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S. Deen



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    MO26 - Anatomical Pathology II (ID 129)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Pathology
    • Presentations: 1
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      MO26.01 - Comparison of outcomes for patients with “Bronchioloalveolar Carcinoma (BAC)” defined by the IASLC classification versus the AJCC staging system (ID 3414)

      10:30 - 10:35  |  Author(s): S. Deen

      • Abstract
      • Presentation
      • Slides

      Background
      Integration of the proposed IASLC classification of adenocarcinomas (ACA) into TNM staging has been challenging for pathologists. Until recently, at Swedish, we staged patients per the AJCC staging and separately described lesions with a BAC component placing them into 3 groups based on the percent of ACA invasion. But, we found this was not a good predictor of survival. We aimed to more clearly define this population by comparing patients reclassified according to the proposed IASLC classification and the AJCC 7[th] edition staging to determine if they could be integrated as a single staging system.

      Methods
      We retrospectively reviewed patients with BAC from 2000-2012 and classified them according to the IASLC classification as ACA in situ (AIS), minimally invasive ACA (MIA) or lepidic predominant ACA (LPA) and according to the AJCC 7[th] edition staging (stage I, II or III). We then reclassified these patients separating AIS and MIA as stage 0 in the AJCC 7[th] edition staging.

      Results
      We evaluated 145 consecutive patients with a median follow-up of 30 months. Using IASLC [AIS (N=23), MIA (N=18), LPA (N=104)]; local recurrence rates were: AIS (4%), MIA (11%) and LPA (2%). Regional (8%) and distant (10%) recurrences were only with LPA. Disease-free survival in patients with AIS (96%) and MIA (89%) was higher versus patients with LPA (80%). Five year cancer-specific survival was 100% for patients with AIS and MIA while it was 84% for LPA patients. Using AJCC 7[th] edition [I (N=125), II (N=12), III (N=8)]; recurrence rates were local: stage I (3%), stage III (13%). Regional: stage I (5%), stage II (8%), stage III (13%); and distant: stage I (6%), stage II (17%), stage III (13%). Stage I disease-free survival was 86%, stage II 75% and stage III 61%. Five year cancer-specific survival was stage I 90%, stage II 81% and stage III 60%. Separating AIS and MIA as stage 0 [0 (N=42), I (N=84), II (N=11), III (N=8)]; local recurrence rates were: stage 0 (7%), stage I (1%), stage III (13%). Regional: stage I (7%), stage II (9%), stage III (13%); and distant: stage I (10%), stage II (18%), stage III (13%). Disease-free survival was higher in stage 0 (93%) compared to stage I (82%), stage II (73%) and stage III (61%). Five year cancer-specific survival was 100% for stage 0, while it was lower for stage I 84%, stage II 80%, and stage III 60%, p<0.05.

      Conclusion
      The IASLC/ATS/ESR classification system appears to better discriminate patients with BAC compared to current AJCC staging. The results also suggest that patients with AIS and MIA may be classified as stage 0 in the AJCC staging system based on favorable outcomes and survival.

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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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      P1.07-041 - Characteristics of a North American Patient Population with the Diagnosis of "Bronchioloalveolar Carcinoma (BAC)" (ID 3001)

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

      • Abstract

      Background
      A body of literature exists describing the evolution of BAC from a subtype of adenocarcinoma of the lung to the currently proposed classification where it is further categorized as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) or lepidic predominant adenocarcinoma (LPA) based on the size of the invasive component of the lesion. The majority of these studies, however, were conducted with Asian populations and very few non-Asian studies on BAC have been published. Our aim was to describe the characteristics of North American patients with BAC, review the management and determine the influence of the epidemiologic difference.

      Methods
      We retrospectively reviewed all patients with a diagnosis of BAC or adenocarcinoma with BAC features on pathology from February 2000 to June 2012. Patients were categorized according to the IASLC/ATS/ESR classification into those with AIS, MIA or LPA based on the dominant lesion resected. Patients with mucinous BAC were excluded (n=7).

      Results
      One hundred and forty four patients were evaluated: AIS (23), MIA (18) and LPA (103). Patient demographics were similar between the groups with over 75% being of non-Asian ethnicity. More patients with AIS and MIA were clinical stage IA (table). Lobectomy was performed at comparable frequencies for AIS (48%) and MIA (53%), though it was the predominant resection approach for LPA (70%). The median size of the resected lesion in patients with AIS (1.5cm) and MIA (1.3cm) was significantly smaller than those with LPA (2.5cm), p<0.001. Patients with AIS and MIA had no clinical or pathological nodal involvement, whereas 12% of patients with LPA were found to have positive nodes (pN1: 6%, pN2: 6%). At a median follow-up of 30 months, recurrence rates were – local: AIS 4%, MIA 11% and LPA 2%; regional: LPA 8%; and distant: LPA 10%. Disease-free survival was significantly higher in the AIS (96%) and MIA (89%) groups versus the LPA group (80%). Five year cancer-specific survival was 100% for patients with AIS and MIA dropping to 84% for patients with LPA.

      Comparative characteristics between AIS, MIA and LPA
      AIS (N=23) MIA (N=18) LPA (N=103)
      Age (median) 68 68 69
      Female 19 (83%) 15 (83%) 77 (75%)
      Non-Asian 19 (83%) 14 (78%) 92 (89%)
      Smoker 16 (70%) 13 (72%) 81 (79%)
      # Comorbidities (median) 1 1 1
      FEV1% (median) 91 89 86
      DLCO/VA% (median) 94 [a] 104 [a] 82
      Clinical Stage
      IA 19 (83%) 16 (89%) 70 (68%)
      IB 4 (17%) 2 (11%) 29 (28%)
      IIA 0 0 3 (3%)
      IIB 0 0 1 (1%)
      Pathologic Stage
      IA 23 (100%) 18 (100%) 53 (51%)
      IB 0 0 31 (30%)
      IIA 0 0 7 (7%)
      IIB 0 0 4 (4%)
      IIIA 0 0 8 (8%)
      [a]p < 0.05 vs. LPA

      Conclusion
      Patients with AIS and MIA have favorable outcomes reflected by the absence of nodal metastases and a 100% 5 year cancer-specific survival compared to patients with LPA. The results of this North American population are consistent with those of published reports based on Asian populations.