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Vittorio Aprile
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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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EP1.15-22 - Primary Epithelial - Myoepithelial Carcinoma of the Lung with Unexpected Aggressive Onset (Now Available) (ID 1110)
08:00 - 18:00 | Author(s): Vittorio Aprile
- Abstract
Background
Epithelial-myoepithelial carcinoma (EMC) is the rarest sub-type of primary salivary gland type neoplasms of the lung. It usually arises from the salivary glands in the trachea or main bronchi and it is generally classified as a low-grade tumour, but because of its rarity and the unknown malignant potential, the treatment of choice has not been established.
Method
A 50-year old Hispanic woman, with no history of previous malignancies or comorbidities, arrived at our institution with cough and dyspnoea. A chest CT showed a lesion of left upper lobe (LUL) bronchus, associated to complete atelectasis of left lung, pleural effusion and two inhomogeneous pleural masses just over the diaphragm. PET/CT revealed increased FDG uptake in LUL and in pleural lesions. Fiberbronchoscopy showed a mass originating from left upper bronchus that occluded left main bronchus. The biopsy of the neoplasm revealed pulmonary EMC. The cytological examination of pleural effusion was negative for neoplastic cells. After cardio-respiratory complete assessment and tumour board evaluation, the patient underwent left pneumonectomy, systematic lymphadenectomy and removal of two solitary lesions respectively located on parietal pleural and on diaphragm en-block with portion of muscle (repaired with non-absorbable running suture) by thoracotomy
Result
The postoperative course was uneventful (hospitalization: 10 days), however two weeks after discharge the patients was readmitted with pleural effusion and fever. The patient underwent a left thoracentesis (amicrobic, no malignant cells) and a fiberbronchoscopy (regular bronchial suture). After 7 days the patient was discharged. Histopathology confirmed R0 resection of EMC (7x5.5x4 cm), and two solitary metastases on parietal pleura and diaphragm. Ki 67 was <30%. Patient underwent adjuvant chemotherapy, was alive and free of disease 32 months after surgery.
Conclusion
Primary EMC of the lung is an extremely rare neoplasm with an unpredictable biological behaviour. The surgical resection represents the gold standard if a complete resection can be reached
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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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P2.17-29 - Impact of Second Predominant Pattern on Recurrence in Early Stage Resected Lung Adenocarcinoma: A Multicentric Study (Now Available) (ID 2515)
10:15 - 18:15 | Author(s): Vittorio Aprile
- Abstract
Background
The ATS/ERS/IASLC adenocarcinoma classification allowed not only a better anatomical-pathological definition, but it showed a significant influence on long-term outcomes. It has been proposed that adenocarcinoma patterns could be divided in three groups according to their clinical and pathological behaviors: low (lepidic), moderate (papillary or acinar) and high grade (micropapillary and solid). Moreover, different patterns might mingle influencing biological features and prognosis. We focused on resected adenocarcinomas analyzing the impact of second predominant pattern on recurrence rate and Disease-Free Survival (DFS).
Method
We retrospectively collected all stage I and II lung adenocarcinoma operated on between January 2014 and December 2017 in seven European thoracic surgery departments. We selected all patients who underwent an anatomical resection with lymphadenectomy; patients with incomplete follow up, pure adenocarcinoma or those composed by more than two subtypes (if third pattern accounted for more than 10%) were excluded. Mucinous adenocarcinoma were considered separately from other patterns. DFS, incidence and localization of recurrence were calculated according to the second predominant pattern.
Result
Among 500 patients, 331 were selected. There were 186 male, mean age was 68.1 years (±SD 8.2) and 105 (31.7%) patients were active smokers at the moment of diagnosis. The majority of patients (271, 81.9%) underwent a lobectomy. Low, medium and high-grade first predominant pattern were 45 (13.6%), 208 (62.9%), 57 (17,2%) respectively and 21 cases were mucinous.
Second predominant pattern was present as follow: acinar 96 (29%), lepidic 86 (26%), papillary 74 (22.4%), solid 29 (8.8%), micropapillary 26 (7.9%), 20 mucinous (6%). DFS analysis showed a significant impact of grade of the second predominant pattern (p=0.046), while first predominant pattern’s grade did not significantly impact on DFS (p=0.322). According to the subtypes of second predominant pattern, lepidic pattern showed a better mean DFS (56.1 versus 49.6 months, p=0.014) and a lower recurrence rate (p=0.018, and, in particular, a lower distant recurrence rate, p=0.016), while micropapillary had a worse DFS (42.3 versus 52.1 months, p=0014), higher recurrence rate (p=0.017, and in particular, a higher regional recurrence, p=0.038); moreover, also pleural invasion influenced DFS significantly (p=0.001). At multivariate analysis, lepidic second pattern and pleural invasion confirmed their influence on DFS (p=0.044, IC 0.28-0.98 and p=0.001, IC 1.36-3.4).
When we analyzed the subgroup with only moderate grade (acinar and papillary) first predominant pattern (208 patients), lepidic and micropapillary second predominant patterns and pleural invasion confirmed their significant impact on DFS (p=0.015; p=0.021; 0.015 respectively).
Conclusion
Our multicentric study confirms the impact of adenocarcinoma patterns on recurrence rate and DFS. The second predominant pattern in early stage resected adenocarcinoma seems to play an important role in influencing the outcomes. Micropapillary and lepidic second pattern demonstrated to be significantly related to recurrence development and their presence should require different and dedicated postoperative management.
