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Yoshinori Handa
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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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P1.13-13 - High-Risk Clinical Stage I Non-Small Cell Lung Cancer Based on High-Resolution Computed Tomography Findings (ID 743)
09:45 - 18:00 | Author(s): Yoshinori Handa
- Abstract
Background
Perioperative systemic therapy for stage I non-small cell lung cancer (NSCLC) has not been established. The purpose of this study was to identify the high-risk patients for recurrence in clinical stage I NSCLC who were potentially candidates for systemic therapy in addition to standard lobectomy.
Method
After excluding patients who underwent sublobar resection, 397 patients with clinical stage I NSCLC who underwent lobectomy with systematic lymph node dissection between April 2007 and March 2016 were analyzed. Solid component size on high-resolution computed tomography (HRCT) was used as tumor size on the basis of the 8th edition of TNM classification. Relapse-free survival (RFS) was estimated using Kaplan-Meier method, and multivariable Cox proportional hazards model was used to identify independent prognostic factors for RFS.
Result
Five-year RFS of all patients was 73.6%. Multivariable Cox analysis revealed that age (hazard ratio [HR], 1.04 (95% confidence interval [CI], 1.01– 1.06; P = 0.005), solid component size (mm) (HR, 1.06 (95% CI, 1.04–1.09; P <0.001), and pure solid type (HR, 1.79 (95% CI, 1.10–2.91; P = 0.02) were independent prognostic factors for RFS. When patients were divided into high-risk group for recurrence (solid component size of >2 cm or pure solid type) and low-risk group (solid component size of <2 cm and part solid type), there was a significant difference in RFS between high-risk group (n = 298; 5-y RFS, 65.0%) and low-risk group (n = 129; 5-y RFS, 91.0%; P <0.001). Lymphatic invasion (29.5% vs. 9.3%, P <0.001), vascular invasion (36.6% vs. 7.8%, P <0.001), pleural invasion (28.4% vs. 9.3%, P <0.001), and lymph node metastasis (17.9% vs. 1.6%, P <0.001) were more frequent in high-risk group than in low-risk group.
Conclusion
In clinical stage I NSCLC, patients with solid component size of >2 cm or pure solid type on HRCT were high-risk group for recurrence. These patients may be potential candidates for systemic therapy such as neoadjuvant immunotherapy.
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P1.17 - Treatment of Early Stage/Localized Disease (ID 188)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.17-09 - Surgical Outcomes of Complex Versus Simple Segmentectomy for Stage I Non-Small Cell Lung Cancer (ID 803)
09:45 - 18:00 | Presenting Author(s): Yoshinori Handa
- Abstract
Background
As segmentectomy becomes widely used for lung cancer treatment, “complex segmentectomy,” which makes several, intricate intersegmental planes, remains controversial because of procedural complexity and risk of increased complications and incurability. Questions remain regarding mortality, morbidity, surgical margin, lymph nodes dissection, and postoperative pulmonary function. We evaluated operative and postoperative outcomes of complex compared to simple segmentectomy.
Method
We retrospectively reviewed clinical stage I lung cancer patients who could tolerate lobectomy and underwent complex or simple segmentectomy between April 2007 and March 2017. Clinicopathologic, operative, and postoperative results of the complex (n = 117) and simple (n = 92) segmentectomy groups were compared.
Result
No significant differences were detected in age, sex, comorbidities, preoperative pulmonary function, tumor histology, and size. Although only median operative time (180 vs. 143.5 minutes; P < 0.0001) was significantly longer in the complex group, 30-day mortality (0% vs. 0%), overall complications (24.8% vs. 22.8%), and prolonged air leakage (11.9% vs. 10.9%) were nearly equivalent between the two groups, respectively. The complex group showed comparable results in median surgical margin distance (16.0 vs. 17.5 mm) and number of dissected lymph nodes (6.0 vs. 7.0 nodes). Margin relapse occurred in two patients in the simple group but none occurred in the complex group. Both groups also showed similar postoperative pulmonary functions.
Conclusion
Complex segmentectomy is a safe option in the treatment of lung cancers with adequate operative outcomes.
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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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P2.17-01 - Analysis of Clinical Features and Prognosis of Non-Small Cell Lung Cancer Exceeding 30 mm Depending on the Ground Glass Opacity (GGO) Ratio (ID 230)
10:15 - 18:15 | Author(s): Yoshinori Handa
- Abstract
Background
The ground glass opacity (GGO) ratio is associated with the prognosis of small (<30 mm) non-small cell lung cancer (NSCLC). However, the clinical features, especially the GGO ratio, and prognosis of NSCLC exceeding 30 mm are not well known. Therefore, this study aimed to determine the characteristics of patients with NSCLC exceeding 30 mm and analyze the clinical significance of the GGO ratio on prognosis.
Method
Totally, 271 patients with NSCLC tumors exceeding 30 mm on preoperative computed tomography scans and who underwent complete resection at our institution between January 2007 and December 2017 were included. The patients were divided into three groups based on the GGO ratio: pure solid tumors, GGO ratio 0–40%, and GGO ratio ≥40%. The cut-off value of 40% was determined based on the recurrence rate for each GGO ratio group. Clinical feature and prognosis of each group were analyzed.
Result
Of the included patients, 147 (54%) had pure solid nodule, 67 (25%) had nodules with a GGO ratio 0–40%, and 57 (21%) had nodules with a GGO ratio ≥40%. Among the patients with a GGO ratio ≥40%, 10 underwent limited resection (segmentectomy in 9 patients and wedge resection in 1); no patients experienced recurrence. Among the 147 patients with pure solid nodules, 47 (32%) experienced recurrence. Among the 67 and 57 patients with GGO ratio 0–40% and GGO ratio ≥40%, 16 (24%) and 2 (4%), respectively, experienced recurrence. The 3-year recurrence-free survival (RFS) rate was significantly shorter in patients with pure solid nodules (60.5%) than in patients with GGO ratio 0–40% (74.0%; p=0.010) and GGO ratio ≥40% ( 93.6%; p<0.001). Moreover, RFS was significantly shorter in patients with GGO ratio 0–40% than in patients with GGO ratio ≥40% (p=0.009). Similar results were observed for overall survival (OS). The 3-year OS rate was significantly shorter in patients with pure solid nodules (79.1%) than in patients with GGO ratio 0–40% (88.2%; p=0.046) and GGO ratio ≥40% (95.6%; p<0.001). Moreover, OS was shorter in patients with GGO ratio 0–40% than in patients with GGO ratio ≥40% with marginal significance (p=0.052).
Conclusion
A pure solid nodule was a major component among NSCLC tumors exceeding 30 mm. Among such patients, as the GGO ratio decreased, the recurrence rate increased. A GGO ratio of 40% is the appropriate cut-off value, and patients with GGO ratio ≥40% have better prognosis compared to patients with GGO ratio <40% or pure solid nodules. The prognosis of patients with GGO ratio ≥40% who undergo limited resection may be similar to that of patients undergoing lobectomy, the standard operation procedure.
