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M. Ito
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OA15 - Sublobar Resections for Early Stage NSCLC (ID 396)
- Event: WCLC 2016
- Type: Oral Session
- Track: Surgery
- Presentations: 1
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OA15.03 - Comparison of Prognosis between Lobectomy and Sublobar Resection for Clinical Stage I Non-Small Cell Lung Cancer with Interstitial Lung Disease (ID 4063)
16:20 - 16:30 | Author(s): M. Ito
- Abstract
- Presentation
Background:
The prognosis after standard lobectomy for non-small cell lung cancer (NSCLC) with interstitial lung disease (ILD) is poor. This study aimed to compare the prognosis after lobectomy and sublobar resection for early NSCLC with ILD.
Methods:
Among 794 consecutive patients with clinical stage I NSCLC who underwent complete resection, 107 patients with ILD on high-resolution computed tomography (HRCT), which was defined according to the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Association classification, were identified.
Results:
Overall survival (OS) was significantly worse for patients with possible usual interstitial pneumonia (UIP) or UIP pattern than those with inconsistent with UIP pattern (3-year OS, 64.5% vs. 82.1%, respectively; P = 0.031). No significant difference existed in OS between lobectomy and sublobar resection for all patients with ILD (3-year OS, 67.1% vs. 81.9%, respectively; P = 0.14). Although in patients with inconsistent with UIP pattern, OS was similar between lobectomy and sublobar resection groups (3-year OS, 81.1% vs. 83.6%, respectively; P = 0.87), OS was better for patients who underwent sublobar resection than lobectomy in patients with possible UIP or UIP patterns (3-year OS, 81.0% vs. 50.5%, respectively; P = 0.069). Multivariate Cox analysis demonstrated that preoperative diffusing capacity of the lung for carbon monoxide (P = 0.018), not the surgical procedure (P = 0.14), was an independent prognostic factor for OS.
Conclusion:
Sublobar resection can be an alternative choice for clinical stage I NSCLC with ILD especially for UIP or possible UIP patterns on HRCT.
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P1.05 - Poster Session with Presenters Present (ID 457)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-056 - Increased Risk of Postoperative Recurrence in EGFR-Positive Stage IA to IB Invasive Lung Adenocarcinoma (ID 4811)
14:30 - 14:30 | Author(s): M. Ito
- Abstract
Background:
Somatic mutations of EGFR represent one of the most frequent genetic aberrations in lung adenocarcinoma and response to tyrosine kinase inhibitors (TKIs) has been favourable in EGFR-positive and advanced lung adenocarcinoma patients. The prognostic significance of EGFR mutations as oncogenic driver mutations in early-stage lung adenocarcinoma has yet to be determined. We aimed to evaluate the oncological significance of EGFR mutations in early-stage lung adenocarcinoma
Methods:
Four hundred and seventy-three consecutive lung adenocarcinoma patients who underwent surgical resection for pathological N0M0 disease, between January 2007 and December 2013, were retrospectively reviewed. The prognostic significance of EGFR mutation status was evaluated in 407 cases from these patients. Overall survival (OS) and recurrence-free interval (RFI) curves were estimated using the Kaplan-Meier method and compared using a log-rank test. Univariate and multivariate analyses were performed using a Cox proportional hazards model.
Results:
There was no statistical significance in the 5-year OS (89.3 vs. 95.3%, P = .20, HR = 1.605) or RFI (86.5 vs. 93.5%, P = .06, HR = 1.956) rates between the EGFR-positive (n=183) and EGFR-negative (n=224) groups. Considering the risk of recurrence and positive EGFR mutation status, OS and RFI rates were subsequently calculated among specific histological subtypes. After adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive mucinous adenocarcinoma (IMA) cases were excluded, all analysed cases were ≤5.0 cm in tumour diameter and were classified as pathological Stage IA-IB. Among specific histological subtypes, the 5-year RFI (81.5 vs. 92.4%, P = .04, HR = 2.160) but not OS rate (86.8 vs. 94.3%, P = .31, HR = 1.499) was significantly poorer in EGFR-positive cases compared to EGFR-negative cases. Univariate analysis, excluding AIS, MIA, and IMA, identified a pathological tumour size of >3.0 cm, a highly malignant subtype (micropapillary or solid predominant adenocarcinoma), pleural/lymphatic/vascular invasion, and a positive EGFR mutation status as significant negative predictive factors for RFI. Multivariate analysis confirmed pleural invasion and a positive EGFR mutation status as independent negative predictive factors for RFI.
Conclusion:
EGFR mutation status is a predictive factor for postoperative recurrence in early-stage lung adenocarcinoma, with the exception of AIS, MIA, and IMA. The risk of recurrence should be considered with EGFR mutation status and predominant histological subtype in resected early-stage lung adenocarcinoma patients.
