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K. Fei
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MINI 06 - Quality/Prognosis/Survival (ID 111)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:R. Meguid, J. Yoshida
- Coordinates: 9/07/2015, 16:45 - 18:15, 605+607
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MINI06.01 - Prognostic Impact of Visceral Pleural Invasion and Its Degrees in Non-Small Cell Lung Cancer: A SEER Database Analysis (ID 2256)
16:45 - 16:50 | Author(s): K. Fei
- Abstract
- Presentation
Background:
Visceral pleural invasion (VPI) is reported to be associated with poor prognosis in non-small cell lung cancer (NSCLC). However, whether a tumor size larger than 3cm with VPI should be upgraded to the next T stage remains unclear. In addition, few studies have clarified the impact of VPI according to nodal status, and whether degree of VPI (PL1, PL2) affects survival is controversial. The objective of this study was to evaluate the influence of VPI and also develop a prognostic nomogram.
Methods:
We retrospectively reviewed the SEER database from 2004 to 2011. Inclusion criteria were defined as: first and only primary NSCLC treated with lobectomy; staging as T1-3N0-2M0, no other non-size-based T factors except VPI. Tumors were divided into 10 groups: A, 0-2cm, non-VPI; B, 0-2cm, VPI; C, 2-3cm, non-VPI; D, 2-3cm, VPI; E, 3–5cm, non-VPI; F, 3–5cm, VPI; G, 5–7cm, non-VPI; H, 5–7cm, VPI; I, >7cm, non-VPI; J, >7cm, VPI. Kaplan-Meier overall survival (OS) curves were compared using the log-rank test. A Cox proportional hazard model was used, and identified independent prognostic factors were entered into the nomogram.
Results:
A total of 26,315 patients were finally identified, 5,941 patients (22.6%) had VPI. VPI showed an adverse impact in all tumor size groups in N0 status (p<0.001). Cox regression showed that VPI is an independent risk factor (HR 1.25; 95%CI 1.19-1.31). In N0 status, the survival rates were significantly different between B with C and D with E groups (p<0.001), whereas not significantly between F with G (p=0.405) and H with I (p=0.506). In N1 and N2 status, only the A and B groups showed a distinct survival impact (p=0.001). Between 2010 and 2011, 5,632 patients performed the elastic stain for differentiating the degrees of VPI, and survival was not significantly different between PL1 and PL2 (p=0.568). The C-index of the nomogram was 0.68. The calibration curves showed optimal agreement between nomogram prediction and actual observation of OS.Figure 1
Conclusion:
The presence of VPI, rather than the extent (PL1, PL2) has an adverse impact on NSCLC patients and N0 status. In a future TNM staging system, VPI should lead to upstaging to the next T category in current 3-7cm tumors. VPI is more aggressive in early-stage tumors, while its prognostic impact in node positive and locally invasive tumors is less significant. We further established and validated a nomogram to provide individual prediction of OS. The nomogram could be helpful for clinicians in decision making.
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MINI 10 - ALK and EGFR (ID 105)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:T. Yap, T. Li
- Coordinates: 9/07/2015, 16:45 - 18:15, Mile High Ballroom 1a-1f
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MINI10.02 - Intratumoral Heterogeneity of ALK-Rearranged and ALK/EGFR Co-Altered Lung Adenocarcinoma (ID 685)
16:50 - 16:55 | Author(s): K. Fei
- Abstract
- Presentation
Background:
Genetic intratumoral heterogeneity has a profound influence on the selection of clinical treatment strategies and addressing resistance to targeted therapy. The purpose of our study is to explore the potential effect of intratumoral heterogeneity on both the genetic and pathologic characteristics of ALK-rearranged lung adenocarcinoma (LADC).
Methods:
We tested ALK fusions and EGFR mutations in 629 LADC patients by using laser capture microdissection (LCM) to capture spatially separated tumor cell subpopulations in various adenocarcinoma subtypes and test for ALK fusions and EGFR mutations in ALK-rearranged, EGFR-mutated, and ALK/EGFR co-altered LADCs in order to compare the oncogenic driver status between different tumor cell subpopulations in the same primary tumor.
Results:
Among the 629 patients, 30 (4.8%) had ALK fusions, 364 (57.9%) had EGFR mutations, and 2 had ALK fusions coexisting with EGFR mutations. Intratumoral heterogeneity of ALK fusions was identified in 9 patients by RT-PCR. In the 2 ALK/EGFR co-altered patients, intratumoral genetic heterogeneity was observed both between different growth patterns and within the same growth pattern. Genetic intratumoral heterogeneity of EGFR mutations was also identified in EGFR-mutated NSCLC. ALK fusions were positively associated with a micropapillary pattern (P=0.002) and negatively associated with a lepidic pattern (P=0.008) in a statistically-expanded analysis of 900 individual adenocarcinoma components, although they appeared to be more common in acinar-predominant LADCs in the analysis of 629 patients.
Conclusion:
Intratumoral genetic heterogeneity was demonstrated to co-exist with histologic heterogeneity in both single-driver and EGFR/ALK co-altered LADCs. As for the latter, one of the dual altered drivers may be the trunk-driver for the tumor.
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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.02-006 - Visceral Pleural Invasion Was Common in Larger (> 2 cm) Ground Glass Nodules, but Showed No Aggressive Prognostic Impact (ID 2348)
09:30 - 09:30 | Author(s): K. Fei
- Abstract
Background:
Visceral pleural invasion (VPI) had been demonstrated as an aggressive sign in solid-density non-small-cell lung cancers. However, its incidence and clinical relevance in ground glass nodules (GGNs) has not been clarified. The present study aims to investigate the clinical, radiological and pathological features of GGNs in patients with VPI.
Methods:
All consecutive surgically treated patients with solitary GGNs between 2008 and 2013 were retrospectively reviewed. Inclusion criteria were defined as: lesions < 3 cm and pleura abutting on computed tomography scan; pathologically confirmed non-small cell lung cancers. Patients with and without VPI were compared for clinical, radiological and pathologic parameters and survival.
Results:
A total of 121 patients were enrolled and 38 had pathologically proven VPI. The median patient age was 61 years old (range, 30-81 years old) and 45 (37.2%) patients were male. The mean follow-up duration was 30 months. The incidence of VPI was 43.9% (25/57) if the tumor diameter was > 2.0 cm and 20.3% (13/64) in < 2.0 cm (p=0.005). It was 20.9% (9/43) in pure GGNs and 37.2% (29/78) in part-solid GGNs (p=0.065). In cases with pleura indentation the incidence was 37.5% (24/64). In lepidic predominant, acinar predominant, papillary predominant and mucinous variant adenocarcinomas, the VPI rate was 44.7%, 84.60%, 52.9% and 100%, respectively (p=0.07). There were five lymph node involvement cases and three death cases due to distant metastasis. There was no statistical difference in 3-year overall survival between patients with VPI and without, nor between pure (all alive) and part-solid GGNs (p=0.956).
Conclusion:
VPI was more commonly seen in large (> 2 cm) GGNs and those with pleural indentations. Histologically it was more frequently seen when acinar was also predominant. Although commonly taken as an aggressive sign predictive of poor prognosis, the presence of VPI in GGNs may be associated with less prognostic significance. Therefore, upgrading of the TNM stage on the basis of VPI for such patients needs further verification.
