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N. Altorki
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ORAL 35 - Surgical Approaches in Localized Lung Cancer (ID 155)
- Event: WCLC 2015
- Type: Oral Session
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:M. de Perrot, J. Mitchell
- Coordinates: 9/09/2015, 16:45 - 18:15, 601+603
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ORAL35.05 - The Role of Surgical Mediastinal Resection in CT Screen-Detected Lung Cancer Patients (ID 960)
17:28 - 17:39 | Author(s): N. Altorki
- Abstract
- Presentation
Background:
Comparison of long-term survival of patients with clinical Stage I non-small-cell lung cancer (NSCLC) with and without mediastinal lymph node resection (MLNR) in the International Early Lung Cancer Action Program, a large prospective cohort in a low-dose CT screening program.
Methods:
All instances of thoracic surgery for first solitary primary non-small-cell lung cancer prompted by low-dose CT screening, performed under an IRB approved common protocol at each of the participating institutions since 1992 to 2014, are included. Follow-up time was calculated from diagnosis to death from lung cancer, last contact, or December 31, 2014, whichever came first. Univariate logistic regression analysis of the demographic, CT, and surgical findings for those with and without MLNR was performed. Kaplan-Meier (K-M) survival rates and Cox regression analysis was performed using all significant univariate variables.
Results:
The 10-year Kaplan-Meier (K-M) NSCLC-specific survival rate for the 225 patients manifesting as a subsolid nodule was 100%, regardless of whether they had MLNR (N = 169) or not (N = 56). For the 373 NSCLC patients manifesting as a solid nodule, for those who had MLNR (N = 285) and those who did not (N = 88), the K-M NSCLC-survival rate was not significantly different (86 % vs. 93%, P = 0.23). The rate was 95% vs. 96% (P = 0.86) for those whose pathologic tumor diameter was <= 10 mm; 83% vs. 94% (P = 0.19) for 11-20 mm, and 79% vs. 86% (P = 0.67) for 21-20 mm. Cox regression analysis comparing MLNR with no MLNR showed that survival rates were not significantly different (P = 0.33), but significantly survival decreased when the tumor diameter was above 20 mm (HR= 5.1, 95% CI: 1.6-15.7).
Conclusion:
Lymph node evaluation is not necessary for resection of subsolid nodules in patients with screen-detected lung cancer.
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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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P1.02-007 - The Histologic Subtype of Lung Adenocarcinoma Should Not Deter Sublobar Resection for Patients with Clinical Stage IA Lung Cancer (ID 2516)
09:30 - 09:30 | Author(s): N. Altorki
- Abstract
Background:
The International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society pathological classification of lung cancer allows for a more comprehensive understanding of the prognostic factors associated with subtypes of lung adenocarcinoma. Micropapillary and solid (MIP/SOL) subtypes have been associated with higher recurrence rates. Some have therefore suggested that sublobar resection (SLR) should be considered a compromise procedure in patients with MIP or SOL tumors. We conducted this study to examine the effect of the resection type [lobectomy (LO) or SLR] on oncological outcomes of patients with MIP/SOL.
Methods:
A retrospective review of a prospective database (2000-2014) was performed to identify patients with clinical stage IA adenocarcinoma, excluding pure ground glass opacities. Propensity score matching (age, gender, FEV1%, and clinical tumor size) was done to obtain balanced cohorts of patients undergoing LO and SLR. The presence of MIP and/or SOL components (≥5%) was assessed by a single pathologist to avoid inter-observer bias. The SLR group of patients had more comorbidities. Therefore, deaths from causes other than lung cancer were censored and freedom from recurrence was used to assess oncological outcomes. Survival analysis was done using the Kaplan Meier method. Multivariable analysis (MVA) was done using Cox regression.
Results:
This study included 300 patients (150 LO vs. 150 SLR, including 77 segmentectomy and 73 wedge resection). Patients undergoing SLR had higher Charlson comorbidity index (P=0.002) and lower DLco% (P=0.01). Patients undergoing LO were more likely to have nodal assessment (99% vs. 85%,P<0.001). Otherwise, no differences in the clinicopathological characteristics were found between the two groups. The presence of ≥5% MIP and/or SOL components was found in 135 patients; LO (58), SLR (77). The 3-year probability of freedom from recurrence in the whole cohort was: MIP (77%), synchronous MIP/SOL (76%), and SOL (61%), compared to 86% freedom from recurrence for other pathological subtypes (median follow-up 41 months). The probability of freedom from recurrence in patients with MIP/SOL subtypes showed a trend favoring the LO group (P=0.092). However, when we excluded patients with SLR with resection margin <1 cm (n=64), there was no difference between LO (80%-72%) and SLR (81%-75%) at 3 and 5 years respectively (P=0.812)(Fig.1). Also, the type of resection (LO/SLR) was not associated with higher recurrence rates in the MVA of the whole cohort. Figure 1
Conclusion:
SLR can be safely performed in clinical stage-IA lung adenocarcinoma, regardless of the histological subtype, provided that a resection margin >1 cm is obtained.
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P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.03-005 - Bilobectomy for Lung Cancer: Postoperative Results, and Long-Term Outcomes (ID 3124)
09:30 - 09:30 | Author(s): N. Altorki
- Abstract
Background:
Bilobectomy for treatment of lung cancer is considered a high-risk procedure as it is associated with increased postoperative complication rate and the negative impact on survival. We analyzed the safety and the oncologic results of this procedure.
Methods:
We retrospectively reviewed a prospectively collected database to retrieve patients who underwent bilobectomy for lung cancer between 1991 and 2015. Age, gender, neoadjuvant treatment, bilobectomy type and indication, complications, pathology, stage, and survival were analyzed using Cox regression in univariate and multivariate analysis. Kaplan–Meier survival curves were obtained and compared by log–rank.
Results:
From our 4144 resected lung cancer cases, bilobectomy was performed on 106(2.5%) patients (55 men; mean age, 65.5 years). There were 51 upper-middle and 55 middle-lower bilobectomies (adenocarcinoma,67 (63.3%); squamous cell carcinoma,35(33%); carcinoid tumor,4(3.8%)). Indications were tumor invasion of the bronchus intermedius in 58 (54.7%), vascular invasion in 26 (24.5%), and tumor crossing the fissure in 22 (20.8%) patients. Induction therapy was performed in 24 patients (24.5%). Thirty-day mortality was 1.89% (n = 2). Overall major morbidity occurred in 13 patients ( 12.3%) among them 9 patients(69.2%) had pulmonary complications . Overall 3 and 5-year survivals were 64.5% and 56.2% respectively. Disease free 3 and 5-year survivals were 47.4% and 43.8% respectively. Significant decrease in 5 year survival was observed among smoker (p=0.046), higher tumor grades (Grade3 versus 1or2 (p=<0.005)), higher stages (stage I, 66.6%; stage II, 51.5%; stage III, 31.2%; p = 0.012)(see Figure) and the nodal(N) disease s (N0, 58.2%; N1and 2, 38.1%; p = 0.054) adversely influenced survival. Multivariate analysis demonstrated that a higher tumor grade (p = 0.005), a larger tumor (p=0.019), advanced N status (p=0.085) and smoking (p=0.056) adversely affecting prognosis. Figure 1
Conclusion:
Bilobectomy is associated with a low mortality and an acceptable morbidity. Survival relates to disease stage and N factor. Optimal prognosis is obtained in patients with early stage, low grade tumors and nonsmoker.
