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T. Ohira
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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: 2
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.03-003 - A Clinicopathological Study of Resected Small-Sized Non-Small Cell Lung Cancer 2 cm or Less in Diameter with N2 Lymph Node Metastasis (ID 1348)
09:30 - 09:30 | Author(s): T. Ohira
- Abstract
Background:
The detection of small-sized (≤ 2 cm) non-small cell lung cancer (NSCLC) has increased with the development of high-resolution computed tomography. The reported 5-year survival rate of T1a (≤ 2 cm) N0M0 patients is more than 80%, and that of p-T (≤ 2 cm) N2M0 patients has also steadily improved.
Methods:
Between January 1991 and December 2011, a total of 917 patients with small-sized NSCLC underwent curative pulmonary resection with systematic lymph node dissection by open thoracotomy or video-assisted thoracic surgery at our hospital. We retrospectively evaluated their postoperative clinical outcomes and survival rates. Survival was analyzed using the Kaplan-Meier method and log-rank test.
Results:
There were 57 (6.2%) patients with mediastinal lymph node metastasis (pN2 disease). The distributions of the histological types were adenocarcinoma 41 cases, squamous cell carcinoma 11, large cell carcinoma 4, and carcinoid 1. The procedures included lobectomy in 48 cases, segmentectomy in 6, and pneumonectomy in 3. The respectively status of lymph node metastasis was single station in 36 cases and multiple station in 21. Skip lymph node metastasis (no hilum lymph node metastasis) was observed in 13 cases. In 44 cases, there was both hilum lymph node and mediastinal lymph node metastases. There were 34 cases (59.6%) that were upstaged from preoperative clinical diagnosis (cN0 or N1). The median overall survival period and 5 year survival of the 57 patients with pN2 was 43.5 months and 41%. The recurrence rate was 70% (40/57) and the median disease-free interval was 41.3 months. Of the 18 patients without recurrence, 14 (77.8%) had single station mediastinal metastasis. The 5-year overall survival rates with multiple station or single station mediastinal metastases were 34.5% and 48.9%, respectively (NS). The 5-year overall survival rates with multiple (hilum and mediastinal) station lymph node metastases and only mediastinal station lymph node metastasis were 37.7% and 64.8%, respectively.
Conclusion:
This study showed that 6.2% of small-sized NSCLC had N2 disease. Moreover, 59.6% of small-sized NSCLC was upstaged from clinical diagnosis to pathological diagnosis. Single station mediastinal metastases showed a longer overall survival rate (64.8%) than multiple station mediastinal lymph node metastases. Therefore, we recommend systematic lymph node dissection for local treatment as well as accurate diagnosis. As multiple mediastinal node metastases showed an unfavorable prognosis, surgery combined with systematic treatment is recommended.
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P1.03-028 - Multicenter Study of the Usefulness of FDG-PET as a Predictor of the Clinicopathological Characteristics and Prognosis of Lung Cancer (ID 1121)
09:30 - 09:30 | Author(s): T. Ohira
- Abstract
Background:
This multicenter study aimed to investigate the performance of standardized uptake value (SUV) on [18F]-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) as a predictor of the clinicopathological characteristics and prognosis of resected lung cancers.
Methods:
A total of 721 patients underwent curative resection with systematic lymph node dissection. The relationship among histological characteristics, pathological staging, prognosis, and SUV on FDG-PET was retrospectively examined.
Results:
There were 107 squamous cell carcinomas and 614 adenocarcinomas. The pathological stages of the cases were IA 408, IB 162, IIA 57, IIB 23, IIIA 65, IIIB 1, and IV 5. The SUVmax on FDG-PET/CT was significantly higher in squamous cell carcinoma than in adenocarcinoma (11.98 ± 6.81 vs 4.03 ± 4.99; p < 0.001) and this tendency was similar in all stages. Pathological N1 (n = 19), N2 (n = 9) cases showed a significantly higher SUVmax than N0 (n = 79) in squamous cell carcinoma (15.00 ± 5.42, 17.24 ± 8.10 vs 10.65 ± 6.50). This was also the case with adenocarcinoma N2 (n = 48) 8.58 ± 6.14, N1 (n = 40) 9.15 ± 7.13 vs N0 (n = 526) 3.23 ± 4.16. Cases with pathological tumor invasiveness such as lymphatic, vascular or pleural infiltration showed a significantly higher SUVmax than cases with no invasiveness in squamous cell carcinoma (13.75 ± 6.75 vs 7.21 ± 4.22; p < 0.001) and adenocarcinoma (7.39 ± 6.12 vs 1.94 ± 2.37; p < 0.001). The areas under the receiver operating characteristic curves for SUVmax used to predict the relapse-free survival were 12.3 (p = 0.058) in squamous cell carcinoma and 2.6 (p < 0.001) in adenocarcinoma. The 2-year relapse-free survival was 93%/68% (SUVmax lower/higher than 12.3) in squamous cell carcinoma and 99%/78% (SUVmax lower/higher than 2.6) in adenocarcinoma. Following multivariate analysis, pathological nodal status and SUVmax were found to be independent predictive factors for relapse-free survival.
Conclusion:
SUVmax of the primary tumor reflected the biological malignancy of lung cancers. As SUVmax tended to be higher in squamous cell carcinoma than in adenocarcinoma, this should be clinically used separately according to histology. SUVmax is also useful for predicting survival, and multimodality treatment might be indicated if the value is high.
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P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.03-035 - Impact of Lymph Node Involvement on Survival in Patients with Completely Resected Pulmonary Squamous Cell Carcinoma (ID 1301)
09:30 - 09:30 | Author(s): T. Ohira
- Abstract
Background:
Lymph node involvement is an important prognostic factor in non-small cell lung cancer (NSCLC) patients. However, the prognostic impact varies among the histological types of NSCLC because of the lymph node spread pattern or other factors. We re-evaluated the impact of lymph node involvement and other clinicopathologic factors on survival in patients with pulmonary squamous cell carcinoma (SqCC) and identified high-risk patients who may benefit from additional therapy.
Methods:
Between 1990 and 2010, 530 consecutive T1-4N0-2M0 SqCC patients underwent complete resection with systematic lymph node dissection at our hospital. We statistically analyzed the association between lymph node involvement and clinicopathologic factors, as well as clinical outcomes.
Results:
The 5-year overall survival (5y-OS) rates of the patients with stages I, II, and III were 66.5%, 57.6%, and 30.0%, respectively (stage I vs stage II, NS). Multivariate survival analysis showed that patients with N2 had significant associations with unfavorable prognosis (HR = 2.58, p < 0.0001). The 5y-OS rate for N2 tumors (32.1%) was significantly worse than those for N0 and N1 tumors (63.0% and 56.6%, respectively). In stages I and II, tumor size > 5 cm, pleural invasion (PL), and age over 70 years were found to be significant independent prognostic factors by multivariate survival analysis, but lymph node status (N0 or N1) was not. Thus, tumors ≤ 5 cm without PL and tumors ≤ 3 cm with PL were classified as the new stage I (5y-OS, 69.8%) in the patients with N0 or N1, and tumors > 5 cm without PL and tumors > 3 cm with PL were classified as the new stage II (5y-OS, 45.7%). In contrast, tumors with N2 were classified as the new stage III (5y-OS, 32.1%). There was a statistically significant difference among these groups.
Conclusion:
N2 status was strongly associated with poor outcome in SqCC patients, but not N1 status. Our results indicate that lymph node status should not be incorporated into the staging system for N0-1 SqCC patients This information might prompt the design of clinical trials on additional therapy for these patients. Figure 1
