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S.Y. Park



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    P1.02 - Biology/Pathology (ID 614)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Biology/Pathology
    • Presentations: 1
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      P1.02-021 - Can <sup>18</sup>F-FDG PET/CT Predict the Pathological Necrosis and Microvessel Density in Lung Adenocarcinomas (ID 7987)

      09:30 - 09:30  |  Author(s): S.Y. Park

      • Abstract

      Background:
      Tumor hypoxia is characterized by necrosis and a low microvessel density (MVD). Necrosis and MVD are invaluable tools for predicting survival outcomes in non-small-cell lung cancer (NSCLC). Furthermore, hypoxia increases the extent of resistance to gefitinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, in lung adenocarcinomas. However, the invasive nature of tumor sampling remains a major clinical obstacle. [18]F-fluorodeoxyglucose positron emission tomography ([18]F-FDG PET) accumulation is a well-validated in vivo measure of tissue glucose metabolism and hypoxia. We hypothesized that [18]F-FDG PET could identify tumor necrosis of, and quantify the MVD in lung adenocarcinoma. Therefore, we investigated the relationship between preoperative [18]F-FDG PET parameters and tumor necrosis and MVD. Hypoxia biomarkers including glucose transporter type 1 (GLUT1), carbonic anhydrase IX and vascular endothelial growth factor were also evaluated.

      Method:
      Data on 164 patients who underwent the surgical resection of pulmonary adenocarcinomas were retrospectively reviewed. Preoperative [18]F-FDG-PET data, the extent of tumor necrosis, and immunohistochemical measures of the expression of GLUT1, carbonic anhydrase IX, vascular endothelial growth factor, and CD31 for detecting MVD were evaluated. The associations between PET parameters and the levels of pathological markers, and the prognostic significance of necrosis, were evaluated.

      Result:
      The standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) level were significantly lower in patients exhibiting no necrosis compared to those with partial or diffuse necrosis. When we divided the patients into two groups based on high vs. low PET parameter values, elevated SUVmax, MTV, and TLG values were significantly more associated with partial or diffuse necrosis than were lower values (p<0.001). A negative correlation was evident between the MVD and SUVmax (p=0.002), MVD and MTV (p=0.038), and MVD and TLG (p=0.019). GLUT1 expression correlated with high PET parameter values, a low MVD, and the presence of necrosis. Patients without necrosis exhibited better 5-year recurrence-free survival and overall survival than patients with necrosis (p<0.001 and p=0.007, respectively). However, a multivariate analysis revealed that necrosis was not of prognostic significance.

      Conclusion:
      High-level FDG accumulation predicted tumor necrosis. Clinicians can thus predict prognosis and improve treatment policies by reference to PET parameters.

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    P3.16 - Surgery (ID 732)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P3.16-019 - Prognostic Factors for Resected Non-Small Cell Lung Cancer in Patients with Type 2 Diabetes Mellitus (ID 8534)

      09:30 - 09:30  |  Author(s): S.Y. Park

      • Abstract

      Background:
      For diabetic patients with lung cancer, blood glucose levels and medications such as metformin and statins may impact survival. This retrospective study defined prognostic survival factors for diabetic patients with resected non-small cell lung cancer.

      Method:
      Between January 2005 and December 2013, 301 patients with type 2 diabetes mellitus who underwent curative resection for non-small cell lung cancer were identified and reviewed retrospectively. Prognostic factors for lung cancer–specific and overall survival were evaluated using the Cox proportional hazards regression model.

      Result:
      The median follow-up period was 48 months (interquartile range, 30–72). In a multivariate analysis for lung cancer–specific survival, older age, forced expiratory volume in 1 second (FEV1) < 80 % predicted, and advanced pathologic stage were significant negative prognostic factors; statin use was a positive prognostic factor [hazard ratio, 0.468; 95% confidential interval, 0.258–0.849]. In a multivariate analysis for overall survival, male sex, older age, FEV1 < 80 % predicted, and advanced pathologic stage were significant negative prognostic factors; proper glycemic control (hazard ratio, 0.645; 95% confidence interval, 0.436–0.952) and statin use (hazard ratio, 0.602; 95% confidence interval, 0.390–0.931) were positive prognostic factors.

      Prognostic factors related to overall survival
      Variable Univariate HR (95% CI) Multivariate HR (95% CI)
      Male 2.682 (1.603–4.486) 2.628 (1.287–5.366)
      Age 1.041 (1.016–1.066) 1.070 (1.042–1.099)
      Smoking 1.927 (1.247–2.979) 0.988 (0.527–1.850)
      FEV1% predicted <80 1.843 (1.254–2.708) 1.647 (1.073–2.530)
      Obesity (BMI ≥25) 0.573 (0.387–0.848) 0.752 (0.496–1.138)
      Proper glucose control 0.700 (0.487–1.006) 0.645 (0.436–0.952)
      Cardiovascular comorbidity 1.315 (0.896–1.929)
      Neoplastic comorbidity 1.259 (0.815–1.946)
      Renal insufficiency 1.338 (0.871–2.055)
      Metformin 1.131 (0.781–1.638)
      Insulin 1.465 (0.886–2.422)
      Statin 0.602 (0.398–0.911) 0.602 (0.390–0.931)
      Non-adenocarcinoma 1.724 (1.203–2.470 0.905 (0.571–1.435)
      Pneumonectomy 2.386 (1.364–4.175) 1.520 (0.806–2.864)
      R1 (vs R0) 1.841 (0.452–7.492)
      Stage
      I Reference
      II 2.594 (1.694–3.973) 3.315 (1.837–5.983)
      III/IV 3.818 (2.445–5.961) 6.515 (3.471–12.226)
      Adjuvant treatment 1.545 (1.076–2.217) 0.606 (0.361–1.018)


      Conclusion:
      Proper glycemic control (HbA1C <7.0) is recommended for diabetic patients undergoing lung cancer surgery. Statin use was associated with improved overall survival and lung cancer–specific survival. Further studies are required to elucidate associations between type 2 diabetes mellitus and anti-neoplastic effects of statins and to evaluate statins as a novel adjuvant treatment for lung cancer.