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Ana Karina Patané
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EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 3
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.15-12 - Predictive Value of Percentage of KI 67 Expression in Bronchopulmonary Carcinoid Tumors (Now Available) (ID 1420)
08:00 - 18:00 | Presenting Author(s): Ana Karina Patané
- Abstract
Background
Introduction The determination of Ki67 has not been shown to be useful in the diagnostic discrimination between typical (CT) and atypical (CA) carcinoid tumors. However, the biological behavior of these tumors is not homogeneous. Objective: to establish a Ki67 cut-off point for carcinoid tumors and to determine its prognostic implications in overall survival and disease-free survival in both histological subtypes.
Method
Material and methods: retrospective cohort on 106 patients with diagnosis of carcinoid tumor (OMS 2015) surgically trated. The% of cells expressing Ki 67 was determined manually by two pathologists specialized in the use of a rabbit monoclonal antibody prediluted anti Ki67 (Clone MIB-1). Ki67-positive nuclei were quantified in 2000 consecutive tumor cells in the areas of highest activity (HOT SPOT) at a magnification of 40X. The comparison of continuous variables was made according to its distribution and the categorical variables with the Chi2 test or Fisher's exact test. To evaluate the association between Ki-67 expression and the occurrence of events, logical regression analysis was performed and ROC curves were constructed to evaluate global predictive capacity as per histological subtype, identifying the best cut-off point using the Youden index. Once this point was identified, the regression analysis was repeated using Ki-67 as a dichotomous variable (equal or greater than the cut-off point versus lower). All tests are two-tailed and a value of p <0.05 was considered statistically significant. The analysis was carried out with the program R: A Language and Environment for Statistical Computing version 3.5.1 (Vienna, Austria)
Result
Results: The data of ki-67 were available in 63/106 patients (59.4%). 40 (65.6%) CT and 23 (34.4%) CA. The 60.3% (n = 38) were women, the average age was 43.7 (SD 15.4) years, 25 (28.8%) were smokers. The median of ki-67 was 0.86 (RIQ 0.50 - 3.25). The presence of lymph node metastases N2 (12.8% vs 38.1%, p = 0.045), recurrence rate (2.5% vs 19%, p = 0.044) and mortality (0 vs 28.6%, p = 0.005) were significantly higher in the group of the CA. The median of ki-67 between the CTs was 0.63 (RIQ 0.44 - 1-93) vs 2.00 (RIQ 0.65 - 4.00) in CA (p = 0.005).The Ki-67 value was not significantly associated to mortality (p = 0.546), nor to risk of relapse, analyzing the entire population (p = 0.489), nor by histological subtype (CT p = 0.677 vs CA p = 0.202). The best cut-off point of Ki-67 on the ROC curve in patients with CA was 1.18. Using this value as a predictive variable, there was no significant association between% Ki-67 and mortality (p = 0.077), but a marginal association with the frequency of relapses (p = 0.054).
Conclusion
Conclusions: Although we have not been able to demonstrate predictive association between KI 67 and mortality, this could be due to the small number of observed events. In the AC subgroup, the marginal association between relapse frequency and Ki 67 values> = to 1.18 presents clinical relevance and future analyzes are required to determine the real predictive value of this variable.
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EP1.15-28 - Survival of Thymoma Is Extensive in Latin-American Patients: Results from Over 10 Years of Experience (CLICaP-LATimus) (ID 2936)
08:00 - 18:00 | Author(s): Ana Karina Patané
- Abstract
Background
Thymomas are a group of rare neoplasm of the anterior mediastinum. Due to their low incidence, large cooperative studies are required to evaluate outcomes. The objective of this study is to present the results and experience in treatment of this pathology in Latin-America.
Method
A retrospective multicenter cohort study was conducted by The Latin-American Consortium for the Investigation of Lung Cancer (CLICaP). Patients with histologically proven thymomas between 1997 and 2018 were included in the analysis. Variables including clinical, pathological and therapeutic outcomes were registered in a centralized manner.
Result
A total of 105 patients were included. Median age at diagnosis was 54 years old (20-84), and with 60% (n = 38) of the included patients were female. Only 11% (n=7) of the patients had an ECOG performance score >1. Twenty-four patients (22.9%, 95%CI 14.8-30.9) presented with pulmonary or distant metastatic involvement with a median of 2 metastatic sites. Furthermore, 21.9 % of patients (n=23, 95%CI 13.9-29.8%) concurrently presented myasthenia gravis. Surgery was performed in 55 patients (52.3%, 95%CI 42.8 – 61.9%), comprising of 15 tumorectomies, 37 thymectomies and 5 biopsies achieving an R0 resection rate of 78% (95%CI 67.3-89.1%). Adjuvant treatment in the form of either chemotherapy, radiotherapy or both was offered to 3(5%), 7(12.7%) and 5(9%) patients, respectively. Disease progression was documented in 10 cases (9%, 95%CI3.9-15.1%) of which 6 (60%) were locoregional, 1 (10%) distant progression and 3 (30%) both locoregional and distant. Median overall survival (OS) was estimated at around 139.5 months (95%CI 86.1-NA). Cox regression indicated that OS was significantly improved by resection (139.5 vs 25.7 months, HR 4.17 [95%CI 12.6-17.8 months]).
Conclusion
Survival in patients with thymomas continues to be very favorable, especially in patients who receive adequate local control. The benefit of adjuvant treatment in this setting remains unclear.
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EP1.15-29 - Real World Characterization and Treatment of Patients with Thymic Carcinoma: Lessons from a Latin-American Study (CLICaP-LATimus) (Now Available) (ID 2921)
08:00 - 18:00 | Author(s): Ana Karina Patané
- Abstract
Background
Thymic carcinoma is a rare tumor that represents a clinical challenge, especially in resource limited settings. The objective of the present study was to characterize patients who presented this disease in Latin-America.
Method
From 2014 until 2018, a multinational Latin-American cooperative retrospective cohort study was performed. Patients with histologically confirmed thymic carcinoma were included. Clinical, pathological and treatment variables were collected across 7 participating nations.
Result
A total of 31 patients were included. Median age at diagnosis was 58 years old (34-69), 48% (n=15) of individuals were women with all but 2 patients (6.5%) achieving an ECOG performance score <2. All patients debuted with Stage IV disease; 24 patients (66%, [95%CI 62-92%]) as stage IVa and 7 as stage IVb (33%, [95%CI 7-37%]) with a median LDH level of 396.5 U/L (153-1529 U/L) and a median of 2 metastatic sites. 13 (41.9%, [95%CI 25-59%]) patients received preoperatory treatment consisting of chemotherapy (n=8, 42%) and chemoradiotherapy (n=5, 16%). Among these patients only 4 (12.9%) were subjected to surgery, two of which underwent a tumorectomy and 2 a thymectomy. 28 (90%, [95%CI 79.9-100%]) received palliative chemotherapy either with sunitinib (n=7, 25%) or cytotoxic agents. Median overall survival (OS) was reached at 20.2 months (95%CI 19-NA months). Patients who received preoperative treatment had a significantly prolonged OS (17.6 vs 26 months, HR 2.93 [95%CI 1.04-8.27 months], p = 0.03).
Conclusion
Thymic carcinoma constitutes an aggressive disease that is often diagnosed in advanced stages. These results suggest that multimodal treatment can be beneficial even in locally advanced cases. Larger clinical trial validating these conclusions are warranted.
