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Y. Shimada



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    MO26 - Anatomical Pathology II (ID 129)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Pathology
    • Presentations: 1
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      MO26.11 - Proposal on incorporating Blood Vessel Invasion into the T classification parts as a practical staging system for stage I Non-small cell Lung Cancer (ID 842)

      11:30 - 11:35  |  Author(s): Y. Shimada

      • Abstract
      • Presentation
      • Slides

      Background
      We investigated blood vessel invasion (BVI) as a possible negative prognostic factor in patients with stage I non-small cell lung cancer (NSCLC) according to the 7[th] Edition of the TNM classification.

      Methods
      Between 1999 and 2007, a total of 694 consecutive patients with pathological stage I NSCLC underwent complete resection with systematic lymph node dissection at Tokyo Medical University Hospital. All sections of the specimens were stained by Elastica van Gieson to visualize elastic fibers and were examined to determine the prognostic symptoms of BVI. We statistically analyzed the association between BVI and clinicopathologic factors, as well as clinical outcomes.

      Results
      BVI was detected in 201 patients with stage I NSCLC (29.0%). The 5-year overall survival (OS) rates of the non-BVI and BVI patients were 90.5% and 66.0%, respectively (p < 0.0001). BVI was found to be a significant independent prognostic factor by multivariate survival analysis in stage IA and stage IB NSCLC (HR 2.591, p < 0.001; HR 2.347, p = 0.009, respectively). The 5-year OS rate of patients with BVI was significantly worse than that of patients without BVI in the T1a (94.5% vs 87.5%, p < 0.0001), T1b (82.7% vs 65.9%, p = 0.034), and T2a (90.9% vs 61.8%, p < 0.0001) subgroups.

      Conclusion
      We identified the presence of BVI as an independent poor prognostic factor in patients with stage I NSCLC. In the future revision of the TNM staging system, the routine use of elastic fiber stains in pathological evaluations of lung cancer for BVI determination might be recommended, and tumors with BVI should be upstaged to the higher current T staging.

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    O28 - Endoscopy (ID 124)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Pulmonology + Endoscopy/Pulmonary
    • Presentations: 1
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      O28.06 - Comprehensive management of central type early lung cancer (ID 1558)

      11:25 - 11:35  |  Author(s): Y. Shimada

      • Abstract
      • Presentation
      • Slides

      Background
      Tumor localization and the precise evaluation of tumor invasion are most important for the management of central type early stage lung cancer (CELC) and Photodynamic therapy (PDT) has come to be considered as the first choice of treatment for CELC. The present guidelines of PDT for CELC were established based mainly on the data obtained from studies since 1980’s. CELCs less than 1 cm in diameter showed a favorable cure rate by PDT, thus this was a good standard to decide the indications of PDT. To obtain complete response (CR) by PDT, evaluation of each lesion is extremely important, including the extent of the tumor on the bronchial surface and the depth of invasion in the bronchial wall. We postulate that the combination of comprehensive diagnosis and the new generation of photosensitizers may increase the CR rate and expand the indications of PDT for larger tumors.

      Methods
      Autofluorescence bronchoscopy (AFB) has been used in the objective evaluation of the margin of the tumor before endoscopic treatment and Endobronchial ultrasonography (EBUS) has been employed to determine the depth of tumor invasion. Ooptical coherence tomography (OCT) has been investigated for clinical use as well. Also, the relatively newer photosensitizer NPe6, which has a stronger antitumor effect than Photofrin has been extensively used for PDT. We routinely used these diagnostic methodologies and NPe6 since 2004.

      Results
      A total of 122 consecutive CELCs were treated by PDT using NPe6 in Tokyo Medical University and CR was obtained in 115 lesions (CR rate 94.3%). Of the 122 lesions examined in this study, 78 had a diameter of ≦1.0 cm and the rest of the 44 cancer lesions were >1.0 cm in size. The CR rate of CELC ≦1.0 cm in diameter was 93.6% (73/78) and for those >1.0 cm in diameter, 95.5% (42/44), respectively. There was no significant difference between tumor size and clinical response. The CR rate to NPe6-PDT is higher than that of Photofrin-PDT in our previous studies. This early result suggests that PDT with NPe6 has a stronger antitumor effect than Photofrin therefore similar treatment outcome even for larger tumors >1.0 cm in diameter should be possible.

      Conclusion
      Objective evaluation by a comprehensive approach using AFB and EBUS enables to select the optimal therapeutic strategy for CELC. These results suggest that PDT with NPe6 may have a similar treatment outcome regardless of tumor size, as long sufficient laser illumination of the entire tumor is possible.

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    P2.07 - Poster Session 2 - Surgery (ID 190)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P2.07-029 - Clinical features and outcome of surgically resected secondary primary non-small cell lung cancer (ID 2607)

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

      • Abstract

      Background
      The incidence of a second primary lung cancer has been reported with 1-2% per patient year. Still, relatively few data has been published about this selected group of patients with sometimes conflicting results. Most data has been included low patient numbers that derived either from multiple institutions or from a long time period that may have rendered conclusions difficult caused by varying diagnostic procedures and therapeutic developments. Moreover, data regarding clinical characteristics is lacking for patients with first primary lung cancer who might be at risk for developing second primary lung cancer

      Methods
      From January 1999 to December 2008, 65 patients with second primary lung cancer, classified by the criteria proposed by Martini and Melamed, were treated at our Institution. We had 34 patients with a synchronous tumour and 31 with metachronous. As second treatment, we performed 11 lobectomies and 54 segmentectomies and widewedge resections. Histology was adenocarcinoma in 58, squamous in 4, adenosquamous in 8, large cells in 2 and pleomorphic in 1.

      Results
      Overall 5-year survival from second surgery was 69%; overall operative mortality was 0.65% (1 patient). Regarding the interval of surgery, the second operation had performed later than 2 years group showed a better 5-year survival than within 2 years group (80.6% and 69.2%, respectively, P = 0.008). Compared with lobectomies, segmentectomy showed a no significantly changes in survival rate(69 and 60%, respectively, P >0.051).

      Conclusion
      From our experience, lobectomy should still be considered as the treatment of choice in the management of second primary lung cancer, but sublobar resection remains a valid option in high-risk patients with limited pulmonary function.

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    P3.19 - Poster Session 3 - Imaging (ID 181)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P3.19-001 - Correlation between whole tumor size and solid component size on high-resolution computed tomography in the prediction of the degree of pathologic malignancy and the prognostic outcome in primary lung adenocarcinoma (ID 138)

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

      • Abstract

      Background
      It is known that in lung adenocarcinoma, ground glass nodule (GGN) tumors have a better prognosis than solid tumors. The aim of this study is to determine whether it is more useful to evaluate the whole tumor size or only the solid component size to predict the pathologic malignancy and the prognostic outcome in lung adenocarcinoma.

      Methods
      Using high-resolution computed tomography (HRCT) data of 232 patients with adenocarcinoma 7 cm or less who underwent curative resection, we retrospectively measured the whole tumor and solid component sizes with lung window setting (WTLW and SCLW) and whole tumor sizes with a mediastinal window setting (WTMW).

      Results
      There was significant correlation between the WTLW and the measurements of pathological specimens (r=0.792, P<0.0001). The SCLW and WTMW values significantly correlated with the area of pathologically confirmed invasion (r=0.762, P<0.0001 and r=0.771, P<0.0001, respectively). The receiver operating characteristics area under the curve for WTLW, SCLW and WTMW used to identify lymph node metastasis or lymphatic or vascular invasion were 0.693, 0.817 and 0.824, respectively. Kaplan-Meier curves of DFS and OS were better divided according to SCLW and WTMW, compared with WTLW. Multivariate analysis of DFS and OS revealed that WTMW was an independent prognostic factor (HR=0.72, 95%CI=0.58-0.90, P=0.004 and HR=0.74, 95%CI=0.57-0.96, P=0.022, respectively).

      Conclusion
      The predictive values of the solid tumor size visualized on HRCT especially in the mediastinal window for pathologic high-grade malignancy and prognosis in lung adenocarcinoma less than 7 cm were greater than those of whole tumor size.