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A. Turna
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MA06 - Locally Advanced NSCLC: Risk Groups, Biological Factors and Treatment Choices (ID 379)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:P. Van Houtte, M. Zemanová
- Coordinates: 12/05/2016, 16:00 - 17:30, Strauss 2
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MA06.02 - Does Pathological Staging Following Neoadjuvant Therapy (ypTNM) Reflect the Reality? (ID 3859)
16:06 - 16:12 | Author(s): A. Turna
- Abstract
- Presentation
Background:
Complete histopathological response or downstaging has been reported as a good prognostic factor for locally advanced non-small cell lung cancer (NSCLC) patients who received neoadjuvant therapy and underwent surgical resection. However, it is yet to be known if the prognosis of pStage I patients is similar to that of ypStage I cases. In this study we aimed to compare the long-term survival following surgical excision between locally advanced NSCLC that have been downstaged to stage I after neoadjuvant therapy versus stage I NSCLC treated by direct surgery.
Methods:
In this is multi-centered study we retrospectively analyzed the medical data of NSCLC patients undergoing surgery (segmentectomy or more) between January 1998 and December 2014. According to the histopathological results patients with Stage 1 (T1-2aN0) disease (n=427) were included into the study. Patients were divided into two groups Group 1: patients who underwent direct surgical resection without any preoperative therapy (n=291), Group 2: Patients who had locally advanced disease (T3-4N0-1 or T1-3N2) and received neoadjuvant treatment (chemotherapy or chemoradiation) for locally advanced NSCLC (n=136). The survival rates and effecting factors were analyzed.
Results:
All but 64 patients were male with a mean age of 60y (20-87y). According to tumor type; 192(45%) patients had squamous cell carcinoma, 158(37%) adenocarcinoma and 77 (18%) patients NSCLC. Neoadjuvant treatment consisted of chemotherapy in 89 (65,4%) and chemoradiation in 47(34,5%) patients. Histopathological investigation of the resected specimen revealed stage Ib (T2aN0) in 205 patients (group 1; n=140, group 2;n= 65, p=0,95). Overall morbidity rate for all patients was 30,9% (132/427) with 1.8% mortality. Five year survival rate in all patiens was 71% (77% in group I and 57% in group 2). The difference was statistically different between the groups, p<0,001.
Conclusion:
This study showed that survival of patients after surgical excision was different in ypStage 1 compared to pStage 1. Histopathological staging does not reflect to the survival figures. Our impression is that IASLC recommendations for staging of NSCLC should be subdivided or revised according to ypTNM staging following neoadjuvant treatment.
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-017 - Does PET/CT SUVmax Value Correlate with Long-Term Survival in Patients with Surgically Treated Stage I Non-Small Cell Lung Cancer (ID 5786)
14:30 - 14:30 | Author(s): A. Turna
- Abstract
Background:
Positron emission tomography (PET/CT), which detects the biologic activity of tumor cells is routinely used in staging of non-small cell lung cancer (NSCLC). However, the role of PET/CT in predicting disease free long-term survival of surgically treated stage I NSCLC is not clear. In this study, we aimed to investigate prognostic value of metabolic uptake (SUVmax) of the tumor in patients with surgically treated stage I NSCLC
Methods:
Two-hundred and sixty patients who had preoperative PET/CT and pulmonary resection for stage I NSCLC between 2005 and 2015 were included into study. The patients were devided into four groups according to the SUVmax value, 0-5, group 1, 5-10 group 2, 10-15 group 3 and over 15 group 4. Lung resection, segmentectomy/lobectomy, was performed within 30 days of PET/CT in all patients. Tumor SUVmax and other potential prognostic variables were chosen for analysis in this study. Patients univariate and multivariate analyses were conducted to identify prognostic factors associated with long-term survival.
Results:
There were 53 females and 207 males with a mean age of 61,5 (range 20-84). The mean SUVmax value of the tumors in PET/CT was 10,1 (1-48). The type of the lung resection was segmentectomy in 33(12,7%) and lobectomy in 227(87,3%). Pathologic staging of the tumor was stage 1A in 156(60%), and stage 1B in 104(40%). Median follow-up time was 44 months, and overall 5-year survival rate was 81,7% and there was no statistically significant difference between the groups (p=0,3). SUVmax value of the tumor was not effected by age, gender, tumor type and location (peripheral or central)(p>0,05). However, it was found that the SUVmax value significantly increased along with tumor size (p<0,05. ). Logistic regression analysis revealed that, there is an association between perineural invasion and SUVmax value of the tumor (p=0.049).
Conclusion:
Although the previous studies revealed correlation between higher SUVmax values and impaired long term survival, this study revealed no correlation between SUVmax values and long term survival in patients with surgically treated stage I NSCLC. However, tumors with higher SUVmax values have higher chance of perineural invasion. Further studies for possible relationship between metabolic activity and histopathologic characteristics of the tumors are warranted.
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-041 - The Impact of Surgical Resection after Concurrent Chemotherapy and High Dose (61 Gy) Radiation in Stage IIIA/N2 Non-Small Cell Lung Cancer (ID 6304)
14:30 - 14:30 | Author(s): A. Turna
- Abstract
Background:
Locally advanced stage IIIA non-small-cell lung cancer with N2 disease is the most advanced stage at which cure can be achieved, but more than 60% of patients eventually die from their disease. For patients with stage IIIA/N2 disease, two standard treatment options are offered: definitive concurrent chemoradiotherapy or surgery combined with chemo/radiotherapy. We aimed to investigate the role of surgery after concurrent chemoterapy and high dose radiation in patients with N2 disease.
Methods:
Between January 2011 and December 2015 eligible patients had pathologically proven, stage IIIA/N2 non-small-cell lung cancer and were prospectively recorded. Those in the chemoradiotherapy group received three cycles of neoadjuvant chemotherapy (AUCx2 carpoplatin and docetaxel 85 mg/m[2 ] docetaxel) and concurrent radiotherapy with 61.2 Gy in 34 fractions over 3 weeks followed by surgical resection, and those in the control group received definitive chemoradiotherapy alone. All patients in two groups were proven to have no N2 disease after chemoradiotherapy.
Results:
A total of 58 patients were enrolled, of whom 21 received chemoradiotherapy followed by surgical resection and 37 had chemoradiotherapy only. Median overall survival was 35 months (95% CI 10.5–44.0) in the chemoradiotherapy + surgery group and 20.3 months (4.5–38.6) in the chemotherapy group (p=0.03). Median overall survival was 37·1 months (95% CI 22·6–50·0) with radiotherapy, compared with 26·2 months (19·9–52·1) in the control group. One patients died in the surgery group within 30 days after surgery.
Conclusion:
Pulmonary resection after high-dose neoadjuvant chemoradiotherapy is safe and surgical resection after chemoradiotherapy may provide better survival in histologically proven N2 stage IIIA non-small cell lung cancer.
