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T. Fukui



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    O29 - Cancer Control & Epidemiology IV (ID 132)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      O29.05 - Prognostic Impact of the Tumor Size Eliminating the Ground Glass Opacity Component: Modified Clinical T Descriptors of the TNM Classification of Lung Cancer (ID 751)

      11:15 - 11:25  |  Author(s): T. Fukui

      • Abstract
      • Presentation
      • Slides

      Background
      The presence of ground glass opacity (GGO) on high-resolution computed tomography (HRCT) is well known to be pathologically closely associated with adenocarcinoma in situ. Recently, measuring the tumor diameter including areas of GGO on HRCT has been reported to possibly overestimate the T status. The purpose of this study was to evaluate the significance of the tumor size measured eliminating the area of GGO on HRCT as a prognostic factor and to propose a refined TNM classification based on modified T descriptors.

      Methods
      Four hundred and seventy-five patients with clinical T1a-T2bN0M0 non-small cell lung cancer underwent surgical resection. All tumors were reclassified based on the diameter measured eliminating the GGO area on HRCT according to the 7th TNM classification of lung cancer. We defined this new classification as modified T descriptors categorized into four groups: mTis+T1a, mT1b, mT2a and mT2b. The overall survival rates of the patients in the current and modified staging groups were evaluated.

      Results
      The 5-year survival rates were 88% and 82% in the patients with T1a and T1b tumors and 90% and 75% in the patients with mTis+T1a and mT1b tumors, respectively. The differences in the survival of the patients classified using mTis+T1a and the other modified T descriptors were more clearly separated statistically than those of the patients classified using the current T1a and other T descriptors.

      Conclusion
      The use of clinically modified T descriptors of the tumor size measured eliminating the GGO component on HRCT may more clearly classify the prognoses of patients with early lung cancer.

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    P1.16 - Poster Session 1 - Other Thoracic Malignancies (ID 186)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P1.16-002 - Histological impact of primary tumor on indication of repeated pulmonary metastasectomy (ID 1346)

      09:30 - 09:30  |  Author(s): T. Fukui

      • Abstract

      Background
      Lung is one of the most common metastatic sites from malignances. Although efficacy of pulmonary metastasectomy (PM) has been reported recently, the prevalence has not been enough among thoracic surgeons. Moreover, beneficial effects of repeated PMs for longer survivals have been poorly evaluated. The aims of this study are to examine the efficacy of repeated PMs (Re-PM) for re-recurred diseases and evaluate the histological impact of the primary tumor on the treatment.

      Methods
      We retrospectively reviewed 263 patients who underwent PMs for various malignancies from 1996 through 2011. These factors below were evaluated; age, gender, origin of primary tumors, disease free interval (DFI) to the first PM, surgical procedure of PM, number of resected tumors, frequency of PMs, DFI after the first PM, overall survival after the first PM and prognosis.

      Results
      Among 263 patients, 166 were male, and 98 were female. The median age was 60　years old (range: 7-85). Origins of primary tumors were following; 91 colorectum, 54 bone and soft tissue, 22 head and neck, 20 adnexa uteri, 17 urinary tract, 14 testis (germ cell tumor), 45 others. Mean number of resected nodules at the first PM was one, and the maximum was 19. Wedge resections were performed most frequently in 159 patients (60%), lobectomies in 69 (26%), segmentectomies in 32 (12%), and bilobectomies in 5 (2%). Re-PMs were indicated in 47 patients (18%). Among them, while the prevalence of Re-PM was 20% (18/91) in colorectal cancer patients, that is as high as 37% (20/54) in bone and soft tissue sarcoma patients. Estimated five-year survival rate of the whole patients was 50.6%. And that of patients without recurrence, with Re-PM and without Re-PM were 92.9, 58.5 and 14.5%, respectively. In univariate analyses, sublober resection of the first PM, DFI and presence of complete resection at the first PM were significant favorable factors for overall survival. In the multivariate analysis, sublober resection and presence of complete resection at the first PM were revealed to be the independent prognostic factors.

      Conclusion
      The large portion of Re-PM patients had colorectal cancer, or bone and soft tissue sarcoma as their primary tumor. Re-PM may improve the survival of selected patients who experienced re-recurrence in lung after PM. Primary tumor of bone and soft tissue sarcoma were the most applicable histology for Re-PM.

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    P2.19 - Poster Session 2 - Imaging (ID 180)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P2.19-010 - The association between baseline clinical-radiological characteristics and growth of pulmonary nodules with ground-glass opacity (ID 1729)

      09:30 - 09:30  |  Author(s): T. Fukui

      • Abstract

      Background
      Pulmonary nodules with ground-glass opacity (GGO) are frequently encountered. We previously reported that, based on natural history of 108 pulmonary nodules that were 3 cm or less and had 50 % or more GGO component, these nodules should be followed for at least 3 years to accurately evaluate lesion growth. However, it remains unclear whether all GGOs should be followed for as long as 3 years. To establish reasonable follow-up plan, it would be useful to if we could predict which of GGO lesions tend to grow by any of clinical-radiographic characteristics. The purpose of this study was to clarify which baseline clinical and radiological characteristics were associated with growth of these nodules.

      Methods
      We retrospectively studied patients between 1999 and 2013 with pulmonary nodules that met the following criteria: (1) lesion diameter of ≤ 3 cm, (2) GGO proportion of ≥ 50%, and (3) observation without treatment in the prior 6 months. We evaluated the changes in lesion size on serial computed tomography. Two endpoints, “Time to 2-mm growth” and “2-mm growth incidence”, were analyzed using Cox proportional hazards and logistic regression models, respectively.Variables for univariate analysis were as follows: age; gender; smoking history; past history of lung cancer; lesion multiplicity; lesion diameter; and solid proportion. Factors for which p-value was < 0.05 in univariate analysis, as well as past history of lung cancer which was reported as a predictor in previous reports, were included in multivariate analysis. To strictly define “no growth”, we excluded lesions which had been observed for less than 3 years in logistic regression analyses.

      Results
      120 pulmonary lesions in 67 patients fulfilled inclusion criteria. At the median observation period of 4.2 years, 34 lesions had become larger by 2mm or more, whereas the remaining 86 had persisted without changing in size. Smoking history and initial lesion diameter were statistically significant in both regression and time-to-event analyses. In terms of time to 2mm growth, hazard ratio (HR) for smoking history was 3.67 (P < 0.01). Compared to those ≤ 1 cm, HRs for 1.1–2 cm and 21-3 cm lesions were 2.23 (P = 0.08) and 5.08 (P = 0.04), respectively. In contrast, odds ratio (OR) for the likelihood of 2mm growth for smoking history was 6.51 (P < 0.01), and OR for lesion diameter of 1.1–3 cm in comparison to ≤ 1 cm was 4.06 (P = 0.02).

      Conclusion
      Smoking history and initial lesion diameter are significantly associated with the growth of these nodules. These results suggested that closer follow up of larger size GGO in smoking patients be recommended.