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Kazuya Takamochi
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EP1.08 - Oligometastatic NSCLC (ID 198)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Oligometastatic NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.08-02 - Surgical Indication for Postoperative Regional Lymph Node Oligo-Recurrence in Non-Small Cell Lung Cancer (ID 220)
08:00 - 18:00 | Author(s): Kazuya Takamochi
- Abstract
Background
Currently, evidence-based guidelines for therapy to treat regional lymph node (LN) oligo-recurrence in post-resection non-small cell lung cancer (NSCLC) are limited. We investigated the clinical outcome of surgery for LN oligo-recurrence in post-resection NSCLC.
Method
From 2008 to 2017, 14 patients received R0 resection for regional LN oligo-recurrence after initial NSCLC R0 surgery. Eligible patients met these criteria: A, no recurrences without regional LN by PET-CT and brain-MRI; B, LN recurrence within 3 regions. We investigated the characteristics of surgically curable NSCLC patients with postoperative regional LN oligo-recurrence, including recurrence-free survival (RFS) and overall survival (OS).
Result
Ten patients were male and 4 were women. The median age was 69 years (62-86). Pathological findings in initial surgery was as follow; adenocarcinoma in 9, squamous cell carcinoma in 5, pathological stage I in 6, II in 4, and IIIA. The regional number of LN recurrence was as follow; 1 region in 11, 2 regions in 1, and 3 regions in 2. The median number of pathological metastatic LN were 2 (1-8). The median size of LN oligo-recurrence was 19 mm (14-38). All the oligo-recurrence LN had uptake in PET-CT. All the recurrent LN site was out of the dissection range at initial surgery. The median period from the initial surgery to oligo-recurrence was 18.1 months (7.0-66.5). The median operation time was 134 minutes (52-452), and median bleeding volume was 15 ml (2-2593). SVC reconstruction was performed in 1. Postoperative complication was detected in 3 cases; arrhythmia in 2 and graft occlusion in 1. There were no cases of perioperative death. EGFR mutation was detected in 4 cases. After LN dissection, 9 patients were followed up without treatment, and the other 5 patients underwent chemotherapy. Six patients (42.8%) out of 14 were recurrence-free after LD dissection. Compared recurrence-free patients with recurrence patients after LN dissection, pathological only one LN of oligo-recurrence (p < 0.01) and EGFR wild type (p = 0.04) were significant in the recurrence-free group. LN oligo-recurrence in only one region also tended to be more frequent in the recurrence-free group (p = 0.09). Pathological N or stage in initial surgery, size of LN oligo-recurrence, recurrence-free interval after initial surgery were no significant difference between recurrence-free and recurrent group. The median RFS and OS after LN resection in all 14 patients was 24.2 and 66.3 months. The 2-year and 5-year RFS rates after LN resection were 52.7% and 35.2%. Eight patients were recurrence after LN dissection; 4 were locoregional and the others were distant. Of the 8 relapsed patients, only 2 patients survive with EGFR-TKI.
Conclusion
Surgery for postoperative regional LN oligo-recurrence in NSCLC should be indicated for the patients with only one LN of oligo-recurrence in only one region or EGFR wild type.
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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: 2
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.17-04 - Multicenter Observational Study of Node-Negative Non-Small Cell Lung Cancer Patients Who Are Excluded from a Clinical Trial (ID 678)
09:45 - 18:00 | Author(s): Kazuya Takamochi
- Abstract
Background
The Japan Clinical Oncology Group (JCOG) conducted a randomized phase III trial (JCOG0707), which compared the survival benefit of tegafur/uracil (UFT) and tegafur/gimeracil/oteracil (S-1) for completely resected pathological stage I (T1>2 cm and T2 in the 6th TNM classification) non-small cell lung cancer (NSCLC). A total of 963 patients were enrolled. Recently, there is a growing concern that those who participated in clinical trials are highly selected and do not represent the “real-world” population. Hereby, we conducted a multicenter observational study of patients excluded from JCOG0707 trial during the study period.
Method
Patients with completely resected pathological stage I NSCLC, eligible for, but excluded from the JCOG0707 trial during the enrollment period (Nov. 2008– Dec. 2013) were eligible for this study. Physicians from institutions that participated in the JCOG0707 retrospectively assessed the medical records of each patient. The final survival data were collected as of Dec. 2018.
Result
Of the 48 institutions participating in JCOG0707, 34 participated in this observational study. They had enrolled 917 (“JCOG” cohort) to JCOG0707. To this study, 5004 patients (“All” cohort), or 85% of those initially considered for JCOG0707 at the 34 institutions, were enrolled. Among them, 2388 (47.7%) were ineligible for the trial and 2616 (52.3%) had not been enrolled to JCOG0707 despite being eligible (“Eligible” cohort). Of the 5004 patients, 1659 (33.2%) received adjuvant chemotherapy, mainly UFT (1550 of 1659, or 93.4% of those received any adjuvant chemotherapy).
The 5-year survival rates (5yOS) for All and Eligible cohorts were 83.9% and 89.1%, respectively, versus 89.2% in the JCOG cohort. The 5yOS with UFT adjuvant were 89.4% in Eligible and 88.9% in JCOG cohorts, respectively.
UFT administration was a significant prognostic factor in All (adjusted HR=0.66, p<0.0001), but not in Eligible cohort (adjusted HR=0.88, p=0.28). The patients were classified into 3 subgroups, those with tumors without GGA (ground-glass area, non-invasive component; GGA-), with GGA (GGA+) and tumor size < 3 cm, and GGA+ with tumor size > 3cm. 5yOS of 744 patients in the Eligible cohort with GGA+ and tumor size < 3cm were excellent, 96.9%/96.4% with/without UFT. For 416 patients with GGA+ tumor sized > 3cm in Eligible cohort, invasive tumor size in the pathological specimen was prognostic but not predictive for UFT effect. When the invasive tumor size was >3 cm, 5yOS with/without UFT were 90.0/87.8%, whereas when it was <3 cm, 5yOS with/without UFT were 96.2/96.2%. UFT tended to be associated with better prognosis in 1389 patients with GGA- tumor when the tumor size was >3 cm, (5yOS 83.8% vs 77.4%, adjusted HR=0.82, p=0.27), but not when it was <3 cm (5yOS 88.1% vs 88.1%, adjusted HR=0.97, p=0.87).
Conclusion
Our “real-world” data reproduced the survival outcome of JCOG0707, especially in Eligible cohort. Invasive tumor size was a prognostic factor in GGA+ tumors, suggesting validity of the 8th IASLC TNM classification. GGA+ tumor with invasive tumor size of <3 cm would not require any adjuvant therapy. UFT effect appears to be limited to large GGA- tumor.
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P1.17-10 - Prediction of Visceral Pleural Invasion in c-N0 Non-Small Cell Lung Cancer (ID 937)
09:45 - 18:00 | Author(s): Kazuya Takamochi
- Abstract
Background
Visceral pleural invasion (VPI) is a tumor invasion pattern and a poor prognostic factor. However, accurate preoperative diagnosis of VPI remains difficult. This study aimed to clarify the clinical and radiological predictors of VPI in patients with c-N0 non-small cell lung cancer (NSCLC).
Method
A retrospective review was conducted in 808 patients with c-N0 NSCLC who underwent complete resection between 2009 and 2014. VPI included pathological pl1 and pl2. Patients with pl3 were excluded. Radiological findings were evaluated based on thin-section CT and PET. The patients were divided into 4 categories according to the following patterns of pleural contact with tumor: a solid component, pleural indentation, a ground glass opacity (GGO) component, and no pleural contact.
Result
VPI occurred in 173 patients (21.4%), with a significantly higher incidence of pathological nodal involvement than those without VPI (32.9% vs 10.6%, p<0.001). Of the 357 patients with pleural contact by a solid component, 248 patients with pleural indentation, and 203 patients with pleural contact by a GGO component/no pleural contact, 152 (42.6%), 21 (8.5%), and none (0%) had VPI, respectively. The length of pleural contact by a solid component was positively correlated to VPI (p<0.001). Receiver-operating characteristic curve analysis revealed a cutoff length of 1 mm, indicating the importance of the presence of pleural contact by a solid component. Multivariate logistic regression analysis revealed that pleural contact pattern, pure-solid tumor, SUVmax, and CEA were independent significant predictors of VPI. Adjusted ORs (95%CI) of pleural contact by a solid component and pleural indentation were 181 (11.8–NA) and 40.1 (2.55–633), respectively (in reference to a GGO component/no pleural contact).
Conclusion
Pleural contact by a solid component was the most relevant predictor of VPI. VPI was reflected by malignant clinical (high CEA) and radiological features (high SUVmax, pure-solid tumor) and a pleural contact pattern (solid component, indentation).
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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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P2.17-03 - Surgical Outcomes of Repeated Anatomical Pulmonary Resection for the Ipsilateral Second Lung Cancers (ID 390)
10:15 - 18:15 | Author(s): Kazuya Takamochi
- Abstract
Background
The opportunity of pulmonary resection for metachronous second lung cancers is increasing as an effective surgical strategy for properly selected patients in the course of postoperative follow-up after thoracic surgery for the first lung cancer. However, the surgical indication is controversial regarding the repeated pulmonary resection for the ipsilateral second lung cancer.
Method
Among surgically resected 3316 non-small cell lung cancer (NSCLC) from 2008 to 2018, ipsilaterally detected 104 metachronous second lung cancers (3.6%) was retrospectively reviewed with regard to the surgical outcomes and clinicopathological characteristics. In this study, re-anatomical resection was defined as a repeated anatomical surgery for ipsilateral secondary NSCLC after major lung resection for primary NSCLC. Overall survival (OS) was estimated using the Kaplan-Meier method. Survival outcomes were evaluated using Cox proportional hazard model. A difference was considered statistically significant when the p-value was less than 0.20 in the univariable, and 0.05 in the multivariable models.
Result
Of all, 61 (67%) were male with an average age of 67y at the second surgery. Pathological-stage I disease was found in 65 (63%). Histologically, adenocarcinoma was frequent in 80 (77%) cases. Seventy-seven (74%) was diagnosed as second primary. The 3y-OS after the second lung resection was 80.1%. Multivariate analysis revealed that radiological pure-solid tumor, pack-year smoking were the independent prognosticators of the OS (p=0.045, 0.001). Operative procedures were not associated with the survival outcomes (re-anatomical: 81.8%, others: 78.2%, p=0.816), however, re-anatomical resection was an independently significant predictor of the postoperative morbidity after the second surgery (p=0.035). Therefore, we focused on the 58 cases that underwent re-anatomical resection. Among them, postoperative morbidity (G3 or more in the CTCAE 4.0) was found in 20 (35%). A multivariable analysis revealed tumor size and postoperative morbidity were the independently significant prognosticators (p=0.003, 0.026). The 3y-OS of tumor less than 20mm was excellent (91.9% vs. 66.6%, p=0.008). Furthermore, we classified them into 2 groups based on the operative modes, i.e., completion pneumonectomy (CP; n=26) and the other re-anatomical resections to avoid CP (non-CP; n=32). The details of non-CP were ipsilateral secondary lobectomy/segmentectomy after the primary lobectomy/segmentectomy in 28 and completion lobectomy after the primary segmentectomy in 4, respectively. Among them, right side operation was more frequent in the non-CP (54% vs. 84%, p=0.011), while intra-pericardial procedure was employed more in the CP (85% vs. 47%, p=0.005). In contrast, the oncological outcomes (3y-OS; 75.8% vs. 87.1%, p=0.881), technical aspects including operative time (242min vs. 234min, p=0.802), bleeding amount (334ml vs. 242ml, p=0.521), blood transfusion (15% vs. 19%, p=0.736), arterial reconstruction (19% vs. 28%, p=0.431), or postoperative morbidity (27% vs. 41%, p=0.275) was similar between CP and non-CP.
Conclusion
Re-anatomical pulmonary resections for the ipsilateral second lung cancers are oncologically feasible but predictive for the postoperative morbidity. In particular, non-CP could be effective strategy to avoid CP for lung preservation, however, this procedure is technically challenging as well as CP, and strict caution would be warranted for the perioperative management. While oncological outcome of small-sized lung cancer is fully favorable even in case that repeated anatomical resection would be needed.
