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G. Ishii
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O09 - General Thoracic Surgery (ID 100)
- Event: WCLC 2013
- Type: Oral Abstract Session
- Track: Surgery
- Presentations: 1
- Moderators:G.E. Darling, W. Weder
- Coordinates: 10/28/2013, 16:15 - 17:45, Parkside Ballroom B, Level 1
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O09.05 - Intraoperative autostapling cartridge lavage cytology in surgical resection of pulmonary malignant tumors - possible role in preventing local failure (ID 2543)
17:00 - 17:10 | Author(s): G. Ishii
- Abstract
- Presentation
Background
Limited resection of primary lung cancer or sublobar resection of pulmonary metastatic tumor can result in cut-end recurrence. It is important to confirm the absence of tumor cells at the cut-end. Since 2004, all autostapling cartridges used for wedge or segmental resection of pulmonary malignancies are washed with 50 ml saline. Washing saline is centrifuged and the sediment is stained using Papanicolaou’s method and examined for cancer cells during surgery to confirm negative margin. The aim of this study is to evaluate the efficacy of the intraoperative autostapling cartridge lavage cytology in preventing surgical cut-end recurrence.Methods
The intraoperative cytology analysis was performed in 271 patients undergoing wedge or segmental resection for 319 lesions including primary lung cancers and pulmonary metastatic tumors between April 2004 and April 2010. We retrospectively reviewed the clinicopathologic features of patients with positive cytology results and those who developed recurrence at the surgical margins.Results
The median age of the 271 patients at surgery was 67 years (range: 31−92 years). The median size of the 319 lesions was 1.4 cm (range: 0.4−3.5 cm), and there were 149 primary lung cancers and 170 pulmonary metastatic tumors (primary site: 116 colorectal and 54 others). Twenty-two lesions (7%) showed positive cytology results (11 primary and 11 metastatic). In primary lung cancers, tumor size (≧ 21 mm, p = 0.02), moderate to poor differentiation (p ＜ 0.01), vascular invasion or lymphatic permeation (p ＜ 0.01), and visceral pleural invasion (p ＜ 0.01) were significant predictors of a positive result. In contrast, there were no significant predictors in pulmonary metastatic tumors. The cut-ends of the 19 lesions among the 22 positive cytology margin lesions were additionally resected, but those of the remaining 3 lesions were not because of impaired respiratory function. With the median follow-up period of 42 months, surgical cut-end recurrence occurred in 2 of the 19 lesions for which additional resection had been performed (11%, 1 primary and 1 metastatic). Of the 3 lesions for which additional resection was impossible, cut-end recurrence developed in 2 (67%, 1 primary and 1 metastatic). Among the 297 lesions showing negative cytology result, cut-end recurrence occurred in 5 (2%, 4 primary and 1 metastatic).Conclusion
Intraoperative autostapling cartridge lavage cytology in sublobar resection for primary or metastatic lung tumor may be useful in preventing surgical cut-end recurrence.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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O29 - Cancer Control & Epidemiology IV (ID 132)
- Event: WCLC 2013
- Type: Oral Abstract Session
- Track: Prevention & Epidemiology
- Presentations: 1
- Moderators:P. Zimmerman, N. Kurimoto
- Coordinates: 10/30/2013, 10:30 - 12:00, Bayside 103, Level 1
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O29.07 - The clinical outcome of non-small cell lung cancer patients with adjacent lobe invasion: proposal for optimal classification according to the status of interlobar pleura in invasion point (ID 1168)
11:35 - 11:45 | Author(s): G. Ishii
- Abstract
- Presentation
Background
In the 7th TNM classification, non-small cell lung cancer (NSCLC) with adjacent lobe invasion (ALI) is classified as T2a regardless of whether across the complete or incomplete fissure. However, no validation analysis has been conducted on this classification. The aim of this study was to analyze the survival of NSCLC patients with ALI with emphasis on the interlobar fissure status at invasion point.Methods
We retrospectively evaluated 2097 consecutive patients with surgically resected NSCLC from 1993 through 2006. Of these, 90 (4.3%) patients had tumors with ALI. Interlobar fissure status of tumors with ALI was examined by using elastic stain. We classified ALI into 2 types: direct ALI beyond incomplete interlobar fissure (no visceral pleurae separating two lobes; ALI-D) and ALI across complete fissure (two lobes separated by 2 visceral pleurae; ALI-A), and compared the clinicopathological features and survival between the groups.Results
The patients with ALI without any other criteria higher than T2b category (n = 60) demonstrated intermediate survival between T2a and T2b tumors (5-year overall survival [OS]: T2a, 61.0%; ALI, 59.6%; T2b, 49.2%). Distinct survival difference was observed between the patients with ALI-A (n = 46) and ALI-D (n = 14) (5-year OS: ALI-D, 85.7%; ALI-A, 52.0%; p = 0.01). The survival of patients with ALI-A was not statistically different from that of patients with T2b tumors, regardless of tumor size (p = 0.85). Conversely, the survival of the patients with ALI-D did not statistically differ from those with T1a or T1b tumors (p = 0.77 and 0.42, respectively).Figure 1Figure 2Conclusion
Interlobar fissure status clearly affected survival of the patients with ALI. ALI should be examined by elastic stains and only ALI-A should be classified as true ALI. We propose that ALI-A tumors ≤ 5 cm should be assigned to T2b but ALI-D tumors do not require adjustment of T descriptor.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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P3.06 - Poster Session 3 - Prognostic and Predictive Biomarkers (ID 178)
- Event: WCLC 2013
- Type: Poster Session
- Track: Biology
- Presentations: 1
- Moderators:
- Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P3.06-016 - Aldehyde dehydrogenase 1 expression in cancer cells could have prognostic value for patients with non-small cell lung cancer who are treated with neoadjuvant therapy: identification of prognostic microenvironmental factors after chemoradiation (ID 1726)
09:30 - 09:30 | Author(s): G. Ishii
- Abstract
Background
Prognostic biomarkers for patients with non-small cell lung cancer (NSCLC) who have been treated with neoadjuvant therapy have not been fully assessed. Identifying biological prognostic markers may help to distinguish patients who are likely to benefit from additional postoperative chemotherapy. The purpose of this study was to analyze prognostic biomarkers in surgically resected NSCLC after treatment with neoadjuvant therapy, with special reference to the immunophenotypes of both the cancer cells and the stromal cells.Methods
A series of 66 patients with NSCLC who were treated with neoadjuvant chemotherapy, chemoradiotherapy, or radiotherapy followed by complete resection at our hospital between April 1992 and December 2009 were reviewed. Among the 66 surgically resected specimens, case with viable tumor cells remained in the specimens were included in this study (n =52). We examined the expressions of geminin and cleaved caspase 3 (proliferation and apoptosis markers), E-cadherin and vimentin (epithelial mesenchymal transition related molecules), ALDH1 and CD44v6 (Stem cells related molecules) in the cancer cells. Furthermore in the stromal cells, the expressions of podoplanin and CD90 in cancer associated fibroblasts (CAFs) and CD204 in tumor associated macrophages (TAMs) were also examined.Results
The 5-year disease-free survival rate of patients with high ALDH1 expression levels in their cancer cells was significantly lower than those with a low ALDH1 level (47.3% vs. 21.5%, respectively; P =0.023). The expression statuses of geminin, cleaved caspase 3, E-cadherin, vimentin, and CD44v6 in the cancer cells had no prognostic impact. The 5-year disease-free survival rate of patients with low or high podoplanin and CD90 levels in CAFs and CD204 levels in TAMs expression levels were not any prognostic impact in the stromal cells (37.9% vs. 29.1%, 33.8% vs. 37.5%, 38.4% vs. 29.0%, P =0.90, P = 0.75, P =0.98). In NSCLC without neoadjuvant therapy matching for clinical stage and histopathology (case control, n =104), the 5-year DFS rate of the patients with a high ALDH1 expression level was 48.3%, while that of the cases with a low ALDH1 expression level was 59.8%. The expression of ALDH1 in cancer cells was not correlated with the prognosis in NSCLC without neoadjuvant therapy (P =0.507). A multivariate analysis identified ALDH1 expression in cancer cells as significantly independent prognostic factors for disease-free survival in patients who received neoadjuvant therapy (P =0.045).Conclusion
The presence of ALDH1-positive cancer cells was an independent recurrence predictor in patients who received neoadjuvant therapy, while CAFs and TAMs did not provide any predictors. Although prospective studies with a larger number of patients are required to confirm the prognostic significance of ALDH1 expression in cancer cells in validation populations with neoadjuvant therapy, our results suggest that the immunophenotypes of ALDH1 expression can serve as a guide to additional treatment after surgical resection in patients who received neoadjuvant therapy.
