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I. López Sanz



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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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      P1.12-014 - Lymph node disection and mediastinal recurrence in early stage nsclc (ID 2192)

      09:30 - 09:30  |  Author(s): I. López Sanz

      • Abstract

      Background
      The aim of this paper was to evaluate survival according to tumor size, and the extent of mediastinal lymphadenectomy. Besides, we analyzed if a more extensive lymphadenectomy, based on the number of lymph nodes (LN) obtained, improves survival in early stages.

      Methods
      Retrospective review of 620 consecutive early stage NSCLC patients operated between 1995 and 2008. None of the patients underwent neoadyuvant treatment. T1 and T2 patients were divided in two subgroups, according to the number of LN resected (0-5, 6-10, ³11).

      Results
      We analyzed a total of 8.484 LN resected and an average of 13.68 (0-48). The majority of patients were male (86%) with a mean age of 65 (33-84). Mean follow-up was 52.6 months. Mean time to relapse was 28.6 months. SCC was the commonest histology (47.4%). Lobectomy was the commonest resection (81.6%) and 56.3% of the patients were staged as T2N0. 5-year overall survival was 53%. Mean survival according to size was 9.9 and 5.6 years (T1 and T2 respectively). In-hospital mortality was 2.7%. Mean survival according to N factor was 6.3 and 4.1 years (N0 and N1 respectively). 67% of the patients had mediastinal recurrence. The number of positive LN increased with the number of LN removed (26.4% vs 9.3% and 10.5%;p <0.001). The analysis showed that patients with more LN resected tend to have better survival (7.5 years, 7.8 years and 8 years; p=0.21). Data were similar if when analyzing LN resected from N2 stations. Survival was significantly worse in the group with positive LN (8.1 vs 2 years). The group with more N2 LN resected had significantly less mediastinal recurrence (16.3%, 9.2% vs 5.9%; p<0.002).

      MEDIASTINAL RECURRENCE
      RESECTED LYMPH NODES NO YES
      0-5 (N= 458) 190 (83,7%) 37 (16,3%)
      6-10 (N = 152) 187 (90,8%) 19 (9,2%)
      ³11 (N=174) 176 (94,1%) 11 (5,9%)

      Conclusion
      The probability of finding some positive mediastinal lymph node increases with a more extensive lymphadenectomy. A complete mediastinal lymphadenectomy provides a better staging and decreases mediastinal recurrence. A complete lymphadenectomy should be performed in all lung cancer patients to achieve a correct staging and a better survival, even in those with an early stage.

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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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      P3.07-027 - Risk factors and outcome of pneumonectomy in lung cancer patients (ID 2197)

      09:30 - 09:30  |  Author(s): I. López Sanz

      • Abstract

      Background
      The purpose of the study was to evaluate complications, risk factors and outcome of pneumonectomy for the surgical treatment of lung cancer patients.

      Methods
      We reviewed retrospectively the hospital records of 64 consecutive patients who underwent a pneumonectomy between January 2007 and December 2012. The majority were male (87, 5%), with a mean age of 63, 7 years (r: 38-80). Comorbidities and complications was assessed. Mean follow up was 22, 8 months.

      Results
      The number of left pneumonectomies was slightly higher (62.5%) than the right ones. Most of the patients were diagnosed of squamous cell carcinoma (57, 1%). 24 patients (37.5%) had N2 disease. Twenty-eight patients (44.4%) were treated with neoadjuvant chemotherapy and 6 (9.4%) with concomitant radiotherapy. Mean VEF1 was 74% (r: 38-125). Diabetes, hypertension and smoking were not significant risk factors. Four patients (6.3%) died within 30 days of surgery. Atrial fibrillation appeared in 9 patients (14%), major pulmonary complications in 4 (6.3%). Late bronchopleural fistula appeared in 4 patients (6, 3%) and the presence of brochopleural fistula was not related to an increase in mortality (p=0. 78). Mean overall survival was 38 months (1-year 72%, 3-years 50% and 5-years 24.7%). Mean survival was higher for a right pneumonectomy (31 vs 38 months). Survival according to size was T1: 33.3 months, T2: 46.3 months, T3: 28.1 months and T4 15.7 months. There was no difference between TNM stage, histological type, neoadjuvant or adjuvant treatment in survival. Survival was lower in patients who underwent chest wall resection (37.4 vs 9.9 months, p=0.035). Body mass index, diabetes, hypertension and arrhythmia didn´t show differences in overall survival.

      Conclusion
      The side of the pneumonectomy was not related to mortality. Bronchopleural fistula, hypertension and diabetes and arrhythmia were not related to an increase in mortality.

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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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      P3.12-011 - Survival in resectable T1 and T2 stage non-small cell lung cancer (ID 2184)

      09:30 - 09:30  |  Author(s): I. López Sanz

      • Abstract

      Background
      The aim of this paper is to review the pulmonary resections for NSCLC and analyze its survival related to the tumor size (T1 and T2), lymph nodes (LN) removed and mediastinal relapse of the disease.

      Methods
      We made a retrospective review of mayor lung resections performed consecutively for T1 and T2 NSCLC at the Vall d'Hebron University Hospital, from October 1995 to December 2011. Mean follow-up was 50 months.

      Results
      We analyzed 755 patients, 646 men (85.5%) with a mean age of 64 years (r: 21-84). The most common histology was squamous cell carcinoma SCC (45%) followed by adenocarcinoma (35%). There were 595 lobectomies, 119 pneumonectomies and 41 bilobectomies. The number of LN removed was directly proportional to the number of positive nodes (p = <0.001). We found significantly more positive nodes in T2 patients (p<0.001). The stages were IA: 152 patients (20%), IB: 348 patients (46%), IIA: 24 patients (3%), IIB: 99 patients (13%), IIIA: 113 patients (15%) and IV: 18 patients (2%). 193 patients (25.6%) were classified as T1 and 562 patients (74.4%) as T2. In the last follow-up 377 patients (49.9%) were dead. In-hospital mortality was 2.9%. 73 patients (12.2%) had mediastinal LN recurrence. Mean time between surgery and relapse was 27 months. Mean overall survival was 7.6 years (1-year: 85%, 3-year: 65%, 5-year: 51%). Mean survival according to size was, T1: 9 years, T2: 7 years (p = 0.006), and to LN was N0: 8.3 years, N1: 6.9 years, N2: 4.9 years. Overall survival was 3.8 years for those who had a recurrence and 8.7 years for those who not (p<0.001).

      Conclusion
      In our series, SCC remains the most common type. The mean overall 5-year survival was 51%, significantly affected by the size of the tumor, mediastinal nodal involvement and the presence of recurrence.