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Shaolei Li



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    OA 16 - Treatment Strategies and Follow Up (ID 686)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Early Stage NSCLC
    • Presentations: 1
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      OA 16.08 - A Modified Pathological N1 Classification Strategy Based on Systematic Dissection of N1 Nodes from Level 10 to 14 for Non-Small Cell Lung Cancer (ID 9157)

      15:45 - 15:55  |  Author(s): Shaolei Li

      • Abstract
      • Presentation
      • Slides

      Background:
      It is necessary to apply a precise standard to predict the oncological outcomes among heterogeneous subgroups of N1 disease ranging from level 10 to 14. Although International Association for the Study of Lung Cancer (IASLC) proposed a new N descriptor in the 8[th] edition of the TNM Classification, lack of dissection on level 13 and level 14 may affect the efficacy of new classification. In this study, we tested a hypothesized classification strategy based on systematic dissection of N1 node from level 10 to level 14.

      Method:
      From March 2007 to December 2014, 156 consecutive patients of non-small cell lung cancer, treating with lobectomy and systematic mediastinal lymphadenectomy, were investigated. Nodes from level 10 to 12 were dissected during operation. Intrapulmonary lymph nodes (level 13-14) were retrieved after surgery. The data were prospectively collected and retrospectively analyzed. All cases were divided into two categories according to the 8[th] edition of the TNM Classification: pN1a was defined as N1 at a single station, while pN1b was defined as N1 at multiple stations. Then, in our proposed classification, N1a (modified) was defined as single level of N1 station involved (not including single level 10 or 11 spread) or level 13 and/or 14 involved, while N1b (modified) was defined as single level 10 or 11 spread or multiple levels of N1 node involvement (not including level 13 and 14 spread). The association between the N1 subgroup status and survival was explored separately using 8[th] IASLC classification and hypothesized classification.

      Result:
      In the whole cohort, a mean±SD of 13.1±7.1 N2 nodes and 12.0+5.2 N1 nodes per case were collected.There were 4.7±3.1 nodes from level 13 and 14. The difference in 5-year overall survival between pN1a and pN1b was not significant (73.9% versus 65.7%, p=0.371). However, the difference in 5-year overall survival between N1a (modified) and N1b (modified) was significant (79.1% versus 60.2%, p=0.018). Multivariate analysis showed the revised N1 classification was an independent prognostic factor for NSCLC (versus N1a, the hazard ratio [HR] of N1b for OS was 2.120, 95% confidence interval [CI]: 1.083-4.151, p=0.028). However, the 8[th] edition IASLC N1 descriptors was not an independent prognostic factor (versus pN1a, HR of pN1b was 1.419, 95% CI: 0.710-2.837, p=0.322).

      Conclusion:
      The hypothesized N1 classification in present study was shown to be a better descriptor to express the outcome than 8[th] edition of the TNM Classification of IASLC. More data are needed to validate this proposal.

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    P2.01 - Advanced NSCLC (ID 618)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P2.01-068 - Lobectomy Improve the Survival of Non-Small Cell Lung Cancer Patients with Occult Malignant Pleural Disease First Detected at Thoracotomy (ID 9131)

      09:00 - 09:00  |  Presenting Author(s): Shaolei Li

      • Abstract
      • Slides

      Background:
      To aim of this study was to determine the clinical and biological prognostic factors for occult malignant pleural disease (MPD) first detected at thoracotomy in patients with non-small cell lung cancer (NSCLC) and evaluate the results of surgical intervention.

      Method:
      A total of 123 patients diagnosed with MPD at consecutive 2894 thoracotomy from January 2006 to October 2016. Clinical and pathological characteristics were evaluated in 120 patients. Survival curves were estimated by the Kaplan–Meier method, and Cox regression analysis was performed to validate the selected risk factors.

      Result:
      With a median follow-up of 34 months, the 5-year overall survival of 120 patients was 28%. Multivariate analyses using the Cox proportional hazards model showed gender (p=0.066), T stages (p<0.001), N stages (p=0.032), pleural invasion in image (p=0.004), pleural effusion (p=0.027), surgery intervention (p=0.024) and EGFR status (p=0.001) were independent predictors of survival. The 5-year survival rate and median survival time (MST) for 21 patients with lobectomy were 71.6% and 62.6 months, compared with 25.6% and 40.0 months in 46 patients with sublobectomy. When 53 patients subjected to open-close surgery, their 5-year survival rate and MST were 23.4% and 30.2 months. There was significant prognostic difference between lobectomy and sublobectomy /open-close surgery (p=0.033/0.016), but no significant difference was found between sublobectomy and open-close surgery (p=0.679) Figure 1



      Conclusion:
      Lobectomy confers better prognosis compared to sublobectomy and exploratory thoracotomy for occult MPD patients with NSCLC.

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