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K.W. Shin
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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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P1.08-066 - Prognostic Factors of Post-Recurrence Survival in Patients with Completely Resected Stage III-N2 Non-Small Cell Lung Cancer (ID 5909)
14:30 - 14:30 | Author(s): K.W. Shin
- Abstract
Background:
Post-recurrence survival (PRS) after curative resection has been considered a multifactorial process dependent on clinicopathological, biological, and treatment modality in non-small cell lung cancer (NSCLC). The aim of this study is to investigate the prognostic factors for PRS in patients with completely resected stage III-N2 NSCLC.
Methods:
Two hundred forty-five patients who had complete resection for pathologic stage III-N2 NSCLC between 2003 and 2014 were enrolled. First, a number of clinicopathological factors were evaluated to find prognostic factors for recurrence by Cox proportional hazards models. Second, the following additional data were evaluated: presence of recurrent symptom, recurrence patterns, treatment modality, use of targeted agents, and recurrence-free interval. The prognostic effects of these factors were analyzed for PRS.
Results:
One hundred twenty-four patients experienced recurrence during a median follow-up period of 36.3 months. Univariate analysis showed that vascular invasion, lymphatic invasion, tumor size, number of positive lymph nodes (LNs), and multistation N2 were poor prognostic factors for recurrence. Lymphatic invasion, tumor size, and number of positive LNs were even worse independent prognostic factors for recurrence by multivariate analysis. Of 124 recurred patients, 21 patients (17%) were symptomatic at the time of initial recurrence, and the remaining 103 patients (83%) were asymptomatic. In these asymptomatic patients, recurrence was detected by tumor markers in 3, computed tomography (CT) in 80, or positron emission tomography-CT (PET/CT) in 20 patients. The mean recurrence-free interval was 14.0 months (≤ 12 months in 72, > 12 months in 52 patients). The patterns of recurrence were presented as loco-regional recurrence in 37 (30%), distant metastasis in 33 patients (27%), and both in 54 patients (43%). The types of initial treatment included surgery in 15 (12%), chemotherapy in 68 (55%), radiotherapy in 19 (15%), and chemo-radiation in 16 patients (13%). The median duration of PRS was 30.5 (1-109) months and the 2-year and 5-year of PRS were 54% and 23%, respectively. Univariate analysis identified no symptom of recurrence, only LN metastasis without distant organ metastasis, treatment modality, and a longer recurrence-free interval as good prognostic factors, while no symptom and a longer recurrence-free interval were independent prognostic factors for PRS in a multivariate analysis.
Conclusion:
No symptom at the time of recurrence and a longer recurrence-free interval were significant predictors of better PRS in patients that have underwent complete resection of stage III-N2 NSCLC.
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P1.08-074 - Effect of Intrapleural Perfusion Hyperthermic Chemotherapy in Non-Small Cell Lung Cancer with Pleural Seeding (ID 5937)
14:30 - 14:30 | Author(s): K.W. Shin
- Abstract
Background:
Pleural seeding is generally associated with poor prognosis in advanced non-small cell lung cancer (NSCLC). Although palliative chemotherapy is the mainstay modality for these patients, intrapleural perfusion hyperthermic chemotherapy (IPHC) may be a good alternative. The aim of this study was to evaluate the efficacy of IPHC and predictive factors for longer survival in NSCLC with pleural seeding.
Methods:
From 2003 to 2014, 51 patients who underwent IPHC for NSCLC with pleural seeding at the first operation in 36 or after postoperative recurrence in 16 patients were enrolled. IPHC was performed with cisplatin (dose:150mg/m[2]) for 90 minutes. For patients with pleural seeding at first operation, parenchymal resection was performed and mediastinal LN was evaluated. We included some procedures other than pre-IPHC pleural biopsy, pre-IPHC lavage cytology, post-IPHC lavage cytology, and post-IPHC pleural biopsy. Subjects were divided into two groups: group I is shorter survivor of less than 36 months and group II is longer survivor of more than 36 months of overall survival duration.
Results:
There were 22 male patients and the mean age was 59.6 years. There were 7 patients in pathologic stage T1, 28 in T2, 13 in T3, and 3 in T4. With respect to N stage, 18 patients in N0, 9 in N1, 17 in N2, and 8 in Nx. Major post-IPHC complication was acute renal insufficiency (n=4). All patients, except 3, received systemic chemotherapy after IPHC. Pleural seeding aggravation was seen in 28 patients, and the development of pleural effusion was observed in 5 patients after IPHC. EGFR mutation was examined in 38 patients after 2007; of which, 20 patients showed to have EGFR mutation. Targeted agents were used in 32 out of 51 patients. The mean overall survival was 36.4 months (5.9-98.0); 28 patients died during the follow-up period. The 2-year and 5-year survival rates were 75.7 % and 39.8%, respectively. The prognostic factors for patients with overall survival of more than 36 months, seen in 19 patients, were old age, negative post-IPHC pleural biopsy, and presence of EGFR mutation.
Conclusion:
IPHC appears to be a safe procedure for advanced lung cancer patients with pleural seeding, and IPHC may provide better survival to only a highly selective group of patients. Old age, negative post-IPHC pleural biopsy, and presence of EGFR mutation are the predictive factors for longer survivor.
