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W. Liang
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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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MINI06.12 - Prognostic Impact of Cancer-involved Lymph Node Ratio in Resected NSCLC Differ between 'N1' or 'N2' Disease (ID 3209)
17:50 - 17:55 | Author(s): W. Liang
- Abstract
Background:
The extent of lymph nodes (LN) involvement and the adequacy of systematic LN sampling are significantly correlated with the prognosis of cancer patients. The index combing these two factors, cancer-involved LN ratio (LNR), has been proved a strong prognostic factor by extensive previous studies, including non-small cell lung cancer (NSCLC). However, intrapulmonary or mediastinal LNs associate with different examination strategy. It might not be appropriate to apply the LNR indistinguishably to all patients. Therefore, we sought to examine the performance of LNR separately.
Methods:
A consecutive cohort of patients who underwent radical resection with systematic lymph node sampling for NSCLC between Sep 2009 and Dec 2011 were collected. LNR for intrapulmonary and hilar LNs was recorded as LNR1, and LNR for mediastinal LNs was recorded as LNR2. LNR was incorporated in the Cox regression model as a continuous variable. Disease free survival (DFS) was the primary endpoint.
Results:
A total of 681 cases were included for analysis. Overall LNR was a significant prognostic factor in overall population (HR 11.75, 95% CI 6.99 to 19.75; P<0.001). For patients with ‘N2’ disease, overall LNR remained a prognostic factor (HR 3.07, 95% CI 1.22 to 7.74; P=0.02). However, further explorations revealed that LNR2 has prognostic impact (HR 3.59, 95% CI 1.68 to 7.67; P<0.01) but not LNR1 (HR 0.99, 95% CI 0.48 to 2.06; P= 0.99). For those with ‘N1’ disease, LNR1 was not a significant prognostic factor (HR 3.19, 95% CI 0.87 to 11.66; P=0.08) but the prognostic value of overall LNR is strong (HR 36.17, 95% CI 6.23 to 210.13; P<0.01).
Conclusion:
This study suggests that for pathological ‘N1’ NSCLC, overall LNR should be considered a prognostic value while for ‘N2’ disease, only medialstinal LNR should be included in prognostic stratification.
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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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ORAL35.07 - The Feasibility and Safety of Complete VATS for NSCLC Under Non-Intubated Intravenous Anesthesia in Comparison with Intubated Anesthesia (ID 1680)
17:50 - 18:01 | Author(s): W. Liang
- Abstract
- Presentation
Background:
General anesthesia with intubated ventilation is the standard in thoracic surgery. However, intubated anesthesia is often associated with postoperative discomfort and related complications. Recently, non-intubated anesthesia has emerged as a new option, but has only been assessed by several small-size reports. This study is to evaluate the feasibility and safety of non-incubated video-assissted thoracic surgery (VATS) for NSCLC under combined intravenous anesthesia (spontaneous respiratory status) and to compare it with the endotracheal intubated anesthesia.
Methods:
We retrospectively collected all NSCLC cases who underwent complete VATS lobectomy or segmental resection in our center under either non-intubated or intubated anesthesia. In this study, all non-intubated anesthesia cases were performed under combined intravenous anaesthetics plus analgesics while the intubated anesthesia cases were performed using double lumen endotracheal anesthesia. All procedures were conducted by the same group of surgeons and anesthesiologists from Dec 2011 to Dec 2014. Intra-operative and post-operative outcomes were compared between the two groups.
Results:
A total of 156 non-intubated and 188 intubated cases were included for analyses (Table 1). All non-intubated segment resections and the majority of non-intubated lobectomies were well exposed and were successfully completed; only 9 non-intubated cases planned for lobectomy (9/115, 7.2%) switched to intubated anesthesia. As shown in Table 2, both non-incubated lobectomy and segmentectomy had comparable outcomes with intubated anesthesia, regarding surgical duration, intraoperative blood loss, etc., as well as post-operative complications. Potential advantages were observed when comparing post-operative feeding time, volume of postoperative pleural drainage, and duration of post-operative hospital stay. Table1. Patient Demographics and Baseline Characteristics
Table2. Operative resultsSegmentectomy Lobectomy Intubated Non-intubated P- value Intubated Non-intubated P- value Age (years) 56.5±12.3 51.2±11.8 0.115 58.9±11.7 56.5±10.3 0.179 Sex(male,%) 11(44%) 12(35.3%) 0.087 97（58.4%） 64（55.2%） 0.215 Smoking 5(25) 7（20.6%） 0.161 21（12.7%） 15（13.0%） 0.679 BMI(kg/m2) 22.7±3.1 22.1±2.2 0.412 23.0±3.5 22.6±2.5 0.316 Tumor size 1.2±0.6 1.0±0.4 0.255 2.9±1.5 2.4±1.4 0.207 stage Ⅰ 25 32 108 87 Ⅱ 0 0 29 8 Ⅲ 0 0 26 20 Segmentectomy Lobectomy Intubated Non-intubated P- value Intubated Non-intubated P- value Surgical duration(min) 149.8±38.7 157.4±40.5 0.483 186.5±57.5 186.1±56.6 0.730 Intraoperative blood loss (mL) 83.6±64.1 73.9±56.5 0.076 154.7±258.3 130.8±185.7 0.165 Conversion to intubation 0 9 Postoperative feeding time (h) 13.9±4.6 7.6±3.2 <0.001 12.9±2.2 7.2±2.5 <0.001 Volume of pleural drainage (mL) 694.8±768.2 486.9±313.8 0.038 817.7±727.2 647.7±402.0 0.023 Chest-tube dwell time (days) 4.0±6.5 2.9±2.5 0.148 3.6±2.5 3.1±1.7 0.321 Duration of postoperative hospital stay (days) 9.5±7.4 7.1±3.5 0.041 8.8±4.1 7.6±2.4 0.044 Number of dissected lymph nodes 6.6±4.7 9.5±6.2 0.408 16.5±9.4 17.1±9.0 0.574 Stations of dissected lymph nodes 2.7±3.5 3.5±1.0 0.526 4.5±1.1 4.6±1.0 0.619
Conclusion:
This large comparative study demonstrated that complete VATS for resection of NSCLC under non-intubated anesthesia is feasible and safe. Non-intubated anesthesia is comparable to intubated approaches, and might have advanteages in terms of post-operative rehabilitation. However, the comparison regarding the long-term outcome is warranted.
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P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.02-003 - Blood Loss Volume During Surgery Is a Significant Adverse Prognostic Factor in Patients with Stage I to IIIA Resected NSCLC (ID 2141)
09:30 - 09:30 | Author(s): W. Liang
- Abstract
Background:
There is little evidence reagrding the impact of blood loss volume during operation on long term survival. Using a large-scale multicenter database for NSCLC, we sought to investigate the prognostic value of blood loss volume.
Methods:
We collected a cohort of resected NSCLC patients from a multi-institutional registry in China (7 centers, 2001-2008) to examine the relationship between blood loss volume and overall survival (OS). According to clinical significance and expertise, blood loss volume was divided into two groups, <200 or ≥200. OS was calculated with the Kaplan-Meier method and univariate comparison between groups was performed using the log-rank test. Cox regression served as a multivariate technique.
Results:
A total of 5,762 cases were available. The mean blood loss volume was 218.4±197.2 mL, median value was 200 mL (0-5000mL). Patients who had less than 200mL blood loss during the operation had more favorable prognosis than those with blood loss of 200mL or more (median OS, 98.8 vs. 76.0 months; HR 0.756, 95% CI 0.691 to 0.829). After adjusting for sex, age, histology, T stage, N stage and operation type (complete VATS, assisted VATS and thoracotomy), blood loss volume remained an independent prognostic factor (HR 0.791, 95% CI 0.716 to 0.874). The volume of blood loss directly correlated with operation time (r=0.21, P<0.001), drainage days (r=0.17, P<0.001), days of ICU stay (r=0.11, P<0.001), drainage volume (r=0.05, P=0.04), and potentially the number of stations examined (r=0.03, P=0.06).
Conclusion:
We revealed that blood loss volume during surgery is a significant adverse prognostic factor for long-term survival. Patients with blood loss volume greater than 200mL require more attention on the recovery strategy. In addition, blood loss volume might be a comprehensive reflection of surgical trauma, and might serve as a marker for evaluating the adequacy of patient’s physical condition for receiving adjuvant chemotherapy.
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P2.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 234)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.04-071 - PD-L1 Expression Is Not Associated with Disease-Free Survival in NSCLC Patients Who Underwent Radical Resection (ID 2856)
09:30 - 09:30 | Author(s): W. Liang
- Abstract
Background:
The expression of Programmed Cell Death Ligand 1 (PD-L1), as a major mechanism of immune escape, has been observed in various malignancies. However, its prognostic impact on non-small cell lung cancer (NSCLC) patients remains controversial, especially those in early stage when theoretically all tumors have been removed. We sought to examine the correlation between PD-L1 expression and prognosis of NSCLC patients after radical resection.
Methods:
A consecutive cohort of 681 patients who underwent radical resection for stage I to III NSCLC in our center between Sep 2009 and Dec 2011 was collected. All available cancerous tissues were collected and were made into tissue arrays. Immunohistochemistry staining using PD-L1 (E1L3N ®) XP ® Rabbit mAb was performed to detect the PD-L1 expression. PD-L1 positive expression was denoted as more than 10% tumor cells with PD-L1 staining, while PD-L1 high expression was denoted as H score≥100. The primary endpoint was disease-free survival (DFS).
Results:
Tissues of 670 patients were available and all of them were eligible for PD-L1 staining. There were 222 events (recurrence/death) and the median follow-up was 3.1 year (range, 0.1 to 5.6). Neither positive expression (HR 0.93, 95%CI 0.69 to 1.25; P=0.61) nor high expression of PD-L1 (HR 0.88, 95% CI 0.59 to 1.31; P=0.54) was associated with DFS (Figure 1). The absence of discrepancies in prognosis did not differ in each stage and histology (Table 1). Figure 1 Figure 1. Kaplan-Meier curve. Table 1. Subgroup analysesSubgroup No. HR 95% CI Sig. Stage I 340 0.754 0.299 1.897 0.548 II 139 0.827 0.406 1.683 0.600 III 162 0.669 0.355 1.259 0.213 Histology Non-squamous without neuroendocrine differentiation 473 0.840 0.483 1.461 0.537 Squamous 146 0.867 0.445 1.690 0.675 Other or mix 49 0.763 0.225 2.585 0.664
Conclusion:
This large scale study showed that PD-L1 is not a prognostic factor in early stage NSCLC after radical resection. These results encourage us to investigate whether the nature of the disease especially regarding immune escape will change after radical resection.
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P2.06 - Poster Session/ Screening and Early Detection (ID 219)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.06-026 - Advanced Bronchoscopies for Diagnosing Precancerous or Cancerous Lesions: A Meta-Analysis (ID 2694)
09:30 - 09:30 | Author(s): W. Liang
- Abstract
Background:
Conventional white light bronchoscopy (WLB) has been used for decades. Some technical advances in bronchoscopies are available for detecting lung precancerous and cancerous lesions currently. Our aim was to investigate the performance of autofluorescence bronchoscopy (AFB), AFB combined with white light bronchoscopy (AFB+WLB), narrow-band imaging bronchoscopy (NBI) and, additionally, to directly compare these new techniques with WLB alone.
Methods:
Pubmed, Embase, Web of Science, Ovid, ProQuest, Scopus and the Cochrane Library were searched for relevant articles. Eligible studies should study any of the new techniques with histopathology as a golden standard, and should have sufficient data to construct 2×2 contingency tables. We used random-effects bivariate models to pool sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the receiver operating curve (AUC) with 95% confidence interval.
Results:
Fifty-three studies involving a total of 6543 patients and 18458 biopsy specimens were included. Single arm synthesis of the new techniques showed that the overall sensitivity of AFB, AFB+WLB, NBI and WLB was 87% (82%-90%), 88% (82%-93%), 96% (78%-99%) and 54% (46%-61%); overall specificity was 65% (58%-72%), 59% (48%-68%), 84% (70%-92%) and 79% (73%-84%); and AUC was 85% (81%-87%), 82% (78%-85%), 94% (91%-96%) and 72% (68%-76%) respectively. In direct comparison, AFB, AFB+WLB and NBI had higher overall sensitivity, DOR and AUC, but lower specificity than WLB alone, regardless of precancerous or cancerous lesions (see in Table 1). In exploratory subgroup analysis, the sensitivities of all techniques were relatively higher in studies with higher proportion of elder patients, or in those with higher proportion of ‘high risk’ patients who had prior/suspected lung cancer or head & neck cancer. Figure 1
Conclusion:
Based on this pooled analysis, the performance of AFB, AFB+WLB or NBI is superior to WLB alone for diagnosing both lung precancerous and cancerous lesions. Its application might be preferably encouraged in populations with higher risk for non-benign lesions.
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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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P3.03-014 - The Impact of Post-Operative Adjuvant Chemotherapy for Resected NSCLC in the Real-World Setting: Single Center Experience (ID 2905)
09:30 - 09:30 | Author(s): W. Liang
- Abstract
Background:
Recent evidence argues against the benefits from adjuvant chemotherapy (ad-chemo) for resected NSCLC in the real world setting. We sought to examine the impact of ad-chemo based on the data from our center.
Methods:
A consecutive cohort of 681 patients who underwent radical resection for stage I to III NSCLC in our center between Sep 2009 and Dec 2011 was collected. Patients who received adjuvant EGFR-TKIs were excluded. Patients lost follow-up upon discharge (uncertain history of ad-chemo) were included in sensitivity analyses. The primary endpoint was disease-free survival (DFS).
Results:
372 patients received ad-chemo whereas 224 did not, and the remaining 85 had no certain record of ad-chemo. There were 222 events (175 recurrence and 47 deaths). Univariate analysis showed that patients who received ad-chemo had shorter DFS than those who did not (HR 1.94, 95%CI 1.40 to 2.67; P<0.001). Incorporation of those without certain record of ad-chemo (HR 1.88; P<0.001) or excluding patients with stage I disease (HR 1.36; P=0.17) did not alter the trend. After adjusting for some important prognostic factors, such as stage, histology, visceral-pleural invasion, the inferiority of ad-chemo remained. In ad-chemo arm, we observed potentially better DFS in patients receiving platinum-based regimen (HR 0.64, 95% CI 0.38 to 1.07; P=0.09) and patients complete 4 or more cycles of ad-chemo (HR 0.73, 95% CI 0.52 to 1.01; P=0.05).
Conclusion:
Current results suggested that applying adjuvant chemotherapy should be based on strict patient selection. Establishment of selection criteria regarding recurrence risk and physical status is highly encouraged.
