Virtual Library
Start Your Search
Jefferson Luiz Gross
Author of
-
+
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
-
+
P2.17-27 - Evaluation of Mediastinal Lymphadenectomy Quality in Patients Operated for NSCLC from the Paulista Lung Cancer Registry (PLCR) (ID 2352)
10:15 - 18:15 | Author(s): Jefferson Luiz Gross
- Abstract
Background
To describe the quality of mediastinal lymphadenectomy in patients operated on for NSCLC considering the resectability criteria proposed by IASLC in 2005 and to evaluate the impact of the definition of complete, uncertain and incomplete resection in overall survival and disease free survival in 5 years.
Method
Retrospective data from patients operated on for NSCLC between Jan/ 2002 and Dec/2018 in 4 institutions in the state of São Paulo were extracted from a prospective database, the Paulista Lung Cancer Registry (PLCR). Complete resection was defined by the absence of gross and microscopic residual disease, systematic lymph node dissection, and negativity of the highest mediastinal lymph node removed. Uncertain resection was defined by free resection margins, but with less rigorous lymph node evaluation than systematic dissection and/or positivity of the highest mediastinal lymph node removed. Incomplete resection was defined by the presence of gorss or microscopic residual disease. Patient follow-up was updated until Jan/2019. Overall survival was analyzed by the Kaplan-Meier method, Log rank test and Cox proportional regression.
Result
A total of 663 patients were identified. Mean age was 65.64 years, 338 men(50.9%). The predominant histological type was adenocarcinoma(n = 466, 70.2%), followed by squamous cell carcinoma(n = 162, 24.4%). Lobectomy was the most commonly performed procedure(n = 576, 86.8%), followed by segmentectomy and pneumonectomy(n = 40, 6.0% and n = 34, 5.1%, respectively). There was 388 patientes(59.81%) classified as stage I, 146(23.1%) stage II, 97(15.3%) stage III and 11(1.74%) stage IV. Resection was complete in 374 cases (56.4%), uncertain in 252 cases(38.0%) and incomplete in 37 cases(5.5%). Mediastinal lymphadenectomy was adequate in 421 cases (63.4%) and inadequate in 242 (36.5%). Reasons for inadequate lymphadenectomy were: no nodal station sampling (n = 30, 4.5%), no station 7 sampling (n = 103, 15.5%) and sampling of less than 3 mediastinal stations (n = 109 , 16.4%). The highest mediastinal lymph node removed was positive in 45 cases (6.7%). Surgical margins were positive in 37 cases (5.5%). The median follow-up was 19.5 months (IQR 7.4 - 42.5), and 5 years follow-up was completed in in 15.5%. During follow-up, 133 (20.4%) patients had recurrence of the disease. Median disease-free survival was 64 months in the general group and 84.0, 58.6 and 31.5 months in the complete, uncertain and incomplete resection groups, respectively (log rank p = 0.15). Median overall survival in the complete resection group was 98.3 months, in the uncertain resection group it was 64 months. The incomplete resection group did not reach the median. There was no statistical difference in survival between groups (log rank p = 0.22).
Conclusion
The analysis showed a high prevalence of uncertain resection, but comparable to other studies already published. This demonstrates that lymphadenectomy is not being performed according to IASLC recommendations. However, in this study, there was no impact on overall survival and disease-free survival at 5 years, which may be due to the small sample size and the short follow-up time of the vast majority of patients included in the PLCR.
