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T. Koike



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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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      P1.07-034 - Number of Metastatic Lymph Nodes and Metastatic Lymph Node Ratio Predict Patient Survival in Resected Non-small Cell Lung Cancer (ID 2265)

      09:30 - 09:30  |  Author(s): T. Koike

      • Abstract

      Background
      The non-small cell lung cancer TNM classification system uses the anatomic extent of lymph node (LN) metastases to define the N category. However, the TNM classification system for breast, gastric, and colorectal cancer has been updated to include number of metastatic lymph nodes (MLNs) in the N staging. In these cancers, the number of MLNs has been shown to be a more effective prognostic factor than the anatomic location of MLNs. Moreover, it has been suggested the ratio of MLNs to total number of LNs examined (lymph node ratio [LNR]) in breast, bladder, gastric, and colorectal cancer is a better prognostic factor. Here, we evaluated the effect of these factors on the disease-free-survival (DFS) of non-small cell lung cancer.

      Methods
      We retrospectively reviewed 428 patients who underwent with pathological examination of resected LNs from 2001 through 2010. The prognostic value of number of MLNs, LNR, or current pN classification was assessed using a multivariate Cox proportional hazards model for DFS, with sex, age, smoking history, tumor size, histology, histological grade. The number of MLNs and LNR were analyzed as a categorical variable, and the patients were divided into 4 groups by the number of MLNs (n[0]: no MLNs, n[1-3]: 1-3 MLNs, n[4-6]: 4-6 MLNs, and n[≧7]: 7 or more MLNs), or by the LNR (n[none]: 0%, n[low]: 1%-9%, n[moderate]: 10-24%, and n[high]: 25% or higher).

      Results
      At least one nodal metastasis was found in 100 patients (23%), represented by n[0] in 328 cases, n[1-3 ]in 77 cases, n[4-6] in 15 cases, and n[≧7] in 8 cases. By the LNR, 328, 55, 25, and 20 cases were assigned to n[none], n[low], n[moderate], and n[high] groups, respectively. The 5-year DFS rate of n[0], n[1-3], n[4-6], and n[≧7] groups were 83%, 48%, 24%, and 0%, respectively, and the 5-year DFS rate of n[none], n[low], n[moderate], and n[high] groups were 83%, 51%, 38%, and 9%, respectively. Multivariate analysis showed the number of MLNs and LNR were significant independent prognostic factor, equal to the current pN classification. Hazard ratios for pN1 and pN2 with respect to pN0 were 2.07 and 5.04. In contrast, hazard ratios were 2.70, 4.03, and 14.7 for n[1-3], n[4-6], and n[≧7] with respect to n[0]; and 2.16, 3.62, and 9.95 for, n[low], n[moderate], and n[high] with respect to n[none].

      Conclusion
      The number of MLN and LNR are strong independent prognostic factor in non-small cell lung cancer. They may add new information to the pN categories of the current TNM classification.

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    P2.07 - Poster Session 2 - Surgery (ID 190)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P2.07-019 - Postoperative Outcome of Patients with Pulmonary Large-cell Neuroendocrine Carcinoma (ID 1725)

      09:30 - 09:30  |  Author(s): T. Koike

      • Abstract

      Background
      Although large-cell neuroendocrine carcinoma (LCNEC) was categorized as a variant of large cell carcinoma on the WHO histologic classification of lung carcinomas, the clinical and biological features of LCNEC resemble those of small cell lung carcinoma. Therefore, there is no consensus on the treatment strategy for LCNEC, and an indication of surgical treatment for LCNEC is still controversial. Even though preoperative accurate diagnosis of LCNEC is difficult, the aim of this study was investigating patients with pulmonary LCNEC in whom better postoperative outcome is expected.

      Methods
      We retrospectively reviewed patients with pulmonary LCNEC on permanent pathologic diagnosis who underwent pulmonary resection at the 3 institutions between 1999 and 2011. We reviewed the medical records of each patient for demographic, clinical, and pathologic data including age, sex, smoking status, preoperative serum CEA, radiologic tumor size, c-stage, surgical procedure, extent of lymphadenectomy, p-stage, lymph node metastasis, visceral pleural invasion, lymphatic permeation, vascular invasion, and adjuvant chemotherapy. Disease-free survival (DFS) was calculated using the Kaplan-Meier method, and factors associated with DFS were analyzed with the log-rank test.

      Results
      Of the 18 patients eligible for this study, 14 were male and 4 were female. The median age was 74 years (range, 53 to 85). According to the current TNM classification, 12 patients had c-stage I disease, 4 had c-stage II disease, and 2 had c-stage IIIA disease. The majority of patients (13 patients, 72%) underwent lobectomy, 1 underwent pneumonectomy, 1 underwent bilobectomy, and 3 underwent wedge resection. On pathologic diagnosis, 8 patients had p-stage I disease, 5 had p-stage II disease, and 5 had p-stage IIIA disease. Following surgical treatment, cisplatin-based adjuvant chemotherapy was applied for 3 patients. The 1-year and 2-year DFS were 39% and 39%, respectively, with the median follow-up period of 9 months (range, 2 to 80). During the follow-up period, 10 patients (56%) developed recurrence, and the recurrence was identified within the first year post-resection in all the 10 patients. By the log-rank test, smoking status (non- or former, vs. current) and surgical procedure (lobectomy or greater, vs. limited resection) were identified as significant factors associated with DFS.Figure 1

      Conclusion
      Of patients with pulmonary LCNEC undergoing surgical treatment, a long-term prognosis might be expected if no recurrence is identified within the first year post-resection. If diagnosis of LCNEC is preoperatively obtained, surgical treatment is recommended for patients without current smoking status, and lobectomy or greater resection should be the surgical procedure of first choice.