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Kenichi Okubo
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P1.06 - Mesothelioma (ID 169)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.06-11 - Overlapping Immunophenotypes Between Mesothelioma and Angiosarcoma: Usefulness of Claudin-5 in the Differential Diagnosis (ID 240)
09:45 - 18:00 | Author(s): Kenichi Okubo
- Abstract
Background
Differential diagnosis between mesothelioma and angiosarcoma remains challenging because of their overlapping morphological and immunohistochemical phenotypes. Angiosarcoma may show both epithelioid and sarcomatoid morphology and is occasionally a cytokeratin-expressing tumor as with mesothelioma. Generally, endothelial markers are always expressed by angiosarcoma but not by mesothelioma; however, a subset of mesothelioma expresses endothelial markers, making the usefulness of these markers limited. Currently, little information is available about the immunoreactivity of mesothelioma to endothelial markers. Therefore, we investigated immunoreactivities of mesothelioma and angiosarcoma to endothelial markers and sought to identify a useful marker in their differential diagnosis.
Method
We enrolled 147 cases of pleural mesothelioma, comprising 93 epithelioid, 25 biphasic, and 29 sarcomatoid subtypes. For comparison, we used 41 cases of angiosarcoma occurring in various organs. Using a tissue block showing the representative morphology, the expressions of endothelial (CD31, CD34, factor-VIII, ERG, and claudin-5) and of mesothelial markers (calretinin, WT-1, CK5/6, and EMA) were evaluated by immunohistochemistry.
Result
Calretinin and WT1 were expressed in 82.2% (120/146) and 82.9% (116/140) cases of mesothelioma, respectively. Among the three subtypes of mesothelioma, the immunoreactivity of sarcomatoid mesothelioma to calretinin was relatively low with the positivity of 48.3% (14/29). Calretinin was expressed in none of the angiosarcoma cases (0/41), whereas WT-1 was expressed in 4.9% (2/41) cases of angiosarcoma. Conventional endothelial marker (CD31, CD34, factor VIII, and ERG) were expressed in 10.3% (15/146), 3.5% (5/142), 3.4% (5/146), and 29.1% (39/134) cases of mesothelioma, respectively. The immunoreactivities of sarcomatoid mesothelioma to conventional endothelial markers were relatively high with the positivity of 31.0% (9/29) for CD31, 7.1% (2/28) for CD34, 10.7% (3/28) for factor VIII, and 56.0% (14/25) for ERG. Claudin-5 expression was observed in all the angiosarcoma cases (36/36), but in none of the mesothelioma cases (0/138).
Conclusion
We showed overlapping immunophenotypes between mesothelioma and angiosarcoma. Endothelial markers, except for claudin-5, were more frequently expressed than expected by mesothelioma, especially by sarcomatoid mesothelioma. High sensitivity and specificity of claudin-5 in the distinguishment of angiosarcoma from mesothelioma suggest the usefulness of this marker, indicating that claudin-5 should be included in a panel of immunohistochemical markers in the differential diagnosis between mesothelioma and angiosarcoma.
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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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P2.17-28 - Examination of the Indication and Validity of Segmental Resection as Intentional and Palliative Limited Resection for Lung Cancer (Now Available) (ID 2482)
10:15 - 18:15 | Author(s): Kenichi Okubo
- Abstract
Background
Segmental resection with lymph node dissection as intentional limited resection is now regarded as the effective surgical procedure for early lung cancer from the view point of curability and preservation of respiratory function. But the curability of this procedure for more advanced cancer is not well known. We may show it by investigating the detailed results of all segmental resection cases as intentional and palliative limited resection.
Method
We targeted 167 cases who passed more than five years after operation among 240 lung cancer cases on whom we have performed segmental resection with lymph node dissection between January in 2003 and March in 2019. It was decided that the indication of segmental resection as intentional limited resection was cStage 0, IA1 and IA2 (UICC 8th) with meeting the SUVmax value of FDG-PET was 1.5 or less (=group A). Segmental resection as palliative limited resection was performed on cStage IB or less patients who had difficulty in lobectomy because of poor respiratory function, multiple lung cancer or presence of serious other disease, etc, (=group B). We investigated prognosis and pathological recurrent factors in both groups, and we considered each indication of segmental resection as intentional or palliative limited resection again.
Result
Group A contains 102 cases and 5-year survival rate was 97% (All death cases died of other disease). In group A, local recurrence occurred in 1 case (pStage IA1, surgical margin insufficient) but distant metastasis did not occur. Group B contains 65 cases and 5-year survival rate was 71% (The original death from lung cancer was 5 cases among 17 death cases). In group B, local recurrence occurred in 4 cases (pStage IA2: 1(surgical margin insufficient), pStage IB: 2, pStage IIIA: 1), distant metastasis occurred in 6 cases (pStage IA3: 1, pStage IB: 1, pStage IIIA: 3, pStage IIIB: 1) and 3 cases on which postoperative adjuvant chemotherapy had been performed had no recurrence (pStage IB: 1, pStage IIB: 2). Recurrence of pStage IA3 was only 1 case (10% in all pStage IA3 cases, Sm, distant metastasis). The multivariable analysis of pathological recurrent factors (pStage, p, v, ly) in group B (except for 3cases on which postoperative adjuvant chemotherapy was performed) showed that lymphatic involvement had a significant influence on recurrence (p-value / Hazard ratio: lymphatic involvement: 0.03 / 6.49, more than pStage II: 0.37 / 2.50).
Conclusion
We are convinced that the current indication of our intentional limited resection to be almost proper but we have thought that we should include a part of Stage IA3 depending on a condition. In palliative limited resection cases, postoperative adjuvant chemotherapy should be considered if possible when pathological result show lymphatic involvement or more than pStage II.
