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A.S. Farivar
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MO26 - Anatomical Pathology II (ID 129)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track: Pathology
- Presentations: 1
- Moderators:E. Brambilla, V.L. Capelozzi
- Coordinates: 10/30/2013, 10:30 - 12:00, Bayside 105, Level 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): A.S. Farivar
- Abstract
- Presentation
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.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.07 - Poster Session 1 - Surgery (ID 184)
- Event: WCLC 2013
- Type: Poster Session
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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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): A.S. Farivar
- 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
[a]p < 0.05 vs. LPAAIS (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%) 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.
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P2.07 - Poster Session 2 - Surgery (ID 190)
- Event: WCLC 2013
- Type: Poster Session
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P2.07-035 - Comparison of Cancer-Specific Outcomes between Open and Minimally Invasive Surgery (MIS) Lobectomy for Early Stage Non-Small-Cell Lung Cancer (NSCLC) (ID 2945)
09:30 - 09:30 | Author(s): A.S. Farivar
- Abstract
Background
The optimal surgical approach for early stage NSCLC continues to be debated. Nodal upstaging could be a surrogate measure for the quality of surgery and may help define superiority of a particular approach. However, nodal upstaging is only one measure of oncologic equivalence and may not translate into cancer recurrence or survival. Additionally, recent publications focusing on oncologic equivalence have compared approaches from different time periods. This study compares nodal upstaging, recurrence rates, disease-free and overall survival between matched groups of open and MIS (VATS/Robotic) lobectomy performed concurrently in a single time period.Methods
We retrospectively compared patients undergoing lobectomy via thoracotomy to MIS for primary, clinical stage I/II NSCLC from 01/04-05/11. Patients were matched for age, gender, comorbidities, PFTs and clinical TNM status.Results
Two hundred and fourteen patients were evaluated with 107 in each group. Preoperatively the MIS group had more T1a tumors (Table). The rate of nodal upstaging was significantly higher in the open group compared to the MIS group [N0 to N1: 12% (13) vs 4% (4), p=0.02; N0 to N2: 7% (7) vs 1% (1), p=0.03]. At median follow-up of 38 and 33 months respectively, recurrence rates for open vs MIS were similar: local 4% (4) vs 2% (2), regional 8% (9) vs 3% (3) and distant 13% (14) vs 12% (13), p=0.23. Disease-free survival was 74% (79) and 83% (88) for open and MIS groups respectively at 36 and 28 months, p=0.14. Overall 2 year survival was 89% (95) for the open group and 91% (97) for the MIS group, p=0.65.Characteristics of open versus MIS groups
OPEN (N=107) MIS (N=107) p-Value Age (median) 69 68 0.574 Female 63 (59%) 71 (66%) 0.260 Smoker 82 (77%) 84 (79%) 0.340 # Comorbidities (median) 1 1 0.589 FEV1% (median) 83 85 0.835 DLCO/VA% (median) 79 83 0.700 Investigations PET Scan 93 (87%) 103 (96%) 0.264 Mediastinoscopy 78 (73%) 85 (79%) 0.264 Clinical Stage 0.150 IA 73 (68%) 82 (77%) IB 33 (31%) 24 (22%) IIA 1 (1%) 1 (1%) Pathologic Stage <0.001 IA 38 (36%) 68 (63%) IB 41 (38%) 32 (30%) IIA 16 (15%) 3 (3%) IIB 2 (2%) 1 (1%) IIIA 9 (8%) 3 (3%) IV 1 (1%) 0 Pathologic T size (cm) (median) 2.8 2.1 0.003 Pathologic N0 status 87 (81%) 102 (95%) 0.001 Conclusion
In the same time period, nodal upstaging after open lobectomy for early stage NSCLC was significantly higher compared to MIS. However, there were no differences in local, regional or distant recurrence rates. Disease-free and overall survival was equivalent at median follow up of 38 months despite the difference in upstaging rates.
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P3.07 - Poster Session 3 - Surgery (ID 193)
- Event: WCLC 2013
- Type: Poster Session
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P3.07-018 - <strong>Assessing Survival and Grading the Severity of Complications in Octogenarians Undergoing Pulmonary Lobectomy</strong> (ID 1685)
09:30 - 09:30 | Author(s): A.S. Farivar
- Abstract
Background
Previous papers have demonstrated that pulmonary lobectomy on octogenarians is safe and feasible. However, there is little data characterizing the survival or the severity of complications in these frail patients after lobectomy. Therefore we reviewed our experience with patients aged eighty and above undergoing lobectomy.Methods
We performed a retrospective review of consecutive patients aged 80 or above that underwent lobectomy between 2004 and 2012. Chart reviews were performed evaluating comorbidities, clinical stage, perioperative and postoperative course, time to recurrence, and date and cause of death. All complications were graded per the Seely Thoracic Surgery morbidity and mortality classification schema.Results
45 patients (mean 82.2 years) underwent lobectomy. PFTs averaged 86% predicted for FEV1. Pathologic stage IA comprised 26% (10 of 39) of our patients; IB 33%(13), IIA 8% (3), IIB 8% (3), IIIA 18% (7), IIIB 3% (1), and IV 5% (2). Of the 45 patients, 28 had complications (60%), but only 18% (8 of 45) were significantly morbid to the patient (grade IIIB or above). Perioperative mortality was 2% (1 of 45). The most common complication was arrhythmia. Median LOS was 6 days for thoracotomy patients, 5.5 days for VATS patients, and 4.5 days for robot. 78% were discharged home, and 16% were readmitted to hospital within thirty days. Six patients had recurrent disease that occurred at an average of 768 days. 50% of our patients are still alive. Only three of the seven known causes of death were from metastatic disease. Five year actuarial survival was 52.3%. Mean survival was 53 months, and median survival was 72 months.Complications Separated by Grade
Grade Definition Example Incidence Grade I Clinically Insignificant Asymptomatic vocal cord paralysis, urinary retention 4% (2 of 45) Grade II Medical Therapy Only AFib, esophagitis, new home O2 26.7% (12 of 45) Grade IIIA Interventions not requiring anesthesia Percutaneous pleural catheters 13.3% (6 of 45) Grade IIIB Interventions requiring anesthesia Return to OR 8.8% (4 of 45) Grade IV Critical illness, reintubation, organ failure MI, PNA, chyle leak 6.7% (3 of 45) Grade V Death 2.2% (1 of 45) Conclusion
Lobectomy on carefully selected octogenarians can be done safely regardless of approach with a low mortality. 60% experienced a complication but when graded in a validated system only 18% were considered significant.
