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Shun-ichi Watanabe
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ES25 - Unmet Need Issues of Current TNM (ID 179)
- Event: WCLC 2020
- Type: Educational Session
- Track: Staging
- Presentations: 1
- Moderators:
- Coordinates: 1/31/2021, 11:45 - 12:45, Scientific Program Auditorium
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ES25.05 - LN Map (ID 4004)
11:45 - 12:45 | Presenting Author(s): Shun-ichi Watanabe
- Abstract
- Presentation
Abstract
Background
There are issues of ambiguity in the current IASLC lymph node chart.
Problems in current lymph node chart
1. LN #1 includes both N3 (supraclavicular LNs) and M1b (infracevical LNs) disease.
2. Most of the pretracheal LN metastases are classified into contralateral disease for left side tumor.
3. A part of #4R could be classified into #10R in some cases, depends on the location of the azygos arch.
4. Precarinal LNs are classified as #10, depending on the location of azygos vein and left main pulmonary artery. The border between left and right precarinal #10 LN is not defined.
5. N2 nodes are generally regarded as mediastinal nodes. However, some of the #10 LNs are located in the mediastinum.
6. Pulmonary arteries are curved structures craniocaudally, and different interpretation of the border between #5 and 10L results in differences among atlases.
7. The area of #7 LN seems to be too wide. Many LNs adjacent to the intermediate bronchus, previously designated as #10, changed to be #7 (N2) LN. Surgical indication has sometimes been changed.
Scope of SPFC project
Minimal: Confine the scope in several stations related with N1 vs N2 and N2 vs N3.
Extended: Provide detailed definitions for borders in all stations – the Japan Lung Cancer Society and the Japanese Society for Radiation Oncology map provided more detailed description
Potential solution
In order to minimize the inter-observer variability and stage migration in nodal designation,
1. Post a document on the IASLC website regarding a more detailed definition of boundary of lymph node stations with CT atlas.
2. Post photographs, drawings and movies of surgical field showing the precise position of each lymph nodes.
References
1. Itazawa T, Tamaki Y, Komiyama T, et al. The Japan Lung Cancer Society-Japanese Society for Radiation Oncology consensus-based computed tomographic atlas for defining regional lymph node stations in radiotherapy for lung cancer. J Radiat Res 2017; 58:86-105.
2. El-Sherief AH, Lau CT, Wu CC, Drake RL, Abbott GF, Rice TW. International association for the study of lung cancer (IASLC) lymph node map: radiologic review with CT illustration. Radiographics 2014; 34:1680-1691.
3. El-Sherief AH, Lau CT, Obuchowski NA, Mehta AC, Rice TW, Blackstone EH. Cross-Disciplinary Analysis of Lymph Node Classification in Lung Cancer on CT Scanning. Chest 2017; 151:776-785.
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FP07 - Pathology (ID 109)
- Event: WCLC 2020
- Type: Posters (Featured)
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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FP07.04 - Predictive Efficacy of Morphological Biomarkers Based on Digital Pathology for ICI Therapy of Non-Small Cell Lung Cancer (ID 3436)
00:00 - 00:00 | Author(s): Shun-ichi Watanabe
- Abstract
Introduction
PD-L1 IHC is a widely used biomarker for immune checkpoint inhibitor therapy (ICI), but it does not have high specificity. It is essential to establish more accurate biomarkers for modern medicine. Our previous preliminary study (presented at 2019 WCLC) indicated the morphological feature's substantial value as a biomarker for ICI therapy. The morphological biomarkers (MBM) using digital whole-slide images can be tested from archived FFPE specimens. Here, we report our study on the prediction potency of morphological biomarkers for lung cancer patients treated by anti-PD1 inhibitors.
Methods
255 NSCLC who received ICI therapy were recruited. Digital images of H&E and PD-L1 (22C3) IHC stained slides of pre-treatment biopsied or resected materials were examined by previously reported image analysis techniques (NEC, Japan). The morphological characteristics of cancer cells were also evaluated by the pathologist's eyeball (PPI, pathological prediction index score 1-3). PD-L1 IHC (22C3) and tumor mutation burden (TMB) by the NGS-based target sequence (NCC oncopanel ®) were examined. Using morphological characteristics of HE images, we build a prediction model using the decision tree method (MBM-DT) first, then applied a deep learning framework (MBM-DNN) to response prediction. We compared the prediction potency for the ICI-therapeutic response of each score. The relative area proportion of the seven-index spider plot using test quality indicators was measured. The logistic regression test was calculated (SPSS). A p-value of less than 0.05 was defined as statistically significant.
Results
Pathological prediction index (PPI) scores showed superior prediction ability to that of the PD-L1 test. The accuracy of PPI-score 3, PPI-score 2+3, PD-L1 with 1% cutoff (PD-L1-1%), PD-L1 with 50% cutoff (PD-L1-50%), TMB-high, and driver gene mutation-negative was 0.71, 0.64, 0.60, 0.66, 0.57 and 0.57, respectively. MBM_DNN had the highest accuracy, specificity, positive prediction value (PPV), and the lowest false-negative rate (FNR) among the tested biomarkers. PPI-(2+3) had the highest sensitivity and negative prediction value (NPV), and false-negative rate (FNR). The seven-index spider plot showed the superiority of PPI-score 3, PPI-score 2+3 to PD-L1. Both PPI and MBM showed superior accuracy to PD-L1, TMB, and gene mutation status. The area proportion of seven test-index spider plots was 50, 56, 45 for PPI-score 3, MBM_DNN, and PD-L1-50%. Accuracy of training, validation, and a test set of MBM-DNN resulted in 0.85, 0.61, and 0.64, respectively. The logistic regression analysis revealed that males, smokers, the absence of driver gene mutation, positive/high expression of PD-L1, high PPI-score, the positive MBM-DNN, and MBM-DT are likely to be non-responder by univariate analysis. PPI-score 2+3(0.31, <0.001), MBM-DNN (0.23, <0.001), and MBM-DT (0.32, <0.001) are the significant factors for prediction of ICI response, but others are not by multivariate analysis. Conclusion
Our results showed the superior value of the morphological biomarker for ICI response prediction, compared to PD-L1 IHC and TMB. The morphological biomarker can be a useful biomarker for clinical therapeutic decisions.
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P04 - Early Stage/Localized Disease - Perioperative Therapy (Neoadjuvant Therapy, Surgery, Adjuvant Therapy) (ID 113)
- Event: WCLC 2020
- Type: Posters
- Track: Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P04.07 - Long-term Postoperative Prognosis of Adenocarcinoma in Situ and Minimally Invasive Adenocarcinoma of Lung (ID 2527)
00:00 - 00:00 | Author(s): Shun-ichi Watanabe
- Abstract
Introduction
Five-year postoperative recurrence-free rates for cases of resected lung adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) have been known to be almost 100%. However, long-term results have not been reported. We analyzed long-term postoperative prognosis of resected cases of AIS and MIA.
Methods
We reviewed pathological findings of 4,768 patients who underwent resection for lung cancer between 1998 and 2010. Of these patients, 524 patients with curative resection for AIS (207 cases, 39.5%) and MIA (317 cases, 60.5%) were enrolled in this study. Postoperative recurrence and survival were retrospectively analyzed.
Results
For AIS / MIA cases, 142 (68.6%) / 200 (63.1%) were females (p = 0.01), and 112 (54.1%) / 117 (36.9%) underwent sublobar resections (p < 0.01). Average pathological total tumor diameter was 13.8±5.7 / 16.2±5.1 mm (p < 0.01), and median postoperative follow-up periods were 100 (range: 1-237) / 101 (range: 1-210) months for AIS / MIA cases. No recurrence of lung cancer was observed in either AIS or MIA patients. For AIS / MIA cases, estimated 10-year postoperative disease-specific survival rates were 100% / 100% (p = 0.72), overall survival rates were 95.3% / 97.8% (p = 0.94). Estimated incidence rates of metachronous secondary primary lung cancer at 10 years after surgery were 5.6% / 7.7% for AIS / MIA cases (p = 0.44).
Conclusion
For cases of AIS and MIA, risk of recurrence is quite low after more than 5 years from curative resection, although development of metachronous secondary primary lung cancer should be noted.
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P26 - Mesothelioma, Thymoma and Other Thoracic Malignancies - Thymic Malignancies (ID 218)
- Event: WCLC 2020
- Type: Posters
- Track: Mesothelioma, Thymoma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P26.09 - Is Thymomectomy alone through Video-Assisted Thoracic Surgery Appropriate for Clinical Stage I (T1N0M0) Thymoma 5cm or Less? (ID 3450)
00:00 - 00:00 | Author(s): Shun-ichi Watanabe
- Abstract
Introduction
The optimal mode of resection for thymoma in nonmyasthenic patients remains unclear. Resection of thymoma involves two components: mode of resection and the surgical approach. There are two modes of resection [with total thymectomy (thymothymomectomy) and without total thymectomy (thymomectomy)], and two surgical approaches (median sternotomy and minimally invasive). The aim of this study was to explore whether or not thymomectomy alone through video-assisted thoracic surgery (VATS) is a relevant option for patients with clinical stage I (T1N0M0) thymoma in the TNM classification.
Methods
Between 1995 and 2019, 327 patients underwent resection for thymic epithelial tumors at National Cancer Center Hospital, Tokyo, Japan. Among them, 102 patients with clinical stage I (T1N0M0) nonmyasthenic thymoma 5cm or less who underwent thymomectomy through VATS were included in this study. We investigated surgical and oncological outcomes.
Results
The patients consisted of 44 men (43.1%) and 58 women (56.9%) with a median age of 62 years (interquartile range [IQR]: 52-69 years). All thymomectomies were performed through either complete VATS with 3 ports or hybrid VATS (incision, 5-8 cm in the fourth intercostal space at the anterior axillary line). The distribution of histologic subtype was type A (n = 17, 16.7%), type AB (n =43, 42.2%), type B1 (n = 18, 17.6%), type B2 (n = 17, 16.7%), and type B3 (n = 6.9%). The median tumor size was 3.1 cm (IQR: 2.4-4.0 cm). In terms of perioperative findings, the median blood loss was 16 ml (range: 5-30 ml) and the median operative time was 85 min (IQR: 71-103 min). Only one patient converted to open thoracotomy due to intra-operative bleeding. There were no operative deaths. The median length of the postoperative hospital stay was 3 days (IQR: 3-4 days). The morbidity rate was 0% and the 30-day mortality rate was 0%. The median follow-up time was 61 months (IQR: 23-98 months). No patients developed postoperative myasthenia gravis. Furthermore, no patients experienced a recurrence of thymoma. Hence, the 5-year freedom from recurrence was 100%.
Conclusion
Thymomectomy alone through VATS is acceptable for clinical stage I thymoma 5cm or less with regard to both surgical and oncological outcomes. For nonmyasthenic patients with thymoma, removal of all normal thymus might be unnecessary. Further studies are needed to evaluate long-term outcomes.
