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S. Akata



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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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      P1.07-037 - Clinical characteristics of completely resected lung cancer with combined pulmonary fibrosis and emphysema (ID 2525)

      09:30 - 09:30  |  Author(s): S. Akata

      • Abstract

      Background
      The occurrence of both emphysema and pulmonary fibrosis in the same patient has received increased attention as the syndrome of combined pulmonary fibrosis and emphysema (CPFE). Patients with CPFE show severely impaired DLCO, hypoxemia at exercise, characteristic computed tomography (CT) imaging feature, and high probability of lung cancer. However, the clinical characteristics of lung cancer patients with CPFE are not well known. The aim of this study is to identify clinical characteristics of completely resected lung cancer with CPFE.

      Methods
      A total of 559 consecutive patients who underwent complete surgical resection for lung cancer from January 2008 through December 2010 were reviewed. Based on preoperative chest HRCT findings, patients were categorized into three groups: those with normal lung (N) (except for lung cancer), emphysema without pulmonary fibrosis (E), and CPFE. The HRCT inclusion criteria of CPFE is as follows; 1) Presence of emphysema, defined as well-demarcated areas of decreased attenuation in comparison with contiguous normal lung and marginated by a very thin or no wall, and/or multiple bullae with upper zone predominance. 2) Presence of a diffuse parenchymal lung disease with significant pulmonary fibrosis, defined as reticular opacities with peripheral and basal predominance, honeycombing, architectural distortion and/or traction bronchiectasis or bronchiolectasis. Chest HRCT scans were reviewed separately by two thoracic surgeons and one radiologist. The clinical characteristics of patients with CPFE were compared with those of the other groups.

      Results
      This study cohort included 328 (58.7%) patients in N group, 136 (24.8%) patients in E group, and 95 (17.0%) patient in CPFE group, with median age of 67 years. The 3-year survival rates were 68.4% in CPFE group, 80.2% in E group, and 89.7% in N group (p < 0.001). CPFE group found a positive correlation with each of the following factors compared to N and E groups; > 67 years (p = 0.004), lymph node metastases (p = 0.033), male gender (p < 0.001), tumor size > 3cm (p < 0.001), vascular invasion (p < 0.001), non-adenocarcinoma (p < 0.001), pleural invasion (p < 0.001), elevated preoperative serum CEA level (p < 0.001). The frequency of patients presenting grade 2 or more severe postoperative complication under CTCAE or Clavien-Dindo classification was 28.4% for CPFE group, 24.3% for E group, and 14.9% for N group (p = 0.004), and respiratory complication was higher for CPFE group (22.1%) than N group (5.8%) and E group (11.8%) (p < 0.001).

      Conclusion
      Resected lung cancer patients with CPFE had some different clinical characteristics in comparison with those with emphysema. Intensive postoperative management and a strict follow-up are required because of higher rate of postoperative complications and aggressive malignant behavior in CPFE patients.

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    P2.21 - Poster Session 2 - Diagnosis and Staging (ID 170)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P2.21-003 - The relationship between the type of bone metastasis and EGFR gene mutation in non-small cell lung cancer (ID 2177)

      09:30 - 09:30  |  Author(s): S. Akata

      • Abstract

      Background
      The bone is the most common distant site of metastasis in non-small cell lung cancer (NSCLC), and patients with bone metastasis have a markedly poor prognosis. There are three types of bone metastasis; such as osteolytic type, osteoblastic type, and mixed type. Assessment of bone metastatic type may be important as a part of therapeutic strategy because it has been noted that osteoblastic tumors would have lead to both a better prognosis and activating epidermal growth factor receptor (EGFR) mutation presence. The aim of this study was to examine the relationship between the type of bone metastasis and clinical characteristics including EGFR gene mutation status in NSCLC patients.

      Methods
      We reviewed the records of 85 unresectable or postoperative recurrent NSCLC patients with at least one site of bone metastasis. The type of bone metastasis was classified by two radiologists reviewing the radiological examination as osteolytic type (OL), osteoblastic type (OB), and mixed-type from the CT findings.

      Results
      Median follow-up time for survivors was 25.4 months. There were 53 (62%) patients with unresectable NSCLC and 32 (38%) patients with postoperative recurrent disease. The number of patients with adenocarcinoma is 75 (87%). The bone metastasis type was OL group in 39 (46%) patients, OB group in 37 (43%) patients, and mixed type in 9 (11%) patients. Survival analysis incorporating mixed type bone metastasis into OB group revealed median survival time of 20.3 months and 30.9 months for OL and OB group, respectively. The difference was not significant (p=0.314), but OB group seems to have better prognosis than OL group. The prevalence of activating EGFR gene mutation was marginally significance in OB group (58%) than in OL group (36%) (p = 0.052). There are no significant relationship between the type of bone metastasis, and sex and smoking history.

      Conclusion
      This study shows that evaluating the type of bone metastasis by CT image enable prediction of EGFR gene mutation status and prognosis in NSCLC patients with bone metastases separately from sex, smoking habit, and race. The presence of osteoblastic metastases or the evolution to metastases should always be noted since it might represent an important predictive factor of response to EGFR-TKI treatment.

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    P3.19 - Poster Session 3 - Imaging (ID 181)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P3.19-001 - Correlation between whole tumor size and solid component size on high-resolution computed tomography in the prediction of the degree of pathologic malignancy and the prognostic outcome in primary lung adenocarcinoma (ID 138)

      09:30 - 09:30  |  Author(s): S. Akata

      • Abstract

      Background
      It is known that in lung adenocarcinoma, ground glass nodule (GGN) tumors have a better prognosis than solid tumors. The aim of this study is to determine whether it is more useful to evaluate the whole tumor size or only the solid component size to predict the pathologic malignancy and the prognostic outcome in lung adenocarcinoma.

      Methods
      Using high-resolution computed tomography (HRCT) data of 232 patients with adenocarcinoma 7 cm or less who underwent curative resection, we retrospectively measured the whole tumor and solid component sizes with lung window setting (WTLW and SCLW) and whole tumor sizes with a mediastinal window setting (WTMW).

      Results
      There was significant correlation between the WTLW and the measurements of pathological specimens (r=0.792, P<0.0001). The SCLW and WTMW values significantly correlated with the area of pathologically confirmed invasion (r=0.762, P<0.0001 and r=0.771, P<0.0001, respectively). The receiver operating characteristics area under the curve for WTLW, SCLW and WTMW used to identify lymph node metastasis or lymphatic or vascular invasion were 0.693, 0.817 and 0.824, respectively. Kaplan-Meier curves of DFS and OS were better divided according to SCLW and WTMW, compared with WTLW. Multivariate analysis of DFS and OS revealed that WTMW was an independent prognostic factor (HR=0.72, 95%CI=0.58-0.90, P=0.004 and HR=0.74, 95%CI=0.57-0.96, P=0.022, respectively).

      Conclusion
      The predictive values of the solid tumor size visualized on HRCT especially in the mediastinal window for pathologic high-grade malignancy and prognosis in lung adenocarcinoma less than 7 cm were greater than those of whole tumor size.