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Rie Nakahara



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    P2.08 - Oligometastatic NSCLC (ID 172)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Oligometastatic NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.08-05 - The Role of Surgical Treatment for Patients with NSCLC Demonstrating Limited Pleural Dissemination (ID 701)

      10:15 - 18:15  |  Author(s): Rie Nakahara

      • Abstract

      Background

      Pleural dissemination or malignant pleural effusion confirmed during surgery generally indicates incurable disease and is a contraindication for lung resection. However, recent studies suggested that complete removal of the disseminated nodule in combination with lung resection is associated with long-term survival when dissemination is limited.

      This study investigated whether there is a curable subgroup of patients with NSCLC exhibiting limited malignant pleural disease (MPD).

      Method

      Among 1966 patients who underwent lung surgery for primary lung cancer at our institution between 1986 and 2015, 61 patients were diagnosed with MPD during the operation. Excluding 3 patients who had other active malignancies and 2 patients who were lost to follow-up, we analyzed 59 patients, including 33 who had signs of MPD on preoperative CT. The type of surgery was biopsy only for 26, extrapleural pneumonectomy (EPP) for 17, lobectomy for 13, and wedge resection for 3. Macroscopic complete resection (MCR) was carried out for 24 patients. All but one patient were followed until December 2018 or death, and the follow-up period for surviving patients ranged from 48 to 361 months (median 158 months).

      Result
      Overall and progression-free survival
      Patients group Type of surgery Number of patients 5yOS/PFS(%) 10yOS/PFS(%) 15yOS/PFS(%)
      All patients 59 28.1/10.1 18.1/6.7 13.8/6.7
      MCR 24 37.5/25.0 25.0/16.7 20.8/16.7
      EPP 17 41.2/29.4 35.3/23.5 29.4/23.5
      No sigh of MPD preoperatively 26 34.6/15.4 19.8/11.5 19.8/11.5
      MCR 11 45.5/36.4 27.3/27.3 27.3/27.3
      EPP 5 60/60 60/60 60/60
      Any sign of MPD preoperatively 33 23.1/6.0 13.2/3.0 9.9/3.0
      MCR 13 30.8/15.3 23.1/7.6 15.4/7.6
      EPP 12 33.0/16.6 25.0/8.3 16.7/8.3

      Among the 59 patients, 4 patients survived without recurrence for more than 10 years. Furthermore, 3 out of the 4 patients were still alive at 361 months, 300 months, and 211 months, respectively. Among the 4 patients, 3 patients did not exhibit signs of malignant pleural disease preoperatively, and all 4 patients underwent EPP. The overall and progression-free survival rates at 5, 10, and 15 years for all 59 patients, the 26 not exhibiting signs of MPD preoperatively, and the 33 patients with signs of MPD according to the type of surgery are presented in the Table. Prognostic factors significantly associated with longer progression-free survival were early clinical stage, adenocarcinoma histology, absence of pathological mediastinal nodal metastasis, MCR, and EPP.

      Conclusion

      A curable subgroup may exist among patients diagnosed with malignant pleural disease during surgery, especially among those without signs of pleural disease preoperatively treated by EPP.