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Y. Tochino



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    P1.22 - Poster Session 1 - Epidemiology, Etiology (ID 166)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Prevention & Epidemiology
    • Presentations: 1
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      P1.22-010 - Goddard classification is associated with clinical characteristics in patients with COPD and advanced NSCLC. (ID 2726)

      09:30 - 09:30  |  Author(s): Y. Tochino

      • Abstract

      Background
      Chronic obstructive pulmonary disease (COPD) is a frequent complication seen in 24.9% in patients with lung cancer. In practice, a decreased respiratory function due to COPD influences to decision of treatment. The airway obstruction is assessed by the Global Initiative for obstructive lung disease (GOLD) classification. On the other hand, Goddard classification is a method for evaluating the emphysema using CT images. The respiratory function of an advanced lung cancer has various modifications such as tumor airway obstruction or atelectasis. The hypothesis is that in patient with COPD and advanced lung cancer patients, GOLD classification may not correspond to the Goddard classification. We evaluated the associations of clinical characteristics with Goddard classification as well as GOLD classification.

      Methods
      Between May 2007 and April 2012, the pre-treatment respiratory function was assessed for patients diagnosed at Osaka City University Hospital as non-small cell lung cancer stage IIIB or IV without EGFR gene active mutations. FEV/FVC% less than 70% were diagnosed for COPD. GOLD and Goddard classification were evaluated. Two doctors independently determined the Goddard classification, and the final score was adopted from the average of two scores. The association of clinical characteristics with Goddard classification as well as GOLD classification was performed by fisher exact test. An univariate analysis was performed to evaluate the prognosis by COX regression method. In multivariate analysis, histology, stage, number of cigarette smoking, and FEV/FVC% were performed to evaluate the prognosis by COX regression selected variable method (stepwise method).

      Results
      A total of 67 patients were enrolled with median age of 70 (49-81). GOLD classification showed normal (n=32), mild (stage I/II, n=30), and moderate (stage III, n=5) airflow obstructions. There was no severe COPD (stage IV) patient. In GOLD classification, no-significant associations of clinical characteristics were observed such as lobe site of primary lesion (p=0.84), tumor histology (p=0.21), gender (p=0.17), and cigarette smoking (p=0.42). Goddard classification showed non (score zero, n=12), mild (score <8, n=32), and moderate-severe (score 8-20, n=23) emphysema findings. In Goddard classification, there were significant associations of clinical characteristics in tumor histology of squamous cell carcinoma (p=0.010), male (p=0.031), and number of cigarette smoking (p=0.020). Univariate analyses showed neither GOLD nor Goddard classification was associated with overall survival. In multivariate analysis, FEV/FVC% was not associated with overall survival.

      Conclusion
      As compared with Goddard classification, the distribution of GOLD classification shift relatively mild direction. Therefore, there is no-significant association of clinical characteristics in GOLD classification, and Goddard classification was significant association of squamous cell carcinoma, male, and cigarette smoking. Surprisingly, the FEV/FVC% did not become a prognostic factor for NSCLC received chemotherapy. The severity of COPD might not influence outcome of chemotherapy in advanced NSCLC.

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    P3.03 - Poster Session 3 - Technology and Novel Development (ID 152)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P3.03-003 - The relationship between fresh macroscopic appearance of tissue specimen by CT guided biopsy and its clinicopathological feature in 58 patients with NSCLC. (ID 2688)

      09:30 - 09:30  |  Author(s): Y. Tochino

      • Abstract

      Background
      The CT-guided lung needle biopsy is a well-established and safety technique for diagnosis. A biopsy specimen often had loose connection and broke to tiny pieces before formalin fixation. Tumor invasion often involves the epithelial-mesenchymal transition (EMT) during which cells lose the lateral attachments to their neighbors and become more motile. The hypothesis is the fresh macroscopic appearance of specimens may relate pathological features and predict clinical features in patients with lung cancer.

      Methods
      The correlations between fresh macroscopic appearance of specimens and pathological findings or clinical outcomes were examined in patients who underwent CT-guided lung needle biopsy in our institution between May 2009 and May 2013. The intensity of fiber stained Azan staining (0, 1+, 2+, and 3+) and the percentage of positive cells (<1%, <25%, <50%, <75, and >75%) were assessed. The score of each case was multiplied to give a final score and the fibrosis was finally classified as low (<200) or high (>200). Comparisons of variables were performed by using Fisher exact tests.

      Results
      A total of 93 (86.1%) of 108 patients had adequate samples for diagnosis. The mean nodule diameter was 26 mm (range 4-75mm). CT findings revealed only three of 93 lesions showed ground-glass opacity, and all of them were in tight connection group. Macroscopically, 21.3% (n=23) specimens had loose connection, and 78.7% (n=85) specimens had tight connection. In loose connections, 73.9% (n=17) diagnosed as malignant and 26.1% (n=6) as benign, with sensitivity of 77.3%, specificity of 100%, and accuracy of 78.3%. In tight connections, 75.3% (n=64) as malignant and 24.7% (n=21) as benign, with sensitivity of 86.5%, specificity of 100%, and accuracy of 88.2%. There were 58 NSCLC samples, including 30 well or moderate (w/d or m/d), and 8 poorly differentiated (p/d) adenocarcinomas (Ad), 7 w/d or m/d, and 6 p/d squamous cell carcinomas (Sq), and 7 undifferentiated carcinoma. In 58 samples, 20.7% (n=12) specimens had loose connection and 79.3% (n=46) specimens had tight connection. In Azan staining, the tight connection group had 32 samples of high and 14 of low scores with the mean score of 213.6, and the loose connection group had 4 of high and 8 of low scores with the mean score of 118.6. The tight connection group had significantly higher scores than the loose connection group (p=0.042). The patients with loose connection had significantly higher rate of distant metastasis than those with tight connection (58.3% vs 21.7%, p=0.028). The median survival times are not reached in both groups.

      Conclusion
      Macroscopically loose connection specimens can afford to provide adequate amount of samples for diagnosis with sensitivity of 77.3%, and this appearance was negatively correlated with amount of fiber. Furthermore, the patients with loose connection tissue were associated with distal metastasis. The loose connection specimens may represent the status of EMT acquisition which is induced tumor initiation, growth, and metastasis. These findings suggest that the macroscopic appearance of tissue specimens obtained from CT guided biopsy can be an effective evaluation for prediction of metastasis in patients with NSCLC.