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Şükrü Dilege



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    P2.13 - Staging (ID 315)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Staging
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.13-11 - Predicting Micrometastasis in Mediastinal Lymph Nodes in Patients with Non-Small Cell Lung Cancer (Now Available) (ID 1945)

      10:15 - 18:15  |  Author(s): Şükrü Dilege

      • Abstract
      • Slides

      Background

      Non-small-cell lung cancer staging is the most important factor affecting both the potential treatment and the prognosis. The evaluation of non-small cell lung carcinoma staging uses the TNM classification (tumor, node, metastasis). The N factor plays a more critical role in staging than T and M factors, because of its unpredictability. We know that undiagnosed micrometastatic nodal disease has a poor prognosis. Detecting micrometastasis is expensive and time consuming, so that’s why we aimed to investigate the factors predicting micrometastatic mediastinal disease.

      Method

      We collected all the lymph nodes from the patients that we operated between July 2012 and July 2013. We excluded all the patients who had an induction treatment and preoperatively diagnosed with mediastinal metastasis. We studied the expressions of three biomarkers; EpCAM, CEACAM5 and KRT19 using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) in lymph nodes and compared the expressions with healthy controls. If all three of them are positive, we have accepted it as micrometastasis. We compared the presence of micrometastasis with the pathological data to identify possible predictive factors.

      Result

      We analyzed 86 lymph nodes from 32 patients. Twenty seven out of 86 lymph nodes (%31.4) were positive for micrometastasis. Eighteen out of 32 patients (%56.3) became micrometastatic and 16 out of 32 patients are upstaged. Four of them are upstaged from N1 to N2 and 12 of them are upstaged from N0 to N2. Micrometastatic patients tend to have poorer survival compared to non-micrometastatic patients but without an statistical significance. However micrometastasis was found significantly higher in tumors with less than 2 cm (p: 0.03) and lower in tumors without lymphovasculary invasion (p: 0.03).

      Conclusion

      In our study tumors with smaller than 2cm in diameter and without lymphovascular invasion have significantly higher micrometastatic potential. In order to validate these parameters as predictive markers this experiment should be performed in a larger cohort with increased control population.

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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): Şükrü Dilege

      • 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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