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P. Hsu



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    P1.12 - Poster Session 1 - NSCLC Early Stage (ID 203)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.12-008 - The effects of different preoperative brain survey strategy on the pathological stage I non-small cell lung cancer patients (ID 1396)

      09:30 - 09:30  |  Author(s): P. Hsu

      • Abstract

      Background
      Brain metastasis is rare in pathological stage I non-small cell lung cancer (NSCLC). Brain magnetic resonance imaging (MR) should discover more synchronous asymptomatic brain metastasis than computed tomography (CT), but the efficacy of brain MR in pathological stage I NSCLC is not yet determined. This study aimed to investigate the effect of different strategies for preoperative brain imaging survey of pathological stage I NSCLC underwent complete resection.

      Methods
      The clinicopathological characteristics of 870 patients underwent complete resection of stage I NSCLC at Taipei Veterans General Hospital between Jan. 2002 and Dec. 2011 were retrospectively reviewed. The patients were divided into three groups according to pre-operative brain survey strategy (no imaging study, CT, or MR). Multivariate analysis for survival was done.

      Results
      In total 870 patients, 446 patients with no brain imaging study, 304 had brain CT and 120 had brain MR. Median age was 65±11.36. Average tumor size was 2.2±1.07, 2.8±1.16 and 2.4±1.01 centimeters in the three groups, respectively. 238, 103 and 544 patients were pathological T1a, T1b and T2a, respectively. Adenocarcinoma was identified in 716(82.3%) patients, while 94(10.8%) had squamous cell carcinoma. With median follow up time of 42.3 months, 21 (2.4%) brain metastases in 870 patients after complete resection were identified, with 7(1.5%), 10(3.3%) and 4(3.3%) patients in each group, respectively (p = 0.027). Within the first year and the second year follow-up, 2 and 11 brain metastases were noted, respectively. In subgroup analysis, 3 patients with brain metastases had pathological T1a, 1 had T1b, and 17 had T2a. The overall 5-year survivals were 76.9%, 72.0% and 85.4% in non-imaging, CT and MR group, respectively (p = 0.014). Disease free survival of each group were 84.1%, 84.0% and 83.4% (p = 0.167). Under multivariate analysis adjusted with age, gender, T stage, pathohistological grading, pleural invasion status and whether patient receiving whole body PET/CT, there were 3 factors associated with poorer survival: age, male sex and T stage. Brain survey strategy did not affect survival in multivariate analysis. Figure 1

      Conclusion
      Preoperative brain MR survey did not have a less frequent rate of brain metastasis comparing with non-imaging and brain CT strategy, nor a better survival in pathological stage I NSCLC patients. Use brain MR in preoperative staging routinely in clinical stage I patients should be reconsidered, especially in NSCLC with smaller tumor size.

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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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      P3.07-013 - Chylothorax Complicating Video-assisted Thoracoscopic Pulmonary Resection in Non-small Cell Lung Cancer (ID 1392)

      09:30 - 09:30  |  Author(s): P. Hsu

      • Abstract

      Background
      Chylothorax complicating pulmonary resection (CCPR) is an infrequent but well-known complication in lung cancer surgery. Previous published studies on this topic were limited and standard thoracotomy for pulmonary resection (STPR) was the surgical approach. Video-assisted thoracoscopic pulmonary resection (VATPR) has become prevalent in the lung cancer surgery nowadays. The purpose of this study is to analyze the clinical data of CCPR after VATPR and evaluate their outcome after treatment.

      Methods
      Between January 2010 and May 2013, we retrospectively reviewed 728 primary non-small cell lung cancer patients who undergone VATPR and mediastinal lymph node dissection (MLND) in our institute. CCPR were noted in 18 patients (2.47%) who constitute the subjects of our study. We initially treated these patients conservatively with oral intake cessation and parenteral nutrition. If conservative treatment failed, reoperation with video-assisted thoracic surgery (VATS) for thoracic duct ligation would be performed. Daily pleural drainage amount, timing of surgical intervention, and treatment responses were recorded and investigated. The data collected were compared to other studies in which STPR was the main operative method.

      Results
      Among the 18 CCPR cases, all of them were adenocarcinoma on the right side of lung. Thirteen of patients received conservative treatment and 5 patients received reoperation for CCPR. All of them were successfully treated with cessation of CCPR without mortality. The average pleural drainage amounts per day in conservative treatment group and reoperation group were 206 ml and 433 ml. The presented study suggests that CCPR with pleural drainage amount less than 400 ml in the first postoperative day will subsided after conservative treatment. CCPR with pleural drainage amount more than 400 ml in the first or second postoperative day can also resolve if drainage amount below 400 ml was seen in the postoperative day 4 and thereafter. Reoperations would be undertaken for CCPR in cases with increasing amount of pleural drainage in the postoperative 4 after conservative treatment.

      Conclusion
      chylothorax, video-assisted thoracoscopic pulmonary resectionVATPR did not incur more CCPR than did STPR in NSCLC surgery. The average pleural drainage amount of CCPR in reoperation cases was less in our study than that in other studies. The timing of surgical intervention for CCPR following VATPR can be earlier if pleural drainage didn’t show trend of decrease after conservative treatment. Figure 1

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    P3.12 - Poster Session 3 - NSCLC Early Stage (ID 206)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.12-025 - Survival in octogenarians with pathological stage I non-small cell lung cancer patients underwent complete resection (ID 3319)

      09:30 - 09:30  |  Author(s): P. Hsu

      • Abstract

      Background
      For patients older than 80 years old, surgical treatments for resectable lung cancer were usually to a limited extent, or even not considered. Few studies evaluated the true effect of surgery for these patients. The aim of this study is to compare the survival between the octogenarians and younger patients with pathological stage I non-small cell lung cncer (NSCLC) underwent complete resection using multivariate analysis.

      Methods
      The clinicopathological characteristics of 870 patients underwent complete resection of stage I NSCLC between Jan. 2002 and Dec. 2011 were retrospectively reviewed. The patients were categorized as octogenarians (aged 80~90) or younger (aged < 80). Survival under multivariate analysis was examined.

      Results
      76 (8.7%) octogenarians were indentified in the 870 patients, average age was 82.4±2.5 years old. The 794 younger patients had average age of 63.0±10.4. Pulomany function test including forced expiratory volume in one second (FEV~1~) and FEV~1~/ forced vital capacity (FVC) were 1.80±0.44 L and 70.5±11.7 % in the elder group, and were 2.23±0.59 L and 76.3±9.9% in the younger patients (p < 0.001). There were 44 (57.9%) lobectomies and 32(42.1%) sublobar resections performed for the octogenarians, while 689 (86.8%) lobectomies and 94(11.8%) wedge resections/segementectomies were done for the younger patients (p < 0.001). Average tumor size was 2.6±1.15 cm and 2.4±1.12 cm, respectively (p = 0.076). Five surgical mortalities were found, 2 (2.63%) were in the elder group and 3 (0.37%) were in the younger group. The overall 5-year survivals of the two groups were 64.9% and 76.9%, respectively (p = 0.015). Under multivariate analysis, male sex, extension of resecion, FEV~1~ and tumor T-status associated with poorer survival. Older than 80 years old didn’t associated with difference in survival (p = 0.911). Figure 1

      Conclusion
      Octogenarians with pathological stage I NSCLC underwent complete surgical resection had similar survival with their younger counterparts. Although they usually had poorer lung function, thus received more wedge resections or segmentectomies, aggressively performing surgical resectionon the elder ones would have similar benefits as on the younger ones.