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Yoohwa Hwang
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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: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.17-20 - Influence of Insurance Status on Survival of Patients with Non-Small Cell Lung Cancer Underwent Surgical Treatment (Now Available) (ID 2833)
08:00 - 18:00 | Presenting Author(s): Yoohwa Hwang
- Abstract
Background
Insurance coverage was an important determinant of access to care and was on potential cause of disparities in lung cancer care outcomes. The aim of the study was to clarify the association between National Health Insurance Status (Health insurance vs Medicare) and survival of patients with non-small cell lung cancer (NSCLC) who underwent surgical treatment.
Method
Among 544 patients who underwent surgical resection for primary NSCLC from January 1997 to July 2017, 116 patients (21.3%) were in the Medicare Group. Data were analyzed to identify the clinical manifestation and to compare the postoperative and oncologic outcomes between two groups.
Result
There was no significant different in distribution of pathologic stage (p=0.89). The rates of squamous cell carcinoma were significantly higher in the Medicare group (43.9% vs 30.9%, p=0.03). Minimally invasive surgical approach was performed more in the Health insurance group (67.3% vs 56.9%, p=0.04). In the Healthy insurance group, the median length of hospital stay was significantly shorter (8 days vs 11 days, p=0.01). Although postoperative mortality rates were not different between two groups (1.7% vs 2.1%, p=0.79), the incidence of postoperative complications was non-significantly higher in the Medicare group (35.1% vs 29.8%, P=0.29). The 5-year overall survival and freedom from recurrence were significantly lower in the Medicare group (63.9% vs 71.1%, p=0.045, 56.5% vs 62.3%, p=0.033, respectively). (Figure. 1)
Conclusion
Socioeconomic status based on National Health Insurance service could have a bad influence on overall survival in patients with surgical treated lung cancer.
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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: 2
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-37 - Prognostic Implication of Surgical Treatment for the Dominant Lung Adenocarcinoma Associated with Part-Solid Nodules (ID 2975)
10:15 - 18:15 | Presenting Author(s): Yoohwa Hwang
- Abstract
Background
The aim was to analyze the prognostic implication of surgical resection for lung adenocarcinoma appearing as part-solid nodules (PSNs) on computed tomography scans .
Method
From 2004 to 2017, the cases of a total of 651 patients (male:female = 259:392, median age, 65years) with surgically resected lung adenocarcinomas manifesting as PSNs were retrospectively reviewed. We compared patient characteristics with t tests for continuous variables and χ2 tests for categorical variables. The prognostic implication of the multiplicity of the surgical extent and other clinical variables in relation to overall-survival (OS) and disease-free survival (DFS) was analyzed by using Cox regression.
Result
Median maximum diameter and solid component diameter of PSNs were 2.0cm and 1.1cm.(range 0.8-7, 0.5-3.4) PSNs were resected by wedge resection, segmentectomy, or lobectomy in 94 (14.4%), 92 (14.2%), and 465 (71.4%) cases, respectively. Pathologic diagnosis was adenocarcinoma in situ, minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IA) in 4 (0.6%), 70 (10.8%), and 577 (88.6%) cases, respectively. The median follow-up duration was 35.4 months. There was no significant difference of OS and DFS among the surgical extent and type of lymph node dissection (Figure 1). Multivariate Cox regression analysis demonstrated that multiple pulmonary nodules [hazard ratio (HR) = 8.3; 95% confidence interval (CI): 3.5-19.8 1.173; p <0.001] and wedge resection (HR = 3.8; 95% CI: 1.19-11.9; p = 0.02) were independent risk factors for the tumor recurrence.
Conclusion
Among the resected lung adenocarcinoma associated with PSNs, multiple PSN and wedge resection is a significant prognostic factor in the lung cancer recurrence.
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P2.17-38 - Predictive Factors for Lymph Node Metastasis in Patients with Clinical Stage I Part-Solid Lung Adenocarcinoma (ID 2998)
10:15 - 18:15 | Author(s): Yoohwa Hwang
- Abstract
Background
Accurate clinical staging of small part-solid nodule is essential for developing a treatment plan and evaluating suitability for minimally invasive surgery. The aim of this study was to evaluate predictive factors for metastasis of N1 and N2 lymph nodes in clinical stage I part-solid lung adenocarcinoma.
Method
Medical records of patients with clinical stage I part-solid adenocarcinoma who had undergone anatomic pulmonary resection with systematic node dissection or node sampling between January 2009 and June 2018 were retrospectively reviewed. To identify predictive factors for lymph node metastasis, univariate and multivariate logistic regression analyses were performed.
Result
Among the 602 patients in this study, the overall prevalence of lymph node metastasis was 3.7% (n = 22), which included 3.0% of N1 lymph nodes (n = 18) and 1.5% of N2 lymph nodes (n = 9). Combined N1 and N2 nodal involvement was found in 5 patients. Nodal metastasis was not observed in tumors with a solid part ≤1.0 cm (cT1mi and cT1a). The nodal metastasis rate in cT1b, cT1c, and cT2a tumors was 4.7% (10/215), 4.8% (3/63), and 12.9% (9/70), respectively. Predictive factors for N1 node metastasis included size of solid part (p = 0.001), and for N2 node metastasis included visceral pleural invasion (p < 0.001) by multivariate analysis. The ratio of ground glass opacity was not associated with lymph node metastasis.
Conclusion
Among the patients with clinical stage I part-solid adenocarcinoma, 3.7% of the patients showed unexpected lymph node metastasis, and large size of solid part and visceral pleural invasion of the tumor were predictive factors of lymph node metastasis in clinical stage I part-solid adenocarcinoma. Sytemic lymph node dissection and anatomic pulmonary resection should be performed, especially in those who have the larger size of solid part and suspicion of visceral pleural invasion.
