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Deog Gon Cho
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EP1.17 - Treatment of Early Stage/Localized Disease (ID 207)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 2
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.17-22 - In Stage I Non-Small Cell Lung Cancer, Abutting Adjacent Structures Is a Possible Prognostic Factor (Now Available) (ID 2948)
08:00 - 18:00 | Author(s): Deog Gon Cho
- Abstract
Background
In TNM staging system, tumor which invades directly adjacent lobe does not change its T status. But there are some papers that emphasize, adjacent lobe invasion should be classified as T3. Here, we report our analysis of clinical characteristics and prognosis of abutting stage I non-small cell lung cancer (NSCLC).
Method
Non-small-cell lung cancer (NSCLC) which does not exceed three centimeters was enrolled. All patients underwent curative surgical resection from October 2008 to April 2017. We divided the patients into two groups. Abutting group comprised of tumors, which abutted adjacent structures (interlobar fissure, parietal pleura, mediastinal pleura, pericardium, and diaphragm) and non-abutting group was not. We compared patient demographics, surgical procedures, pathologic status, and recurrence rate. Finally, we compared overall survival using Kaplan Meier survival curves.
Result
Non-small-cell lung cancer (NSCLC) which does not exceed three centimeters was enrolled. All patients underwent curative surgical resection from October 2008 to April 2017. We divided the patients into two groups. Abutting group comprised of tumors, which abutted adjacent structures (interlobar fissure, parietal pleura, mediastinal pleura, pericardium, and diaphragm) and non-abutting group was not. We compared patient demographics, surgical procedures, pathologic status, and recurrence rate. Finally, we compared overall survival using Kaplan Meier survival curves.
Conclusion
In stage I NSCLC which does not exceed three centimeters, abutting to the adjacent structures could be an unfavorable factor in prognosis after curative surgical resection. Further study should be conducted.
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EP1.17-23 - Omentopexy for Post-Pneumonectomy Bronchopleural Fistula in Patients with Non-Small Cell Lung Cancer After Salvage Radiotherapy (Now Available) (ID 2970)
08:00 - 18:00 | Presenting Author(s): Deog Gon Cho
- Abstract
Background
Preoperative chemotherapy or radiotherapy could affect bronchial mucosa blood flow and also the normal healing process of bronchial stump after surgical resection. Otherwise, bronchopleural fistula (BPF) is the worst and time consuming complication in lung cancer surgery. Pneumonectomy is reported as a high risk surgery of BPF. Here, we report our successful treatment experience of BPF using omentum after salvage radiotherapy in NSCLC patient.
Method
Retrospective medical chart review
Result
A sixty-four years old male patient who had a history of chronic obstructive pulmonary disease diagnosed as squamous carcinoma in left upper lobe, clinical stage of T2aN1M0. Because interlobar artery invasion was suspicious, the patient was treated with radical radiotherapy. After 6600cGy of radiotherapy, the lesion showed marked response. Thus we decided to perform curative surgical resection, pneumonectomy. The patient had discharged in postoperative day 11 and the pathologic report was ypT1aN0M0. But after 1 week from discharge, the patient readmitted and complained of dyspnea and profound sputum. In bronchoscopy, fistula was seen. We performed the second operation. Due to hard fibrosis, direct closure of bronchial stump was not possible. Thus, we covered the stump site with omental flap in multilayers. The patient discharged uneventfully and now in disease free status almost after 2 years from initial operation.
Conclusion
Neoadjuvant radiation therapy and pneumonectomy are risk factors for post-operative BPF. Direct closure with buttressing biocompatible flap is the treatment of choice. But if direct closure is not possible, double-layered omentopexy could be an alternative treatment strategy.
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P1.04 - Immuno-oncology (ID 164)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Immuno-oncology
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.04-64 - The Opposite Role of PD-L1 Expression in EGFR Mutant Lung Cancer Treated with PD-1 Inhibitor Before and After EGFR TKI: Pilot Study (ID 3018)
09:45 - 18:00 | Author(s): Deog Gon Cho
- Abstract
Background
Standard treatment of EGFR mutant lung cancer is EGFR tyrosine kinase inhibitor (TKI). But PD-1 inhibitor in EGFR mutant lung cancer is also effective treatment option. PD-L1 expression is suggested as predictive biomarker for drug efficacy, but in EGFR mutant lung cancer, PD-L1 expression change after TKI have not been established and their role in PD-1 inhibitor treatment was not studied well.
Method
This study evaluated 18 EGFR mutant lung cancer patients treated with PD-1 inhibitor at St. Vincent hospital from April 2016 to January 2019. Following baseline data were recorded at the time of PD-1 inhibitor treatment: Age, Sex, ECOG performance status, PD-1 inhibitor type, line of treatment, lymphopenia, NLR (neutrophil-lymphocyte ratio), hyponatremia, presence of brain, liver and bone metastasis, EGFR status, PD-L1 expression. Progression free survival (PFS) and overall survival (OS) was evaluated and Cox survival analysis was used for these analyses.
Result
Median age was 61 years old and female was predominant (66.7%). Nivolumab and pembrolizumab was treated in 11 (61.1%) and 7 (38.9%) patients, respectively. Lymphopenia (<1,000/microleter) was 8 (44.4%) and high NLR (≥ 3) was 9 (50.0%). Hyponatremia (135 mEq/L) was noted in 5 (27.8%) and metastasis of brain, liver and bone were 9 (50%), 5 (27.8%) and 8 (44.4%). Median PFS and OS were 42 days and 102 days, respectively. Although high PD-L1 expression (SP263 ≥10%) before EGFR TKI is not significant predictive factor (Hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.09-2.45, P-value: 0.368) for PFS, high expression of PD-L1 before EGFR TKI tend to have favorable outcome. But, high PD-L1 expression (SP263 ≥10%) after EGFR TKI is associated with poor PFS outcome (HR: 2.20, 95% CI: 0.42-11.53). Regarding OS, high PD-L1 expression (SP263 ≥10%) before EGFR TKI is associated with prolonged survival (HR: 0.47, 95% CI, 0.09-2.41, P-value: 0.362), although it is not statistically significant. But, high PD-L1 expression after EGFR TKI tend to have shorter survival (HR: 3.34, 95% CI: 0.64-17.51, P-value: 0.154).
Conclusion
The role of PD-L1 expression between before EGFR TKI and after EGFR TKI is opposite. This study is small study as a pilot setting and further studies are needed to evaluate these findings.
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P2.01 - Advanced NSCLC (ID 159)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.01-68 - High NLR Is Poor Predictive Biomarker for NSCLC Treated with PD-1 Inhibitor in Real World Practice (ID 2392)
10:15 - 18:15 | Author(s): Deog Gon Cho
- Abstract
Background
PD-1 inhibitor in NSCLC is effective treatment option. PD-L1 expression and tumor mutation burden (TMB) is suggested as predictive biomarker for drug efficacy, but especially in the real-world, predictive factors have not been established. Therefore, we evaluated predictive biomarker for NSCLC treated with PD-1 inhibitor in real world practice.
Method
This study evaluated 73 NSCLC patients treated with PD-1 inhibitor at St. Vincent hospital from April 2016 to January 2019. Following baseline data were recorded at the time of PD-1 inhibitor treatment: Age, Sex, ECOG performance status, PD-1 inhibitor type, line of treatment, lymphopenia, NLR (neutrophil-lymphocyte ratio), hyponatremia, presence of brain, liver and bone metastasis, EGFR status, PD-L1 expression. Progression free survival (PFS) and overall survival (OS) was evaluated and Cox survival analysis was used for these analyses.
Result
Median age was 66 years old and male was predominant (67.1%). Nivolumab and pembrolizumab was treated in 34 (46.6%) and 39 (53.4%) patients, respectively. Lymphopenia (<1,000/microleter) was 20 (27.4%) and high NLR (≥ 3) was 41 (56.2%). Hyponatremia (135 mEq/L) was noted in 18 (24.7%) and metastasis of brain, liver and bone were 19 (26%), 12 (16.4%) and 28 (38.4%). Median PFS and OS were 84 days and 180 days, respectively. For PFS, ECOG performance status, presence of brain, liver, bone metastasis, PD-L1 (22C3), presence of EGFR mutation, lymphopenia and NLR was significant predictive factors in univariate analysis. As independent factors, presence of liver (Hazard ratio (HR): 3.32, 95% confidence interval (CI): 1.13-9.75, P-value: 0.029), bone metastasis (HR: 2.90, 95% CI: 1.25-6.75, P-value: 0.013), high PD-L1 expression (≥50%) (HR: 0.32, 95% CI: 0.14-0.72, P-value: 0.006) and high NLR (≥ 3) (HR: 2.58, 95% CI: 1.16-5.77, P-value: 0.021) were remained in multivariate analysis. Regarding OS, ECOG performance status, presence of bone metastasis, hyponatremia, lymphopenia and NLR were significant predictive factor for PD-1 inhibitor. In multivariate analysis, poor ECOG status (2 or 3 compared to 0 or 1) (HR: 2.95, 95% CI 1.54-5.64, P-value: 0.001) and high NLR (≥ 3) (HR: 3.29, 95% CI: 1.68-6.47, P-value: 0.001) were significant predictive factors.
Conclusion
High NLR is significant predictive biomarker for both PFS and OS in this real world study. Further studies are needed to evaluate these findings.
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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
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-18 - Acute Respiratory Distress Syndrome After Curative Surgical Resection for Lung Cancer (Now Available) (ID 2129)
10:15 - 18:15 | Presenting Author(s): Deog Gon Cho
- Abstract
Background
Bilateral lung infiltration is the most dreadful sign after lung cancer surgery. Either it is post -operative pneumonia or exacerbation of underlying lung disease (Interstitial lung disease), the lungs gradually shut down and finally develop ARDS (Acute Respiratory Distress Syndrome). Here, we report our experience and treatment outcome of post-operative ARDS after curative surgical resection for lung cancer.
Method
From October 2008 to April 2017, the patients who underwent curative surgical resection for primary lung cancer were analyzed. We retrospectively reviewed medical records in two hospitals.
Result
A total of 2140 patients were enrolled. Among them, 1246 were male (58.2%) and 894 were female (41.8%). The mean age was 64.5±10.0. In surgical procedures, 1496 (70%) cases of lobectomy, 117 (5.5%) cases of segmentectomy, 201 (9.4%) cases of wedge resection, 71 (3.3%) cases of bilobectomy, and 31 (1.4%) cases of pneumonectomy were performed. Combined procedures (lobectomy with wedge resection) were 222 (10.4%) cases. With Berlin definition of ARDS, a total of 29 (1.4%) patients were diagnosed. In table 1, we compared two groups and analyzed risk factors using univariable analysis. In multivariable analysis (table 2), advanced age, %VC(vital capacity), and underlying lung disease were associated with ARDS. Of 29 ARDS patients, 19 (65.5%) patients died in spite of maximum treatment. Broad antibiotics (96.6%), and steroid therapy (86.2%) were most applied treatments. We compared the patient’s characteristics and the timing of treatment between two groups (survivor / non-survivor). But, there was no clinical significance.
Conclusion
In conclusion, ARDS after lung cancer surgery is rare but fatal. Advanced age, low vital capacity, and patient’s underlying lung diseases are possible risk factors for ARDS after surgery. In practice, various treatments including broad antibiotics and steroid therapy are applied to treat or control this disaster. But still, mortality is extremely high and their role is uncertain.
