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J. Han



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    O17 - Anatomical Pathology I (ID 128)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Pathology
    • Presentations: 1
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      O17.02 - Clinicopathologic, radiologic, and molecular characteristics of completely resected mucinous adenocarcinomas in the lung: Implications for prognosis (ID 3316)

      10:40 - 10:50  |  Author(s): J. Han

      • Abstract
      • Presentation
      • Slides

      Background
      The real prognosis of mucinous adenocarcinomas (MAs) diagnosed according to the current IASLC/ATS/ERS lung adenocarcinoma classification is controversial, and in particular, the prognostic value of MA and the relationship among pathologic features, clinicoradiologic presentation, and response to surgical treatment are still unclear. Therefore, the aim of this single-institution retrospective study is to analyze the prognostic role of clinicopathologic and radiologic features in surgically resected MA in a homogenous population of Asian patients.

      Methods
      Analyzed variables are clinicoradiologic presentations, operation type, histologic subtypes, and stage. Univariate and multivariate analyses of survival were performed.

      Results
      From 1994 through 2011, 161 resected lung carcinomas were diagnosed as MA in 158 patients, according to the IASLC/ATS/ERS classification. 158 patients included 114 in 1 stage (72%), 29 in 2 (18%), and 15 in 3 (10%). 117 tumors (73%) were nodular-type and 44 (27%) were consolidation-type. Among 117 nodular MAs, 6 were pure GGO nodules.7 tumors presented as multiple lesions. 4 were AIS (lepidic pattern), 1 was MIA (acinar), and 156 (97%) were invasive adenocarcinoma (147 with acinar and 9 with cribriform pattern). The 5-year recurrence rate was 22%, and the 5-year survival rate was 88%. Five-year OS for patients with nodular type compared with those with consolidation-type was 89 versus 57 % (P < 0.001). Based on the multivariate Cox-proportional analysis, consolidation-type on CT (HR 1.42), cribriform pattern (HR 10.35), higher stage (HR 1.51), and higher SUVmax (HR 1.27) were significant poor prognostic predictor for DFS. As for recurrence, SUV max was the only significant predictor in both multivariate Cox-proportional analysis (HR 1.16, P = 0.016) and the log-rank test (cut-off 4.4, P = 0.045). Figure 1 Figure 2

      Conclusion
      Consolidation-type on CT, cribriform pattern, higher stage, and higher SUVmax would be predictive for lower overall survival. Also, SUVmax would be predictive for higher recurrence and may necessitate more aggressive adjuvant treatment.

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    P1.21 - Poster Session 1 - Diagnosis and Staging (ID 169)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P1.21-009 - Reliability of transthoracic fine needle aspiration and core needle biopsy for the diagnosis of pulmonary mucinous adenocarcinoma (ID 2759)

      09:30 - 09:30  |  Author(s): J. Han

      • Abstract

      Background
      In case of mucinous adenocarcinoma (MA), cytologic atypia is usually mild to moderate and can be absent in some cases, creating a diagnostic pitfall in recognizing MA in small tissue biopsy and cytology specimens. Specific diagnosis of mucinous subtype in small tissue n FNA is important because it is considered an invasive neoplasm until proven otherwise, and it carries a worse prognosis for its aggressive behavior with frequent multicentricity and intrapulmonary metastatic spread. The purpose of this study was to evaluate the diagnostic accuracy of transthoracic fine needle aspiration (FNA) or core needle biopsy (CNB) of MA of the lung.

      Methods
      We retrospectively reviewed a consecutive series of 184 patients who underwent curative operation for MA. Among those patients, 105 patients underwent pre-operative percutaneous FNA (n= 34) or CNB (n= 79). Eight patients underwent both FNA and CNB for the same tumors. Diagnostic accuracies of FNA and CNB for MA were evaluated, and the contribution of various clinicopathologic parameters to subtyping accuracy was analyzed.

      Results
      Diagnostic accuracies of FNA and CNB in determining malignancy were 67.6% and 87.3%, respectively. 20.6% and 59.5% were successfully diagnosed as MA through FNA and CNB, respectively. Univariate analysis implicated type of procedure and prominent growth pattern of mucinous adenocarcinoma as significant factors for successful pathologic diagnosis. Figure 1

      Conclusion
      CNB of diagnosis of MA is feasible and accurate. Our data support the suitability of small biopsy specimens for the new therapeutic paradigms even in mucinous adenocarcinoma.

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    P2.12 - Poster Session 2 - NSCLC Early Stage (ID 205)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.12-017 - Clinical Impact of Dynamic Contrast-Enhanced CT in Stage IA Non-Small Cell Lung Cancer: Net Enhancement is an Independent Predictor of Recurrence. (ID 2501)

      09:30 - 09:30  |  Author(s): J. Han

      • Abstract

      Background
      Microvessel density is known as a prognostic indicator for patients with solid organ malignancy and the extent of enhancement on CT is positively correlated with the extent of microvessel density. The purpose of this study is to investigate the prognostic significance of dynamic contrast-enhanced (DCE) CT in patients with stage IA non-small cell lung cancer (NSCLC).

      Methods
      From January 2003 through December 2006, we retrospectively enrolled 118 patients (men: women = 67:51; mean age, 58.6 years) with stage IA NSCLC who underwent DCE CT with helical technique (unenhanced images and series of dynamic enhanced images covering primary lung cancer at 30, 60, 90 and 120 seconds and 5 and 10 minutes) after intravenous contrast medium injection and followed by curative surgery. Data were collected on age, pathologic subtype, and size, peak attenuation and net enhancement of primary lung cancer and then correlated with overall, metastasis-free, and recurrence-free survivals that occurred through December 31, 2011.

      Results
      Figure 1In multivariate analysis, net enhancement of primary lung cancer was independently associated with recurrence (hazard ratio [HR] 1.024, P=.013), metastasis (HR 1.027, P=.023), and overall survival (HR 1.025, P=.044). Net enhancement of 80 HU predicted significantly higher risk for the recurrence (P=.028) and metastasis (P=.025) after curative surgery of stage IA lung cancer. The significance of tumor size was proved only in the correlation with recurrence (HR 1.069, P=.038) .

      Conclusion
      Our study confirmed the prognostic significance of net enhancement as an indirect biomarker of tumor angiogenesis for patients with stage IA NSCLC.

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    P3.09 - Poster Session 3 - Combined Modality (ID 214)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 2
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      P3.09-013 - Outcomes and predictors for recurrence and survival after neoadjuvant concurrent chemoradiation followed by operation in patients with clinical stage III-N2 non-small-cell lung cancer (ID 2053)

      09:30 - 09:30  |  Author(s): J. Han

      • Abstract

      Background
      This study assessed the impact of imaging, surgical, histopathologic and patient-related factors on the risks of local and distant recurrence and overall survival for patients with stage III-N2 non small cell lung carcinoma (NSCLC) undergoing definitive resection after neoadjuvant concurrent chemoradiation (neoCCRT).

      Methods
      We retrospectively examined 129 consecutive patients with stage III-N2 NSCLC received neoCCRT followed by curative surgery between 2008 and 2011. We reviewed clinical data and operation method. We also analyzed histopathologic factors such as subtype, pathologic invasive tumor characteristics, differentiation, residual tumor size, or the number of residual LNs as well as imaging characteristics on chest CT and PET/CT. Disease free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and predictive factors for recurrence and survival were identified by univariate and multivariate Cox-proportional analyses.

      Results
      112 (87%) patients were pathologically staged for N2-positive status (82 patients by mediastinoscopic biopsy and 30 patients by EBUS). The 5-year recurrence rate was 28.3 %, and the 5-year survival rate was 43.4 %. Five-year OS for patients with recurrence compared with those without was 29.5 versus 59.1 % (P = 0.028). Based on the multivariate Cox-proportional analysis and log-rank test, history of adjuvant therapy was the only significant prognostic predictor for prolonged OS (HR 0.134, 95 % CI 0.039–0.455, P = 0.001). As for recurrence, less size decrease on CT (HR 1.030, 95 % CI 1.005–1.056, P = 0.017), higher T stage (HR 2.450, 95 % CI 1.322–4.540, P = 0.004), larger residual tumor size on the pathologic specimen (HR 1.124, 95 % CI 1.010–1.252, P = 0.016), and presence of lymphovascular invasion (HR 4.180, 95 % CI 1.093–15.984, P = 0.037) were the significant predictors in both the multivariate Cox-proportional analysis and the log-rank test. Figure 1

      Conclusion
      Recurrence remains high in resected stage III-N2 NSCLC patients after neoCCRT and nodal downstaging, and patients who received adjuvant therapy had longer overall survival rate than patients who did not. Size decrease on CT, T stage, residual tumor size on the pathologic specimen, and presence of lymphovascular invasion would be predictive for higher recurrence and may necessitate more aggressive adjuvant treatment.

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      P3.09-015 - The role of adjuvant treatment in N2 positive non-small cell lung cancer patients treated with neoadjuvant chemoradiation followed by surgery: A retrospective single center experience. (ID 2673)

      09:30 - 09:30  |  Author(s): J. Han

      • Abstract

      Background
      The optimal management of locally advanced N2 positive non-small cell lung cancer (NSCLC) is still controversial. Some studies have shown promising results of neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgical resection in terms of survival benefit without increasing morbidity and mortality. However, the role of adjuvant treatment after completion of neoadjuvant CCRT followed by surgery in N2 positive NSCLC patients has not defined yet.

      Methods
      From March 2006 to December 2011, 249 N2 positive NSCLC patients received neoadjuvant CCRT (weekly docetaxel/cisplatin with 45Gy/25Fx of thoracic radiotherapy) followed by curative surgery. Patients who died with post-operative complications within a month after surgery (n=5) were excluded to minimize selection bias.

      Results
      Among 244 patients, 80 patients (32.8%) receieved adjuvant radiotherapy alone, 26 patients (10.7%) received adjuvant chemotherapy alone, 57 patients (23.4%) received both of adjuvant radiotherapy/chemotherapy, and 80 patients (32.8%) did not receive adjuvant treatment. Survival was compared according to adjuvant treatment (any kind of adjuvant treatment [n=164, 67.2%] vs. no adjuvant treatment [n=80, 32.8%]). There was no significant differences between two groups in age over 60 years, ECOG performance, initial T stage, initial multistation N2 disease, completion of neoadjuvant CCRT, R0 resection, and pathologic down staging of N2 disease. In the univariate analysis, median overall survival (OS) and progression-free survival (PFS) were 54.1 months vs. 37.9 months (P=0.016) and 23.4 months vs. 17.7 months (P=0.239) in adjuvant treatment group and no adjuvant treatment group, respectively. In subgroup analysis, adjuvant treatment group showed significantly better OS than no adjuvant treatment group in patients who achieved N2 down staging by neoadjuvant CCRT (n=146, 59.8%) (78.1 months vs. 44.7 months, P=0.027) but not in patients who did not achieve pathologic N2 down staging (n=98, 40.2%) (32.3 months vs. 21.6 months, P=0.125).

      Conclusion
      This results suggest that adjuvant treatment may contribute survival benefit even after completion of neoadjuvant CCRT following curative surgery in N2 positive NSCLC. The role of adjuvant treatment should be seeked further in carefully selected patients who benefit most, such as CCRT sensitive patients who achieved pathologic N2 down staging.