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T. Krajc
Moderator of
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OA07 - Lymph Node Metastases and Other Prognostic Factors for Local Spread (ID 376)
- Event: WCLC 2016
- Type: Oral Session
- Track: Surgery
- Presentations: 7
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OA07.01 - Incidence, Local Distribution and Impact of pN2 Skip Metastasis in Patients Undergoing Curative Resection for NSCLC (ID 4177)
14:20 - 14:30 | Author(s): A. Steindl, S. Tahon, M. Nguyen, B. Dome, V. Laszlo, W. Klepetko, M.A. Hoda, T. Klikovits
- Abstract
- Presentation
Background:
Background: The presence of N2 lymph node (LN) involvement has strong impact on therapy and prognosis in non-small cell lung cancer (NSCLC). N2 LN metastasis may occur by skipping N1 LN stations (N2skip-met). We aim to analyze incidence, local distribution and impact of N2skip-mets in a large cohort of patients undergoing curative resection for NSCLC.
Methods:
Methods: A retrospective non-interventional singe-center cohort study was conducted, assessing all patients undergoing curative resection for NSCLC between 2006 and 2013 at our institution by reviewing medical charts. Incidence of N2skip-mets among these patients was the primary endpoint. Subsequent secondary correlation of clinical parameters was performed using uni- and multivariate logistic and cox regression models.
Results:
Results: In total, 1110 patients were enrolled, with the following pathological LN status: 789 (71%) pN0, 211 (19%) pN1, 105 (9.5%) pN2, 5 (0.5%) pN3. Histological subtype was: adenocarcinoma, n=675 (61%); squamous cell carcinoma, n=309 (28%); other, n=126 (11%). Incidence of N2skip was 55% (47/105). N2skip-mets occurred more frequently in right sided tumors (odds ratio (OR) 2.14, p=0.058) and patients with adenocarcinoma (vs. other, OR 1.54, p=0.19). Presence of N2skip-mets did not correlate with tumor size (ROC, area under curve (AUC) 0.44, p=0.32). Strikingly, presence of N2skip-mets was significantly increased in smokers (OR 3.5, 95% CI 1.38-8.83, p=0.006). Moreover, patients with N2skip-mets were more likely to develop subsequent brain mets (OR 4.13, p=0.06). Overall- and recurrence free survival will be presented at the conference.
Conclusion:
Conclusion: N2skip-mets occur in a high number of patients with N2 disease, with distinct differences in clinicopathologic features. Considering the results of this study, subclassification of N2 disease as recently proposed by the IASLC may have clinical impact in patients with resectable NSCLC.
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- Abstract
- Presentation
Background:
Clinical practice involving segmental nodes (No.13) and subsegmental nodes (No.14) retrieval for pathological examination varies during lung cancer surgery. This study aims to evaluate whether omitting No.13 and No.14 node retrieval could lead to an inferior oncological outcome for pN0 non-small cell lung cancer（NSCLC）patients.
Methods:
This retrospective study analyzed 442 cases of NSCLC, both treating with R0 resection and systematic mediastinal lymphadenectomy and confirming as pN0 on postoperative pathology. Study group defined cases whose N1 nodes investigation involving from No.10 to No.14 in pathological report. In Control group, N1 nodes investigation only include No.10 to No.12. Clinical and pathological parameters of above two groups were balanced by propensity score matching based on surgical quality and the oncological outcomes between two groups were assessed by log-rank test.
Results:
Seven cases were lost during follow up and 435 cases entered final analysis (Study group, n=170 vs. Control group, n=265). A total of 5.0±3.0 nodes per case were collected from No. 13 and No. 14 in Study group, which included 3.1±1.9 nodes of No. 13 and 2.0±2.2 of No. 14. Tumor-located segments harbored 2.8±2.2 lymph nodes, compared to 2.2±2.3 from non-tumor located segments (p=0.006). After propensity score matching, 143 cases remained in each group. Overall survival (OS) and disease-free survival (DFS) were improved in Study group compared with Control group (the 5-year OS rates, 89±3% vs. 77±4%, p=0.027; the 5-year DFS rates, 81±4% vs. 67±4%, p=0.021, Figure1A,1B). In multivariate analysis, T staging and performing intrapulmonary nodes collection were the prognostic factors for pN0 cases. For the whole cohort, patients with two intrapulmonary stations collected showed better survival than those with zero intrapulmonary station retrieved（Figure1C, 1D）.
Conclusion:
Inferior oncological outcomes of pN0 cases without intrapulmonary node retrieval suggests this procedure may play a role in outcome evaluation for pN0 NSCLC patients.
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OA07.03 - Prognostic Significance of Micrometastases in Mediastinal Lymph Nodes of Patients With Radically Resected Non-Small Cell Lung Cancer (ID 5060)
14:40 - 14:50 | Author(s): P. Gwóźdź, M. Pasieka-Lis, K. Kołodziej, J. Pankowski, M. Zieliński
- Abstract
- Presentation
Background:
Recurrence occurs in 30-50 % of patients operated for early stage non-small cell lung cancer (NSCLC), what suggests the existence of occult metastases at the time of surgery. Preoperative detection of occult micrometastases in mediastinal lymph nodes could contribute to better selection of patients apropriate for surgery. This retrospective study was undertaken to determine the prognostic significance of preoperatively detected mediastinal lymph node (LN) micrometastases in patients treated with radical surgical resection for stage I and II NSCLC.
Methods:
From January 2007 to December 2010, 82 patients with stage I and 67 patients with stage II NSCLC underwent transcervical extended mediastinal lymphadenectomy (TEMLA) and subsequent radical pulmonary resection. A total of 4841 mediastinal lymph nodes resected during TEMLA procedure and determined as metastases-free by hematoxylin and eosin staining were labelled to detect occult micrometastases (dual immunohistochemical staining with AE1/AE3 and BerEP4 antibodies).
Results:
Micrometastases were detected in mediastinal LN of 16 patients (9,7%). 11 patients had only one LN station affected (68,8%). Subcarinal LN were most frequently affected station (11 patients, 68,8%). There was significant correlation between the presence of micrometastases and tumor size. 5-year total survival was significantly better for stage I (64,1%, p=0.0001) and stage II (44,4%, p<0.05) patients without micrometastases comparing to those with micrometastases (18,8%). By multivariate analysis, only the presence of micrometastases was demonstrated to be a significant prognostic factor for 5-year total survival.
Conclusion:
Presence of micrometastases in mediastinal LN of patients with radically resected stage I and II NSCL is associated with significantly reduced 5-year total survival. Preoprative detection of micrometastases with immunohistochemical staining of mediastinal LN resected during TEMLA procedure improves staging and may contribute to better patient selection for curative surgery.
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OA07.04 - Discussant for OA07.01, OA07.02, OA07.03 (ID 7075)
14:50 - 15:05 | Author(s): Y.-. Wu
- Abstract
- Presentation
Abstract not provided
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OA07.05 - Prognostic Impact of Pleural Lavage Cytology (PLC): Significance of PLC after Lung Resection (ID 5801)
15:05 - 15:15 | Author(s): S. Katsumata, J. Yoshida, G. Ishii, K. Sekihara, T. Miyoshi, K. Aokage, T. Hishida, M. Tsuboi
- Abstract
- Presentation
Background:
We previously reported the prognostic significance of pleural lavage cytology (PLC) in patients undergoing surgery for non-small-cell lung cancer (NSCLC). Based on a larger cohort of more than 3500 NSCLC patients, which is the largest ever reported from a single institution in the literature, we evaluated the prognostic impact of PLC on survival and recurrence.
Methods:
From January 1993 to July 2015, 3671 patients underwent R0 surgical resection for NSCLC at our institution and PLC results before (pre-) and after (post-) lung resection were both available. The cytological evaluation was classified into 3 categories: negative (-), suggestive (±), positive (+). We excluded 77 patients whose PLC results were suggestive, and 3594 patients were analyzed. The impact of PLC results on survival and recurrence was evaluated with conventional clinicopathological factors.
Results:
The overall survival (OS) of pre-PLC (+) patients was significantly inferior to that of pre-PLC (-) patients. However, the 5-year OS rate of pre-PLC (+) patients was 43%, which was significantly better than that of patients with pleural dissemination (11%). In the following analyses, we divided the patients into 3 groups according to pre/post- PLC results as follows: Pre (-)/ post (-), Group A (n=3461); pre (+)/ post (-), Group B (n=43); and post (+), Group C (n=87). Statistically significant difference was not observed between Groups A and B in OS or in recurrence-free survival (RFS) (p=1.00, 0.28, respectively). However, there were significant differences in OS and RFS between Groups B and C (p=0.01 and p=0.02), and between Groups A and C (p<0.01 and p<0.01), respectively. In univariate and multivariate analyses of clinicopathological factors including post-PLC results to identify prognosticators for OS, post-PLC(+) (hazard ratio (HR) =2.20, p<0.01), older age (≥65 years; HR=1.95, p<0.01), smoking history (+) (HR=1.48, p<0.01), elevated serum CEA level (>5.0 mg/dL; HR=1.28, p<0.01), pathological(p)T≥2 (HR=1.28, p<0.01), pN≥1 (HR=1.48, p<0.01), pStage≥II (HR=1.51, p<0.01), pl(+) (HR=1.43, p<0.01), ly(+) (HR=1.32, p<0.01), and v(+) (HR=1.53, p<0.01) were found to be significant independent unfavorable prognosticators.
Conclusion:
The prognostic impact of pre-PLC was moderate and not prohibiting lung resection. Post-PLC was shown to be a strong independent prognostic factor. Its impact on survival of NSCLC patients was very strong, and therefore should be incorporated in the future TNM classification.
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OA07.06 - In Early-Stage Lung Adenocarcinomas, Survival by Tumor Size (T) is Further Stratified by Tumor Spread through Air Spaces (ID 5905)
15:15 - 15:25 | Author(s): T. Eguchi, K. Kameda, S. Lu, M. Bott, K.S. Tan, D. Jones, W.D. Travis, P.S. Adusumilli
- Abstract
- Presentation
Background:
We investigated whether tumor spread through air spaces (STAS) further stratifies survival beyond tumor size, T-descriptor independent of resection type (lobectomy or limited resection) and surgical margin.
Methods:
In patients with pT1a-T2bN0M0 lung adenocarcinomas (LADC, n=1399), tumor size, distance of STAS from the tumor, type of resection, surgical margin were evaluated. The patients with small (≤2cm) tumors were divided into STAS(-) (n=561) and STAS(+) (n=307) and their cumulative incidence of recurrence (CIR), and lung cancer-specific death (CID) were compared with patients with larger tumors (2-3cm, n=299) by use of competing risk analysis.
Results:
Of 1399 tumors, 521 (37%) were STAS(+). Compared to STAS(-), recurrence rates were higher with STAS(+) tumors even when the margin is ≥tumor size (Figure 1). In patients with ≤2cm STAS(+) tumors, CIR and CID are higher than in patients with larger (2-3cm) tumors (Figure 2). The poor prognostic influence of STAS(+) was evident even when analyzed by the procedure or recurrence pattern (Figure 2 table).
Conclusion:
STAS further stratifies survival beyond tumor size, T-descriptor in early-stage (pT1a-2b) lung adenocarcinoma based on the higher prognostic potential for recurrence and lung cancer-specific death independent of the type of resection or margin. Figure 1 Figure 2
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OA07.07 - Discussant for OA07.05, OA07.06, OA07.07 (ID 7074)
15:25 - 15:40 | Author(s): M. Krasnik
- Abstract
- Presentation
Abstract not provided
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