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H. Asamura
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MINI 11 - Tobacco Control and Prevention (ID 108)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Prevention and Tobacco Control
- Presentations: 1
- Moderators:S.M. Janes, E. Stone, K.M. Cummings
- Coordinates: 9/07/2015, 16:45 - 18:15, 601+603
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MINI11.07 - The Relationship between Smoking Status and Prognostic Factors after Surgery in Lung Cancer Patients with Chronic Obstructive Pulmonary Disease (ID 1388)
17:10 - 17:15 | Author(s): H. Asamura
- Abstract
Background:
Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD), which frequently coexists with lung cancer. For non-small cell lung cancer (NSCLC) patients with COPD, the poor prognostic factors after curative surgery and their association with smoking status are unclear.
Methods:
We enrolled 858 patients who underwent curative surgical resection for pathological stage I or II NSCLC in our institute between January 2002 and December 2012. Of these patients, those with COPD, as determined by a fixed post-bronchodilator ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) below 0.7, were evaluated (n = 302). Clinical and pathological characteristics of the patients were retrospectively analyzed using the Cox regression hazards model to determine those that serve as poor prognostic factors after surgery.
Results:
The mean follow-up time was 49.3 months (±30.8 months; range, 1 to 135 months). The five-year disease-free survival rate was 70.2%, and the overall survival rate was 81.5%. Of 302 COPD patients, 243 (80.5%) had a smoking habit, whereas 59 (19.5%) did not. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion, 143 patients (47.5%) were diagnosed with stage I COPD and 159 patients (52.6%) were diagnosed with stage II COPD. The presence of a smoking habit (p = 0.010, hazard ratio [HR] 3.340, 95% confidence interval [CI] 1.334-8.359), lymphatic permeation (p = 0.001, HR 2.352, 95% CI 1.450-3.814), pathological T2 or T3 disease (p = 0.005, HR 1.666, 95% CI 1.165-2.381), and a preoperative serum carcinoembryonic antigen (CEA) value > 0.5 ng/ml (p = 0.041, HR 1.637, 95% CI 1.021-2.625) were determined to be indicators of poor recurrence-free survival in multivariate analysis. For overall survival rates, a smoking habit (p = 0.048, HR 7.527, 95% CI 1.017-55.738), a preoperative serum CEA value > 0.5 ng/ml (p = 0.001, HR 2.782, 95% CI 1.495-5.175), a histology of squamous cell carcinoma (p = 0.014, HR 2.220, 95% CI 1.175-4.193), and pathological N1 disease (p = 0.031, HR 2.505, 95% CI 1.089-5.762) were determined to be poor prognostic indicators in multivariate analysis. The disease stage as determined by the GOLD criterion was associated with neither recurrence-free nor overall survival rates. With regard to smokers, the number of pack-years did not significantly influence prognosis.
Conclusion:
We identified poor prognostic indicators for resected NSCLC in COPD patients. It should be noted that COPD patients who did not smoke had a better prognosis after surgery than those who did. Neither the number of pack-years in smokers nor the stage of COPD was related to prognosis after surgery.
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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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P1.02-011 - The Discordance of Two Major Diagnostic Criteria for Chronic Obstructive Pulmonary Disease Affects Lung Cancer Prognosis after Resection (ID 1250)
09:30 - 09:30 | Author(s): H. Asamura
- Abstract
Background:
Chronic obstructive pulmonary disease (COPD) has been reported to be associated with the development of lung cancer and poor prognosis after curative surgery for early-stage non-small cell lung cancer (NSCLC). The Global Initiative for Chronic Obstructive Lung Disease defines COPD as a fixed post-bronchodilator ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) below 0.7. Age-dependent cut-off values below the lower fifth percentile (LLN) of this ratio derived from the general population have been proposed as an alternative. In patients with obstruction according to the LLN cut-off point but not according to the fixed cut-off point, the prognosis after curative surgery for NSCLC is not known.
Methods:
We enrolled 556 patients with FEV1/FVC ≥0.7 who underwent curative surgical resection for pathological stage I or II NSCLC in our institute between January 2002 and December 2012. The post-surgical prognosis was compared between patients with obstruction (obstructed patients) and without obstruction (non-obstructed patients) according to the LLN cut-off point, using a Cox regression hazards model.
Results:
Of the 556 patients, 42 (7.6%) met the criteria of the LLN cut-off point. The 5-year recurrence-free rate was significantly lower in the obstructed patients (54.4%) than in the non-obstructed patients (77.1%), in univariate analysis (p < 0.01). The 5-year overall survival rate was also significantly lower in the obstructed patients (64.0%) than in the non-obstructed patients (91.1%), in univariate analysis (p < 0.01). Multivariate analysis showed that the obstructed patients had a poor recurrence-free (p = 0.05) and overall survival (p < 0.01) probability.
Conclusion:
Even if COPD is not diagnosed according to the fixed cut-off point, those who meet the criteria of the LLN cut-off point have a poor prognosis after curative surgery for NSCLC.
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P2.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 225)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.08-032 - Multimodality Treatment for Advanced Thymoma (ID 2589)
09:30 - 09:30 | Author(s): H. Asamura
- Abstract
Background:
Surgery remains the center of treatment of resectable thymoma. Radiation and chemotherapy have been applied widely as adjuvant treatment. However, the optimal treatment strategy for advanced thymoma remains controversial. This study aimed to evaluate the efficacy of multimodal treatment for patients with advanced stage III, IV thymoma.
Methods:
A total 250 consecutive patients with thymoma were treated in our hospital from January 1985 to December 2013. Among these, 70 patients were staged as Ⅲ and Ⅳ. The overall survival (OS) was analyzed according to clinicopathological factors and types of treatment.
Results:
There were 32 patients with stage III (46%), 35 patients with IVa (50%), and 3 patients with IVb (4%). The 10-year OS rates of patients with III+IV, III, IVa were 76%, 89%, and 64%, respectively. Types of treatment were as follows: surgery alone in 23 patients (33%), surgery followed by radiation in 31 (44%), surgery followed by chemotherapy in 2 (3%), surgery followed by chemo-radio therapy in 8 (11%), chemo-radio therapy alone in 6 (9%). There was no significant difference in OS among the treatment groups. Twenty-eight (40%) patients coexisted with myasthenia gravis (MG). There were no differences in OS between those with and without MG. Significant difference in OS was observed between 49 patients who underwent R0/R1 resection and 21 patients who underwent R2 resection (P = 0.004). The disease-free survival was worse in patients with combined full-dose mediastinal and low-dose, entire thoracic radiation than in those with full-dose mediastinal radiation alone (P = 0.04).
Conclusion:
In this retrospective study, it was shown that the surgical resection should always try to leave no gross tumor behind to ensure better prognosis. Although the future comparative, prospective study seems difficult because of the limited number of new cases, the multimodal approach with maximal treatment intensity looks promising.
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-007 - Salvage Surgery for Local Recurrence after Cryoablation for Non-Small Cell Lung Cancer: Importance of Diagnosis of Recurrence without Delay (ID 2598)
09:30 - 09:30 | Author(s): H. Asamura
- Abstract
Background:
Non-surgical treatment for lung cancer, such as stereotactic body radiation therapy (SBRT), radiofrequency ablation (RFA), and percutaneous cryoablation have been performed as alternatives to surgery for lung cancer in patients with comorbidities, limited pulmonary reserve, or early diseases. Not many, but the significant portion of patients with such local modalities experience the local failures. The salvage surgery for such recurrence might have been attempted with considerable technical and oncological difficulties. Two cases with salvage resection for local failure after cryoablation are described.
Methods:
We reviewed two patients who had previously undergone cryoablation, in whom local recurrences were treated with salvage surgery. We evaluated perioperative parameters and histological findings, which indicated the local failure.
Results:
Case1: A woman was underwent cryoablation treatment for second primary T1aN0M0 lung adenocarcinoma in left lower lobe after 6 years of right lower lobectomy for lung adenocarcinoma. 4 years after the cryoablation, CT scan showed a tumor increasing in size in the area of treatment and local recurrence was suspected. Recurrence of adenocarcinoma was confirmed by CT guided biopsy. Segmentectomy of posterior segment of left lower lobe was performed. Operation time was 155minutes and blood loss was 72 ml. This patient is alive without any sign of recurrence after 8 years from surgery. Case2: A woman was underwent cryoablation for clinical stage T1aN0M0 lung adenocarcinoma in right lower lobe after 20 years of right upper lobectomy for lung cancer. 3 years after the cryoablation, CT scan showed a tumor growing in size in the area of treatment and local recurrence was suspected. Local recurrence of adenocarcinoma was proved by CT guided biopsy. Segmentectomy of superior segment of right lower lobe was performed. Operation time was 291minues and blood loss was 230 ml. This patient is alive without any sign of recurrence after 22 months from surgery. In both cases, salvage surgeries were performed without any difficulties. Pathological examinations showed viable cancer cells with necrotic tissue and fibrosis around which was consistent with the local recurrence after cryoablation.
Conclusion:
The salvage surgery for the local failures after non-surgical treatment modalities might be indicated in selected cases. The difficulties in diagnosis of local recurrence might cause the optimal timing of surgery.
