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Y. Takahashi



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    O13 - Limited Resections (ID 101)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O13.03 - Survival of 1963 lobectomy-tolerable patients who underwent limited resection for cStage I non-small cell lung cancer (ID 1030)

      10:50 - 11:00  |  Author(s): Y. Takahashi

      • Abstract
      • Presentation
      • Slides

      Background
      Although the standard operation for lung cancer is lobectomy, precise preoperative diagnosis of the “very early” lung carcinomas may identify patients that can be treated by limited resection. Previous reports on limited resection included patients who were not candidates for lobectomy. The survival of non-small cell lung cancer (NSCLC) patients who were fit for lobectomy and underwent limited resection has not been studied in a large enough scale.

      Methods
      A nationwide multi-institutional project collected clinical data of patients who underwent limited resection (segmentectomy or partial resection) for clinical T1-2N0M0 non-small cell lung carcinoma, who were 75 years old or younger at the time of operation and were considered fit for lobectomy by the physician. Overall and disease free survival, freedom from recurrence were analyzed and factors affecting survival or recurrence were identified.

      Results
      The median age of 1963 patients was 63 years. The mean maximal diameter of the tumor was 1.4 ± 0.6 cm. The overall and recurrence free survival after limited lung resection was 93.7 % and 90.4 % at 5 years, respectively. The recurrence free proportion and local recurrence free proportion were 93.3 % and 98.4 % at 5 years, respectively. Prognostic factors in overall survival were pathologically proven lymph node metastasis, interstitial pneumonia, male gender, older age, complications (cardiac disease, diabetes etc.), radiological invasive cancer, and multiple lesions. The consolidation/tumor ratio on CT of ≤ 0.25 predicted good outcome especially in cT1aN0M0 disease. Prognosis and recurrence was not affected by the method of limited resection (segmentectomy (n=1225) or partial resection (n=738)).

      Conclusion
      If the patient was 75 years old or younger and was judged fit for lobectomy, the result of limited resection for cStage I NSCLC was excellent and was not inferior to the reported result of lobectomy for small sized NSCLC. The radiological noninvasive carcinomas rarely recur and are especially good candidates for limited resection.

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    P2.06 - Poster Session 2 - Prognostic and Predictive Biomarkers (ID 165)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Biology
    • Presentations: 1
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      P2.06-018 - Correlation of TS mRNA expression level and TS protein level detected by immunostaining for use in post-operative primary lung cancer therapy (ID 1697)

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

      • Abstract

      Background
      There has been a focus on the use of thymidylate synthase (TS) as a biomarker for the long term administration of metabolic antagonists for lung cancer. TS mRNA levels have been measured by real time RT-PCR in tumors collected using a micro-dissection method; however, this method has not been applicable for general use and its clinical use has been problematic. Therefore, this study investigated the correlation of TS mRNA expression level and a commonly used semiquantitative immunohistochemical method.

      Methods
      Resected lung specimens were collected from 47 patients with Stage IA (T1b) and IIB primary non-small-cell lung cancer who had undergone lobectomy between 2006 and 2012 at our Hospital. Levels of mRNA expression were measured using the Danenberg Tumor Profile method while TS immunostaining with anti-TS mouse IgG MoAB was graded into 4 levels.

      Results
      Of 47 patients, 24 patients were male and 23 patients were female. Thirty six people had adenocarcinoma while 11 patients exhibited squamous cell carcinoma. The number of patients at each IA, IB, IIA and IIB stage were 20, 20, 5, and 2, respectively. TS mRNA expression levels of these patients were between 0.69 and 12.68 (a median value of 2.47). Immunostaining indicated that Grade 0, 1, 2, and 3 were observed in 3, 17, 15 and 12, respectively. A moderate positive correlation was observed at a correlation coefficient of r=0.4880 between mRNA expression levels and immunostain levels (A). Moreover, a significant correlation between mRNA expression levels and immunostain levels was observed when mRNA expression levels were divided into two groups, one with higher than median values and the other with lower than median values, where Grade 0 and 1 were assigned as negatively stained and Grade 2 and 3 were assigned as positively stained (B).Figure 1

      Conclusion
      Immunostaining is a useful method for measuring TS level when TS is being considered as an appropriate biomarker for postoperative adjuvant chemotherapy with 5-FU delivertives.