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Masaya Yotsukura



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    P1.05 - Early Stage NSCLC (ID 691)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Early Stage NSCLC
    • Presentations: 1
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      P1.05-009 - Analysis of Postoperative Prognosis in Terms of the Difference Between the Invasive Growth Area and the Total Tumor Diameter (ID 9888)

      09:30 - 09:30  |  Presenting Author(s): Masaya Yotsukura

      • Abstract

      Background:
      In the 8[th] edition of the TNM classification of lung cancer, the T descriptor reflects the invasive growth area, which is not always equal to the total tumor diameter. In this study, we analyzed the difference in postoperative prognosis between tumors for which the invasive growth area was equal to the total tumor diameter and those for which the invasive growth area was smaller than the total tumor diameter.

      Method:
      One hundred forty-two patients with pathological stage I lung adenocarcinoma that was completely resected in our institute were enrolled. Adenocarcinoma in situ and minimally invasive adenocarcinoma were excluded. The average age at operation was 67.8±9.7 years, 87 patients were male, the average total tumor diameter was 1.9±0.6 cm, and the average invasive growth area was 1.6±0.6 cm. In 61 patients, the invasive growth area was smaller than the total tumor diameter (Group A), and in the remaining 81, the invasive growth area was equal to the total tumor diameter (Group B). The postoperative prognosis was compared between Groups A and B.

      Result:
      The estimated 5-year recurrence-free survival (RFS) probabilities by the Kaplan-Meier method in Groups A and B were 94.4% and 70.1%, respectively (p = 0.002, log-rank test). By a log-rank test, T factor (p < 0.001) and lymphatic permeation (p = 0.031) were also significantly associated with RFS. By a multivariate COX proportional hazards model, Group B (p = 0.045) and a pathological T descriptor of T1c or more (p = 0.001) were independently associated with RFS. Group B had a higher percentage of smokers (p = 0.004) and a higher percentage of cases in which the predominant histological subtype was other than a lepidic pattern (p < 0.001).

      Conclusion:
      Tumors for which the invasive growth area is equal to the total tumor diameter are associated with smoking and a predominant subtype of other than a lepidic pattern, and have a worse prognosis than tumors for which the invasive growth area is smaller than the total tumor diameter.

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    P1.17 - Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies (ID 703)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
    • Presentations: 1
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      P1.17-017 - Usefulness of FDG-PET for Differentiating Thymic Epithelial Tumors from Malignant Lymphomas (ID 10578)

      09:30 - 09:30  |  Author(s): Masaya Yotsukura

      • Abstract

      Background:
      It is difficult to diagnose the tumor in the anterior mediastinum by computed tomography. Distinguishing between thymic epithelial tumors and malignant lymphoma is important, because therapeutic strategy is difficult in each disease. The objective of this study was to clarify the usefulness of positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) for distinguishing thymic epithelial tumors and malignant lymphoma.

      Method:
      We retrospectively reviewed FDG PET-CT scans of 62 patients pathologically diagnosed by surgery or biopsy as thymic epithelial tumors or malignant lymphoma. FDG uptake was measured as the maximum standard uptake value (SUVmax). Student t tests were used to assess association between SUVmax and pathological diagnosis.

      Result:
      Among the 62 patients, 36 patients had a pathological diagnosis of thymoma: WHO classification type A in 3 patients (11%), type AB in 9 patients (19%), type B1 in 6 patients (19%), type B2 in 15 patients (42%), and type B3 in 3 patients (7%). Eleven patients had the thymic carcinoma. Fifteen patients had the malignant lymphoma. The SUVmax in malignant lymphoma (14.9 ± 6.4) was significantly higher than that in the thymic epithelial tumors (5.1 ± 2.5) (p＜0.001). The SUVmax in thymic carcinoma (7.8 ± 　3.2) was higher than that in the thymoma (4.0 ± 1.5) (p=0.002). The ROC curve of SUVmax for predicting malignant lymphoma indicated that the optimal cutoff value　was 7.3. This value had a sensitivity of 0.89 and a specificity of 0.87

      Conclusion:
      FDG PET-CT is helpful for distinguishing malignant lymphoma from thymic epithelial tumors with cut off value of 7.3.

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    P3.08 - Locally Advanced Nsclc (ID 724)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Locally Advanced NSCLC
    • Presentations: 1
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      P3.08-002 - Lymphovascular Invasion Is Not a Postoperative Prognostic Factor for Large-Sized Lung Cancer (ID 9643)

      09:30 - 09:30  |  Author(s): Masaya Yotsukura

      • Abstract

      Background:
      Numerous studies about small-sized lung cancer have been published recently. On the other hand, few studies have considered large-sized tumors. In this study we analyzed the prognostic factors for tumors that measured 5 cm or more.

      Method:
      Of the 547 patients who underwent resection of the lung due to primary lung cancer in our institution between 2002 and 2011, 90 had tumors that measured 5 cm or more. Among these 90 patients, 43 were adenocarcinomas, 32 were squamous cell carcinomas, 68 were male, and 14/26/1 cases were pathological N1/2/3, respectively. The average age was 70.1±8.9 years, and the average tumor diameter was 6.7±1.9 cm. Age at operation, gender, tumor location, operative method, tumor size, nodal status, lymphatic permeation, vascular invasion, pleural invasion (pl), preoperative pulmonary function status, serum carcinoembryonic antigen level, smoking status, and Charlson comorbidity index were analyzed using a Cox proportional hazards model to identify the postoperative prognostic factors.

      Result:
      In a univariate analysis, tumor size of 7 cm or more (p = 0.03), pathological N status of N2 or more (N0 vs. N2/3: p = 0.03), pl3 (pl0 vs. pl3: p=0.02), and < 80 (p=0.04) were found to be associated with a poor postoperative overall survival (OS). Lymphatic permeation (p = 0.66), and vascular invasion (p=0.10) were not significantly associated with OS. A multivariate analysis was performed using the 4 factors that were associated with a poor OS in the univariate analysis. As a result, tumor size of 7 cm or more (p < 0.01), pathological N status of N2 or more (N0 vs. N2/3: p < 0.01), and pl3 (pl0 vs. pl3: p=0.01) were independently associated with a poor OS.

      Conclusion:
      For large-sized lung cancer, tumor size, nodal status and pleural invasion were related to OS, whereas lymphovascular invasion was not.

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    P3.13 - Radiology/Staging/Screening (ID 729)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      P3.13-031 - Predicting Factor for the Dissociation of the Diameter Between Radiographical Solid Part and Pathological Invasive Part in Lung Adenocarcinoma (ID 10184)

      09:30 - 09:30  |  Author(s): Masaya Yotsukura

      • Abstract

      Background:
      In part-solid nodule of lung adenocarcinoma, the diameter of the solid part in computed tomography(CT) scan correlates with the diameter of the pathological invasive part. However, there are some cases revealing dissociation between them. We analyzed clinical factors predicting the dissociation of the diameter between radiographical solid part and pathological invasive part in adenocarcinoma less than 3 cm.

      Method:
      Among 291 cases with a lung adenocarcinoma smaller than 3 cm, we identified 91 cases whose solid part in preoperative thin-slice CT scan was less than 5 mm. Based on pathological diagnosis of invasive part, we divided these cases into Adenocarcinoma in situ/Minimally Invasive Adenocarcinoma(AIS/MIA) group (less than 5 mm) and Massive invasion group (5mm or larger), and retrospectively analyzed the clinicopathological factors. We also performed logistic regression analysis to detect the factors predicting the dissociation between radiographical and pathological findings.

      Result:
      Of 91 cases, 67 cases were in AIS/MIA group (AIS: 57, MIA: 10) and 24 cases were in Massive invasion group. In univariative analysis, cases of Massive invasion group were significantly higher in Brinkman index, CEA, age, and total tumor size than those of AIS/MIA group (p = 0.02, 0.01, 0.04, 0.03 respectively). With these detected four factors, we performed logistic regression analysis after determining threshold by ROC curve, which resulted in Brinkman index equal or larger than 400, and age equal or elder than 67 as significant predictive factors for Massive invasion group (p < 0.01, p = 0.05 respectively). Among 11 cases positive for these two factors, 7 cases (63.6 %) were in Massive invasion group.

      Conclusion:
      In the cases of radiographical AIS/MIA, the diameter of pathological invasive part tends to exceed 5 mm if Brinkman index equal or larger than 400, and age equal or elder than 67.