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K. Yoshida
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MO03 - Thymic Malignancies (ID 123)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track: Medical Oncology
- Presentations: 3
- Moderators:F. Detterbeck, M. Okumura
- Coordinates: 10/28/2013, 10:30 - 12:00, Bayside Gallery B, Level 1
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MO03.01 - Outcome of surgical treatment for thymic epithelial tumors based on the nationwide retrospective database of 3033 patients in Japan (ID 2284)
10:30 - 10:35 | Author(s): K. Yoshida
- Abstract
- Presentation
Background
Thymic epithelial tumor, consisting of thymoma, thymic carcinoma and thymic neuroendocrine carcinoma, is a relatively rare neoplasm, and there is not a satisfying consensus in the treatment strategy. Because of lack of TNM staging system and global consensus on pathological classification, global research in these research has been difficult. To participate in movement of establishing the global database, Japanese Association for research of the Thymus (JART) conducted the project of Japanese nation-wide database in 2012.Methods
Patients undergoing surgical treatment during 20 years between 1991 and 2010 in Japan were collected from 32 institutes. 3182 patients were first enrolled, but after exclusion of cases with insufficient information, 3033 cases remained for analysis finally.Results
1435 patients (44%) were male, and 1595 were female (not identified in 3 patients). The age at operation was 13 to 88 years (mean 57 years old). Pathological diagnosis was thymoma in 2505 patients (Type A: 203, Type AB: 710, Type B1: 599, Type B2: 669, Type B3: 329), thymic carcinoma in 381 patients (Squamous cell carcinoma: 223, neuroendocrine carcinomas 66), and unclassified or unknown in 147 patients. According to Masaoka staging system, 1063 patients were in stage I, 1084 were in stage II, 477 in stage III, 197 in stage IVA, 57 in stage IVB (undetermined in 155 patients). Complete resection was achieved in 2753 patients (92%), subtotal resection (mass reduction of more than 80%) in 157 patients (5%), partial resection including biopsy in 86 patients (unknown in 37 patients). 249 patients were alive with tumor. 316 patients were dead during the observation period, and 161 patients died from tumor. Among 2557 patients who underwent complete resection (R0), 269 patients (10.5%) had tumor recurrence. In the patients who underwent complete or subtotal resection, 10-year overall survival rate was 89% in thymoma, 56% in squamous cell carcinoma, 30% in non-squamous thymic carcinoma, 72% in well-differentiated neuroendocrine carcinoma and 29% in poorly-differentiated neuroendocrine carcinoma. According to Masaoka stage, 10-year overall survival rate was 94% in stage I, 93% in stage II, 74% in stage III, 59% in stage IVA and 44% in stage IVB. In thymoma patients who underwent complete resection, recurrence-free survival rate at 10 years was 96% in type A, 99% in type AB, 92% in type B1, 80% in type B2, 72% in type B3. By Cox’ proportional hazard model, involvement of the mediastinal pleura (p=0.01), involvement of the lung (p=0.01), pleural dissemination (p=0.0009), distant metastasis (p=0.01) and WHO histological subtype (p<0.0001) were found to be independent factors for tumor recurrence after complete resection, while nodal metastasis, intrapericardial dissemination, involvement of pericardium, pulmonary artery, SVC, brachiocephalic vein, aorta, or brachiocephalic artery were not.Conclusion
Japanese nation-wide database revealed the oncological difference among thymoma, thymic carcinoma and thymic neuroendocrine carcinoma. In thymoma, involvement of pleura and lung, pleural dissemination, distant metastasis and WHO histological classification were significant factors of tumor recurrence. These results are supposed to contribute to clinical practice for tumor treatment as well as establishment of global TNM classification.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MO03.02 - Surgical Outcome of Patients with Stage III Thymoma in the Japanese Nationwide Database (ID 2842)
10:35 - 10:40 | Author(s): K. Yoshida
- Abstract
- Presentation
Background
Stage III thymoma has a variety characteristics in terms of involved organs, complex surgery and multimodal strategy, and a careful consideration is required in choices of treatments. Recently the Japanese Association for Research on the Thymus (JART) conducted a nationwide large cohort analysis for thymic epithelial tumors. The aim of this study is to clarify clinical characteristics and therapeutic outcome of patients who underwent surgical resection for stage III thymoma using this database.Methods
Clinical data of 3,033 thymic epithelial tumor patients of 1991 to 2010 were collected rom 32 Japanese institutes. Medical information registered included patients’ characteristics, types of surgery, pathological diagnosis, perioperative therapy, and clinical outcomes were registered. In this study, stage III thymoma patients who underwent surgery were extracted from the database, and retrospectively analyzed for clinical characteristics and surgical outcome.Results
A total of 340 records of patients were analyzed in this study, which comprised 186 males (54.7%) and 153 females (45.0%), 83 (24.4%) with myasthenia gravis, 42 (12.4%) with induction chemotherapy, 18 (5.3%) with preoperative radiotherapy, and 29 (8.5%) with adjuvant chemotherapies. WHO histologic types comprised 16 A (4.7%), 40 AB (11.8%), 47 B1 (13.8%), 118 B2 (34.7%) and 97 B3 (28.5%). Involved organs were lung in 209 (61.4%), pericardium in 167 (49.1%), chest wall in 7 (2.1%), phrenic nerve in 88 (25.9%) and great vessels in 134 (39.4%). Completeness of resection was R0 in 268 (78.8%), R1 in 35 (10.3%) and R2 in 20 (5.9%). Complications were observed in 85 (25.0%) including arterial fibrillation, phrenic nerve palsy, bleeding and crisis of myasthenia gravis, and 30-day mortality rate was 1.8% (6 cases). Tumor recurrence was experienced in 96 (28.2%), and 39 (11.5%) died during the observation. Overall and disease-free 10-year survival rates were 81.0% and 56.7%, respectively. Involved organs except for chest wall, completeness of resection or myasthenia gravis did not affect the survivals. Number of involved organs (1 vs. >2) and tumor length (<7cm vs. >7cm) affected disease-free survival but not overall survival. Among factors suggested to affect overall survival by univariate analyses such as male, surgical complication, WHO histologic type B1-3, chest wall invasion, induction treatments, and recurrence, independent adverse predictors were revealed by a multivariate analysis to be male (p=0.031, HR=2.47), induction chemotherapy (p=0.034, HR=2.39), postoperative complication (p=0.018, HR=2.41) and recurrence of disease (p=0.041, HR=2.15). Of 96 patients with recurrence, 47 patients who underwent salvage resection showed better prognosis than 49 patients who did not (p=0.009).Conclusion
This nationwide registry study exhibited favorable surgical outcome in Japanese patients with stage III thymoma. Effectiveness of multimodal treatments need to be further investigated in prospective controlled trials.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MO03.04 - Analysis of lymphatic metastases of thymic epithelial tumors on Japanese database (ID 3196)
10:45 - 10:50 | Author(s): K. Yoshida
- Abstract
- Presentation
Background
Thymic epithelial tumors sometimes metastasize to lymph nodes (LNs). The frequency of lymph node metastasis, the pattern of node metastasis and the relationship between prognosis and node metastasis are still unclear.Methods
We registered patients with thymic epithelial tumors who had undergone resection between 1991 and 2010 from 29 institutes in Japan by the Japanese Association for Research on the Thymus (JART). We investigated the collected data according to the site of lymphatic metastasis. Yamakawa-Masaoka's paper (Cancer 1991;68:1984–7.) tentatively classified the N factor to 3 groups: metastasis to anterior mediastinal lymph nodes around the thymus were defined as N1, metastasis to intrathoracic lymph nodes other than anterior mediastinal lymph nodes as N2, and metastasis to extrathoracic lymph nodes as N3.Results
The rate of lymphatic metastasis in thymoma was 1.75% (44 cases of 2508). Most of metastatic nodes were located in anterior mediastinal lymph nodes (N1, 78%). There is a significant difference of overall survival between thymomas with LN metastasis and those without LN metastasis (p<0.0001, 10-year survival: 89.8% vs 63.6%). Thymomas with N1 metastasis showed a good prognosis than those with other node metastasis, although there is no significant relationship (5-year survival: 64.4% vs 52.5%). The rate of lymphatic metastasis in thymic carcinoma including thymic carcinoid was 22% (84 cases of 380). Most of metastatic nodes were located in anterior mediastinal lymph nodes (N1, 69%). There is a significant difference of overall survival between thymic carcinomas with LN metastasis and those without LN metastasis (p<0.0001, 10-year survival: 59.5% vs 18.4%). Thymic carcimomas with N1 metastasis showed good prognosis than those with other node metastases, although there was no significant relationship (5-year survival: 55.5% vs 27.5%).Conclusion
The rate of lymphatic metastasis in thymoma and thymic carcinoma was 1.75% and 22%, respectively. Both tumors frequently metastasized to the anterior mediastinal nodes. There was a significant difference of overall survival between tumors with LN metastasis and without LN metastasis in both tumors. And both tumors with N1 metastasis showed good prognoses than those with other node metastases, although there was no significant relationship. We think that it may be reasonable to consider the anterior mediastinal lymph node group (N1) to be a primary lymph node of thymic epithelial tumor.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P2.19 - Poster Session 2 - Imaging (ID 180)
- Event: WCLC 2013
- Type: Poster Session
- Track: Imaging, Staging & Screening
- Presentations: 2
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P2.19-005 - Tumor growth rate of ground-glass nodules after long-term follow-up: The usefulness of a combination of initial computed tomography attenuation and tumor size as a predictor for tumor growth (ID 1023)
09:30 - 09:30 | Author(s): K. Yoshida
- Abstract
Background
Pulmonary ground-glass nodules (GGNs) often grow over a long period of time. Elucidating the growth rate of GGNs is of great importance in deciding on follow-up intervals in clinical practice. The objective of this study was to clarify the natural history and tumor growth rate of GGNs after a long-term follow-up.Methods
We retrospectively studied 121 cases of patients with GGNs, who had more than 50% of ground-glass opacity component and were monitored using high-resolution computed tomography (CT) for >2 years. Factors affecting the time to tumor progression were evaluated using the Kaplan–Meier method and Cox proportional hazard model analysis. Tumor growth rate was evaluated using specific growth rate (SGR), which was calculated using volume-doubling time (VDT) data (SGR = ln 2/VDT).Results
During a median follow-up period of 59.7 months, GGNs showed enlargement or increase in attenuation in 66 patients and no change in 55 patients. In multivariate analysis using Cox proportional hazard model, the initial mean CT attenuation value > –670 Hounsfield unit (HU) and initial tumor size > 8 mm were independent predictive factors for time to tumor growth (p < 0.0001 and p = 0.0006, respectively). The Kaplan-Meier curves evaluating time to tumor progression, which was divided into 4 parts according to the initial mean CT attenuation value and initial tumor size, showed that the final estimated probability for patients with GGNs with a mean CT attenuation value < –670 HU and tumor size < 8 mm was 14.5%, whereas that for the other 3 groups was more than 50%, and with a significant difference (p < 0.0001). Comparing the tumor growth rates in these 4 groups, the SGR in GGNs with a mean CT attenuation value < –670 HU and tumor size < 8 mm was significantly lower than that in GGNs with a mean CT attenuation value > –670 HU and tumor size > 8 mm (p < 0.0001) and with a mean CT attenuation value > –670 HU and tumor size < 8 mm (p = 0.0005).Conclusion
A combination of the measurement of the mean CT attenuation and the tumor size in the initial CT examination may be useful for predicting GGN growth. Lower-attenuation and smaller-size GGNs grow, but with slow growth rate, and, for patients with such GGNs, longer follow-up intervals may be useful in clinical practice. -
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P2.19-006 - Novel computed tomography windows for predicting pathological invasion area in pulmonary subsolid tumors (ID 1158)
09:30 - 09:30 | Author(s): K. Yoshida
- Abstract
Background
Preoperatively distinguishing non-invasive or minimally invasive lung adenocarcinomas from invasive lung adenocarcinomas on the basis of the classification proposed by the International Association for the Study of Lung Cancer, American Thoracic Society and European Respiratory Society (IASLC/ATS/ERS) is essential. However, in some cases, this distinction is potentially difficult to make by using the conventional computed tomography (CT) settings, i.e., lung and mediastinal windows. The objective of this study is to evaluate novel CT window settings for preoperative detection of pathologically invasive adenocarcinomas.Methods
We retrospectively investigated 112 pathological T1a adenocarcinomas with a ground-glass opacity pattern ratio on preoperative CT of more than 50%. In the CT performed before an operation, the window level/window width was set as follows: -300/600, -250/500, -200/400, -150/300, and 30/400 (conventional mediastinal window). Under these viewing conditions, a maximum diameter of residual tumor was defined as the predictive invasion diameter. Receiver operating characteristic curve analyses were used to verify whether each viewing condition could be used to predict pathologically invasive adenocarcinomas that have a maximum invasion diameter of more than 5 mm.Results
The area under the curve values for the -300/600, -250/500, -200/400, -150/300, and 30/400 settings were 0.87, 0.91, 0.86, 0.84, and 0.78, respectively. The sensitivity and specificity in the window setting of -250/500 was 98.1% and 67.8%, when the cut-off value for the predictive invasion diameter was set at 6 mm.Conclusion
We determined novel CT window settings. The window level/window width setting of -250/500 might be useful for predicting pathological invasion of more than 5 mm in T1a lung adenocarcinomas.
