Author of

• 31199

  +

  P2.09 - Pathology (ID 174)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Pathology
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

  • 31215

    +

    P2.09-15 - PD-L1 Expression and Lymphocyte Infiltration in Resected Stage IIIAN2 NSCLC: Preliminary Data from a Lung ART Ancillary Study (ID 1344)

    10:15 - 18:15  |  Author(s): Olaf Mercier
    • Abstract

    Background
    

    Patients with resectable stage IIIA N2 NSCLC, are at high risk of both systemic and loco-regional relapse following surgical resection, necessitating neo-adjuvant or adjuvant treatments. Prognostic biological markers are needed. Parameters from the immune microenvironment, including PD-L1 expression and lymphocytic infiltration, have been poorly described in this group of patients. Thus we assessed simultaneously PD-L1 expression and TIL density in a cohort of stage IIIA N2 Lung ART patients, and correlated the results with clinical and pathological features before adjuvant treatment.

    Method
    

    Formalin fixed paraffin-embedded tumor surgical specimens from 247 patients included in the Lung Adjuvant Radiotherapy Trial (NCT00410683) were studied. PD-L1 immunohistochemistry was performed centrally on whole slides using a validated clinical PD-L1 assay. Expression of PD-L1 in tumor cells (TC) and immune cell (IC) was scored by a trained pathologist. Morphological assessment of TIL density (percentage of tumor area) was performed on whole hematoxylin-eosin stained slides. Surgical and pathology reports were reviewed by an independent expert committee for tumor staging. Association between immune parameters and baseline clinical characteristics were assessed in exploratory analyses in order to provide insights on immune activity in resected NSCLC patients.

    Result
    

    PD-L1 expression in ≥1% TC, ≥50% TC, ≥1% IC, ≥10% IC was observed in 47.8%, 21.9%, 61.5%, 7.3% of patients, respectively. In univariate analysis, high PD-L1 expression in both tumor cells and immune cells for all cut points correlated strongly with a higher TIL density (p-values ≤0.001). In 41 (16.6%) patients with preoperative chemotherapy (CT), a higher TIL density was observed (mean 28.1 vs. 17.5%, p=0.0018) as compared to patients without preoperative CT, but no difference was noted for PD-L1 expression in both TC and IC,. Skip N2 metastases were associated with a higher TIL infiltration (mean 22.9% vs. 17.4% p=0.014). We found no significant correlation between PD-L1 or TIL infiltration with the number of mediastinal lymph nodes stations involved on pathological examination and with histological tumor subtypes (squamous cell carcinoma vs. adenocarcinoma).

    Conclusion
    

    PD-L1 expression levels in TC and IC appeared similar in stage IIIA N2 NSCLC as compared to other stages. Expression in both TC and IC strongly correlated with TIL infiltration, suggesting a prominently immune-induced expression mechanism. Preoperative chemotherapy was associated with a higher TIL infiltration but not higher PD-L1 expression. Patients with skip N2 metastases harbored a higher level of TIL density, a finding consistent with a more active immune microenvironment in this group of patients with better prognosis. These data will be subsequently updated on a larger number of patient and correlated to clinical follow-up.

• 31780

  +

  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
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

  • 31808

    +

    P2.17-24 - Minimally Invasive Surgery for Lung Cancer Improves Short Term Outcomes in Patients with History of Head and Neck Carcinoma (ID 2309)

    10:15 - 18:15  |  Author(s): Olaf Mercier
    • Abstract

    Background
    

    Lung cancer resections are at high risk for major complications in patients with history of head and neck carcinoma (HNC). We initiated a minimally invasive video assisted thoracic surgery (VATS) program since 2014. Our objective was to determine whether VATS lobectomy had better short term outcome than open lobectomy in this subset of patients.

    Method
    

    We performed a retrospective monocentric analysis of consecutive standard lobectomies performed for lung cancer in patients with history of HNC at our institution between January 2010 and December 2017. Patients with more complex procedures were excluded. Patients’ characteristics and short term outcome were compared between VATS and open lobectomy (OL) groups. Quantitative data were compared using parametric test when normally distributed and using non-parametric test when not normally distributed. Qualitative data were compared using Chi² or exact Fischer’s test when appropriate. P<0.05 was considered significant.

    Result
    

    Among 85 patients, 52 underwent an OL and 33 VATS lobectomy. There was no significant difference between the two groups regarding age, sex ratio, HNC location, history of HNC treatment, pathology and stage of lung cancer, history of coronary artery disease, respiratory function or neutrophil to lymphocyte ratio. Postoperative death occurred in 2 patients only in the OL group. In the VATS group, there was a significant decrease in proportion of postoperative life-threatening complications requiring hospitalization in intensive care unit (12/52 vs. 1/33, P=0.01). The main results are reported in the Table.

    

    Conclusion
    

    We found that minimally invasive thoracic surgery was associated with better short term outcomes compared to open surgery for lung cancer resection in patients with history of HNC. Therefore, we suggest that standard lobectomy in patients with history of HNC should be performed by VATS procedure. Further studies are required to confirm our finding.