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Yasuhiro Tsutani
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P1.13 - Radiology/Staging/Screening (ID 699)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.13-011a - Stratification Based on PET/CT Findings for Malignant Grade of Radiologically Pure Solid Small-Sized (≪ 2cm) Lung Cancer (ID 9372)
09:30 - 09:30 | Author(s): Yasuhiro Tsutani
- Abstract
Background:
Radiologically pure solid tumors are heterogeneity because of including various histological type, however, small-sized tumors are difficult to be preoperatively diagnosed histology. The aim of this study was to identify preoperative predictors for pathological malignant of pure solid lung cancer in clinical early stage.
Method:
The data from a multi-center database of 220 patients who underwent anatomical resection for radiologically pure solid, tumor size 2 cm or less, and clinical N0 lung cancer were retrospectively analysed. Factors affecting survival were assessed using Cox regression analysis. Predictors were found by drawing the receiver operating characteristic curves (ROC) and evaluated the possible cutoff value for independent prognostic factor.
Result:
Pure solid tumors included 164 (74%) adenocarcinoma, 33 (15%) squamous cell carcinoma, 16 (7%) neuroendocrine tumor, 5 (2%) pleomorphic carcinoma, and 3 (1%) adenosquamous cell carcinoma. In multivariate analyses, high malignant grade histology such as micropapillary and solid predominant adenocarcinoma, adenosquamous cell carcinoma, neuroendocrine tumor, or pleomorphic carcinoma and pathological lymph node metastasis were an independent prognostic factors for recurrence-free survival. The ROC showed that 3.55 in maximum standardized uptake value (SUV max) was cut-off value for detecting high malignant grade histology or lymph node metastasis (area under the curve, 0.71; 95% confidence interval, 0.63 – 0.78). Tumors with SUV max ≥ 3.55 had significantly more high-grade histology, the presence of lymphatic and vascular invasion, and lymph node metastasis and poorer recurrence-free survival rate than SUV max < 3.55 (Figure). Figure 1
Conclusion:
The prognosis of radiologically pure solid tumor with small size and clinical N0 lung cancer was stratified according to SUV max. SUV max could evaluate pathological malignant grade and help the decision of appropriate surgical procedure.
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P2.05 - Early Stage NSCLC (ID 706)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.05-011 - Segmentectomy versus Wedge Resection in Patients with Clinical Stage I Non-Small Cell Lung Cancer Who Were Unfit for Lobectomy (ID 8208)
09:30 - 09:30 | Presenting Author(s): Yasuhiro Tsutani
- Abstract
Background:
The purpose of this study is to compare the surgical outcomes after segmentectomy versus wedge resection in patients with clinical stage I non-small cell lung cancer (NSCLC) who were unfit for lobectomy.
Method:
Between April 2007 and December 2015, 99 patients with clinical stage I NSCLC who were considered unfit for lobectomy and underwent sublobar resection were identified. Propensity scores were estimated including variables such as age, sex, smoking history, solid tumor size, SUVmax of the tumor, preoperative pulmonary functions, and Charlson comorbidity index. Surgical outcomes were compared between patients who underwent segmentectomy and those who underwent wedge resection.
Result:
Thirty-nine patients underwent segmentectomy and sixty patients underwent wedge resection. Operation time (median, 169 min vs. 72.5 min, P <0.001) and blood loss (median, 84 g vs. 10 g, P = 0.001) were significantly different between the procedures. Severe postoperative complications (> Grade IIIa) was more frequently in segmentectomy (15.4%) than in wedge resection (3.3%, P = 0.054). Propensity score-adjusted multivariable analysis showed that operative procedure was an independent predictive factor for severe postoperative complication (segmentectomy, odds ratio = 8.18; P = 0.021). Overall survival (OS) and recurrence-free survival (RFS) were not significantly different between segmentectomy (3 y-OS, 79.1%, 3 y-RFS, 77.7%) and wedge resection (3 y-OS, 86.3%, 3 y-RFS, 68.5%; P = 0.81, P = 0.91, respectively). Propensity score-adjusted multivariable Cox analysis revealed that operative procedure was not an independent factor for OS (segmentectomy, hazard ratio = 1.7, P = 0.24) or RFS (segmentectomy, hazard ratio = 1.1, P = 0.82). In propensity score matching method, similar results were observed.
Conclusion:
Segmentectomy is more toxic, but provides similar prognosis compared with wedge resection. Wedge resection may be an optimal procedure in patients with clinical stage I NSCLC who were considered unfit for lobectomy.
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P2.15 - SCLC/Neuroendocrine Tumors (ID 716)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.15-011 - Therapeutic Strategies and Genetic Comparisons in SCLC and LCNEC of the Lung Using Next-Generation Sequencing (ID 9119)
09:30 - 09:30 | Author(s): Yasuhiro Tsutani
- Abstract
Background:
Small cell lung cancer (SCLC) and large cell neuroendocrine carcinoma (LCNEC) of the lung are highly malignant tumors and classified as variants of endocrine carcinoma and subdivided into pure or combined type. Clinical benefit of this stratification and strategy for target therapy has not been established in these tumors.
Method:
This study aimed to compare genetic and clinicopathological features between SCLC and LCNEC or pure and combined types, evaluate the usefulness of classification methodology, and explore the possibility of target therapy using next-generation sequencing (NGS). NGS custom panel was designed to cover 36 genes with median coverage percentage of 99.57% (80.89-100). As clinicopathological features, patients’ characteristics and immunohistochemistry using 8 antibodies were evaluated.
Result:
In 13 SCLC and 22 LCNEC cases, 72 point mutations, 19 deletions, and 3 insertions were detected. As therapeutically targetable variants, mutations in EGFR (L858R), KRAS (G12D, G12A, G12V), and PIK3CA (E545K) were detected in 5 cases. One combined LCNEC cases harboring EGFR mutation (L858R) showed response to EGFR-tyrosine kinase inhibitor. However, these therapeutically targetable cases were not accompanied by specific features in immunohistochemistry or histology. And there was no significant genetic feature between SCLC and LCNEC or pure and combined types.
Conclusion:
Although even SCLC and LCNEC cases harbored therapeutically targetable mutations and potentially include the benefit for target therapy, they were not identifiable by clinicopathologic background. And there was not significant genetic difference between SCLC and LCNEC, including between pure and combined types. Classifying SCLC and LCNEC in same category is reasonable. However, distinguishing the pure type from combined type was not validated. Comprehensive genetic analysis should be performed to detect targetable variants in any type of SCLC and LCNEC.
