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Naziye Ak



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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: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.15-11 - Outcomes of Thymoma and Determinants of Survival: 16 Years Experience of a Tertiary Cancer Center (Now Available) (ID 1065)

      08:00 - 18:00  |  Author(s): Naziye Ak

      • Abstract
      • Slides

      Background

      We aimed with this study to explore the demographics and clinical outcome of patients with thymoma.

      Method

      A total of 203 patients with thymoma (Masaoka stage II-IV) treated from 2002-2018 were included in this retrospective analysis. IBM-SPSS statistical software version 20 for Windows (IBM, NY) was used for analysis. Survival analysis were estimated by the Kaplan–Meier method and compared by the log-rank test. p<0.05 was considered statistically significant. Cox-regression tests used for multivariate analysis.

      Result

      Male:female ratio was 105:98 with median age 49 years (Range 11-77). At presentation, patients with stage II, III and IV disease were 90, 67 and 45, respectively. A total of 123 patients(60,6%) had myasthenia gravis, and 56,1% of these patients had presented with myasthenia related symptoms. Majority of the patients were operated with sternotomy(n=103), and mean hospital stay was 8,34 days (Table 1). A total of 76 patients had received adjuvant radiotherapy, and 31 patients and 35 patients had received adjuvant and neoadjuvant chemotherapy, respectively. At mean follow-up of 218,6 months(95%CI:201,8-235,3), 5-year and 10-year OS rates were 93,8% and 89,2%. 30 patients had recurrence after surgery, and 5-year and 10 year DFS rates were 76,5% and 68,3%. Masaoka-Koga stage(p<0.0001), postoperative hospital stay more than 10 days(p=0,004) and needing neoadjuvant chemotherapy(p=0,003) were significant effects on DFS. Among patients who had given neoadjuvant chemotherapy, comparing cisplatin with etoposide or doxorubicin based combinations did not change DFS(p=0,34) or OS (p=0,48). Adjuvant radiotherapy and chemotherapy also have no survival effect on DFS and OS. On univariate analysis, age(p=0.013), Masaoka-Koga stage(p=0.001), postoperative hospital stay more than 10 days(p=0,006) and having recurrence(p=0,013) were significant effects on OS. Stage (p=0,001) and age (p=0.007) retained its prognostic significance on multivariate analysis (Table 2).

      Table1: Patient demographics and summary of the treatment approachs.

      Age n = 203

      <=50

      >50

      111 (% 54,7)

      92 (% 45,3)

      Gender n = 203

      Male

      Female

      105 (% 51,7)

      98 (% 48,3)

      Myasthenia Gravis n = 203

      Yes

      No

      123 (% 60,6)

      80 (% 39,4)

      Acetylcholine Receptors n=123

      Yes

      No

      113 (% 91,87)

      10 (% 8,13)

      Masaoka Stage of Thymoma

      n = 202

      II

      III

      IV

      Unknown

      90 (% 44,3)

      67 (% 33)

      45 (% 22,2)

      1 (% 0,5)

      Pathology n = 203

      Type A

      Type AB

      Type B1

      Type B2

      Type B3

      Mixed

      Micronodular Thymoma

      Unknown

      15 (% 7,4)

      20 (% 9,9)

      40 (% 19,7)

      67 (% 33,0)

      32 (% 15,8)

      25 (% 12,3)

      1 (% 0,5)

      3 (% 1,5)

      Surgery type

      VATS (Thoracoscopic)

      Sternotomy

      Thoracotomy

      RATS

      Inoperable

      54 (% 26,6)

      103 (% 50,7)

      37 (% 18,2)

      5 (% 2,5)

      4 (%2)

      Treatment Modality

      Neoadjuvant Chemotherapy

      Adjuvant Chemotherapy

      Adjuvant Radiotherapy

      35 (% 17,6)

      31 (% 15,6)

      76 (% 38,2)

      Table 2: Five-year overall survival and recurrence-free survival estimates in patient subgroups

      5-Year Survival Rate

      OS

      P

      RFS

      P

      Age

      ≤50

      %96,6 +/- 1,9

      0,013

      %77,8 +/- 4,5

      0,510

      >50

      %84,2 +/- 4,7

      %75 +/- 5,4

      Gender

      Male

      %91,5 +/- 3,4

      0,852

      %76,5 +/- 5

      0,687

      Female

      %90,9 +/- 3,3

      %76,5 +/- 4,9

      Masaoka stage

      2

      %96 +/- 2,3

      0,001

      %93,1 +/- 3

      <0,001

      3

      %88,4 +/- 5

      %77,8 +/- 6,4

      4

      %85,4 +/- 6,2

      %42,1 +/- 8,8

      Myasthenia Gravis

      Yes

      %93,1 +/- 2,6

      0,648

      %80 +/- 4

      0,358

      No

      %87,3 +/- 5

      %69,4 +/- 6,7

      Diagnosed before 2008

      Yes

      %97,3 +/- 2,7

      0,544

      %80 +/- 6,8

      0,247

      No

      %89,1 +/- 2,8

      %75,4 +/- 4,1

      Chemotherapy

      No

      Neoadjuvant

      Adjuvant

      %93 +/- 2,4

      %86,9 +/- 7,2 %75 +/- 15,3

      0,74

      %86,4 +/- 3,2

      %47,7 +/- 10

      %21,8 +/- 13,4

      <0,001

      Radiotherapy Type

      No

      Neoadjuvant

      Adjuvant

      %90,3 +/- 3,3

      %50 +/- 3,5 %93,5 +/- 3,2

      0,588

      %79,6 +/- 4,5

      -

      %74,9 +/- 5,5

      0,436

      Time of initiation of adjuvant therapy

      Early

      Late

      %90,9 +/- 8,7

      %89,1 +/- 6,1

      0,867

      %65,3 +/- 14,3

      %72,8 +/- 8,5

      0,853

      Pathology Type

      Type A

      Type AB

      Type B1

      Type B2

      Type B3

      Mixed Hystology

      %88,9 +/- 10

      %100

      %91,8 +/- 4,5

      %93,2 +/- 3,9

      %84,9 +/- 8,5

      %85 +/- 7,7

      0,506

      %83,6 +/- 10,3

      %87,1 +/- 8,6

      %77,4+/- 7,1

      %76,7 +/- 6,3

      %77,8 +/- 9,3

      %57,2 +/- 11,7

      0,538

      Hospitalisation Days

      <10 days

      %95,7 +/- 1,9

      0,006

      %87,1 +/- 3,1

      0,004

      >=10days

      %78,9 +/- 7,2

      %56,9 +/- 8,9

      Recurrence

      Yes

      %88,9 +/- 6

      0,013

      NA

      -

      No

      %91,7 +/- 2,6

      NA

      Conclusion

      Masaoka-Koga clinical stage and age are the important prognostic factors predicting OS. Postoperative hospital stay is related to DFS and OS.

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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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      P2.17-23 - The Role Adjuvant Chemotherapy in Resected Stage 1 NSCLC with High Risk Factors: A Turkish Oncology Group Study (Now Available) (ID 2301)

      10:15 - 18:15  |  Author(s): Naziye Ak

      • Abstract
      • Slides

      Background

      Adjuvant chemotherapy is accepted as a standard treatment for suitable patients who have undergone surgery for T2N0 non-small cell lung cancer with tumors larger than 4 cm. Despite similar relapse rates, the benefit of adjuvant chemotherapy for smaller tumors with high risk features is not clear. In this retrospective analysis our aim was to evaluate the prognostic impact of adjuvant platin-based chemotherapy in high-risk stage 1 NSCLC patients.

      Method

      This cooperative group study included 250 NSCLC patients who underwent curative surgery for stage 1 NSCLC with tumor size 2-4 cm and adverse prognostic factors consisting of visceral pleural invasion(VPI), lympho-vascular invasion(LVI), high grade, presence of solid-micropapillary(SMP) components or STAS. Records of patients were analyzed to investigate the prognostic impact of adjuvant chemotherapy in this cohort. DFS was defined as the time from surgery to the last follow-up, until relapse or death, CSS;time from surgery to death related to cancer or last known contact, OS;time from diagnosis to death or last known contact. Statistical analysis was performed using SPSS 20.0 software(SPSSInc,Chicago,USA).

      Result

      Median age at presentation was 63 years (range 18-90). The mean tumor size was 29.4 ± 7.4 mm. The frequency of patients with specified risk factors were: VPI: n: 92 (36.8%); LVI: n: 91 (36.4%); Grade 3:n: 49 (19,6%); SMP:n: 76 (30.4%); STAS:n: 15 (6%). A total of 51 patients had received adjuvant platin-based chemotherapy. There were significantly more patients who received chemotherapy in the younger age group (<65 ears old, ≥65 years old) and those with larger tumors (2 – 3 cm, 3 – 4 cm).

      During a median follow-up period of 91.8 months; 79 patients(31.6%) experienced recurrence, 62 patients(24.8%) have died, 144 patients(57.6%) were alive without disease and 24 patients (9.6%) were alive with disease.

      5-year and 10-year OS rates were 72.7%(± 3,5) and 46.8%(± 8), respectively. There was a significant improvement in DFS with adjuvant chemotherapy, especially in groups with VPI (93.3% vs 53.6%, p:0.016) and SMP (92.3% vs 57.3%, p:0.03). There was also a non-significant trend for improved CSS and OS among patients who received CT.

      Table 1. Effects of chemothrapy on survival.

      Chemotherapy Group

      Events/N Median 5-years DFS

      Non - treatment Group

      Events/N Median 5-years DFS
      P Value
      DFS 12/51 NE % 74.9 ± 6.3 81/190 71.1 months % 54 ± 4.2 0,032*
      CSS 4/49 NE % 89 ± 5 41/179 91.8 months % 76.9 ± 3.8 0,078
      OS 10/49 NE %77.4 ± 6.4 51/179 88.9 months % 72.1 ± 4 0,541

      *All values are stratified, respecting to significant confounding factors such as age, gender and tumor size.

      Conclusion

      Adjuvant platin-based chemotherapy should be considered for this subset of patients having high grade tumors, or those with VPI, LVI or solid-micropapillary components. Prospective, randomized trials incorporating clinical and molecular risk factors are required to clarify the role of adjuvant chemotherapy for stage 1 NSCLC patients.

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