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Koji Kawaguchi
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P1.08 - Locally Advanced NSCLC (ID 694)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.08-002 - Blood Supply to the Tumor Do Not Predict the Effect of Induction Therapy in Patients with Locally Advanced Lung Cancer (ID 8065)
09:30 - 09:30 | Presenting Author(s): Koji Kawaguchi
- Abstract
Background:
Induction therapy is a promising optional treatment for locally advanced lung cancer including superior sulcus tumors. However, predictors of the effect and pathologic complete responses have not been well-known. We hypothesized that those tumors invading neighboring structures would be more sensitive to induction therapy owing to the richer blood supply to them from involved organs. The purpose of this study was, therefore, to evaluate predictors for pathologic complete responses of induction therapy and whether the volume of blood supply to the tumor could predict the efficacy of induction therapy.
Method:
Patients who underwent induction therapy followed by surgery for locally advanced lung cancer were retrospectively reviewed. The volume of blood supply to the tumor was defined as the CT value (HU; Hounsfield Unit) calculated by subtraction of the non-enhanced value from the contrast-enhanced value (divided early phase and late phase) at the maximal dimension of the tumor on dynamic CT before induction therapy. The measured areas of the tumor were encircled by freehand with disengaging of bony structures. The efficacy of induction therapy was categorized to the pathologic complete response (pCR) and residual tumor (pRT) group.
Result:
From 2005, 50 patients were enrolled in this study. There were 43 males and 7 females, with a median age of 63 years old. The tumors consisted of 38 T3 lesions and 12 T4 lesions (40 chest wall, 7 mediastinum, and 3 vertebrae). Induction therapy included chemoradiotherapy in 39 patients, chemotherapy in 6, and radiotherapy in 5, and the dose of radiation was 40Gy in 33 patients, 45Gy in 1, 50Gy in 6, and 60Gy in 4, respectively. All patients except one underwent a complete resection, and the pathologic complete response was obtained in 15 (30%). The mean CT values of early and late phases in pCR groups were 14.1±12 HU and 30.6±14 HU, and those in pRT were 15.3±13 HU and 35.3±19 HU, respectively. By a logistic regression analysis, smaller size of the tumor (less than 42 mm) was the only trend of the predictor for pCR (p = 0.064), whereas maximum standardized uptake value on FDG-PET and CT values of early and late phases on contrast-enhanced CT had no correlations toward pathologic complete responses.
Conclusion:
The volume of blood supply to locally advanced lung cancers did not predict the effect of induction therapy, whereas smaller sized tumor tended to have a better effective response in this study.
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P3.09 - Mesothelioma (ID 725)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.09-006 - Preoperative Six-Minute Walk Distance and Desaturation in Patients with Malignant Pleural Mesothelioma (ID 8762)
09:30 - 09:30 | Author(s): Koji Kawaguchi
- Abstract
Background:
Surgery for malignant pleural mesothelioma (MPM) is an invasive procedure associated with high morbidity. MPM often invades adjacent structures such as the chest wall, diaphragm, and mediastinum. Therefore, pulmonary functions and levels of physical fitness are reduced in advanced MPM. The aim of this study was to characterize preoperative exercise capacity and relate it to pulmonary functions, oxygenation, and postoperative outcomes in patients with MPM.
Method:
A retrospective study was conducted on 18 patients with MPM who were scheduled to undergo extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D) followed by postoperative rehabilitation at Nagoya University Hospital from July 2012 to April 2016 (Institutional Review Board approval No. 2015-0413). To estimate preoperative exercise capacity, 6-min walk test (6MWT) and oxygen saturation of a peripheral artery (SpO~2~) during the 6MWT were assessed. Grades III and IV of the Clavien-Dindo classification were defined as major postoperative complications.
Result:
The age was 65.8 ± 6.4 years. Preoperative 6-min walk distance (6MWD) was 465.9±96.7 m. Minimum SpO~2~ ranged from 86% to 97%. The 6MWD significantly correlated with inspiratory capacity (r=0.507, P<0.05) and % of predicted value of diffusing capacity of the lung for carbon monoxide (%DL~CO~) (r=0.470, P<0.05). The minimum SpO~2~ during 6MWT significantly correlated with % of predicted values of vital capacity (r=0.619, P<0.01) and total lung capacity (r=0.493, P<0.05) and postoperative days of extubation (r=-0.495, P<0.05). The preoperative partial pressure of oxygen in arterial blood significantly correlated with %DL~CO~ (r=0.505, P<0.05). There was a total of 13 major postoperative complications (8 respiratory failure, 2 pneumonia, 1 empyema, 1 atrial fibrillation, and 1 prolonged air leak) in 6 patients. There was no in-hospital death or death within 30 days after surgery. The incidence of major complications was significantly associated with longer stays in intensive care unit (3.3±1.8 vs. 1.7±1.0 days, P<0.05) and hospital (54.2±31.2 vs. 12.3±3.2 days, P<0.05) but not with preoperative physical status or pulmonary functions. Stays in hospital after EPP (n=7) were significantly longer than those after P/D (n=11) (median 28 vs. 12 days, P=0.01) but there was no significant difference in incidence of major complications between the EPP and P/D groups.
Conclusion:
Our results indicate that the 6MWT is a convenient and useful field test to assess preoperative physical status in patients with MPM. Future studies with a larger cohort are required to elucidate risk factors for postoperative morbidity and mortality.
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P3.16 - Surgery (ID 732)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.16-010 - Preoperative Six-Minute Walk Distance Is Associated with Complications of Pneumonia after Lung Resection (ID 8147)
09:30 - 09:30 | Author(s): Koji Kawaguchi
- Abstract
Background:
Postoperative pulmonary complications such as pneumonia are significant negative predictors of short- and long-term survival after thoracic surgery. A preoperative cardio-pulmonary function is known as a predictor for postoperative pulmonary complications in patients with lung cancer. However, little is known about the relationship between preoperative exercise capacity and complication of pneumonia after lung resection. The 6-min walk distance (6MWD) measured by the 6-min walk test (6MWT) is a simple, safe, and inexpensive field test that can be used to evaluate the functional exercise capacity. We examined the association between preoperative 6MWD and development of postoperative pneumonia.
Method:
A retrospective study was conducted on patients with malignant lung tumors who were scheduled to undergo lung resection at Nagoya University Hospital from January 2014 to December 2015 (Institutional Review Board approval No. 2015-0413). Preoperative pulmonary function tests and 6MWT were assessed. A logistic regression model and receiver operating characteristic (ROC) curves were used to analyze clinical variables and compare the performance on 6MWD and percentages of predicted values of forced expiratory volume in 1 s (%FEV~1~) and diffusion capacity of the lung for carbon monoxide (%DLco).
Result:
The data from a total 321 patients including 283 with primary lung cancer and 38 with metastatic lung tumors were analyzed. Preoperative 6MWD significantly correlated with age, FEV~1~, forced vital capacity (FVC), %DLco, and serum albumin level. Pneumonia developed in 13 patients (4.0%) and the 6MWD of patients with pneumonia was significantly lower than that of patients without (413.9±89.0 vs. 495.2±93.2 m, p=0.002). Incidences of smoking history and comorbidity of COPD and interstitial lung disease were significantly higher and %FEV~1~, FEV~1~/FVC, %DLco, and serum albumin level were significantly lower in patients with pneumonia than in those without. Length of hospital stay after surgery was significantly longer in patients with pneumonia than in those without (30.4±29.6 vs. 7.4±7.0 days, p<0.001). In ROC analysis, 6MWD ≤450 m was a threshold for predicting postoperative pneumonia with 69.2% sensitivity and 71.1% specificity. A 6MWD ≤450 m, %FEV~1~ <80%, %DLco <80%, serum albumin <3.5 g/dL, and blood loss during surgery >200 g were significantly associated with development of postoperative pneumonia in a logistic model adjusted by age, sex, and primary lung cancer.
Conclusion:
Preoperative 6MWD is associated with development of pneumonia after lung resection for malignancies. Preoperative 6MWT is a useful screening tool in patients with primary and metastatic lung tumors.
