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Sanghoon Jheon
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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 | Author(s): Sanghoon Jheon
- 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): Sanghoon Jheon
- 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.
