Virtual Library

Start Your Search

Adem Deligönül



Author of

  • +

    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
    • +

      P1.13-07 - Comparison of the 7th and 8th Edition of TNM Staging for NSCLC in Patients Undergoing Pulmonary Resection After Neoadjuvant/Induction Treatment (ID 1141)

      09:45 - 18:00  |  Author(s): Adem Deligönül

      • Abstract

      Background

      The new staging system for lung cancer (8thTNM) has been defined and in use since 2017. The aim of this study was to confirm the novel staging system's distinctive ability and prognostic performance in patients with clinic local advanced NSCLC undergoing Neoadjuvant/Induction (N/I) treatment followed by pulmonary resection.

      Method

      The patients with locally advanced NSCLC who underwent segmentectomy or larger lung resection after N/I treatment between 2000 and 2017 were prospectively recorded and retrospectively analyzed. ypTNM stages of the patients were recorded using the 7th and 8th TNM staging system. The results were analyzed.

      Result

      The study included 449 patients with a mean age of 58.92 ± 8.47, 30 were female and 419 male. Chemotherapy as an N/I was the treatment of choice for 321 (71.5%) patients and chemoradiation in 128 (28.5%) patients. The type of lung resection was segmentectomy in 22 (4.9%), lobectomy in 345 (76.8%) and pneumonectomy in 82 (18.3%). According to the 7th TNM classification; complete response, T0N0, was observed in 78, stage 1a in 83, Ib in 53, IIa in 66, IIb in 45, IIIa in 90, IIIb in 5 and stage IV in 29 patients. However, according to the 8th TNM classification; complete response, T0N0, was observed in 78, Ia1 in 18, Ia2 in 24, Ia3 in 42 patients, Ib in 35, IIa in 21, IIb in 98, IIIa in 88, IIIb in 16, and stage IV in 29 patients. When the long-term survival was analyzed for the 7th and 8th TNM Staging System, significant differences were observed in stages for each edition respectively (p <0.001, p <0.001).

      Conclusion

      In patients undergoing surgery after neoadjuvant/induction treatment, a significant number of stage migration was detected between the 7th and 8th staging system. The 8th TNM classification showed no improvement in the ability to differentiate between subgroups compared to the older version, especially for ypStage1. To prove that the 8th TNM classification is a superior method for staging patients with N/I, further studies with larger databases are needed for this group.

  • +

    P2.13 - Staging (ID 315)

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

      P2.13-06 - Finding a Place for Pathological Near Complete Response Patients Following Neoadjuvant/Induction Therapy in the TNM Staging (ID 1029)

      10:15 - 18:15  |  Author(s): Adem Deligönül

      • Abstract

      Background

      It has been shown that 10% or less in the number of live tumor cells in patients who underwent surgery after neoadjuvant/induction (N/I) treatment for locally advanced non-small cell lung cancer (NSCLC) is a more important prognostic factor than the tumor diameter. Therefore, to improve the accuracy of TNM staging, the IASLC recommends calculating the new pathological ypT stage by multiplying the percentage of viable tumor cells with the total tumor size (Picture 1). The aim of this study was to determine the effect of this recommendation on long-term survival rates.

      Method

      Data of 1190 patients who underwent segmentectomy or larger lung resections for NSCLC in our academic center between 1996 and 2017 were prospectively recorded and evaluated retrospectively. Four hundred and sixty-nine (39.4%) patients who underwent surgery after N/I treatment for locally advanced NSCLC were included in the study. The patients were divided into 3 groups; Pathological complete response (CR, Group 1) as defined as no viable tumor cells regardless of tumor size, group 2 was accepted as near complete response (nCR), where the tumor contained ≤%10 live tumor cells, tumor size > 5 cm without lymph node metastasis, group 3 consisted of ypStage1 patients. The long term survival and its impacting factors were analyzed.

      Result

      In histopathological examination, 16.6% (78/469) patients had CR, 4% (19/469) had nCR, 17.7% (83/469) had ypStage 1a and 7.7% (36/469) had ypStage 1b. Five-year survival; 72.5% in Group 1, 30% in Group 2 and 63.4% in Group 3.

      Conclusion

      The best survival was observed in patients with pathological CR. Although, IASLC suggests that the nCR should be considered as Stage 1, because of the significantly low survival figures, T3-4 seems to be the more appropriate classification than the IASLC proposal.

      pic-1.dpi_300.jpg

      Picture 1. A 48y male patient with 12-cm mass adjacent to the trachea (1a). Diagnosis of NSCLC was confirmed. Major response was observed after chemoradiotherapy (1b). After negative mediastinoscopy, right upper lobectomy and lower lobe superior segmentectomy was performed with a bronchoplasty. Histopathological examination revealed a tumor size of 7.5x6 cm with live tumor cells ≤5% without lymph node metastasis. The IASLC recommends (T stage = Tumor Size x Number of Live Tumor Cells (5%)) patient's stage as ypStage 1.