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Ayten Kayi Cangir

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    MA06 - Challenges in the Treatment of Early Stage NSCLC (ID 124)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 12
    • Now Available
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      MA06.01 - Mediastinal Lymph Node Dissection (MLND) v Systematic Sampling (SS) v Neither (NN) in Population-Based Cohort (Now Available) (ID 2974)

      13:30 - 15:00  |  Presenting Author(s): Meredith Ray  |  Author(s): Nicholas Faris, Carrie Fehnel, Cheryl Houston-Harris, Olawale Akinbobola, Philip Ojeabulu, Matthew P Smeltzer, Ray Osarogiagbon

      • Abstract
      • Presentation
      • Slides

      Background

      American College of Surgeons’ Oncology Group (ACOSOG) Z0030 revealed similar survival after MLND v SS for early-stage non-small cell lung cancer (NSCLC), but a recent meta-analysis of 1,980 patients in 5 randomized controlled trials from 1989-2007 suggested superior survival after MLND, raising doubts about Z0030 findings. We compared survival of patients with MLND v SS v NN in a population-based cohort.

      Method

      All resections for NSCLC in all institutions within 4 contiguous United States Hospital Referral Regions from 2009-2018 stratified by ACOSOG Z0030 nodal examination criteria into MLND (stations 2R,4R, 7, 8, 9 and 10R for right-side resections; 4L, 5, 6, 7, 8, 9, and 10L for left-sided), SS (minimum of 4R, 7, and 10R on the right and 5,6,7 and 10L on the left, but MLND definition not met), and NN (neither MLND nor SS ).

      Using appropriate statistical tests, we compared demographic and clinical characteristics, perioperative complication rates and survival, adjusting survival for extent of resection, histology, age, race, sex and insurance.

      Result

      2118 patients met Z0030 eligibility criteria (clinical T1/2,N0/non-hilar N1,M0): 15% had MLND, 15% SS, 69% NN. The distribution of age, race, insurance was similar, but 54% v 51% v 43% of MLND v SS v NN, were female (p=.0002). Use of preoperative PET-CT scans was similar (p=.5797), but invasive staging was used in 21% v 19% v 28% (p<.01), Although the distribution of clinical T,N and aggregate stage was similar (p>.05), 10% of the patients who met neither MLND nor SS criteria had no lymph nodes examined (pathologic NX). The median (interquartile range) number of mediastinal lymph nodes examined was 8(6-12), 5(4-8), 2 (0-5) (p<.001); hilar/intrapulmonary nodes 5(2-9), 6(3-10), 3(1-7) (p<.001). Postoperative complication rates were similar, including rates of cardiac arrhythmia, chylothorax and ICU re-admission. ICU length of stay (LOS) was 1(1-2) days in all groups, hospital LOS was 5(3-7), 5(3-8), 6(4-10) days. The 30-day mortality rate was 4% for all groups. Unadjusted hazard ratio (HR) was 0.80 (0.56-1.10, p=1.664) between MLND and SS; adjusted (a)HR 0.81 (0.58-1.138, p=0.2273). Survival of MLND and SS patients was significantly better than NN (Figure): aHR 0.62(0.48-0.81, p=0.0004) for MLND v NN; aHR 0.76 (0.60-0.98, p=0.0304) for SS v NN.

      figure acosog.png

      Conclusion

      ACOSOG systematic nodal dissection was achievable and safe in a ‘real-world,’ population-based cohort. SS was associated with similar survival to MLND in early-stage NSCLC, corroborating Z0030 findings. However, the majority of resections did not attain either criteria, with significantly worse survival.

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      MA06.02 - NSCLC Surgery Outcomes Between Facility Types and Association with Guideline Directed Surgical Quality of Care Metrics  (Now Available) (ID 2245)

      13:30 - 15:00  |  Presenting Author(s): David E. Gerber  |  Author(s): Mitchell Von Itzstein, Rong Lu, Yang Xie

      • Abstract
      • Presentation
      • Slides

      Background

      Non-small cell lung cancer (NSCLC) treatment outcomes differ between facility types. Surgical outcome differences may be related to modifiable factors and likelihood of receiving guideline centered care, which could be improved with new policy initiatives. We therefore analyzed the National Cancer Database (NCDB), to determine the variables related to different outcomes between facility types.

      Method

      The NCDB is a cancer registry curated by the Commission on Cancer that captures demographic and clinical data for an estimated 80% of NSCLC patients in the United States. A retrospective analysis of the NCDB was performed from 2004-2013 for Stage 1, 2 and 3a NSCLC patients treated with surgery. We compared overall survival between academic comprehensive cancer programs (ACAD) and community cancer programs (CCP) and four surgical quality metrics; lobectomy or greater vs sublobectomy, positive vs negative margin status, whether regional lymph node (LN) surgery was performed and number of nodes removed (less that 10 or equal to or greater than 10), in addition to 16 other demographic and clinical variables known to affect NSCLC survival. Kaplan-Meier estimates, log-rank test, multivariate Cox proportional hazard models and propensity score matching were used to evaluate survival differences while adjusting the effects of covariates. Quality of matching was checked using Wilcoxon rank sign test, chi-square test, and multivariate logistic regression models.

      Result

      The total cohort was 75,976 patients. After propensity matching for clinical and demographic variables, median overall survival (OS) for Stage 1, 2 and 3a was 76, 51 and 36 months for ACAD and 67, 43 and 32 months for CCP respectively (p<0.002 for all). Overall, selection of lobectomy or greater was the same between facility types (p=0.645), but ACAD were more likely to have negative margins (92.3% vs 89.8%, p<0.00001), perform LN dissection (89.5% vs 84.3%%, p<0.00001) and remove greater than 10 LN (37.4% vs 23.1%%, p<0.00001). After contrast matching for the surgical quality metrics, OS for Stage 1, 2 and 3a was 73, 49 and 34 months for ACAD and 67, 43 and 32 months at CCP respectively, with a non-significant P value for Stage 3a sub-cohort. Analysis revealed that the four key surgical quality measures explained 38% of the OS difference in median survival (p<0.00001).

      Conclusion

      In this large cohort of Stage 1, 2 and 3a NSCLC patients treated surgically, OS was higher at ACAD compared to CCP, which was in part explained by differences in surgical quality metrics. In the era of discussions of nationalized healthcare, policymakers will need to consider the differential treatment outcomes at different centers and consider consolidating treatment for NSCLC at high performing centers or improving the quality care measures of low performing centers.

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      MA06.03 - Poor Pulmonary Function Does Not Define “Medical Inoperability”:  Short and Long Term Results of a Matched Lung Cancer Cohort (Now Available) (ID 2846)

      13:30 - 15:00  |  Presenting Author(s): Brendon M Stiles  |  Author(s): Adam N Sholi, Mohamed K Kamel, Abu Nasar, Ajita Naik, Sebron Harrison, Benjamin Lee, Jeffrey L Port, Nasser K Altorki

      • Abstract
      • Presentation
      • Slides

      Background

      Patients with suboptimal pulmonary function tests (PFTs) are often denied surgery for NSCLC. However, there is no consensus definition of compromised lung function. This study compared morbidity and survival following surgery in patients with preoperative %predicted FEV1or DLCO <50% (Low-Group) versus those with both values >50%(High-Group).

      Method

      A prospectively-maintained database was reviewed for patients undergoing surgery for NSCLC between 1990–2019. Propensity matching (1:2) was performed based on age, gender, histology, pathologic stage, and comorbidity index. Overall survival (OS) was estimated using Kaplan-Meier analysis and multivariable analysis identified predictors of survival.

      Result

      Among 2982 patients with PFT data, 372(12.5%) had FEV1or DLCO <50%. We matched 321 patients with FEV1or DLCO <50% to 637 patients with both PFTs >50%. No significant differences were observed in perioperative complications(Table) or 30-day mortality between Low and High groups (0.3% vs. 0.6%, p=0.668). The Low group more frequently underwent sublobar resection (41% vs. 22%, p<0.001). Median follow-up was 41 months, and median, 3-, and 5-year OS for the Low and High groups was 118 vs.148 months, 79% vs. 82%, and 70% vs. 74%, respectively (p=0.003). Patients with both FEV1and DLCO <50% (n=44) had a median survival of 109 months and 3- and 5-year OS of 77% and 71%. Multivariable analysis identified advanced age (HR=1.03, CI 1.01–1.05), higher clinical stage (HR=1.85, CI 1.22–2.82), and earlier year of surgery (HR=1.06, CI 1.01–1.12) as predictors of poor survival, but not FEV1or DLCO <50% (p=0.672). Among the Low group only, advanced age (HR=1.05, CI 1.02–1.07) and sublobar resection (HR=1.60, CI 1.04–2.45) predicted worse OS.

      pfttable.png

      Conclusion

      Patients with decreased lung function have comparable perioperative outcomes to patients with normal lung function and experience excellent long-term survival. “Medical inoperability” should therefore be determined by surgeons and not by pulmonary function alone.

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      MA06.04 - Discussant - MA06.01, MA06.02, MA06.03 (Now Available) (ID 3736)

      13:30 - 15:00  |  Presenting Author(s): Daniel J Boffa

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MA06.05 - Predictive Performance of Quantitative Metabolic Metrics of FDG-PET/CT on Survival and the Effect of Adjuvant Chemotherapy in Lung Cancer (Now Available) (ID 1294)

      13:30 - 15:00  |  Presenting Author(s): Yojiro Makino  |  Author(s): Yoshihisa Shimada, Sachio Maehara, Hagiwara Masaru, Masatoshi Kakihana, Naohiro Kajiwara, Tatsuo Ohira, Norihiko Ikeda

      • Abstract
      • Presentation
      • Slides

      Background

      Growing evidence suggests metabolic metrics of tumors, maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on FDG-PET/CT, reflect the malignancy of early-staged lung cancer. We aimed to investigate the role of metabolic metrics in predicting prognosis and response to adjuvant chemotherapy in pathological stage I (the 7th Edition of TNM Staging of Lung Cancer) lung adenocarcinoma (p-I Ad).

      Method

      The study included 452 patients with p-I Ad who underwent FDG-PET/CT followed by complete resection between July 2012 and December 2017. In this study, MTV is defined as the total tumor volume with an SUV > 2.5 while TLG is calculated as mean of SUV x MTV. The three metabolic metrics measured by a three-dimensional workstation and clinico-pathological factors were analyzed to identify the factors associated with unfavorable overall survival (OS) and recurrence-free survival (RFS). We assessed whether the metabolic metrics were associated with response to oral adjuvant chemotherapy with uracil-tegafur (AC with UFT) in patients with p-I Ad amenable to the treatment.

      Result

      All the three metabolic metrics were significantly correlated with unfavorable OS and RFS on univariate analyses (SUVmax; p=0.047 / p<0.001, MTV2.5; p=0.003 / p<0.001, TLG2.5; p=0.005 / p<0.001). On multivariate analyses, smoking status (p=0.043), the value of serum CEA (p < 0.001), and SUVmax (p=0.001) were independent determinants for poorer RFS while gender (p=0.013) and MTV2.5 (p=0.028) were independent significant factors for unfavorable OS. The receiver operating characteristic areas under the curves for SUVmax, MTV2.5, and TLG2.5 relevant to recurrence were 0.901, 0.849, and 0.872, respectively. Among 239 patients who fitted the criteria of AC with UFT (p-IA > 2cm or p-IB), 80 patients (33.4%) received the treatment (250 mg of tegafur per square meter of body-surface area per day). Although the administration of AC with UFT did not significantly affect RFS and OS (p=0.411 and 0.753), patients with TLG2.5 > 12.8, which value corresponded to the cut-off level, who were not given AC with UFT exhibited worse RFS than those who received the treatment (5-year RFS rate of 72.1% vs. 92.7%; p=0.041).figure.png

      Conclusion

      Metabolic metrics on FDG-PET/CT such as SUVmax, MTV, and TLG enable us to estimate survival outcomes and the effectiveness of AC with UFT in patients with p-I Ad. Patients with metabolically active tumors should be considered high risk, and this information can be useful for the selection of appropriate therapeutic strategy including AC with UFT.

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      MA06.06 - A Phase III Study of Adjuvant Chemotherapy in Patients with Completely Resected, Node-Negative Non-Small Cell Lung Cancer  (Now Available) (ID 285)

      13:30 - 15:00  |  Presenting Author(s): Hideo Kunitoh  |  Author(s): Hiroyuki Sakurai, Masahiro Tsuboi, Masashi Wakabayashi, Morihito Okada, Kenji Suzuki, Norihiko Ikeda, Makoto Takahama, Mitsuhiro Takenoyama, Yasuhisa Ohde, Katsuo Yoshiya, Isao Matsumoto, Motohiro Yamashita, Takashi Marutsuka, Hiroshi Date, Toru Hasumi, Yoshinori Yamashita, Norihito Okumura, Shun-ichi Watanabe, Hisao Asamura

      • Abstract
      • Presentation
      • Slides

      Background

      Post-operative UFT (tegafur/uracil) has been shown to prolong survival of Japanese patients with completely resected, p-stage I (T1> 2 cm) non-small cell lung cancer (NSCLC). This trial, the Japan Clinical Oncology Group (JCOG) 0707, aimed at estimating the efficacy of S-1 (tegafur/gimeracil/oteracil) compared to UFT as adjuvant therapy in this population.

      Method

      Eligible patients had received complete resection with lymph node dissection for p-stage I (T1-2N0M0, T1> 2 cm, by 5thEdition UICC TNM) NSCLC, within 56 days of enrollment. Patients were randomized to receive: oral UFT 250mg/m2/day for 2 years (Arm A), or oral S-1 80mg/m2/day for 2 weeks and 1 week rest, for 1 year (Arm B). The initial primary endpoint was overall survival (OS). Based upon the monitoring in Jun. 2013, which showed the combined OS of the 2 arms better than expected (4-year OS of 91.6% vs. presumed 5-year OS of 70-76.5%), it was judged to be underpowered. The study protocol was amended so that the primary endpoint is relapse-free survival (RFS). With the calculated sample size of 960, this study would detect the superiority of Arm B over Arm A with power 80% and one-sided type I error of 0.05, assuming the 5-year RFS of 75% in Arm A and the hazard ratio of 0.75.

      Result

      From Nov. 2008 to Dec. 2013, 963 patients were enrolled (Arm A : 482, Arm B : 481): median age 66 (range: 33 to 80), male 58%, adenocarcinoma 80%, p-T1/T2 46%/54%. Only 2 received pneumonectomy. >Grade 3 toxicities (hematologic/nonhematologic) were observed in 15.9 (1.5/14.7) % in Arm A, and in 14.9 (3.6/12.1) % in Arm B, respectively. 60.0% of the patients in Arm A and 54.7% of them in Arm B completed the protocol treatment (p=0.10). There were 4 cases of deaths during protocol treatment, probably of cardio-vascular origin, with 1 in Arm A and 3 in Arm B. At the data cut-off of Dec. 2018, the hazard ratio (HR, Arm B vs. Arm A) of RFS was 1.06 (95% confidence interval (C.I.): 0.82-1.36), showing no superiority of S-1 over UFT. The HR of OS was 1.10 (95% C.I.: 0.81-1.50). The 5-year RFS/OS rates were 79.4%/88.8% in Arm A and 79.5%/89.7% in Arm B, respectively. Pre-specified subset analyses for gender, age, smoking, stage, tumor side, lymph node dissection area, pleural invasion and histology revealed no remarkable results; S-1 arm was not superior to UFT arm in each analysis. Of the 77 and 85 OS events for Arm A/Arm B, 45 each (58%/53%, respectively) were due to the NSCLC. During the follow-up period, secondary malignancy was observed in 85 (17.8%) and 84 (17.8%) in Arm A and Arm B, respectively.

      Conclusion

      Post-operative adjuvant therapy with oral S-1 was not superior to that with UFT in stage I (T>2 cm) NSCLC after complete resection. UFT remains standard in this population. Future investigation should incorporate identification of high-risk population for recurrence, since survival of each arm was so good with substantial number of OS events due to other causes of deaths in this trial.

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      MA06.07 - E1505: Adjuvant Chemotherapy +/- Bevacizumab for Early Stage NSCLC: Updated Chemotherapy Subset Analysis (Now Available) (ID 2885)

      13:30 - 15:00  |  Presenting Author(s): Heather A Wakelee  |  Author(s): Suzanne E Dahlberg, Steven M Keller, William J Tester, Seena C Aisner, Jan M. Rothman, Jyoti D Patel, Robert Delaune, Sean R McDermott, Atif Shafqat, Roman Perez-Soler, Andrew E Chapman, Samer S Kasbari, Anne M Traynor, Tracey L Evans, Leora Horn, Stephen L Graziano, David R Gandara, Alex A Adjei, Charles A Butts, Natasha B Leighl, Suresh S Ramalingam, Joan H Schiller

      • Abstract
      • Presentation
      • Slides

      Background

      Adjuvant chemotherapy (chemo) for resected early stage NSCLC provides modest survival benefit with limited comparison data between regimens. From this trial we previously reported that adding bevacizumab (B) to adjuvant chemo failed to improve either disease free survival (DFS) or overall survival (OS). Here we update outcomes by chemotherapy regimen with an additional 30 months of follow-up.

      Method

      Enrolled patients with resected early stage NSCLC, stratified by stage, histology, sex, and chemo option, were randomized 1:1 to chemo alone or with B (15 mg/kg every 3 weeks for up to 1 year). Chemo consisted of a planned 4 cycles of every 3 week cisplatin with either vinorelbine (V), docetaxel (D), gemcitabine (G) or pemetrexed (P).

      Result

      From July 2007 to September 2013, 1501 patients were enrolled with this distribution of chemo: V 25.0%, D 22.9%, G 18.9% and P 33.2%. P was added in 2009 and restricted to non-squamous (NSq) pts. Chemo regimen was chosen (not randomized). Arms were well balanced for known prognostic factors; 28% had Sq histology. Median f/up per chemo group is: V 83.5 months(m); D 89.9m; G 87.8m; P 71.9m. In pooled analysis DFS differed by histology ranging from 29.9m(G)-43.5m(V) for NSq and 59.4m(V)-77.3m(G) for Sq. OS also differed by histology ranging from 80m(D)-98.8m(P) for NSq and 98m(G)-119m(V) for Sq. A non-significant decline in both DFS and OS was seen when B was added to D or V regimens, regardless of histology. Conversely, the addition of B to P improved both DFS (HR 0.74, p= .00994) and OS (HR 0.65, p= .00368). We thus compared outcomes across non-B regimens and though numerical differences were seen in median DFS and OS, these failed to reach statistical significance. Toxicity details were presented previously.

      Conclusion

      B did not improve OS when added to adjuvant chemo for patients with surgically resected early stage NSCLC, though variable DFS and OS outcomes by chemotherapy regimen have emerged with longer-term follow-up. These include a significant positive improvement in DFS and OS with B combined with P and trends of worse outcomes when B was added to other regimens. Ongoing molecular analysis of samples will hopefully elucidate the etiology of these differences.

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      MA06.08 - Discussant - MA06.05, MA06.06, MA06.07 (Now Available) (ID 3737)

      13:30 - 15:00  |  Presenting Author(s): Jordi Remon

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MA06.09 - Timing of Driver Mutation Development and the Genetic Evolution of Semi-Solid Lung Nodules into Early NSCLC (Now Available) (ID 2980)

      13:30 - 15:00  |  Presenting Author(s): Gavitt A Woodard  |  Author(s): Vivianne Ding, Il-Jin Kim, Kirk Jones, Gordon Chavez, Greg Haro, Johannes Kratz, Michael J. Mann, Julia Rotow, Collin M Blakely, David M Jablons

      • Abstract
      • Presentation
      • Slides

      Background

      The genetic changes that drive the appearance of a ground glass opacity and subsequent development of an invasive solid component within a semi-solid lesion (SSL) are not well understood. Biomarkers that predict the transition to invasive cancer are needed to determine when ground glass lesions will evolve into invasive cancer.

      Method

      From a prospective database 65 patients with surgically resected SSL between 2011-2018 were identified. Clinical characteristics and disease free survival was compared between SSL and 155 stage I adenocarcinomas resected during the same time period. Paraffin tissue blocks were obtained from 22 of the SSL and areas of normal lung (NL) ground glass (GG) and solid (S) tumor were identified and microdissected separately from within the same lesion. Next generation sequencing (NGS) was performed on DNA extracted from 19 nineteen matched GG and S samples on twenty-five common lung cancer driver mutations. Affymetrix microarray of over 48,000 transcripts was performed on S, GG, and NL samples from eight patients with SSL.

      Result

      No patients with a resected SSL has recurred to date with significant differences in 5-year disease free survival verses stage I adenocarcinomas from the same time period (100% vs 80.9%, log-rank p-value 0.007). Driver mutations in the solid component of SSL were EGFR mutation (43%; L858R 26% and exon 19 deletion 11%), KRAS mutation (21%), and no mutation identified (42%). All driver mutations present in S component of SSL were also identified in GG regions of the same lesion with very similar gene expression profiles. Only 32 transcripts were significantly different between GG and S areas of the same tumor. The greatest difference observed between GG and S portions of the same tumor was significantly higher expression of secreted phosphoprotein 1 (SPP1) in the invasive solid portion suggesting that SPP1 may serve as a biomarker of invasive potential.

      Conclusion

      This is the first study to examine the systems genetics of mutations and gene expression from the microenvironments of solid and ground glass areas within the same tumor. Mutations are present in the ground glass portion of a semi-solid tumor suggesting early development of driver mutations. Increased expression of SPP1 emerged as the most promising biomarker of invasive potential of a semi-solid lesion. In other studies SPP1 has been shown to correlate with poor prognosis and is a biomarker that warrants further study.

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      MA06.10 - Stereotactic Ablative Radiotherapy in the Management of Synchronous Early Stage Non-Small Cell Lung Cancers (Now Available) (ID 1924)

      13:30 - 15:00  |  Presenting Author(s): Zeina Ayoub  |  Author(s): Eric D Brooks, James W Welsh, Aileen Chen, Saumil Gandhi, John Victor Heymach, Ara A Vaporciyan, Joe Y Chang

      • Abstract
      • Presentation
      • Slides

      Background

      The aim of the study is to evaluate the efficacy and patterns of failure of early stage synchronous non-small cell lung cancer (NSCLC) treated with stereotactic ablative radiotherapy (SABR).

      Method

      Patients with synchronous NSCLC who received SABR (50 grays in 4 fractions or 70 grays in 10 fractions) to at least one lesion were reviewed. Synchronous lesions were defined as multiple ipsilateral or contralateral intrapulmonary lesions diagnosed within 6 months.

      Result

      Out of a total of 912 patients treated with SABR for early stage NSCLC between 2005 and 2015, 82 (9%) had synchronous disease. The median age was 70 years and 34 (41.5 %) patients were males. The median diameter was 2.1 cm (Interquartile range (IQR) 1.6-3 cm) for index lesions and 1.5 cm (IQR 1.1-2.2 cm) for second lesions. At a median follow-up time of 58 months, the 1, 3 and 5-year progression-free survival (PFS) rates were 85.4%, 47.3% and 28.5%, respectively; the corresponding overall survival rates were 95.1%, 66.9% and 52.4% and the 1, 3 and 5-year local recurrence (LR)-free survival rates were 97.3%, 79.6% and 70.8%, respectively. Among the 39 (47.6%) patients with disease progression, intralobal LR was the first site of failure in 15 (18.3%) patients, with a total of 19 local recurrences out of 169 (11.2%) thoracic lesions. Isolated regional recurrence occurred in 3 (3.7%) patients, and distant failure in 221 (25.6%) patients. On multivariate analysis, factors associated with improved PFS were an improved ECOG PS score (HR 10.786; 95% CI 2.845-40.902; p-value <0.001), DLCO (HR 0.947; 95% CI 0.903-0.994; p-value 0.026) and an index lesion pathology of adenocarcinoma (HR 0.167; 95% CI 0.033-0.841; p-value 0.030). Only the ECOG PS score maintained significance (HR 6.165; 95% CI 2.081-18.263; p-value 0.001) on multivariate analysis for OS. No association was found between the use of chemotherapy as part of the initial management strategy and survival outcomes. Similarly, no difference in outcomes was observed whether all lesions were treated with SABR compared to SABR and other modalities.

      Conclusion

      SABR achieves promising long-term survival and tumor control rates and may be a potential curative treatment for synchronous early stage NSCLC. Our data indicates that patients presenting with synchronous NSCLC lesions can be approached as having two separate primary lung tumors, and be offered definitive local therapy with aims of cure.

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      MA06.12 - Discussant - MA06.09, MA06.10, MA06.11 (Now Available) (ID 3738)

      13:30 - 15:00  |  Presenting Author(s): Samina Park

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      MA06.13 - Tsuguo Naruke Lectureship Award for Surgery (Now Available) (ID 3901)

      13:30 - 15:00  |  Presenting Author(s): Raja Flores

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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Author of

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    P1.15 - Thymoma/Other Thoracic Malignancies (ID 184)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.15-12 - A Different Aspect to Tumor Size Dilemma in Thymoma's TNM Staging Classification (Now Available) (ID 1827)

      09:45 - 18:00  |  Author(s): Ayten Kayi Cangir

      • Abstract
      • Slides

      Background

      Thymic epithelial tumors including thymomas are relatively rare thoracic neoplasms; though thymomas are the most common tumors of anterior mediastinum in adults. Among the TNM classifications of many solid tumors, tumor size is included in definition of T descriptor and as a key for staging it plays an important role in predicting prognosis and affects clinical decision making. However, TNM or the other classifications of thymomas do not take tumor size into consideration.

      Method

      Between 2004 and 2018, 204 consecutive patients with thymic epithelial tumors underwent surgical resection in Department of Thoracic Surgery, Ankara University Medical School. One hundred and forty-three patients with thymoma were included in the study. When survival analysis was performed, sixteen cases were excluded due to missing datas of either survival and/or tumor diameter. Remaining 127 patients were classified into two groups: a. largest tumor diameter (LTD), b. mean tumor diameter (largest diameter+shortest diameter/2) (MTD). Then each were divided into three subgroups ( LTDa/ MTDa ≤5cm; LTDb/ MTDb 5.1-10 cm; LTDc/ MTDc >10 cm). LTDa, LTDb and LTDc subgroups contained 47 (37%), 60 (47.3%) and 20 (15.7%) patients; while MTDa, MTDb and MTDc subgroups had 66 (52%), 56 (44.1%) and 5 (3.9%) patients respectively.

      Result

      There were 78 males and 65 females, with a mean age of 49.6 years (10-78). Results of the survival analysis according LTD and MTD subgroups are shown in Table 1. In survival analysis, there were significant differences in the presence of MG, resection status (R0 vs R1), T status and the Masaoka-Koga staging (p=0.018, p=0.001, p=0.015, p = 0.003), respectively. In survival analysis for MTD subgroups, survival decreased as the tumour size increased. In LTD group, the only difference which was close to statistical significance was in R0 group for 10 years OS (p=0.051).

      Table 1: 10-year survival according to tumor diameter groups

      Largest Tumor Diameter (LTD)

      Mean Tumor Diameter* (MTD)

      ≤5cm

      5.1-10cm

      p value

      ≤5cm

      5.1-10cm

      p value

      10 years overall survival (%)

      (LTD:107(48/59) patients, MTD:122 (66/56))

      87.6

      80

      0.246

      91.2

      74.8

      0.088

      10 years disease-free survival (%)

      (LTD:94 (40/54) patients, MTD:107 (56/51))

      75.5

      56.5

      0.113

      82.6

      41.9

      0.052

      10 years overall survival in R0 resection (%)

      (LTD:91(37/54) patients, MTD:104 (53/51))

      95.2

      81.1

      0.051

      96.8

      75.9

      0.027

      10 years disease-free survival in R0 resection (%)

      (LTD:82 (34/48) patients, MTD:93 (48/45))

      75.2

      57.7

      0.159

      82.4

      43.1

      0.095

      Conclusion

      In this study, complete resection was the most powerful prognostic factor for thymoma as reported by Ruffini et al. Though complet resection is associated with better survival, tumor size is an essential factor on decision of complete resection. Therefore, the largest or mean tumor size should be a criterion in the thymoma TNM staging system.

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    P2.15 - Thymoma/Other Thoracic Malignancies (ID 185)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.15-07 - Bimanual Examination Is Indispensable in the Surgery of Lung Metastatic Tumors! (Now Available) (ID 1828)

      10:15 - 18:15  |  Author(s): Ayten Kayi Cangir

      • Abstract
      • Slides

      Background

      Thoracic computed tomography (Th CT) is used to evaluate the surgical outcome of lung metastatic tumors. However, Th CT is often inadequate on the detection of millimetric lesions and it alone is a problematic for guiding complete resection. It is recommended for complete resection that the intraoperative bimanual palpation of the lung to be used with care and meticulously. In addition, there are studies for minimally invasive surgical methods may be an alternative to thoracotomy where bimanual evaluation is not possible. In this study, we aimed to evaluate the number of radiological and pathological metastases in patients who underwent metastasectomy with muscle conservative thoracotomy (MCT).

      Method

      Between 2008 and 2018, 204 patients with metastatic lung tumors who underwent metastasectomy were included in the Department of Thoracic Surgery, Ankara University Faculty of Medicine. Preoperative Th CT imaging of all patients was evaluated in a multidisciplinary council. The relationship between the numbers of metastases detected by pathological examination of patients and the number of pulmonary nodules reported as 'metastasis' in preoperative Th CT was retrospectively analyzed.

      Result

      55% (n: 111) of the patients were F, 45% (n: 93) were M, mean age was 46.4 (13-77). %25 (n:52) of two hundred and four patients had bilateral, 3% (n: 8) of the patients had 3 and 1% (n: 4) of the patients had 4 metastasectomy with MCT due to contralateral lung metastasis or re-metastasectomy. The number of pulmonary nodules detected in Th CT was 740 (mean: 2,6), although the number of pulmonary nodules resected was 1503 (mean: 5,29). In histopathological evaluation of these nodules, 1120 (mean: 3,94) were reported as metastases. 2,03 fold of the nodules detected in Th CT were detected by bimanual intraoperative examination and 1.5 fold of nodules detected in Th CT were pathologically assessed as metastasis. Primary tumor numbers and histologies of 1120 metastatic nodules respectively; 42% (n: 475) were epithelial tumors and 58% (n: 645) were mesenchymal tumors.

      Conclusion

      In this study, 740 pulmonary nodules were reported in Th CT of 204 patients. However, 763 additional pulmonary nodules were detected by bimanual palpation. 49.8% (380/763) of 763 additional pulmonary nodules were metastatic. Although minimally invasive surgery is a successful method for the surgery of many thoracic malignancies, bimanuel palpation of the lung with open surgery is still an effective method for the complete resection of pulmonary metastases. Bimanual examination is indispensable especially in the pulmonary metastasectomy of sarcomas.

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