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K. Yokoi
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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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P1.03-073 - Predictors for Pathological N1 and N2 Disease in Clinical N1 Non-Small-Cell Lung Cancer (ID 3938)
14:30 - 14:30 | Author(s): K. Yokoi
- Abstract
Background:
Patients with clinical N1 (cN1) non-small-cell lung cancer (NSCLC) is usually considered to be candidates for curative resection. However, they sometimes have unexpected mediastinal nodal involvement (pN2). To avoid futile pulmonary resection, accurate preoperative evaluation of nodal status would be necessary. The purpose of this study was to identify predictors for lymph node metastasis in cN1 NSCLC patients.
Methods:
We retrospectively reviewed data on the clinicopathological and radiological features of 170 patients with cN1 NSCLC who had undergone complete resection at Nagoya University Hospital between 2004 and 2015. Hilar and/or intrapulmonary lymph nodes with ≥ 1.0 cm in the short axis on computed tomography or with high accumulation of [18F]Fluorodeoxyglucose (FDG) in positron emission tomography compared with that of the adjacent mediastinal tissue were considered as cN1 in our institution. The association between clinicoradiological variables and nodal status was analyzed to identify predictors for lymph node metastasis.
Results:
The cohort consisted of 125 males and 45 females, ranging in age 39 to 84 years. There were 62 (36%) adenocarcinomas, 82 (48%) squamous-cell carcinomas, 10 (6%) large-cell carcinomas, and 16 (10%) other types of cancers. The breakdown by pathological N category was 61 (36%) pN0, 72 (42%) pN1, and 37 (22%) pN2 patients. Among pN2 patients, only three showed negative N1 lymph nodes (skip pN2 metastasis). Female gender, adenocarcinoma histology, middle or lower lobe orign and positive N1 lymph node (pN1) were significantly associated with pN2 by univariate analysis. Logistic regression analysis showed that the female and pN1 were significant predictor for pN2 with the odds ratio of 3.0 and 13.1, respectively (P = 0.02 and 0.0001, respectively). In addition, using the 63 patients extracted from our cohort of this study, we sought the predictor of pN1. The maximum size of the lymph node and standardized uptake value of the FDG were significant factor for pN1 with the cut-off value of 1.3 cm and 4.28, respectively.
Conclusion:
Female gender and pN1 was significantly assosiated with pN2 in cN1 NSCLC patients of our cohort. The large size and a high accumulation of FDG of hilar or intrapulmonary lymph node might predict the pN1.
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P2.04 - Poster Session with Presenters Present (ID 466)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Mesothelioma/Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.04-004 - Thymectomy without Definitive Diagnosis Could Be Feasible in Patients with Suspicious of Thymic Epithelial Tumor (ID 4086)
14:30 - 14:30 | Author(s): K. Yokoi
- Abstract
Background:
As for thymic epithelial tumors (TETs), National Comprehensive Cancer Network guideline has suggested that complete excision of tumor should be performed without preoperative biopsy when resectable. However, there have been very few evidences on this strategy of diagnosis and treatment. The purpose of this study is to evaluate the validity of radical resection of anterior mediastinal masses (AMMs) without pathological confirmation.
Methods:
Two hundred and fifty-eight patients with AMMs underwent surgical resection between 2004 and 2015 at the Nagoya University Hospital. Among them, 186 patients were suspected to have TETs by clinical features, serum tumor markers, and the findings of computed tomography (CT) and positron emission tomography (PET). We retrospectively reviewed cases of the patients with AMMs and evaluated the strategy of treatment for them.
Results:
Of the186 patients with suspicious of TETs, 56 patients received preoperative biopsy and had the pathological diagnosis. The method included CT-guided needle biopsy in 49 patients (26%) and video-associated thoracic surgery biopsy in 4 (2%) to plan neoadjuvant therapy and/or to distinguish from malignant lymphomas or malignant germ cell tumors, and intraoperative pathologic examination using frozen section of the tumor in 3 (1.6%). The remaining 130 patients (70%) underwent thymectomy without pathological confirmation. Among them, the tumors in 115 patients (88%) were finally diagnosed as TETs including 100 thymomas, 11 thymic carcinomas and 4 thymic carcinoids. The patients except one received complete resection. The remaining 15 patients (12%) were diagnosed as 4 thymic cysts, 4 lymphomas of mucosa-associated lymphoid tissue type (MALT), 2 bronchogenic cysts, 2 mature teratomas and 3 other tumors. Thymic cysts with thick wall in part and small MALT lymphomas with intermediate accumulation of PET were sometimes difficult to distinguish from TETs preoperatively.
Conclusion:
Eighty-eight percent of the patients with suspicious of TETs who underwent thymectomy without biopsy were accurately diagnosed and properly treated with complete resection. Thymectomy without a definitive diagnosis could be feasible in patients with suspicious of TETs when they are considered resectable, although there are some tumors such as thymic cyst and MALT lymphoma hard to distinguish from TETs.
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-007 - Detection of Brain Metastasis in Resected Lung Cancer with the New Postoperative Follow-Up Program (ID 5445)
14:30 - 14:30 | Author(s): K. Yokoi
- Abstract
Background:
In our previous study, follow-up brain MRI for the detection of early brain metastasis was examined every 2 months during the first 6 months after operation until 1995. In the study, asymptomatic brain metastases were found at the frequency of 2.3%. After that, the follow-up program was changed as follows; brain MRI performed on a postoperative patient at two points of 2-3 months (early check time) and 5-6 months (late check time) after operation. We reviewed the detection rate of brain metastasis in the new program.
Methods:
Between January 1996 and December 2009, 954 patients with primary lung cancer underwent complete surgical resection. Of 954 cases, 712 received brain MRI in accordance with the new follow-up program. The frequency, the point of brain metastases detection, treatment for brain metastases, and prognosis were reviewed.
Results:
Of total 712 cases, 24(3.4%) patients with brain metastases were detected as initial recurrence lesion with follow-up MRI. Seven of these 24 cases were detected at the point of early check time (early group). The remaining 17 cases were detected at the point of late check time (late group). In the early group, 3 patients had a single metastasis and 1 had three lesions. The remaining 3 had more than four lesions. On the other hand, 10 of 17 late group had a single metastasis and 5 had two or three lesions, and the remaining 2 had more than four lesions. In early group, the pathological stagings were 2 stage1, 3 stage2, 2 stage3. All cases of solitary metastasis and 1case of three metastatic lesions were treated with stereotactic radiosurgery (SRS). Two cases with more than four lesions were treated with whole brain radiotherapy (WBRT). In late group, the pathological stagings were 5 stage1, 5 stage2, 7 stage3. All but 2 cases were treated with SRS. The overall median survival time from thoracic surgery was 17 months in early group and 20 months in late group. Two cases from the late group were recurrence free for 104 and 81 months.
Conclusion:
In early group, they frequently had multiple brain metastases and were treated with WBRT. On the other hand, in late group, a single metastasis was discovered in many patients and was treated with SRS. Among them, some patients had long recurrence-free survival. From these results, we changed postoperative follow-up program for detection of the brain metastasis to check at only one point of 5-6 months after operation.
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P3.04-038 - Pulmonary Resection for Metastatic Pancreaticobiliary Cancer: Can It Be Justified as a Treatment of Choice? (ID 5016)
14:30 - 14:30 | Author(s): K. Yokoi
- Abstract
Background:
Patients with distant metastases of pancreaticobiliary cancers still have poor prognoses of 3-7% of 5-year survival, and the best reported median overall survival time (MST) of pancreatic carcinoma patients with metastatic stage IV disease treated with optimal chemotherapy was only 11 months. Surgical resection for metastatic lesions from pancreaticobiliary cancer is scarcely performed because of their malignant potential, therefore, few studies have reported on pulmonary metastasectomy for those patients. The purpose of this study is to review our experience of pulmonary resection for metastatic pancreaticobiliary cancer, and to assess whether this treatment offers them better survival.
Methods:
Between 2007 and 2015, 21 patients of pancreaticobiliary cacncer had potentially resectable pulmonary metastases after definitive resection of primary site (pancreatic cancer, n=9; cholangiocarcinoma, n= 10; gallbladder cancer, n= 2). There were 14 males and 7 females with a median age of 67 years (42-81years). The medical records were retrospectively reviewed, and the overall survival was analyzed. Disease-free interval (DFI) was defined as the time between operations for the primary cancer and the metastatic lesion.
Results:
The median DFI was 51months (4-145 months), and 11 patients had solitary pulmonary lesion, 5 had double lesions, and 6 had three or more. Operative procedures of metastasectomy consisted of 15 wedge resections, 2 segmentectomies, and 4 lobectomies. Although no surgical complications and operative mortalities occurred, 9 patients died of primary diseases after pulmonary resection. The estimated MST after pulmonary resection was 35 months, and 3 and 5-years survival was 32% and 16%, respectively.Overall 3-year survival of patients with longer DFI (DFI> 36months) was marginally significantly better than that of those with shorter DFI (DFI≦36months) (49% vs. 19%, p=0.17). The longest survivor was still alive more than 5 years without recurrence after lung resection.
Conclusion:
Pulmonary resection for metastatic pancreaticobiliary cancer could be performed safely and might offer better survival. Although the optimal operative indication is still unclear, our results suggest that pulmonary resection could be a treatment of choice in selected patients with those diseases. Longer DFI before pulmonary metastasis might be helpful to select proper patients for the metastasectomy.
