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S. Shiono



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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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      MO26.02 - Predominant histologic subtype by IASLC/ATS/ERS classification is correlated with prognosis and EGFR mutation in surgically resected lung adenocarcinoma (ID 354)

      10:35 - 10:40  |  Author(s): S. Shiono

      • Abstract
      • Presentation
      • Slides

      Background
      The purpose of this study is to validate the prognostic impact and the frequency of EGFR mutation in lung adenocarcinoma of Japanese patients based on new lung adenocarcinoma classification proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS).

      Methods
      We reclassified 486 adenocarcinomas according to the new classification. The percentage of each histopathological subtype and the predominant pattern were determined. EGFR mutation also was investigated 241 of 486 adenocarcinomas. The relationship between these results and clinicopathological backgrounds was investigated statistically.

      Results
      The histopathological assessment according to the IASLC/ATS/ERS classification showed that 8.4% (n = 41) of the cases were adenocarcinoma in situ (AIS) ; 9.2% (n = 45) were minimally invasive adenocarcinoma (MIA) ; 18.3% (n = 89) were lepidic predominant ; 20.4% (n = 99) were acinar predominant ; 28.0% (n = 136) were papillary predominant ; 10.5% (n = 51) were solid predominant ; 2.3% (n=11) were micropapillary (MP) predominant, and 2.9% (n=14) were invasive mucinous adenocarcinoma (IMA). In univariate analysis, the patients with AIS and MIA subtypes had neither recurrence nor death within the follow-up periods. This was followed by the patients with lepidic predominant. The patients with papillary predominant, those with acinar predominant and those with IMA showed almost similar disease-free survival. The patients with solid predominant and MP predominant showed worse disease-free survival (Figure). Multivariate analysis showed that the new classification was an independent predictor of disease-free survival (Hazards ratio: 2.59; 95% confidence interval: 1.69-3.96; p<0.001). EGFR mutation was detected in 131 of 241 adenocarcinomas (54.4%). The each prevalence of EGFR mutation of AIS/MIA/Lepidic/Papillary/Acinar/Solid/MP/IMA was 62.1%/60%/77.1%/50%/49%/27.8%/42.9%/0%.Figure 1

      Conclusion
      The new IASLC/ATS/ERS adenocarcinoma classification is very useful predictive marker to plan and determine a therapeutic strategy for lung adenocarcinoma.

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    P2.12 - Poster Session 2 - NSCLC Early Stage (ID 205)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P2.12-003 - Postoperative recurrence and the personalized postoperative surveillance for resected lung cancer patients (ID 367)

      09:30 - 09:30  |  Author(s): S. Shiono

      • Abstract

      Background
      Half of the patients who have a complete lung cancer resection have a recurrence. However, advances in radiographic modalities and chemotherapy enable physicians to achieve better outcomes for postoperative lung cancer recurrence. Yet, for cases with recurrence, postoperative follow-up methods have not been adequately assessed and there is currently no evidence-based postoperative surveillance method. We evaluated cases with postoperative recurrence and the personalized postoperative surveillance periods and methods used.

      Methods
      Follow-up after surgery consisted of a regular outpatient clinic check-up, including physical examination, history taking, blood tests, and chest X-ray, which were done three or four times per year for five years. During the follow-up period, annual chest and brain computed tomography scanning was done. If the patients were completely followed for 5 years, then surviving patients continued to be followed using chest X-ray or CT. Between May 2004 and December 2011, 547 patients had completely resected lung cancers in our institution. We retrospectively reviewed their prospectively collected database.

      Results
      We selected 106 patients (19.4%) who had a postoperative recurrence for an analysis of associations between recurrence and clinical factors. Regarding pathological stages, 24 of 257 (9.3%) with stage IA, 23 of 115 (20.0%) with stage IB, 18 of 61 (29.5%) with stage IIA, 10 of 25 (40.0%) with stage, IIB 30 of 50 (60.0%) with stage IIIA, and 1 of 2 (50.0%) with stage IV developed a recurrence. Sixty-eight patients (64%) were found to have a recurrence during follow-up surveillance and 38 patients (36%) were found to have a recurrence based on symptoms. The median time to recurrence was 12 months (1–72 months). Cumulative recurrence rates after surgery were 53% at 1 year, 81% at 2 years, and 98% at 5 years. Multivariate analysis showed that an advanced stage (stage II-IV; p < 0.01) and lymphovascular invasion positive (LVI; p = 0.01) were independent factors for earlier recurrence. Comparing those patients who were advanced stage and LVI positive with those who did not have these factors, 90.8% of high-risk patients had a relapse and 55.1.% of the other patients had a relapse within 2 years after surgery (p < 0.01). Five-year survival after surgery for patients with recurrence was 31.6% and 5-year survival after recurrence was 9.0%. Multivariate analysis showed that recurrence with symptoms (p < 0.01) and shorter time to recurrence (< 24 months; p < 0.01) were independent prognostic factors after recurrence.

      Conclusion
      Although this study was retrospective and included some biases, advanced stage and LVI positive patients should be intensively followed-up. Personalized follow-up programs for resected lung cancer patients should be considered.