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M. Szołkowska



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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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      P3.07-030 - Surgical treatment of bronchopulmonary carcinoid tumors - a single institution experience (ID 2319)

      09:30 - 09:30  |  Author(s): M. Szołkowska

      • Abstract

      Background
      Bronchopulmonary carcinoid (BPC) comprise about 2-5% of lung tumors. BPC are malignant neoplasms with indolent course. Surgical treatment is the gold standard therapy.

      Methods
      We present our experience of 228 patients treated surgically for typical (TC) and atypical carcinoid (AC) from1998 to 2011 in National Tuberculosis and Lung Diseases Research Institute. We tried to determine the variables influencing the long-term survival of patients with BPC. Among 4467 patients, treated surgically for non-small cell carcinoma, BPC encompassed 5,1%. All cases were reviewed and classified according to the latest WHO classification (2004). The clinical course and survival analysis were performed.

      Results
      The number of BPC during last 14 years gradually growth, from 13,4 cases per year between 1998-2004 to 19,1 cases between 2005-2011. 102 cases (44,7%) were classified as TC and 126 (55,3%) as AC. There were 158 females (69%) and 70 men (31%) and the mean age was 52 ys. Men were significantly younger then females (49 vs 53). Symptoms were present in 143 patients, the most commonly were cough (31%), respiratory tract infection (31%), then haemoptysis (18%), dyspnoe (12%) and atelectasis (3,5%). No patients showed a carcinoid syndrome. There were no correlation between smoking status and BPC. Most of the tumors were central (73,7%), the remaining were peripheral. The mean diameter of BPC was 2,25cm (range 0,6-7,0cm). AC were significantly larger (2,54 vs 1,9) and centrally located were also larger the peripheral. Surgical treatment consisted of: 146 standard lobectomies (64%), 19 pneumonectomies (8%), 23 bilobectomies (10%), 23 sleeve lobectomies (10%), 2 sleeve-pneumonectomies (1%), 7 anatomic segmentectomies (3%), 2 wedge resections (1%), 6 – bronchoplastic procedures without lung resection (2,6%). Radical mediastinal lymphadenectomy was added in all cases exept 1. Involvement of lymph nodes was present in 35 cases (15,4%), N1 -22 (9,7%) and N2 – 13(5,7%). Infiltration of bronchial or vessel margin (R1) was revealed in 8 cases. The postoperative TNM stage contained IA (50%) disease, IB (31%), IIA (10%), IIB (2,6%), IIIA (6,1%), IV (0,4%). The stages IB, IIIA and IV more often related to AC. Four patients died in short time after operation (0,2 -2 months). Three of them were after pneumonectomies, one – sleeve-lobiectomie. In most cases tumor was localized centrally. The mean follow-up time for all patients was 69,3 months (range 0,2-172), with 204 still alive. Four patient died of tumor progression (3 from A, 1 from TC), remaining 8 patients from other causes, from 12 – the cause of death was unknown. Lymph nodes metastasis were seen in 5 cases (20,8%). Overall, 5, 10 and 14-years survival for TC was respectively 95%, 92,1% and 90,2%, for AC – 93%, 90,6% and 88,9%.

      Conclusion
      BPC demonstrate gradual growth during last years. Lung carcinoids are tumors with an excellent prognosis in most cases, even in the presence of metastases in lymph nodes and positive surgical margin (bronchial or vessel). Histologic subtypes did not infleunce on survival. Surgery currently represents the best treatment with good results and long survival but long-time observation is necessary.

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    P3.18 - Poster Session 3 - Pathology (ID 177)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Pathology
    • Presentations: 1
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      P3.18-011 - Prognostic value of blood and lymphatic vessels embolism (pV, pL) in early stage lung cancer (IA, IB). (ID 2309)

      09:30 - 09:30  |  Author(s): M. Szołkowska

      • Abstract

      Background
      Stage of lung cancer (TNM) is most valuable prognostic factor. Most of patient in IA and IB stage survive 5 years, but in 10% of them the relapse of the disease is noticed. Therefore identifying the negative prognostic factors is crucial. The neoplastic emboli in blood and lymphatic vessels seem to be one of them.

      Methods
      The retrospective analysis of lung cancer patients operated on from 2002 thru 2006 at our institution was done. In all patient included into the study group the IA or IB stage was diagnosed and the neoplastic emboli in both blood and lymphatic vessels of the tumor were found. The survival rate in this group was compared with those without such findings. Among 1648 patient operated on between 2002 and 2006 564 were classified as IA or IB (pN0) stage (after rejecting 22 of them due to R1). Among 271 pts during microscopic detection neoplastic emboli in blood or lymphatic vessels were found. The analyzed group consisted of 208 women and 356 men. The stage IA was established in 212 pts, including 115 in pT1a, 97 in pT1b. Stage IB was diagnosed in 352 pts (pT2a) among whom 149 have infiltration of parenchymal pleura detected. All of them underwent the radical resection – all surgical margins were negative. The pathological examination revealed adenocarcinoma in 230 pts, squamous cell lung cancer in 203 pts, large cell lung cancer in 30, carcinoid in 80 pts and other kind of NSCLC in remaining 21 pts.

      Results
      5-year survival rates recorded were as follow – in stage IA 79,9% and 74,1% in pT1A pT1b respectively, in stage IB (pT2a) 59,9%. The presence of neoplastic emboli in blood and lymphatic vessels of tumor correlated with poorer prognosis of survival (V=0 L=0 – 72%, V=1 L=0 63,3%, V=0 L=1 64,7%, V=1 L=1 58,1%).

      Conclusion
      Therefore we concluded that such finding should be considered a negative prognostic factor and ought to be recorded in every pathology report.