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T. Ohtsuka
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MINI 11 - Tobacco Control and Prevention (ID 108)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Prevention and Tobacco Control
- Presentations: 1
- Moderators:S.M. Janes, E. Stone, K.M. Cummings
- Coordinates: 9/07/2015, 16:45 - 18:15, 601+603
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MINI11.07 - The Relationship between Smoking Status and Prognostic Factors after Surgery in Lung Cancer Patients with Chronic Obstructive Pulmonary Disease (ID 1388)
17:10 - 17:15 | Author(s): T. Ohtsuka
- Abstract
Background:
Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD), which frequently coexists with lung cancer. For non-small cell lung cancer (NSCLC) patients with COPD, the poor prognostic factors after curative surgery and their association with smoking status are unclear.
Methods:
We enrolled 858 patients who underwent curative surgical resection for pathological stage I or II NSCLC in our institute between January 2002 and December 2012. Of these patients, those with COPD, as determined by a fixed post-bronchodilator ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) below 0.7, were evaluated (n = 302). Clinical and pathological characteristics of the patients were retrospectively analyzed using the Cox regression hazards model to determine those that serve as poor prognostic factors after surgery.
Results:
The mean follow-up time was 49.3 months (±30.8 months; range, 1 to 135 months). The five-year disease-free survival rate was 70.2%, and the overall survival rate was 81.5%. Of 302 COPD patients, 243 (80.5%) had a smoking habit, whereas 59 (19.5%) did not. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion, 143 patients (47.5%) were diagnosed with stage I COPD and 159 patients (52.6%) were diagnosed with stage II COPD. The presence of a smoking habit (p = 0.010, hazard ratio [HR] 3.340, 95% confidence interval [CI] 1.334-8.359), lymphatic permeation (p = 0.001, HR 2.352, 95% CI 1.450-3.814), pathological T2 or T3 disease (p = 0.005, HR 1.666, 95% CI 1.165-2.381), and a preoperative serum carcinoembryonic antigen (CEA) value > 0.5 ng/ml (p = 0.041, HR 1.637, 95% CI 1.021-2.625) were determined to be indicators of poor recurrence-free survival in multivariate analysis. For overall survival rates, a smoking habit (p = 0.048, HR 7.527, 95% CI 1.017-55.738), a preoperative serum CEA value > 0.5 ng/ml (p = 0.001, HR 2.782, 95% CI 1.495-5.175), a histology of squamous cell carcinoma (p = 0.014, HR 2.220, 95% CI 1.175-4.193), and pathological N1 disease (p = 0.031, HR 2.505, 95% CI 1.089-5.762) were determined to be poor prognostic indicators in multivariate analysis. The disease stage as determined by the GOLD criterion was associated with neither recurrence-free nor overall survival rates. With regard to smokers, the number of pack-years did not significantly influence prognosis.
Conclusion:
We identified poor prognostic indicators for resected NSCLC in COPD patients. It should be noted that COPD patients who did not smoke had a better prognosis after surgery than those who did. Neither the number of pack-years in smokers nor the stage of COPD was related to prognosis after surgery.
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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.02-017 - Complications after Lobectomy or Segmentectomy for cT1aN0M0 Non-Small Cell Lung Cancer (ID 540)
09:30 - 09:30 | Author(s): T. Ohtsuka
- Abstract
Background:
Although lobectomy is considered the standard surgical approach for clinical T1aN0M0 non-small cell lung cancer (NSCLC), several recent studies have shown segmentectomy could be a substitute for lobectomy for early stage NSCLC. However, the differences of perioperative complications between lobectomy and segmentectomy have not yet been fully evaluated. The aim of this study is to investigate the postoperative complications which occurred after lobectomy or segmentectomy using propensity-matched analysis.
Methods:
Between February 2006 and February 2013, 100 patients underwent lobectomy and 111 patients underwent segmentectomy for clinical T1aN0M0 NSCLC. A retrospective comparison with each group was performed in perioperative mortality, morbidity, operative time, blood loss, length of hospital stay, chest tube duration and clinical parameters including age, gender, preoperative forced expiratory volume in 1 second percentage predicted (preop FEV1%), and Charlson Comorbidity Index (CCI). Data was analyzed for all patients and their propensity score matched pairs.
Results:
The rate of postoperative complications in the segmentectomy group (n = 21, 19%) was significantly higher than that in the lobectomy group (n = 7, 7%) (p < 0.01). The majority of complications were prolonged air leak. There was no significant difference in postoperative length of hopital stay and chest tube duration.The average operative time of 263 ± 64 minutes and estimated blood loss of 133 ± 125 ml for segmentectomy were significantly more than those of lobectomy (201 ± 61 minutes and 88 ± 101ml, respectively). In propensity score matched analysis (61 patients each), the average operative time of 270 ± 70 minutes for segmentectomy was longer than that of lobectomy (202 ± 67 minutes). Postoperative complications were more frequent in the segmentectomy group than those in lobectomy group (19.6% and 6.5%, p = 0.03).
Conclusion:
Although segmentectomy could offer preservation of pulmonary function, significantly more postoperative complications occurred in the segmentectomy group compared with lobectomy group. The majority of complications were prolonged air leaks in all patients and propensity matched pairs. The operation time was also longer in the segmentectomy group. Surgeons should bear in mind that complications can happen more frequently after segmentectomy than after lobectomy for cT1aN0M0 NSCLC.
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P2.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 225)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.08-032 - Multimodality Treatment for Advanced Thymoma (ID 2589)
09:30 - 09:30 | Author(s): T. Ohtsuka
- Abstract
Background:
Surgery remains the center of treatment of resectable thymoma. Radiation and chemotherapy have been applied widely as adjuvant treatment. However, the optimal treatment strategy for advanced thymoma remains controversial. This study aimed to evaluate the efficacy of multimodal treatment for patients with advanced stage III, IV thymoma.
Methods:
A total 250 consecutive patients with thymoma were treated in our hospital from January 1985 to December 2013. Among these, 70 patients were staged as Ⅲ and Ⅳ. The overall survival (OS) was analyzed according to clinicopathological factors and types of treatment.
Results:
There were 32 patients with stage III (46%), 35 patients with IVa (50%), and 3 patients with IVb (4%). The 10-year OS rates of patients with III+IV, III, IVa were 76%, 89%, and 64%, respectively. Types of treatment were as follows: surgery alone in 23 patients (33%), surgery followed by radiation in 31 (44%), surgery followed by chemotherapy in 2 (3%), surgery followed by chemo-radio therapy in 8 (11%), chemo-radio therapy alone in 6 (9%). There was no significant difference in OS among the treatment groups. Twenty-eight (40%) patients coexisted with myasthenia gravis (MG). There were no differences in OS between those with and without MG. Significant difference in OS was observed between 49 patients who underwent R0/R1 resection and 21 patients who underwent R2 resection (P = 0.004). The disease-free survival was worse in patients with combined full-dose mediastinal and low-dose, entire thoracic radiation than in those with full-dose mediastinal radiation alone (P = 0.04).
Conclusion:
In this retrospective study, it was shown that the surgical resection should always try to leave no gross tumor behind to ensure better prognosis. Although the future comparative, prospective study seems difficult because of the limited number of new cases, the multimodal approach with maximal treatment intensity looks promising.
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-007 - Salvage Surgery for Local Recurrence after Cryoablation for Non-Small Cell Lung Cancer: Importance of Diagnosis of Recurrence without Delay (ID 2598)
09:30 - 09:30 | Author(s): T. Ohtsuka
- Abstract
Background:
Non-surgical treatment for lung cancer, such as stereotactic body radiation therapy (SBRT), radiofrequency ablation (RFA), and percutaneous cryoablation have been performed as alternatives to surgery for lung cancer in patients with comorbidities, limited pulmonary reserve, or early diseases. Not many, but the significant portion of patients with such local modalities experience the local failures. The salvage surgery for such recurrence might have been attempted with considerable technical and oncological difficulties. Two cases with salvage resection for local failure after cryoablation are described.
Methods:
We reviewed two patients who had previously undergone cryoablation, in whom local recurrences were treated with salvage surgery. We evaluated perioperative parameters and histological findings, which indicated the local failure.
Results:
Case1: A woman was underwent cryoablation treatment for second primary T1aN0M0 lung adenocarcinoma in left lower lobe after 6 years of right lower lobectomy for lung adenocarcinoma. 4 years after the cryoablation, CT scan showed a tumor increasing in size in the area of treatment and local recurrence was suspected. Recurrence of adenocarcinoma was confirmed by CT guided biopsy. Segmentectomy of posterior segment of left lower lobe was performed. Operation time was 155minutes and blood loss was 72 ml. This patient is alive without any sign of recurrence after 8 years from surgery. Case2: A woman was underwent cryoablation for clinical stage T1aN0M0 lung adenocarcinoma in right lower lobe after 20 years of right upper lobectomy for lung cancer. 3 years after the cryoablation, CT scan showed a tumor growing in size in the area of treatment and local recurrence was suspected. Local recurrence of adenocarcinoma was proved by CT guided biopsy. Segmentectomy of superior segment of right lower lobe was performed. Operation time was 291minues and blood loss was 230 ml. This patient is alive without any sign of recurrence after 22 months from surgery. In both cases, salvage surgeries were performed without any difficulties. Pathological examinations showed viable cancer cells with necrotic tissue and fibrosis around which was consistent with the local recurrence after cryoablation.
Conclusion:
The salvage surgery for the local failures after non-surgical treatment modalities might be indicated in selected cases. The difficulties in diagnosis of local recurrence might cause the optimal timing of surgery.
