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Takuya Nagashima



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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
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      P1.13-14 - Prognosis and Clinicopathologic Characteristics of Skip N2 Metastasis in Completely Resected Non-Small Cell Lung Cancer (ID 1226)

      09:45 - 18:00  |  Author(s): Takuya Nagashima

      • Abstract

      Background

      In our daily practice of non-small cell lung cancer (NSCLC) surgery, we sometimes encounter cases of pathological stage was up because of unexpected lymph node metastasis. If single-station N2 metastasis without N1 (skip-N2) of the tumor ≤ 5cm was noted postoperatively, it becomes stage IIIA like other N2 disease, and is to be poor prognosis in the current TNM staging system. The aim of this study is to analyze the impact for prognosis and clinicopathologic characteristics of skip-N2 disease.

      Method

      We identified 415 patients with <T3 N1-2 NSCLC who underwent anatomical lung resection completely between January 2000 and December 2018. The degree of lymph node metastasis was classified into three; N1, skip-N2 and the other N2 (N2). The prognosis and clinicopathologic characteristics of patients were analyzed comparing skip-N2 with N1 and N2.

      Result

      The median follow-up time was 45.7 months. Cases with N1 was 215 (51.8%), skip-N2 was 48 (11.6%) and N2 was 152 (36.6%). Among 48 cases of skip-N2, only 8 cases (16.7%) was diagnosed as N2 preoperatively. 5-year overall survival rate (5y-OS) for N1, Skip-N2 and N2 were 70.9%, 65.7% and 45.3% respectively. 5-year recurrence free survival rate (5y-RFS) for N1, Skip-N2 and N2 were 69.8%, 60.4% and 36.0% respectively. Prognosis of Skip-N2 had similar N1 (5y-OS; p=0.476, 5y-RFS; p=0.534) and had a tendency of better prognosis than N2 (5y-OS; p=0.08, 5y-RFS; p=0.01). As for clinicopathologic characteristics (patients characteristics, tumor marker, tumor size, tumor location, clinical stage and pathological characteristics), there were no significant differences between Skip-N2 disease and the other N1-2 disease. In skip-N2, 98% of cases were found within the extent of lobe specific lymph-node dissection.

      Conclusion

      From clinicopathologic factors which can be obtained preoperatively, it is difficult to predict skip-N2. But the possibility of skip N2 among clinical N0 is not high, almost of skip N2 were detectable during surgery; lobe specific lymph node dissection is appropriate for clinical N0. The prognosis of skip N2 showed similar outcome of N1 rather than N2, but the prognosis is not enough; adjuvant chemotherapy is necessary for this population.

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    P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.18-17 - Outcome of Surgical Treatment for Clinical N1 Non-Small Cell Lung Cancer (ID 1224)

      10:15 - 18:15  |  Author(s): Takuya Nagashima

      • Abstract

      Background

      Main stem treatment for clinical N1 NSCLC is surgery, but it is sometimes difficult to perform because tumor or metastatic lymph-node invade hilar structures. Nowadays, treatment outcome has been improved. This study aims to reconsider the surgical outcome of N1 NSCLC.

      Method

      The data of 337 cases who underwent at least lobectomy and lymph node dissection for NSCLC from 2000 to 2014 was retrospectively reviewed. The factors which may have impact for survival and treatment related death (TRD) were examined.

      Result

      Median follow up period was 51.7 months. 337 cases were 15.3% of all lobectomy and pneumonectomy performed in this period. 248 males and 89 females, average age was 67.1. Lobectomy was 309 including 15 bronchoplasty and pneumonectomy was 28. Mean operative time was 212 minutes, blood loss was 110g. TRD was noted in 6 (1.8%); 3 interstitial pneumonia, 2 myocardial infarction and a stroke, 4 cases (1.2%) died within 30 day after surgery.During this time, TRD of clinical N0 was 8 case (0.46%) and N2 was a case (0.82%). TRD of N1 was significantly frequent (p=0.026). Pathologically, N0 was 152 cases (45.1%), N1 was 116 (34.4%) and N2 (20.5%); pathological accuracy of N1 was only one third. 5 year survival rate of clinical N1 was 59.3%, 83.6% in N0 and 54.1% of N2. In histology, adenocarcinoma was 184, 113 squamous, 8 large, 7 adenosquamous and 25 other. Induction therapy, blood loss and pathological N status had negative impact for survival. On the other hand, operative time and right side had negative impact for TRD.

      Conclusion

      The outcome of clinical N1 has been improved compared with historical report, but the accuracy of clinical N1 is not satisfied one. TRD rate in N1 was relatively high, surgery for N1 NSCLC should be performed by certified thoracic surgeons.