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H. Horio
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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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P1.05-059 - Factors Associated with Recurrence and Survival in Patients with Curatively Resected Stage IA Adenocarcinoma of the Lung (ID 5990)
14:30 - 14:30 | Author(s): H. Horio
- Abstract
Background:
Even when meticulously clinically and pathologically studied, completely resected stage IA adenocarcinoma of the lung does recur. However, there are few data regarding the patterns of recurrences and their risk factors in this population. Therefore, this study characterizes cancer recurrence and its risks and assesses recurrence-free survival in patients with curatively resected stage IA adenocarcinoma.
Methods:
Between January 1990 and December 2005, a total of 214 patients were given a final diagnosis of pathologic stage IA (UICC-7) adenocarcinoma of the lung. The medical records of these patients were retrospectively reviewed with regard to patient characteristics, tumor pathologic findings and follow up status. Survival was analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis.
Results:
The median follow up after curative resection was 83 months. Cancer recurred in 28 patients (13%). Among them, local recurrence occurred in 10 patients (5%), whereas distant recurrence occurred in18 patients (8%). Recurrence earlier and later than 5 years after surgery was in 15 patients (7%) and in 13 patients (6%), respectively, with nearly constant risk. At 5 years after index resection, 175 patients (82%) were alive without evidence of cancer recurrence, 11 patients (8%) had experienced recurrence of cancer but still alive and 11 patients (5%) had died with non-cancer causes. Recurrence-free 5- and 10-year survival rates were 92.5 and 70.0%, respectively. Univariate analysis revealed five significant prognostic factors: gender (p=0.0177); lepidic component (p =0.0007); tumor location (p=0.0099); pleural invasion (p=0.0274) and lymphatic or vascular vessel invasion (LVI) (p< 0.0001). Multivariate analysis revealed lepidic component, tumor location, and LVI as significant factors. Hazard ratios for recurrence were 0.381 for having lepidic component (95% CI, 0.147-0.979; p= 0.0451), 0.361 for right sided tumor (95% CI, 0.188-0.692; p= 0.0022), and 2.785 for having LVI (95% CI, 1.392-5.555; p= 0.0038).
Conclusion:
Surgically “cured” stage IA adenocarcinoma of the lung recurs. Our analyses indicate no-lepidic component, tumor location, LVI as an independent indicator for cancer recurrence. Identifying high-risk patients for recurrence will simplify decision making for postoperative treatment strategies.
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-060 - Survival of Patients with Unsuspected N2 (Stage IIIA) Non-Small Cell Lung Cancer (ID 5696)
14:30 - 14:30 | Author(s): H. Horio
- Abstract
Background:
There are few studies evaluating the N2 pattern and outcomes when a patient with non–small cell lung cancer (NSCLC) unexpectedly is found to have N2 disease at the time of thoracoscopy or thoracotomy. The objective of this study was to determine the survival of patients who have completely resected, nonsmall-cell, stage IIIA, lung cancer from unsuspected (nonimaged) N2 disease.
Methods:
A retrospective review of NSCLC patients treated with lobectomy for clinically unsuspected mediastinal nodal disease (cT1-cT3 cN0-cN1, pN2 disease) at our institution between January 2008 and December 2011 was conducted. All patients underwent computed tomography scan with contrast, R0 resection with complete thoracic lymphadenectomy, and had unsuspected, pathologic N2 NSCLC. Positron emission tomography scan or invasive staging was added in the attending physician’s choice.
Results:
Unsuspected pN2 disease was found in 10.9% of patients (31 out of 284) who underwent lobectomy as primary therapy for cT1-cT3 cN0-cN1 NSCLC. Of these, cN0pN2 and cN1pN2 were 9.6% (26 out of 270) and 35% (5 out of 14), respectively. Compare to cN0 group, unsuspected pN2 was more frequent in the cN1group (p=.0023). In terms of the pattern of metastasis, multiple and single pN2 was observed similarly in cN0 and cN1 group (p=.9484). The 5-year overall survival of the entire unsuspected pN2 was 68.5%, and cN0pN2 cohort tended to have better prognosis than cN1pN2 cohort (71.1%(cN0pN2) vs. 50.0%(cN1pN2); p=.0898). No significant difference in 5y-OS between unsuspected single and multiple pN2 could be seen; (70.5%(single) vs. 66.7%(multiple); p=.07803).
Conclusion:
This analysis suggests that, in the setting of unsuspected pN2 NSCLC, proceeding with anatomic surgery does not appear to compromise outcomes. As unsuspected pN2 disease was more frequent in cN1 cohort and revealed poor prognosis, perioperative invasive mediastinal staging and additional therapy should be considered.
