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Ignacio Escobar



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    P2.13 - Staging (ID 315)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Staging
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.13-04 - Molecular Nodal Restaging Based on Embryonic Markers Expression Adds No Relevant Clinical Information in Resected Lung Cancer (ID 1149)

      10:15 - 18:15  |  Author(s): Ignacio Escobar

      • Abstract
      • Slides

      Background

      The relapse rate in non-small cell lung cancer (NSCLC) is high, even in localised disease, suggesting that the current approach to pathological staging is insufficiently sensitive to detect occult micrometastases present in resected lymph nodes. Therefore, we aimed to determine the prognostic value of the expression of embryonic molecular markers in histologically-negative lymph nodes of completely-resected NSCLC.

      Method

      76 NSCLC patients undergoing radical resection were included. Primary tumours and 347 lymph nodes were studied. The molecular markers finally were selected based on testing of 27 normal lung and 129 lung tumour samples as well as 25 lymph nodes obtained from non-neoplastic diseases. CEACAM5, FGFR2b, and PTPN11 expression levels were evaluated through mRNA analysis using real-time RT-qPCR assay. Statistical analyses included the Kruskal-Wallis test, Kaplan Meier curves, and log-rank tests.

      Result

      CEACAM5 expression levels were scored as high in 90 lymph nodes (26%). The molecular-positive lymph nodes lead to the restaging of 37 (62%) pN0 patients as molecular N1 or N2 and 5 (31%) pN1 cases were reclassified as molecular-positive N2. Surprisingly, molecular-positive patients (42, 55%) associated with a better OS (overall survival, p=0,04) than molecular-negative patients (34, 45%). FGFR2b overexpression was observed in 41 (12%) lymph nodes leading to the restaging of 17 patients (22%). Again a trend was observed towards a better DFS (disease-free survival) in the restaged patients (p=0,09). PTPN11 expression levels were high in 109 (31%) lymph nodes and led to the restaging of 41 (54%) patients who did not correlate with clinical outcome (p=0,61). The combination of CEACAM5-FGFR2b restaged the same number of patients than CEACAM5 only. Accordingly, high expression levels of CEACAM5 or FGFR2b in the primary tumour were related to better DFS (p<0,06; p<0,02, respectively); PTPN11 did not correlate with prognosis (p=0,37).

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      Conclusion

      Molecular nodal restaging based on expression levels of CEACAM5 and/or FGFR2b, does not add relevant clinical information to pathological staging of NSCLC likely related to the better prognosis of their overexpression in primary tumors.

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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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      P2.17-10 - Effects of the Omega-6/Omega-3 Ratio on Postoperative Complications After Lung Resection: Preliminary Results (ID 1862)

      10:15 - 18:15  |  Author(s): Ignacio Escobar

      • Abstract
      • Slides

      Background

      In the last 3 decades, the intake of omega-6 (n-6) fatty acids has increased while the intake of omega-3 (n-3) has decreased, leading to an increase in the n-6/n-3 ratio, which is now 20:1. This ratio has been postulated as an inflammatory marker of carcinogenesis, implicated in the development of multiple chronic diseases, and associated with postoperative complications due to the proinflammatory effects of omega 6. Consequently, the preoperative assessment of nutritional markers, together with immunonutrition, represent a promising target to improve outcomes in patients with lung cancer who are candidates for surgical resection. The aim of this study was to assess the effect of the n-6/n-3 ratio on postoperative complications in patients undergoing radical-intent surgery for lung cancer.

      Method

      Prospective cohort study of 38 patients diagnosed with lung cancer treated with radical surgery between October 2017 and May 2018. The n-6/n-3 ratio was determined immediately prior to surgery with the patient under anesthesia.

      Result

      Of the 38 surgically-treated patients, 29 were men (76%) and 9 women (24%). Mean patient age was 62 ±10 years. Twelve (32%) patients were active smokers at the time of surgery. The most common histological subtype was adenocarcinoma (60%) and most patients underwent lobectomy (68%). The mean body mass index (BMI) was 27 ±5 and the mean preoperative prognostic nutritional index (PNI) score was 48±7. The mean n-6/n-3 ratio was 20 ±6. The most common complications were prolonged air leak (> 5 days) in 11 patients (29%) and respiratory failure in 6 patients (16%). Patients with prolonged air leak had a significantly higher n-6/n-3 ratio than patients without prolonged air leak (25 ±3 vs. 18 ±6, respectively; p=0.02). Patients with an n-6/n-3 ratio > 20 were significantly more likely (p=0.002) to present prolonged air leak. Neither BMI nor PNI were significant predictors of air leak duration.

      Conclusion

      These preliminary findings indicate that patients with a higher n-6/n-3 ratio—that is, those with a greater proinflammatory status—were more likely to present prolonged air leak than those with a lower inflammatory status. Based on these encouraging results, we propose to continue with this line of research to better understand the effects and prognostic value of immunonutritional status on the clinical course of patients after lung cancer surgery.

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