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Shinji Kikuchi
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P2.02 - Biology/Pathology (ID 616)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.02-025 - Histological Difference of Tumor-Infiltrate Lymphocytes in Non-Small Cell Lung Cancer (ID 7506)
09:30 - 09:30 | Author(s): Shinji Kikuchi
- Abstract
Background:
Lymphocytes play important roles in cancer immunity. Tumor-infiltrate lymphocytes (TILs) are seen in non-small cell lung cancer (NSCLC) and generally classified according to their localization (epithelial area and stromal area). The distribution and the number of TILs are quite different. Cancer cells have an ability to evade from cancer immunity, and the several mechanisms of the ability have been reported; decreased expression of tumor antigen, inhibition of immune response, induction of immunosuppressive cells, and secretion of immunosuppressive cytokines. We hypothesized that the mechanisms of evasion from cancer immunity would influence TIL representation. In this study, we investigated the differences of TILs in histological differentiation, since we considered that histological difference could affect cancer immunity.
Method:
We retrospectively investigated surgical specimens between 2009 and 2015. Consecutive 20 cases with minimally invasive adenocarcinoma (MIA), lepidic adenocarcinoma (Ad lepidic), acinar or papillary adenocarcinoma (Ad aci/pap), solid adenocarcinoma (Ad solid) and squamous cell carcinoma (Sq) were selected (total 100 cases). We checked all fields of the tumors in the slice with maximum tumor-diameter microscopically at 100-fold magnification. TILs in the field were judged as positive when more than 10 lymphocytes flocking in tumor epithelial area or stromal area were observed. TILs of the tumors were assessed as the rate of the TIL positive fields in all, and separately evaluated in epithelial area and stromal area. Then, analysis of variance was used to assess the histological differences of TILs. Significant difference was considered as p-value was less than 0.05.
Result:
The average rates of TIL positive fields in epithelial area of MIA, Ad lepidic, Ad aci/pap, Ad solid and Sq were 11.2 ± 20.4%, 15.8 ± 20.4%, 26.9 ± 20.9%, 52.4 ± 30.0% and 27.8± 28.8%, respectively. The rate of Ad solid was significantly higher than those of MIA, Ad lepidic and Ad aci/pap, and the rate of Sq was also significantly higher than those of MIA and Ad lepidic. The average rates of TIL positive fields in stromal area of MIA, Ad lepidic, Ad aci/pap, Ad solid and Sq were 41.9 ± 26.1%, 51.2 ± 28.3%, 57.6 ± 23.2%, 67.7 ± 25.4% and 67.8 ± 30.0%, respectively. The rate of MIA was significantly lower than Ad solid and Sq.
Conclusion:
TILs were significantly different representation depending on the histology. Especially in adenocarcinoma, the TILs differed according to the grade of differentiation. These results might show that highly differentiated lung adenocarcinoma has low expression of tumor antigen.
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P2.17 - Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies (ID 718)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.17-004 - Salvage Surgery for Pulmonary Metastases in Patients with Testicular Germ Cell Tumors (ID 10054)
09:30 - 09:30 | Presenting Author(s): Shinji Kikuchi
- Abstract
Background:
Germ cell tumors of testicular origin are the most common malignancy in young males. The lungs and the retroperitoneal space are frequently the initial sites of metastatic disease. Salvage surgery is an important treatment modality for residual post-chemotherapy pulmonary masses. We analyzed the prognostic predictors of survival in the patients after pulmonary metastasectomy.
Method:
Between September 1989 and December 2015, 32 patients underwent pulmonary resection of thoracic metastases following cisplatin-based chemotherapy. Germ cell tumors of mediastinal origin were excluded. These patients’ records were subsequently reviewed.
Result:
All patients underwent high orchidectomy and cisplatin-based chemotherapy. The primary tumor histology demonstarated 2 seminomas and 30 nonseminomatous germ cell tumors. Twenty-three patients (72%) received two or more chemotherapy regimens. International Germ Cell Cancer Collaborative Group classification, TNM factors, and serum tumor marker level at diagnosis were not associated with prognosis after pulmonary metastasectomy. The mean age at pulmonary surgery was 31.9 years. The surgical procedures included wedge resection in 23 (72%) and segmentectomy/lobectomy in 9 (28%). There were no perioperative deaths and major postoperative complications. The overall 5-year survival rate was 73% after an average follow-up of 55 months. The pathology of residual pulmonary masses revealed viable tumor cells in 12 patients (38%), necrosis alone in 18 patients (56%), and mature teratoma alone in 2 patients (6%). Preoperative increased lactic dehydrogenase (LDH) levels were significantly associated with the viable tumor cells of residual masses. The size of pulmonary metastases has not been found to be statistically related to malignant tumor cells. A significantly poor survival was observed using univariate analysis in patients with preoperative high free-βHCG (p=0.012), high intact HCG (p=0.031), high LDH (p<0.001), removing 5 or more lung metastases(p=0.012), and viable tumor cells of residual masses (p=0.026).
Conclusion:
We conclude that pulmonary resection in metastatic testicular tumors is a safe and effective treatment strategy. Increased tumor marker levels, free-βHCG/intact HCG or LDH, removing 5 or more lung metastases, and viable tumor cells of residual masses were identified as prognosis-related criteria for a poor prognosis.
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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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P3.16-039 - Right Upper Lobectomy with SVC Reconstruction after Induction Chemoradiotherapy for a Patient with Bulky N2 NSCLC (ID 7522)
09:30 - 09:30 | Author(s): Shinji Kikuchi
- Abstract
Background:
The treatment strategy for N2 IIIA non-small cell lung cancer (NSCLC) is still controversial. Some believe that patients with bulky N2 are not good candidates for trimodality treatment. In addition, with regard to the survival of patients underwent lung resection with SVC reconstruction, patients with SVC involvement due to direct invasion of the main tumor have longer survival compared to those with SVC involvement due to mediastinal lymph node (LN) metastasis. We encountered a patient with bulky N2 NSCLC with SVC involvement.
Method:
A 69-year-old man complaining of cough was referred to our hospital for examination of a chest abnormal shadow. Chest CT showed a 58-mm pulmonary mass lesion in the right upper lobe and mediastinal LN swelling (#4R: 31 mm, #2R: 15 mm), which resulted in stenosis of the SVC. Transbronchial biopsy of the mass and EBUS-TBNA of the #4R LN showed squamous cell carcinoma. Since distant metastasis was not apparent, the patient was diagnosed with locally advanced IIIA lung cancer with bulky N2. After induction of concurrent chemoradiotherapy (2 cycles CDDP+VNR + 45 Gy radiotherapy), the lesion showed 9.5% reduction and was defined as stable disease according to the RECIST criteria.
Result:
Since it would be difficult to dissect the SVC and #4R LN, and this procedure would require substantial time, we approached by median sternotomy and right fourth intercostal thoracotomy and established the shunt between the left brachiocephalic vein and the right atrial appendage prior to cross-clump of the SVC. The SVC was resected because of extensive firm adhesion of the #4R LN, and reconstructed with a 12-mm reinforced polytetrafluoroethylene graft. The anastomosis was performed using a 5-0 Plorene suture. The patient underwent right upper lobectomy with mediastinal dissection and combined resection of the SVC. The operation time was 494 min and blood loss was 700 g. The patient was discharged on postoperative day 16. Pathological examination revealed the effect of chemoradiotherapy was Ef2, and viable cells were present in the #4 LN (ypN2).
Conclusion:
While the long-term outcome of this patient is unknown, we believe the trimodality treatment is an option for bulky N2 NSCLC with SVC involvement.
