate overall survivals differences.
Result
Mean age and male/female ratio were 70.5±7.8 and 3:1, respectively. The mean FDG-SUVmax was 8.1 (SD±5.1); the overall detection rate was 88.3% with 16 patients (11.6%) presented with SUVmax<2.5 (“PET-negative”). The distribution of clinic-pathological variables according to PET-status was reported in Figure 1. PET-negative cases are more frequently observed in older patients (p=0.027) and early stage tumors (FN at 33.3% in Stage I and FN at 40.0% in T1-tumors, both p=0.014). SUVmax values were higher in sarcomatoid (11.8±4.6) and biphasic (mean 9.3±7.0) than in epitheliod (6.9±3.8) tumors (p<0.001). Concerning long-term survivals, we found that among with Stage (p=0.032) and histology (p=0.014), the FDG metabolic uptake (SUVmax values both as continuos and cathegorical variable) was a prognostic factor as confirmed at multivariable analysis (H.R.:2.65,C.I.:1.23-5.70,p<0.001; see Figure 2).
Conclusion
Despite MPMs have an aggressive biological behavior, a low metabolic uptake at 18F-FDG PET/CT-scan may be observed in part of them (about 12% in our cohort), especially in early-stage tumors occurring in elderly patients. High SUVmax value correlates with locally-advanced stage and non-epitheliod MPMs and is associated with a worse prognosis.
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P2.17 - Treatment of Early Stage/Localized Disease (ID 189)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-29 - Impact of Second Predominant Pattern on Recurrence in Early Stage Resected Lung Adenocarcinoma: A Multicentric Study (Now Available) (ID 2515)
10:15 - 18:15 | Author(s): Filippo Lococo
- Abstract
Background
The ATS/ERS/IASLC adenocarcinoma classification allowed not only a better anatomical-pathological definition, but it showed a significant influence on long-term outcomes. It has been proposed that adenocarcinoma patterns could be divided in three groups according to their clinical and pathological behaviors: low (lepidic), moderate (papillary or acinar) and high grade (micropapillary and solid). Moreover, different patterns might mingle influencing biological features and prognosis. We focused on resected adenocarcinomas analyzing the impact of second predominant pattern on recurrence rate and Disease-Free Survival (DFS).
Method
We retrospectively collected all stage I and II lung adenocarcinoma operated on between January 2014 and December 2017 in seven European thoracic surgery departments. We selected all patients who underwent an anatomical resection with lymphadenectomy; patients with incomplete follow up, pure adenocarcinoma or those composed by more than two subtypes (if third pattern accounted for more than 10%) were excluded. Mucinous adenocarcinoma were considered separately from other patterns. DFS, incidence and localization of recurrence were calculated according to the second predominant pattern.
Result
Among 500 patients, 331 were selected. There were 186 male, mean age was 68.1 years (±SD 8.2) and 105 (31.7%) patients were active smokers at the moment of diagnosis. The majority of patients (271, 81.9%) underwent a lobectomy. Low, medium and high-grade first predominant pattern were 45 (13.6%), 208 (62.9%), 57 (17,2%) respectively and 21 cases were mucinous.
Second predominant pattern was present as follow: acinar 96 (29%), lepidic 86 (26%), papillary 74 (22.4%), solid 29 (8.8%), micropapillary 26 (7.9%), 20 mucinous (6%). DFS analysis showed a significant impact of grade of the second predominant pattern (p=0.046), while first predominant pattern’s grade did not significantly impact on DFS (p=0.322). According to the subtypes of second predominant pattern, lepidic pattern showed a better mean DFS (56.1 versus 49.6 months, p=0.014) and a lower recurrence rate (p=0.018, and, in particular, a lower distant recurrence rate, p=0.016), while micropapillary had a worse DFS (42.3 versus 52.1 months, p=0014), higher recurrence rate (p=0.017, and in particular, a higher regional recurrence, p=0.038); moreover, also pleural invasion influenced DFS significantly (p=0.001). At multivariate analysis, lepidic second pattern and pleural invasion confirmed their influence on DFS (p=0.044, IC 0.28-0.98 and p=0.001, IC 1.36-3.4).
When we analyzed the subgroup with only moderate grade (acinar and papillary) first predominant pattern (208 patients), lepidic and micropapillary second predominant patterns and pleural invasion confirmed their significant impact on DFS (p=0.015; p=0.021; 0.015 respectively).
Conclusion
Our multicentric study confirms the impact of adenocarcinoma patterns on recurrence rate and DFS. The second predominant pattern in early stage resected adenocarcinoma seems to play an important role in influencing the outcomes. Micropapillary and lepidic second pattern demonstrated to be significantly related to recurrence development and their presence should require different and dedicated postoperative management.
