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A. Hattori



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    P1.18 - Poster Session 1 - Pathology (ID 175)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pathology
    • Presentations: 1
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      P1.18-011 - Is Visceral Pleural Invasion Significant Prognostic Factor in Lung Cancer Patients with Ground Glass Opacity on Thin-Section CT Scan? (ID 1919)

      09:30 - 09:30  |  Author(s): A. Hattori

      • Abstract

      Background
      Due to the recent amendment of lung cancer staging by the IASLC committee, pathological visceral pleural invasion (VPI) has been considered as a new prognostic factor and even pT1a-b lung cancers is included in pT2a, if the tumors have VPI. Basically, lung cancers with VPI are often revealed in patients with radiologically “pure-solid” appearance on thin-section CT scan. On the other hand, controversies still remain with regard to the prognostic significance of VPI in patients with radiologically early lung cancer with ground glass opacity (GGO) predominance.

      Methods
      Between 2004 and 2012, among 543 patients with surgically resected pN0 non-small cell lung cancer less than 30mm in diameter, 466 patients that revealed radiologically “part-solid” and “pure-solid” appearance on thin-section CT scan were retrospectively reviewed. Pure-solid tumors were defined as a tumor constructed only by consolidation without GGO, whereas part-solid tumors were defined as a focal nodular opacity that contained both consolidation and GGO on thin-section CT scan. Several clinicopathological factors were evaluated to elucidate the prognostic factors for each group using a multivariate analysis. Survivals for each group were calculated by Kaplan-Meier estimation.

      Results
      Among 466 eligible lung cancers, 209 (45%) were pure-solid and 237 (55%) were part-solid nodule on thin-section CT scan. In the group with pure-solid nodule, 128 patients were men and 81 were women with average age of 67 years. VPI was found in 79 (38%) patients. Based on a multivariate analysis, VPI, maximum tumor diameter and CEA level were significant prognostic factors in patients with pure-solid nodule (p=0.0071, 0.0278, 0.0314). The 5-year survival in patients with VPI (-) (81.3%) was significantly greater than that in VPI (+) (70.1%) (p=0.0051). While the group with part-solid nodule included 97 men and 140 women with average age of 66 years. VPI was found in 24 (10%) of the patients with part-solid nodule, however, it was not a significant prognostic factor in these lesions (p=0.4697). Furthermore, the 5-year survival in patients with VPI (-) was 94.9%, whereas that with VPI (+) was 85.6% (p=0.3798).

      Conclusion
      It is no doubt regarding the prognostic significance of visceral pleural invasion in patients with radiologically pure-solid lung cancer. On the other hand, even pleural invasion may not participate in the prognosis in patients with part-solid lung cancers. Thus, upgrading of TNM staging system and administration of postoperative chemotherapy due to pleural factor should be carefully considered in lung cancer patients with GGO predominance.

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    P2.07 - Poster Session 2 - Surgery (ID 190)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P2.07-050 - Short term preoperative efficacy of tiotropium for patients with resectable lung cancer and chronic obstractive pulmonary disease: Preliminary results of one arm prospective study (ID 3472)

      09:30 - 09:30  |  Author(s): A. Hattori

      • Abstract

      Background
      It was reported that in chronic obstructive pulmonary disease (COPD) patients, tiotropium improves lung function. However diagnosis of COPD is often made during evaluation of patients with lung cancer for surgical intervention and the efficacy of tiotropium for these patients is unclear. Thus a prospective study is needed to investigate it.

      Methods
      A prospective study was conducted on patients undergoing pulmonary resection for lung cancer with COPD (ratio of forced expiratory volume in 1 second (FEV~1~)/ forced vital capacity (FVC) less than 70%) between July 2011 and January 2012. Patients with a known history of asthma, chronic respiratory disease other than COPD were excluded. Primary endpoint was evaluating the incidence of postoperative complication. Secondary endpoints were improvement of pulmonary function tests after more than 1-week treatment using tiotropium preoperatively.

      Results
      Of 168 lung cancer patients for six months, 21 (12.5%) patients with COPD were enrolled. Pulmonary complications (prolonged air leak; 4 (19.0%), sputum retention; 2 (9.5%), hypoxia needing transient home oxygen therapy; 2 (9.5%)) were observed in seven (33.3%), although there was no critical complication such as acute respiratory failure and no side-effect related tiotropium. Treatment of tiotropium resulted in a significant improvement of FVC (pre-FVC 2.96±0.70 vs post-FVC 3.18±0.58; p=0.005) and FEV1 (pre-FEV~1~ 1.78±0.44 vs post FEV~1~ 1.91±0.18; p=0.0003), but there was no significant difference between pre-RV (residual volume) / TLC (total lung capacity)% and post-RV/TLC% ( 108.8±20.1 vs 102.4±16.1; p=0.237).

      Conclusion
      In this prospective study, we were safely able to use tiotropium without critical complication and it improved FVC and FEV~1~ in patients with COPD. But it did not improve RV/TLC% statistically and there remains doubt about efficacy of titropium. We thought that there is a problem of compliance in inhalation drug and need to reveal the population in which tiotropium was effective, and then we should perform a prospective randomized control trial.