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Y. Ohtaki



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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): Y. Ohtaki

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

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-036 - Postrecurrence survival of surgically resected pulmonary adenocarcinoma patients according to EGFR and KRAS mutation status (ID 2786)

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

      • Abstract

      Background
      The aim of this study was to clarify the prognosis of pulmonary adenocarcinoma patients after postoperative recurrence according to EGFR and KRAS mutations and recurrence site.

      Methods
      Between July 2002 and December 2011, a total of 297 consecutive patients underwent surgical resection for primary pulmonary adenocarcinoma. Among all the patients, we retrospectively evaluated 58 recurrent adenocarcinoma patients. They were divided into the groups according to presence of EGFR mutation and KRAS mutation, and compared clinicopathological features, recurrence sites and postrecurrence survival.

      Results
      EGFR, KRAS mutations were detected in 26 patients (45%), 11 patients (19%), respectively. Of the cases with EGFR mutations, L858R point mutation in exon 21 was most frequently observed in 18 cases, secondly deletion in exon 19 was in 8 cases. Initial recurrence was detected in distant in 25 (43%), local in 17 (29%), and both in 16 (28%). In EGFR mutant (EGFR+) cases, bilateral/contralateral lung recurrences were significantly frequently occurred. EGFR+ cases had significantly better outcome than KRAS+ cases and EGFR-KRAS- (Wild) cases. 2-year postrecurrence survival rate were 81%, 18%, and 47% in EGFR+, KRAS+, and Wild cases, respectively. Patients with distant organ recurrence (D+) showed significantly worse survival than those without distant recurrences in only Wild cases, but not significant in EGFR+ cases and entire cohort. Multivariate analysis revealed that only EGFR mutation and number of recurrent lesions were statistically significant independent postrecurrence prognostic factors. Figure 1Figure 2

      Conclusion
      Our results indicate there were distinct survival differences in recurrent adenocarcinoma patients according to driver mutations. Patients with EGFR mutated tumors could be expected of long survive regardless of presence of distant site recurrences, and patients with KRAS mutated adenocarcinoma had poor outcome after postoperative recurrence. The examination of driver mutations is essential for prediction of postrecurrence survival after surgical resection.