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Yuki Nishioka
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EP1.08 - Oligometastatic NSCLC (ID 198)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Oligometastatic NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.08-04 - Local Treatment for Patients with Pulmonary Oligo-Recurrence of Non-Small Cell Lung Cancer (Now Available) (ID 2550)
08:00 - 18:00 | Author(s): Yuki Nishioka
- Abstract
Background
The concept of oligo-recurrence, which is theoretically curable by definitive local therapy, has been proposed in several cancers. But the efficacy of local therapy for patients with pulmonary oligo-recurrence of non-small cell lung cancer (NSCLC) is unclear. The aim of this study was to investigate the efficacy of local therapy for pulmonary oligo-recurrence of NSCLC.
Method
We retrospectively analyzed the data on 35 patients who underwent lung resection or radiotherapy for pulmonary oligo-recurrence in our institution, between 2000 and 2016. We evaluated independent risk factors for overall survival and progression-free survival after local treatment for patients with pulmonary oligo-recurrence of non-small cell lung cancer. In this study, pulmonary oligo-recurrence was defined as local recurrences limited within lungs after local or systemic treatment for NSCLC.
Result
There were 26 men and 9 women with median age of 72 years [interquartile range (IQR), 64-75]. The median follow-up time was 48.8 months [IQR, 16.3-66.7]. Previous therapies for NSCLC were pulmonary resections in 26 patients (74.2%), stereotactic radiosurgery for brain metastasis in 3 (8.6%), radiotherapy for lung tumors in 3 (8.6%), chemoradiotherapy in 2 (5.7%) and chemotherapy (ALK-TKI) in 1 (2.9%). The median progression-free interval between previous therapy and local treatment for oligo-recurrence was 29.0 months [IQR, 16.0-44.5]. Histopathology were adenocarcinoma in 26 patients (74.2%), squamous cell carcinoma in 7 (20.0%), adenosquamous carcinoma and large cell neuroendocrine carcinoma in 1 (2.9 %). Among 21 patients (60.0%) who underwent surgical resection for pulmonary oligo-recurrence, surgical procedures were wedge resection in 11 patients, segmentectomy in 3, lobectomy in 5 and pneumonectomy in 2. Among 14 patients (40.0%) who underwent radiotherapy for pulmonary oligo-recurrence, 11 patients (31.4%) underwent stereotactic body radiotherapy. There were no treatment-related death. Three-year overall survival and progression-free survival were 60.3% and 49.6%. Post-treatment recurrence occurred in 16 (60.4%) patients (local; 6, distant; 2, local and distant; 8). Univariate analyses identified progression-free interval between previous therapy and local treatment for pulmonary oligo-recurrence as independent risk factor for overall survival (HR 0.97 [95% CI 0.95-1]; p=0.039).
Conclusion
Local therapy for pulmonary oligo-recurrence of NSCLC are feasible and the post-therapeutic survival is acceptable. But there are highly selective patients in our study, further study is needed for curative intent treatment.
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P1.12 - Small Cell Lung Cancer/NET (ID 179)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.12-23 - DLL3 Is a Predictive Marker of Sensitivity to Adjuvant Chemotherapy for High-Grade Neuroendocrine Tumors (ID 1752)
09:45 - 18:00 | Author(s): Yuki Nishioka
- Abstract
Background
High-grade neuroendocrine carcinomas (HGNECs) include Large-cell neuroendocrine carcinoma (LCNEC) and small-cell lung cancer (SCLC), which represent ~18% of primary lung cancer. The mammalian Notch family ligands delta-like 3 (DLL3) is considered to be a potential therapeutic target for HGNECs. The clinicopathological significance of DLL3 for HGNEC was still unclear.
Method
We used the prospectively maintained database of Hyogo Cancer Center (Akashi, Japan), and reviewed the medical records of patients who underwent tumor resection and were diagnosed with HGNEC between January 2001 and December 2009. We performed immunohistochemistry for DLL3(E3J5R, monoclonal, 1:300 dilution, CST), and all samples were evaluated by an expert pathologist without knowledge of the patient’s outcome. The results were reported as negative (no positive cell) or positive (more than 1% positive cells). We investigated the correlation between the sensitivity of HGNEC to adjuvant chemotherapy and the results of immunohistochemical staining for DLL3. Overall survival (OS) and recurrence-free survival (RFS) was estimated by the Kaplan–Meier method, and differences in distribution were evaluated using the log-rank test.
Result
We identified 58 patients who underwent complete resection of the primary tumor and who were diagnosed with HGNEC(LCNEC n=39, SCLC n=19). The mean follow-up period was 50.9months. Twenty-one patients (LCNEC n=12, SCLC n=9) received adjuvant chemotherapy. All of them received platinum-based anticancer drugs. DLL3 was positive in 16 (51.7%) LCNEC patients and 14 (73.7 %) SCLC patients. The distribution of pathologic stage in DLL 3 positive and negative patients was stage I in 17 and 14 patients, stage II in 5 and 9 patients, and stage III in 8 and 5 patients. There was no significant difference in OS and RFS between DLL3 positive and negative patients (DLL3 positive vs. negative, 5-year OS: 40.0% vs. 39.3% p=0.79, 5-year RFS: 46.4% vs. 41.5% p=0.87). Amon patients with DLL3 positive tumors, no difference was found in 5-year OS and RFS between patients with adjuvant chemotherapy and those without adjuvant chemotherapy (Adjuvant chemotherapy vs. Surgery alone, 5-year OS: 57.1% vs. 25.0% p=0.28, 5-year RFS: 42.9% vs. 36.5% p=0.92). In contrast, when the tumors were negative for DLL3, a significantly greater 5-year OS and RFS was observed for the patients with adjuvant chemotherapy than for those without adjuvant chemotherapy (Adjuvant chemotherapy vs. Surgery alone: 5-year OS: 100.0% vs. 19.1% p<0.01, 5-year RFS: 85.8% vs. 33.3% p=0.02).
Conclusion
DLL3 might be a predictive marker of sensitivity to adjuvant chemotherapy for HGNEC.
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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
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-15 - Clinical Features and Prognosis of Lung Cancer with Cavity Lesion (ID 2023)
10:15 - 18:15 | Author(s): Yuki Nishioka
- Abstract
Background
There have been conflicting results about the clinical features and prognosis of primary lung cancer with cavity lesion (LC-CL). We, therefore, revisited the clinicopathological features of primary LC-CL and reassessed whether they exhibited poor prognosis in non-small-cell lung cancer.
Method
Between 2006 and 2014, 377 patients underwent complete resection for clinical T1aN0 non-small-cell lung cancer. Clinical stage was adapted to the seventh edition of the lung cancer stage classification system. Among these cases, 23 (6.1%) were diagnosed as LC-CL. We compared the characteristics and prognosis between LC-CL and the others.
Result
LC-CL showed higher CEA (≧5 ng/mL) (p<0.01), higher SUV max (≧2.5) (p=0.02), the status of smoking history (p<0.01), larger actual pathologic tumor size (≧3cm) (p<0.01), lymphatic invasion (p=0.03), as compared with the others. The overall and recurrence-free survival of the patients with LC-CL were shorter than those of the others (p=0.01 and 0.03, respectively). Univariate analysis revealed that sex (p=0.01), age (≧70) (p<0.01), CEA (p<0.01), SUV max (p<0.01), smoking history (p<0.01), pathologic tumor stage (≧Ⅱ) (p=0.01), vascular invasion (p<0.01), lymphatic invasion (p=0.04), pleural invasion (p<0.01) and cavity lesion (p=0.01) showed significant poor prognostic factors. Multivariate analysis revealed that age (p=0.02) and SUV max (p<0.01) remained significant prognostic factors, but cavity lesion was not significant (p=0.17).
Conclusion
Although the value of its prognostic factor was not significant, primary LC-CL should be considered to have aggressive malignant behavior in non-small-cell lung cancer.
