Author of

• 31431

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  P1.13 - Staging (ID 181)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Staging
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall

  • 31434

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    P1.13-03 - Lung Adenocarcinomas Manifesting as Radiological Part-Solid Nodules Define a Special Clinical Subtype (ID 35)

    09:45 - 18:00  |  Author(s): Haiquan Chen
    • Abstract

    Background
    

    According to guidelines from the Fleischner Society in 2017, subsolid nodules are categorized into pure ground glass nodules (pGGNs) having only a GGO component and part-solid nodules having both GGO and solid components on thin-section computed tomography (TS-CT). Persistent part-solid nodules with solid components ≥ 6mm should be considered highly suspicious.Clinicopathologic features and prognostic predictors of radiological part-solid lung adenocarcinomas were unclear.

    Method
    

    We retrospectively compared clinicopathologic features and survivals of part-solid tumors with those of pure ground glass nodules (pGGNs) and pure solid tumors receiving surgery at Fudan University Shanghai Cancer Center, and evaluated prognostic implications of consolidation-to-tumor ratio (CTR), solid component size and tumor size for part-solid lung adenocarcinomas.

    

    Result
    

    911 patients and 988 pulmonary nodules (including 329 part-solid nodules (PSNs), 501 pGGNs & 158 pure solid nodules) were analyzed. More female patients (P=0.015) and non-smokers (P=0.003) were seen in PSNs than those in pure solid nodules. Prevalence of lymphatic metastasis was lower in PSNs than that in pure solid tumors (2.2% vs 27%, P=0.000). 5-year lung cancer specific recurrence free survival (LCS-RFS) and overall survival (OS) of PSNs were worse than those of pGGNs (P<0.001; P=0.042), but better than those of pure solid tumors (P<0.001; P<0.0001), respectively. CTR (OR: 12.90; 95% CI: 1.85-90.04), solid component size (OR: 1.45; 95% CI: 1.28-1.64) and tumor size (OR: 1.23; 95% CI: 1.15-1.31) could predict pathologic invasive adenocarcinoma for PSNs. None of them could predict the prognosis. Patients receiving sublobar resection had comparable prognoses with those receiving lobectomy (5-year LCS-RFS: P=0.178; 5-year LCS-OS: P=0.319). Prognostic differences between patients with systemic lymph node dissection (sLND) and those without sLND were statistically insignificant.

    Table1 Baseline clinicopathologic characteristics of objects in this study

    	All N=988	Part Solid nodule N=329	Pure Ground Glass nodule N=501	Pure Solid nodule N=158	P value
    Age (Mean±SD)	56.49±10.83	58.89±9.71	53.64±10.86	60.54±10.52	0.000
    Gender					0.015
    Male	277(30.4)	91 (28.9)	124 (28.2)	62 (39.5)
    Female	634(69.6)	224 (71.1)	315 (71.8)	95 (60.5)
    Smoking status					0.003
    Smoker	153(16.8)	52 (16.5)	62(14.1)	39(24.8)
    Non-smoker	758(83.2)	263(83.5)	377(85.9)	118(75.2)
    Tumor size(mm)	15.14±7.38	20.51±7.18	10.22±3.84	19.54±5.58	0.000
    Location					0.009
    RUL	364 (36.8)	126 (38.3)	197 (39.3)	41 (25.9)
    RML	67 (6.8)	21 (6.4)	29 (5.8)	17 (10.7)
    RLL	181 (18.3)	48(14.6)	93 (18.6)	40 (25.3)
    LUL	266 (26.9)	98 (29.8)	130 (25.9)	38 (24)
    LLL	110 (11.2)	36 (10.9)	52 (10.4 )	22 (14.1)
    Surgery					0.000
    Wedge resection	456(46.2)	72(21.9)	370(73.8)	14(8.9)
    Segmentectomy	97(9.8)	33(10.0)	58(11.6)	6(3.8)
    Lobectomy	435(44.0)	224(68.1)	73(14.6)	138(87.3)
    Pathology					0.000
    AIS/MIA	509(51.5)	56(17.0)	447(89.2)	6(3.8)
    IAD	479(48.5)	273(83.0)	54(10.8)	152(96.2)
    Lepidic predominant	154(32.6)	104(38.8)	30(55.5)	30(55.5)	0.000
    Solid/Micropapillary predominant	21(4.5)	4(1.5)	1(1.9)	16(3.4)	0.000
    Acinar/Papillary predominant	290(61.4)	157(58.6)	22(40.7)	111(74.0)	0.000
    Mucinous adenocarcinoma	7(1.5)	3(1.1)	1(1.9)	3(2.0)	0.753
    Pathologic N status					0.000
    N0	904 (94.9)	305(97.8)	488 (100)	111(73)
    N1/2	48(5.1)	7(2.2)	0 (0)	41 (27)

    Conclusion
    

    Part-solid lung adenocarcinoma showed different clinicopathologic features compared with pure solid tumor. CTR, solid component size and tumor size could not predict the prognosis. Part-solid lung adenocarcinomas define one special clinical subtype.

• 31322

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  P2.11 - Screening and Early Detection (ID 178)

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

  • 31338

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    P2.11-14 - Evolutionary Action Score of TP53 Predicts the Prognosis of Patients with Stage I Lung Adenocarcinoma (ID 53)

    10:15 - 18:15  |  Author(s): Haiquan Chen
    • Abstract

    Background
    

    Several studies have reported that TP53 mutations were associated with poor prognoses for patients with non-small-cell lung cancer. TP53 was reported to have a mutation rate of 46% in lung adenocarcinoma patients. Whether these mutations are of the same prognostic value is questionable. Here we use an algorithm named Evolutionary Action of TP53 (EAp53) which stratifies TP53 missense mutations into high-risk and low-risk groups based on the scores calculated to see whether different types of TP53 mutations are of prognostic value for patients with stage I lung adenocarcinoma.

    Method
    

    Whole-exome sequencing was performed on 83 patients who underwent surgery and with a pathologically confirmed adenocarcinoma between January 2011 and August 2013 at Fudan University Shanghai Cancer Center. No patient underwent neoadjuvant therapy. Missense TP53 mutations were classified to low-risk and high-risk groups according to their EAp53 score, which assesses the genotype-phenotype perturbation of point mutations. Patients were divided into 4 groups based on TP53 mutational status: wild-type TP53, truncating mutations, including frame-shift mutations, nonsense mutations, small indels, and splice-site mutations; high-risk missense mutations, defined as missense mutations with an EAp53 score >75.00; low-risk missense mutations, defined as missense mutations with an EAp53 score ≤75.00.

    Result
    

    Mutations of major driver genes, tumor suppressor genes and genes of interest for lung adenocarcinoma, including EGFR (60%), TP53 (35%), RB1 (7%), RBM10 (5%), NF1 (4%), CDKN2A (2%), ERBB2 (2%), KRAS (2%), PIK3CA (2%), SMARCA4 (2%), APC (1%), BRAF (1%), KEAP1 (1%) and STK11 (1%) were identified in our cohort of 83 stage I lung adenocarcinoma patients (fig 1a).

    TP53 mutations were identified in 29 patients (35%), with 11 high-risk, 9 low-risk, and 11 truncating mutations. Compared with patients with wild-type TP53, patients with TP53 mutations had a significantly lower tumor mutational burden (p < 0.001, fig 1b). Furthermore, there was a significant difference between the wild-type/low-risk group and the truncating/high-risk group (p < 0.001, fig 1b).

    Compared with the low-risk group, the high-risk group had significantly worse recurrence-free survival (p = 0.046), while there was no significant difference between the low-risk group and the wild-type group (p = 0.695, figure 1c). Moreover, when we combined the groups into a high-risk/truncating group and a low-risk/wild-type group, the high-risk/truncating group had a significantly worse recurrence-free survival (p = 0.0081, figure 3c) and overall survival (p = 0.0029, figure 1c).
    
    
    
    

    Conclusion
    

    TP53 mutational type is of prognostic value for patients with stage I lung adenocarcinoma.