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I. Takeyoshi



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    O29 - Cancer Control & Epidemiology IV (ID 132)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      O29.07 - The clinical outcome of non-small cell lung cancer patients with adjacent lobe invasion: proposal for optimal classification according to the status of interlobar pleura in invasion point (ID 1168)

      11:35 - 11:45  |  Author(s): I. Takeyoshi

      • Abstract
      • Presentation
      • Slides

      Background
      In the 7th TNM classification, non-small cell lung cancer (NSCLC) with adjacent lobe invasion (ALI) is classified as T2a regardless of whether across the complete or incomplete fissure. However, no validation analysis has been conducted on this classification. The aim of this study was to analyze the survival of NSCLC patients with ALI with emphasis on the interlobar fissure status at invasion point.

      Methods
      We retrospectively evaluated 2097 consecutive patients with surgically resected NSCLC from 1993 through 2006. Of these, 90 (4.3%) patients had tumors with ALI. Interlobar fissure status of tumors with ALI was examined by using elastic stain. We classified ALI into 2 types: direct ALI beyond incomplete interlobar fissure (no visceral pleurae separating two lobes; ALI-D) and ALI across complete fissure (two lobes separated by 2 visceral pleurae; ALI-A), and compared the clinicopathological features and survival between the groups.

      Results
      The patients with ALI without any other criteria higher than T2b category (n = 60) demonstrated intermediate survival between T2a and T2b tumors (5-year overall survival [OS]: T2a, 61.0%; ALI, 59.6%; T2b, 49.2%). Distinct survival difference was observed between the patients with ALI-A (n = 46) and ALI-D (n = 14) (5-year OS: ALI-D, 85.7%; ALI-A, 52.0%; p = 0.01). The survival of patients with ALI-A was not statistically different from that of patients with T2b tumors, regardless of tumor size (p = 0.85). Conversely, the survival of the patients with ALI-D did not statistically differ from those with T1a or T1b tumors (p = 0.77 and 0.42, respectively).Figure 1Figure 2

      Conclusion
      Interlobar fissure status clearly affected survival of the patients with ALI. ALI should be examined by elastic stains and only ALI-A should be classified as true ALI. We propose that ALI-A tumors ≤ 5 cm should be assigned to T2b but ALI-D tumors do not require adjustment of T descriptor.

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    P1.07 - Poster Session 1 - Surgery (ID 184)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P1.07-018 - Surgical Treatment for Super-elderly Patients ( over 85 years old ) with Lung Cancer (ID 1414)

      09:30 - 09:30  |  Author(s): I. Takeyoshi

      • Abstract

      Background
      It is by now widespread that surgical resection is standard curative treatment for lung cancer, however in super-elderly cancer patients (over 85 years old) there is no clear evidence of safety and efficacy of surgical approach. This study attempts to clarify the benefit of surgical treatment for them.

      Methods
      Between January 2002 and December 2012, among 1229 consecutively treated patients with primary lung cancer who underwent surgical resection, 29 patients (2.4%) were over 85 years old. Clinicopathological information on these patients was retrospectively reviewed and the surgical outcome was investigated.

      Results
      There were 21 men and 8 women, with a mean age of 86.5 years old (range, 85-91 years old). All patients were selected as operable candidates based on the results of routine staging procedures consisting of physical examination, blood chemistry, chest roentgenograms, bronchoscopy, computed tomography of the thorax, abdomen, MRI of brain, and radionuclide bone scanning. Indications for surgery included clinical stage I,II, or IIIA (except bulky N2 ) disease. The surgical procedure was lobectomy in 19 patients, sleeve lobectomy in 2 patients, segmentectomy in 1 patient, and wedge resection in 7 patients. Curative operation ratio was 75.9%. The median intraoperative blood loss and operative time were 96 ml and 165 min. There was no blood transfusion case in this series. Postoperative pathological stage was stage IA in 11 patients, IB in 8 patients, IIA in 1 patient, IIB in 5 patients, IIIA in 2 patients, IIIB in 1 patient. 25 patients (86%) were what is called limited disease. Histological diagnosis was adenocarcinoma in 14 (48.3%) patients, squamous cell carcinoma in 11(37.9%) patients, large cell neuroendocrine carcinoma (LCNEC) in 2 (6.9%) patients, large cell carcinoma in 1 (3.45%) patient, undifferentiated carcinoma in 1 (3.45%) patient. Patients presented postoperative complications in high rate. The complications recorded were delirium in 9 (31.0%) patients, respiratory failure 3 (10.3%) patients, acute renal failure in 2 (6.9%) patients, angina attack in 2 (6.9%) patients, atrial fibrillation in 1(3.5%) patient, cerebral infarction in 1 (3.5%) patient. Although surgical morbidity rate was 62.1%, surgical mortality rate was 0%. 14 patients died until now, 7 of them were recurrent death. Overall patient 1, 3, and 5 years survival rate were 100%, 68.5% and 38.6%, respectively. Postoperative hospital days were 19.5±7.51.　

      Conclusion
      Although surgical morbidity rate is high and postoperative hospital days is long, surgical results in this study are acceptable and support the value of surgical treatment in super-elderly patients with lung cancer.

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    P2.16 - Poster Session 2 - Other Thoracic Malignancies (ID 187)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P2.16-001 - Diagnosis and surgical resection of solitary pulmonary nodules in patients with breast cancer (ID 1266)

      09:30 - 09:30  |  Author(s): I. Takeyoshi

      • Abstract

      Background
      The differential diagnosis of solitary pulmonary nodules (SPNs) in patients with breast cancer is vital but difficult using radiological features. We assessed the nature of SPNs in these patients and the role of surgery in diagnosis and treatment.

      Methods
      Thirty consecutive patients who underwent surgery for an SPN between 2002 and 2011 after curative surgery for breast cancer were retrospectively evaluated.

      Results
      Most (93%) SPNs were malignant. Pathological diagnoses in patients with SPNs were primary lung cancer (n = 20, 67%), pulmonary metastasis from breast (n = 7, 23%) or colon (n = 1, 3%) cancer, and benign conditions (n = 2, 7%). Among the 20 patients with primary lung cancer, 15 (75%) had stage IA tumors (T1aN0M0). The average disease-free interval was significantly longer in patients with primary lung cancer than in those with pulmonary metastases from breast cancer (P = 0.031). The five-year survival rates after pulmonary resection for lung metastasis from breast cancer patients and primary lung cancer patients were 100 and 61.1%, respectively.

      Conclusion
      SPNs found in patients with breast cancer have a high probability of malignancy, especially primary lung adenocarcinoma. Early resection of SPNs in patients who were diagnosed with both primary and metastatic lung cancer led to a good prognosis. We suggest that early pathological diagnosis by surgical resection should be conducted for the early diagnosis and appropriate treatment of SPNs in patients with breast cancer.

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    P3.06 - Poster Session 3 - Prognostic and Predictive Biomarkers (ID 178)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P3.06-019 - MDM2 309T>G polymorphism and risk of lung cancer in a Japanese population (ID 1769)

      09:30 - 09:30  |  Author(s): I. Takeyoshi

      • Abstract

      Background
      The MDM2 protein plays an important role in regulating cell proliferation and apoptosis by interaction with multiple proteins including p53 and Rb. c.309 (rs2279744) polymorphism (T>G) in the MDM2 promoter has been shown to result in higher levels of MDM2 RNA and protein. In order to evaluate the association of the MDM2 309T>G polymorphism and lung cancer risk, we carried out a case-control study in a Japanese population.

      Methods
      The MDM2 genotypes were determined in 469 lung cancer patients and in 682 healthy control subjects using Smart Amplification Process (SmartAmp). Statistical adjustment was made for sex and age.

      Results
      The distribution of the MDM2 309T>G genotypes was not significantly different between control and overall lung cancer cases. Subgroup analysis of KRAS G to T transversion adenocarcinoma indicated that G/G genotype of SNP309 may be associated with lung cancer carcinogenesis (adjusted OR = 2.42 95% C.I. = 1.01-5.82 p = 0.05) compared to T/T + T/G genotypes. G/G genotype has lower-level exposure to cigarette smoke than T/T + T/G genotypes (p=0.03) among squamous cell lung cancer patients. There was however no effect of either polymorphism on age at diagnosis of lung cancer or on overall survival.

      Conclusion
      Our results indicate that the MDM2 309T>G polymorphism is not significantly associated with lung carcinogenesis but may be associated with smoking related cancer of the lung.

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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-036 - Postrecurrence survival of surgically resected pulmonary adenocarcinoma patients according to EGFR and KRAS mutation status (ID 2786)

      09:30 - 09:30  |  Author(s): I. Takeyoshi

      • Abstract

      Background
      The aim of this study was to clarify the prognosis of pulmonary adenocarcinoma patients after postoperative recurrence according to EGFR and KRAS mutations and recurrence site.

      Methods
      Between July 2002 and December 2011, a total of 297 consecutive patients underwent surgical resection for primary pulmonary adenocarcinoma. Among all the patients, we retrospectively evaluated 58 recurrent adenocarcinoma patients. They were divided into the groups according to presence of EGFR mutation and KRAS mutation, and compared clinicopathological features, recurrence sites and postrecurrence survival.

      Results
      EGFR, KRAS mutations were detected in 26 patients (45%), 11 patients (19%), respectively. Of the cases with EGFR mutations, L858R point mutation in exon 21 was most frequently observed in 18 cases, secondly deletion in exon 19 was in 8 cases. Initial recurrence was detected in distant in 25 (43%), local in 17 (29%), and both in 16 (28%). In EGFR mutant (EGFR+) cases, bilateral/contralateral lung recurrences were significantly frequently occurred. EGFR+ cases had significantly better outcome than KRAS+ cases and EGFR-KRAS- (Wild) cases. 2-year postrecurrence survival rate were 81%, 18%, and 47% in EGFR+, KRAS+, and Wild cases, respectively. Patients with distant organ recurrence (D+) showed significantly worse survival than those without distant recurrences in only Wild cases, but not significant in EGFR+ cases and entire cohort. Multivariate analysis revealed that only EGFR mutation and number of recurrent lesions were statistically significant independent postrecurrence prognostic factors. Figure 1Figure 2

      Conclusion
      Our results indicate there were distinct survival differences in recurrent adenocarcinoma patients according to driver mutations. Patients with EGFR mutated tumors could be expected of long survive regardless of presence of distant site recurrences, and patients with KRAS mutated adenocarcinoma had poor outcome after postoperative recurrence. The examination of driver mutations is essential for prediction of postrecurrence survival after surgical resection.