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K. Yarimizu
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P3.01 - Poster Session with Presenters Present (ID 469)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.01-002 - The Clinical Impact of Spread through Air Spaces (STAS) in Surgically Resected pStage I Lung Squamous Cell Carcinoma (ID 3904)
14:30 - 14:30 | Author(s): K. Yarimizu
- Abstract
Background:
Spread through air spaces (STAS) is identified as a newly invasive pattern in lung adenocarcinoma. It contributes to the significantly increased recurrence rate for patients with small adenocarcinoma. But the presence of STAS and its clinical impact has remained uncertain in squamous cell carcinoma (SQCC.) The purpose of this study is to analyze whether STAS happens in surgically resected pathological Stage I (pStage I) lung SQCC.
Methods:
We retrospectively reviewed 141 pStage I patients of SQCC (Female/Male, 13/128; Smoker/Never smoker, 135/6; pStage IA/IB, 93/48). Tumor STAS was defined as tumor cells within the air spaces in the lung parenchyma beyond the edge of the main tumor. Statistical analyses were conducted to investigate the relationship between its presence and the clinicopathological background factors, including the clinical outcome.
Results:
STAS was identified in 23 of 141 patients (16.3%) with limited (7.1%) and extensive (9.2%) feature, respectively. Both disease-free survival (DFS) and overall survival (OS) were significantly worse in the patients with STAS in comparison with the patients without STAS (5-year DFS, 35.1% vs. 65.6%, p<0.01; 5-year OS, 41.7% vs. 71.2%, p<0.01, respectively). In multivariate analyses adjusting for sex, year, smoking history and pStage, the presence of STAS was found to be an independent predictive factor of both DFS (HR=3.154, 95%CI: 1.592-6.249; p=0.001) and OS (HR=3.07, 95%CI: 1.595-5.911; p=0.0008). The 141 tumors were divided into patients who underwent limited resection and those who underwent standard resection in order to examine whether the surgical procedure affected the DFS and OS of patients with and without STAS. In the standard resection group, both 5-year DFS and 5-year OS were worse in the patients with STAS in comparison with the patients without STAS (44.1% vs.68.3%, p=0.03; 53.8% vs. 72.3%, p=0.048, respectively). In the limited resection group, both 5-year DFS and 5-year OS were worse in the patients with STAS in comparison with the patients without STAS (0% vs.57.5%, p=0.001; 0% vs. 66.4%, p=0.001, respectively).
Conclusion:
STAS happened in lung SQCC and was found to be an independent predictive factor of both DFS and OS. Both 5-year DFS and 5-year OS were worse in the patients with STAS regardless of surgical procedure.
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P3.04 - Poster Session with Presenters Present (ID 474)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Surgery
- Presentations: 3
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.04-005 - Evaluation of Noninvasive Lung Adenocarcinoma Using 3D-CT Imaging (ID 5150)
14:30 - 14:30 | Author(s): K. Yarimizu
- Abstract
Background:
Computed tomography (CT) can reveal small pulmonary nodules of ≤ 2 cm. Nodules with a consolidation-to-tumor ratio (C/T ratio) ≤ 0.5 on thin-section chest CT are generally recognized as noninvasive lung cancer. However, estimations of C/T ratios on CT may vary between observers. Three-dimensional (3D) imaging can provide more accurate information than 2D-CT for distinguishing noninvasive lung cancers. The aims of this study were to determine the 3D-C/T ratios of small pulmonary nodules on 3D-CT images and explore the relationship between 3D-C/T ratios and the histopathological invasiveness of lung cancers.
Methods:
This was a retrospective analysis of a total of 82 patients with lung adenocarcinoma who had a ground glass opacity (GGO) on CT and underwent surgery from April 2013 to March 2016. We constructed 3D tumor images and calculated the 3D-C/T ratios of GGOs using a 3D analysis system (SYNAPSE VINCENT[®]; Fuji Film). The relationships between 3D-C/T ratio and histopathological indicators of invasiveness were evaluated. Pathological noninvasive cancer was defined as follows: no lymph node metastasis (n[-]), no lymphatic invasion (ly[-]), no vascular invasion (v[-]), and no pleural invasion (pl[-]).
Results:
10 (12%) of 82 tumors were found to be invasive by histopathology, with the following positive indicators: n(+) in 5 (6%), ly(+) in 3 (4%), v(+) in 2 (2%), and pl(+) in 6 (7%). The median 3D-C/T ratio was 0.39. The mean 3D-C/T ratios by pathological findings were as follows: n(+) 0.74 vs n(-) 0.35 (p < 0.01), ly(+) 0.74 vs ly(-) 0.36 (p = 0.06), v(+) 0.58 vs v(-) 0.37 (p = 0.27), and pl(+) 0.57 vs pl(-) 0.35 (p = 0.04). The 3D-C/T ratios of invasive cancer vs noninvasive cancer were 0.71 and 0.34, respectively (p < 0.01). By ROC curve analysis, a 3D-C/T ratio cutoff value of 0.43 provided a sensitivity and specificity of 100% and 61%, respectively, for the diagnosis of invasive cancer.
Conclusion:
This was a pilot study that evaluated the usefulness of 3D-CT imaging for assessing the invasiveness of small lung adenocarcinomas. A prospective observational study of 3D-CT imaging for diagnosing invasive lung adenocarcinoma is warranted.
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P3.04-014 - Surgical Outcome and Diagnosis of cN1 Lung Cancers after Introducing PET/CT (ID 4692)
14:30 - 14:30 | Author(s): K. Yarimizu
- Abstract
Background:
The mainstay of therapy for cN1 lung cancer is surgery; however, the pre-operative radiologic assessment of cN1 lung cancer remains challenging and it has been reported that approximately 30% of cN1 cases are pathologically pN2. The aim of this study was to determine the pre-operative evaluation and outcomes of patients with cN1 lung cancer.
Methods:
A prospectively-collected institutional database was used. In the current study, cN1 was defined as hilar lymph nodes 1 cm in the short axis on CT and standardized uptake values > 2.5 on PET/CT. Between January 2004 and March 2016, a total of 1082 lung cancer patients underwent surgery. After excluding patients who received pre-operative treatment or had an incomplete resection, 86 (7.9%) cN1 patients were retrospectively studied. We compared the characteristics and prognosis of cN1 patients with 783 (72.4%) cN0 patients. Because the patients with cN1pN2 were underestimated, we investigated the frequency and predictive factors for cN1pN2.
Results:
The median follow-up time was 48 months. Compared with cN0 patients, the proportion of males, smokers, and squamous cell carcinomas was higher in cN1 patients (p < 0.01). In addition, cN1 patients had elevated CEA levels and increased SUV on PET/CT. Lymph node metastases were noted as follows: cN1pN0, 32 (37.2%); cN1pN1, 37 (43.0%); cN1pN2, 17 (19.8%); cN0pN0, 701 (89.5%); cN0pN1, 50 (6.4%); and cN0pN2, 32 (4.1%). Lymph node metastases were underestimated in 99 cN0 and cN1 patients (11.4%). The incidence of pN2 was higher in cN1 cases (p < 0.01). The 5-year survival for cN1 cases was 51.9%. The 5-year overall survival of the underestimated cases was as follows: cN1pN2, 18.0%; cN0pN1, 63.7%; and cN0pN2, 39.5%. Among the underestimated cases, survival of cN1pN2 patients was significantly reduced (p < 0.01). In addition, univariate analysis showed that smoking (p = 0.04) and peripheral tumors (p < 0.01) were predictive factors for cN1pN2. Multivariate analysis confirmed that cN1 peripheral tumors tended to be pN2. In 44 cases with peripheral tumors and cN1, 14 (31.8%) were pN2.
Conclusion:
PET/CT can decrease the number of underestimated patients with cN1 lung cancer. Amongst cN1 lung cancer patients, pN2 existed in approximately 20% of cases. Especially, since around 30% of peripheral tumors with cN1 were pN2, invasive staging would be warranted before the treatment.
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P3.04-021 - Readmission Rate is Not Increased with Shortened Hospital Stay after Lung Cancer Surgery (ID 4844)
14:30 - 14:30 | Author(s): K. Yarimizu
- Abstract
Background:
In health economics, keeping costs down is a great concern. Early discharge has been enabled after surgery for lung cancer by clinical pathways, preoperative rehabilitation and the introduction of Enhanced Recovery After Surgery (ERAS) protocols. However, even if a shortened hospitalization has a benefit for hospital management, it has not been clarified whether it has a good influence on the patient’s recovery after surgery. In this study, we examined the relationship between a shortened hospitalization and patient recovery after lung cancer surgery; in particular, we focused on the rate of rehospitalization within 30 days after discharge.
Methods:
We investigated the postoperative course of 318 patients who underwent lung cancer surgery from April 2013 through February 2016. Based on the execution of ERAS, we divided the patients into a shortened group (ERAS performed) and a usual group (ERAS not performed), and compared the rates of rehospitalization and postoperative complications.
Results:
There were 202 men and 116 women, and their median age was 71 years. The shortened group contained 90 cases, and the usual group contained 228 cases. Limited resections were carried out in 19 of 90 patients in the shortened group and in 72 of 228 patients in the usual group (p=0.06). The median duration of postoperative hospitalization was 4 days in the shortened group and 6 days in the usual group (p < 0.001). The incidence of complications was 23.3% (21/90) in the shortened group and 28.0% (64/228) in the usual group (p = 0.38). The rate of rehospitalization within 30 days after surgery was 6.7% (6/90) in the shortened group vs 4.4% (10/228) in the usual group (p = 0.40). In addition, one case in each group required rehospitalization within one week after discharge; thus, there was no significant difference in incidence between groups.
Conclusion:
Health economics is different throughout the world. The timing of discharge depends on the discretion of each institution. Although this study was carried out in a non-randomized setting, we revealed that a shortened hospital stay did not increase the postoperative complication and readmission rates of patients who underwent surgery for lung cancer. Shortening of hospital stay by the introduction of ERAS and other challenges could provide a benefit for patient and hospital management.
