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Erkan Kaba
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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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EP1.15-11 - Outcomes of Thymoma and Determinants of Survival: 16 Years Experience of a Tertiary Cancer Center (Now Available) (ID 1065)
08:00 - 18:00 | Author(s): Erkan Kaba
- Abstract
Background
We aimed with this study to explore the demographics and clinical outcome of patients with thymoma.
Method
A total of 203 patients with thymoma (Masaoka stage II-IV) treated from 2002-2018 were included in this retrospective analysis. IBM-SPSS statistical software version 20 for Windows (IBM, NY) was used for analysis. Survival analysis were estimated by the Kaplan–Meier method and compared by the log-rank test. p<0.05 was considered statistically significant. Cox-regression tests used for multivariate analysis.
Result
Male:female ratio was 105:98 with median age 49 years (Range 11-77). At presentation, patients with stage II, III and IV disease were 90, 67 and 45, respectively. A total of 123 patients(60,6%) had myasthenia gravis, and 56,1% of these patients had presented with myasthenia related symptoms. Majority of the patients were operated with sternotomy(n=103), and mean hospital stay was 8,34 days (Table 1). A total of 76 patients had received adjuvant radiotherapy, and 31 patients and 35 patients had received adjuvant and neoadjuvant chemotherapy, respectively. At mean follow-up of 218,6 months(95%CI:201,8-235,3), 5-year and 10-year OS rates were 93,8% and 89,2%. 30 patients had recurrence after surgery, and 5-year and 10 year DFS rates were 76,5% and 68,3%. Masaoka-Koga stage(p<0.0001), postoperative hospital stay more than 10 days(p=0,004) and needing neoadjuvant chemotherapy(p=0,003) were significant effects on DFS. Among patients who had given neoadjuvant chemotherapy, comparing cisplatin with etoposide or doxorubicin based combinations did not change DFS(p=0,34) or OS (p=0,48). Adjuvant radiotherapy and chemotherapy also have no survival effect on DFS and OS. On univariate analysis, age(p=0.013), Masaoka-Koga stage(p=0.001), postoperative hospital stay more than 10 days(p=0,006) and having recurrence(p=0,013) were significant effects on OS. Stage (p=0,001) and age (p=0.007) retained its prognostic significance on multivariate analysis (Table 2).
Table1: Patient demographics and summary of the treatment approachs. Age n = 203
<=50
>50
111 (% 54,7)
92 (% 45,3)
Gender n = 203
Male
Female
105 (% 51,7)
98 (% 48,3)
Myasthenia Gravis n = 203
Yes
No
123 (% 60,6)
80 (% 39,4)
Acetylcholine Receptors n=123
Yes
No
113 (% 91,87)
10 (% 8,13)
Masaoka Stage of Thymoma
n = 202
II
III
IV
Unknown
90 (% 44,3)
67 (% 33)
45 (% 22,2)
1 (% 0,5)
Pathology n = 203
Type A
Type AB
Type B1
Type B2
Type B3
Mixed
Micronodular Thymoma
Unknown
15 (% 7,4)
20 (% 9,9)
40 (% 19,7)
67 (% 33,0)
32 (% 15,8)
25 (% 12,3)
1 (% 0,5)
3 (% 1,5)
Surgery type
VATS (Thoracoscopic)
Sternotomy
Thoracotomy
RATS
Inoperable
54 (% 26,6)
103 (% 50,7)
37 (% 18,2)
5 (% 2,5)
4 (%2)
Treatment Modality
Neoadjuvant Chemotherapy
Adjuvant Chemotherapy
Adjuvant Radiotherapy
35 (% 17,6)
31 (% 15,6)
76 (% 38,2)
Table 2: Five-year overall survival and recurrence-free survival estimates in patient subgroups 5-Year Survival Rate
OS
P
RFS
P
Age
≤50
%96,6 +/- 1,9
0,013
%77,8 +/- 4,5
0,510
>50
%84,2 +/- 4,7
%75 +/- 5,4
Gender
Male
%91,5 +/- 3,4
0,852
%76,5 +/- 5
0,687
Female
%90,9 +/- 3,3
%76,5 +/- 4,9
Masaoka stage
2
%96 +/- 2,3
0,001
%93,1 +/- 3
<0,001
3
%88,4 +/- 5
%77,8 +/- 6,4
4
%85,4 +/- 6,2
%42,1 +/- 8,8
Myasthenia Gravis
Yes
%93,1 +/- 2,6
0,648
%80 +/- 4
0,358
No
%87,3 +/- 5
%69,4 +/- 6,7
Diagnosed before 2008
Yes
%97,3 +/- 2,7
0,544
%80 +/- 6,8
0,247
No
%89,1 +/- 2,8
%75,4 +/- 4,1
Chemotherapy
No
Neoadjuvant
Adjuvant
%93 +/- 2,4
%86,9 +/- 7,2 %75 +/- 15,3
0,74
%86,4 +/- 3,2
%47,7 +/- 10
%21,8 +/- 13,4
<0,001
Radiotherapy Type
No
Neoadjuvant
Adjuvant
%90,3 +/- 3,3
%50 +/- 3,5 %93,5 +/- 3,2
0,588
%79,6 +/- 4,5
-
%74,9 +/- 5,5
0,436
Time of initiation of adjuvant therapy
Early
Late
%90,9 +/- 8,7
%89,1 +/- 6,1
0,867
%65,3 +/- 14,3
%72,8 +/- 8,5
0,853
Pathology Type
Type A
Type AB
Type B1
Type B2
Type B3
Mixed Hystology
%88,9 +/- 10
%100
%91,8 +/- 4,5
%93,2 +/- 3,9
%84,9 +/- 8,5
%85 +/- 7,7
0,506
%83,6 +/- 10,3
%87,1 +/- 8,6
%77,4+/- 7,1
%76,7 +/- 6,3
%77,8 +/- 9,3
%57,2 +/- 11,7
0,538
Hospitalisation Days
<10 days
%95,7 +/- 1,9
0,006
%87,1 +/- 3,1
0,004
>=10days
%78,9 +/- 7,2
%56,9 +/- 8,9
Recurrence
Yes
%88,9 +/- 6
0,013
NA
-
No
%91,7 +/- 2,6
NA
Conclusion
Masaoka-Koga clinical stage and age are the important prognostic factors predicting OS. Postoperative hospital stay is related to DFS and OS.
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P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-16 - VATS Lobectomy and Chest Wall Resection for NSCLC (ID 1034)
10:15 - 18:15 | Author(s): Erkan Kaba
- Abstract
Background
The classic surgical approach in patients with NSCLC invading the chest wall is lobectomy and chest wall resection by thoracotomy in the majority of patients. However, this approach can be performed by video-assisted thoracoscopic surgery (VATS) or robotic surgery (RATS) as a result of increased experience and technological developments. The aim of this study was to evaluate the feasibility of the technique and its results in patients undergoing lung and chest wall resection by means of minimally invasive surgery.
Method
The data of patients who underwent anatomical lung resection using VATS or RATS for NSCLC in three academic hospitals between 2013-2018 were prospectively recorded and reviewed retrospectively. Fourteen patients, all but three males with a median age of 62 ± 6.0 years, undergoing lung and chest wall resection were included in the study. Surgical results were evaluated.
Result
Neoadjuvant/induction treatment was chemo-radiotherapy in three and chemotherapy in two patients. The preferred surgical technique was RATS in two patients, and multiportal VATS in 10 and uniportal VATS approach in two patients. Upper lobectomy was performed in 11 patients, lower in two patients and upper lobe posterior segmentectomy in one patient. Standard small incision for chest wall resection was performed in four, Hybrid approach in 10 patients. Five patients had one, 6 patients had two, two patients had three and one patient had four ribs resections. Chest wall reconstruction was not necessary in any of the patients. The mean operation time was 96.4 ± 21.8 minutes. Complications were observed in 5 (35.7%) of the patients without mortality. The most common complication was prolonged, >5 days, air leak in four patients (28.6%). Ten patients (71.4%) were classified as T3N0, one patient (7.1%) as T4N0, one patient (7.1%) as T4N1, and two patients (14.1%) as T3N0M1. Surgical margins were reported as tumor-free (R0) in all patients. Adjuvant chemotherapy was given in eight patients (57.1%). The two-year survival rate was 66.8%.
Conclusion
Lobectomy and chest wall resection with minimally invasive surgery is a safe and feasible method in patients with NSCLC with chest wall invasion. Compared with thoracotomy, it provides equivalent oncologic outcomes as well as less postoperative pain, smaller incision, and faster recovery.
