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M. Takao
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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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OA15.02 - Survival Outcomes in Sublobar Resection for Clinical T1N0M0 Non-Small Cell Lung Cancer: Wedge Resection or Segmentectomy (ID 4710)
16:10 - 16:20 | Author(s): M. Takao
- Abstract
- Presentation
Background:
Lobectomy remains the standard treatment for early-stage non-small cell lung cancer (NSCLC).In practice, however, sublobar resection has been selectively offered for patients with clinical Stage IA NSCLC as curative treatment. To seek optimal surgical procedure for early stage lung cancer, we carried out retrospective analyses of 2122 patients who had undergone limited resection for c-T1N0M0 NSCLC from 26 institutions of Japanese association for chest surgery.
Methods:
A total of 1963 patients with lobectomy tolerance were eligible for survival analysis. We retrospectively categorized patients of these nodules on numbers of criteria for CT findings; scores were added according to the dominance of ground glass appearance (GGA); >75% = 0, <75% =1, and size of tumor; T1a =0, T1b =1. Statistical analyses were carried out using propensity-matching and Kaplan-Myer with log-rank testing.
Results:
We analyzed 1:1 matched 731 patients for segmentectomy and wedge resection with propensity matching.The overall survival (OS) for score 0 group was 90.2% in segmentectomy (n=419) and 94.7% in wedge resection (n=451) (p=0.0351). The disease free survival (DFS) for score 0 group was 90.2% in segmentectomy and 92.7% in wedge resection (p=0.0645). The OS for score 1 group was 93.6% in segmentectomy (n=278) and 80.4% in wedge resection (n=246)(P<0.001)(Fig. 1). The DFS for score 1 group is 94.1% in segmentectomy and 75.3% in wedge resection (P<0.001). The OS for scores 2 was 79.1% in segmentectomy (n=34) and 69.2% in wedge resection (n=34) (p=0.109). The DFS for score 2 group was 87.0% in segmentectomy and 58.1% in wedge resection (p=0.581). Figure 1
Conclusion:
This study showed that GGA dominant T1a may be treated by wedge resection where possible. The consolidation dominant T1b did not benefit from sublobar resection. In patients with GGA dominant T1b or consolidation dominant T1a, anatomical segmentectomy with curative intension may provide better prognosis.
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P1.08 - Poster Session with Presenters Present (ID 460)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.08-035 - Analysis of Post-Operative Recurrence in a Population with NSCLC Harboring an EGFR Mutation: A Single Institutional Retrospective Study (ID 6306)
14:30 - 14:30 | Author(s): M. Takao
- Abstract
Background:
The post-operative recurrence in the patients resected EGFR mutated NSCLC was higher than wild-type, as previous reported. However, whether EGFR mutational status is prognostic factor or not had not been yet proven, and we assessed the background of the patients with surgically resected NSCLC harboring EGFR mutation and the post-operative clinical course.
Methods:
We reviewed all patients with EGFR mutated NSCLC who received surgical therapy for lung cancer between March 2007 and April 2016 at Matsusaka Municipal Hospital in order to assess post-operative recurrence and overall survival retrospectively. Survival curves of time to post-operative recurrence and overall survival were calculated using the Kaplan-Meier method and were compared using the log-rank test. Subgroup analyses were conducted to evaluate predictive factors for post-operative recurrence.
Results:
A total of 116 patients were enrolled. The median age was 72.5, ranging from 37-88 years of age. Of the total, 83 patients (71.6%) were female, and 90 patients had never smoked. All patients except one with squamous cell carcinoma were diagnosed pathologically with adenocarcinoma. Of the patients 41.9% were diagnosed with Ex19 deletion and 50.0% were diagnosed with Ex21 L858R. Median time to post-operative recurrence was 70.5 months for the entire population. Multivariate analysis revealed that age (p=0.008), subtype of EGFR mutation (p=0.034), and pathological stage (p=0.00033) were predictive factors for post-operative recurrence. Subgroup analysis revealed there was a significant difference in time to post-operative recurrence between patients over 75 y.o and those under 74 y.o even in the population who received a lobectomy. (p=0.031)
Conclusion:
Elderly patients, and those with the Ex21 L858R point mutation, had a tendency to relapse after surgical therapy among the EGFR mutated NSCLC population. The rate of post-operative recurrence in EGFR mutated patients tended to be higher compared to historical data. Because of differences with retrospective data and the small sample size, further investigations are warranted to confirm these results.
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P1.08-056 - Surgical Results of Thoracoscopic Anatomical Sublobar Resections for Early-Stage Lung Cancer (ID 5390)
14:30 - 14:30 | Author(s): M. Takao
- Abstract
Background:
High-resolution computed tomography (HRCT) has been used to detect ground glass nodules (GGN), and sublobar resections might be currently accepted for patients with early stage malignant GGN. Aim of this study was to evaluate the surgical results of thoracoscopic sublobar resections for early-stage lung cancer.
Methods:
Twenty patients (6 males and 14 females, a mean age of 72.5 years) performed surgical treatment for thoracoscopic anatomical sublobar resections from April 2012 to May 2016. Anatomic sublobar resections were selected with the following criteria; stage IA disease with no regional lymph node metastasis; tumor up to 2 cm in diameter; a low tumor standardized uptake value (SUV) evaluated in (18)F fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET) ; predominantly ground-glass appearance on CT imaging. The high resolution CT scanner, Philips Brilliance iCT (Medical Imaging Resources, An Arbor, MI) with both 128 and 256 slice configurations was used. CT data were transferred to an imaging analysis system (Zio station ver.2, Tokyo, Japan) for image reconstruction and we performed preoperative CT-guided marking in surface of near the tumor.
Results:
In all 20 cases, the reconstruction of the pulmonary artery and vein could image branches and resected in lung segment. Right side: One case of the upper lobe S1; 5 cases of the lower lobe S6 (3), S8 (1) and S10 (1). Left side: 10 cases of the upper lobe S1+2a, S1+2c, S1+2a+b, S1+2c+S3a, S3b+c, apicoposterior segmentectomy, S3(2) and upper lober trisegmentectomy (2); 4 cases of the lower lobe S6, S8+S9, S10 and basal segmentectomy. All pulmonary nodules were found in the excised target segments with safety margin. According to postoperative pathological examination of the all operative specimens were adenocarcinoma , and the diameters of pulmonary tumors resected were 15.8±3.3 and invasive size were 6.2±3.1 mm. Furthermore, the pathological results were given Atypical adenomatous hyperplasia (2), adenocarcinoma in situ (2), minimally invasive adenocarcinoma (5), Lepidic predominant adenocarcinoma (10) and papillary predominant adenocarcinoma (1).
Conclusion:
At the time of writing, local recurrences had not occurred in sublobar resection, so we should be considered for early stage lung cancer in these conditions. Moreover the 3D-CT angiography could be used preoperatively as a tracing method to identify the resected line of lung segment and very useful for anatomic sublobar resections, especially in thoracoscopic surgery.
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-016 - Surgical Implications of the New Lung Adenocarcinoma Classification - Usefulness for Selecting Cases Undergoing Sublobar Resection (ID 3936)
14:30 - 14:30 | Author(s): M. Takao
- Abstract
Background:
The 2015 World Health Organization (WHO) Classification of Lung Tumors has just been published and it confirmed a new adenocarcinoma classification based on histomorphologic subtype. We evaluated an appropriateness of new classification in a series in our institute and whether the classification could be useful for selecting limited cases undergoing sublobar resection.
Methods:
We retrospectively reviewed clinical records of all patients operated on for non-small cell lung cancer from 1997 to 2014 (n=1059). 382 patients (36.1%) had pathological stage IA adenocarcinoma of the lung classified. Pathologists performed histopathologic subtyping according to new 2015 WHO classification. Statistical analyses were made including Kaplan–Meier and Cox regression.
Results:
Three overall prognostic groups were identified: low grade: adenocarcinoma in situ (AIS, n=115, 30.1%) and minimally invasive adenocarcinoma (MIA, n=37, 9.7%) had 97.5% and 96.9% of disease-free survival at 5 years (DFS, median follow-up was 72 months); intermediate grade: non-mucinous lepidic adenocarcinoma (n=72, 18.8%), acinar adenocarcinoma (n=72, 18.8%), and papillary adenocarcinoma (n=56, 14.7%), with 84.5%, 83.8%, and 63.1% of DFS; and high grade: invasive mucinous adenocarcinoma (n=11, 2.9%), solid adenocarcinoma (n=14, 3.7%) and micropapillary adenocarcinoma (n=5, 1.3%), with 81.5% of DFS. DFS in low grade was significant better than in other two grades (P<.001), however, there was no significant difference between in intermediate and high grade groups. The recurrent cases in MIA, lepidic, and acinar adenocarcinomas were probably observed papillary component. Preoperative imaging examinations such as consolidation/tumor (C/T) ratio on high resolution CT and maximum standardized uptake value (SUVmax) by FDG-PET were correlated with histopathologic grade according to new classification (P<.05). Moreover, sublobar resection was undergone for 195 cases (51.0%), more cases had been identified small tumor, low C/T ration, low SUVmax, and low grade subtypes, and DFS in sublobar resection was 93.2% which was significant better than in lobectomy (79.5%, P=.0034).
Conclusion:
Most of subtypes correlated with DFS, except of papillary adenocarcinoma and subtypes in high grade clinical aggressiveness, which may need more clinical investigation. As papillary components were observed in many recurrent cases, papillary is potentially higher malignancy and could be classified into high grade. Patients in low grade subtypes who underwent sublobar resection had better DFS, which can be predicted using tumor size and preoperative imaging examinations such as C/T ratio and SUVmax. So, the new classification has advantages for better selection of limited cases undergoing sublobar resection as a curative surgery.
