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T. Hishida



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    O09 - General Thoracic Surgery (ID 100)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 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): T. Hishida

      • Abstract
      • Presentation
      • Slides

      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.

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    O29 - Cancer Control & Epidemiology IV (ID 132)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Prevention & Epidemiology
    • Presentations: 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): T. Hishida

      • Abstract
      • Presentation
      • Slides

      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 2

      Conclusion
      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.

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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
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      P3.06-050 - Characteristic Immunophenotype of Solid Subtype Component<br /> in Lung Adenocarcinoma (ID 3289)

      09:30 - 09:30  |  Author(s): T. Hishida

      • Abstract

      Background
      Lung adenocarcinomas represent a morphologically heterogeneous tumor composed of an admixture of different histologic subtypes (lepidic, papillary, acinar, and solid subtype). The presence of a solid subtype component is reported to be associated with a poorer prognosis. The aim of this study was to evaluate the characteristic immunophenotype of the solid subtype component compared with the immunophenotypes of other components.

      Methods
      We analyzed the clinicopathological characteristics of stage I adenocarcinoma patients with predominant solid subtype disease. Furthermore, we immunostained adenocarcinomas with predominant lepidic, papillary, acinar, and solid subtype components (n = 23 each) for 10 molecular markers of tumor invasiveness and scored the results.

      Results
      Patients showing predominance of the solid subtype component (solid subtype adenocarcinoma) had a poorer prognosis than those showing predominance of the lepidic, papillary, or acinar component. Lymphovascular invasion was more often detected in solid subtype tumors than in others. The solid subtype component showed a significantly stronger staining intensity of laminin-5 expression than the lepidic, papillary, and acinar components (P\\0.001, P\\0.001, and P = 0.016, respectively). The fibronectin and vimentin expression levels were also significantly higher in the solid subtype component than in other components. This immunostaining character was validated by using mixed-subtype adenocarcinomas containing all four components in the same tumor.

      Conclusion
      This study concluded that the solid subtype component in lung adenocarcinomas exhibit the invasive immunophenotype, including increased laminin-5 expression, compared with the other components, which may be associated with a poorer prognosis.

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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-045 - Thin-section computed tomography findings of lung adenocarinoma inherent with metastatic potential (ID 3259)

      09:30 - 09:30  |  Author(s): T. Hishida

      • Abstract

      Background
      Pulmonary solid nodules on chest computed tomography (CT) included inflammatory nodule, benign tumor, carcinoid tumor, small cell lung cancer, large cell carcinoma, large cell neuroendocrine carcinoma, squamous cell carcinoma, and poorly-differentiated adenocarcinoma, and so on. If the solid nodule was highly suspicious of malignant tumor or diagnosed as being primary lung cancer, a surgical resection would be recommended as expeditiously as practicable because of its metastatic potential. On the other hand, most well-defined ground-glass nodules including part-solid nodules were atypical adenomatous hyperplasias or lung adenocarcinomas. The development of spatial resolution on CT had provided improvement in predicting malignancy of these nodule shadow suspected of lung cancer. The aim of this study was to elucidate the preoperative chest thin-section CT (TSCT) findings of lung nodules which were inherent with metastatic potential from the perspective of recurrence and long term results.

      Methods
      We reviewed 392 primary lung adenocarcinomas with clinical T1N0M0 who underwent surgery between 2003 and 2007. Independent recurrence predicting parameters were extracted from the following ten parameters by using logistic regression analysis; sex, age, smoking index, preoperative serum carcinoembryonic antigen level, tumor location, maximum tumor size, consolidation tumor ratio (C/T ratio), tumor disappearance rate (TDR), the maximum size of consolidation at lung window setting (lung consolid), and the maximum size of consolidation at mediastinal window setting (med consolid). We evaluated extracted parameters by using receiver operating characteristic area under the curve (ROC-AUC) for recurrence prediction and identified these optimal cut-off levels of these parameters for prediction of whether patients had a good chance of being cured by surgical resection from their recurrence rate and survival.

      Results
      The median follow-up period was seven years. The 75 of 392 patients recurred. C/T ratio, lung consolid, and TDR were extracted as an independent recurrence predictor. ROC-AUC of these parameters was 0.70, 0.71, and 0.64 for predicting recurrence, respectively. If C/T ratio was 0.5 or less, distant metastatic recurrence was observed in only one of 75 patients and if lung consolid was 10 mm or less, it was also observed in only one of 82 patients. There were significant differences in overall survival and recurrence free survival among two populations divided by these cut-off levels of C/T ratio and lung consolid.

      Conclusion
      If the C/T ratio was 0.5 or less and/or lung consolid size was10 mm or less in cT1N0M0 lung adenocarcinoma patients, the recurrence rate was extremely low if they underwent a standard surgical resection. But when TSCT parameters of lung nodules exceeded these cut-off values, the recurrence rate wound increase and the prognosis would become worse even if they underwent complete resection. In these cases a prompt surgical resection would be recommended.