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M. Inoue
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P1.02 - Biology/Pathology (ID 614)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.02-022 - Spontaneous Regression of Primary Pulmonary Synovial Sarcoma; A Case Report (ID 7990)
09:30 - 09:30 | Author(s): M. Inoue
- Abstract
Background:
Primary pulmonary synovial sarcoma is rare, comprising 0.5% of all primary lung malignancies, and spontaneous regression, defined as tumor disappearance without treatment, is very unusual.
Method:
This is a case report of a primary pulmonary synovial sarcoma showing spontaneous regression. The clinical and pathologic records were reviewed, and histologic analysis of the resected specimens was performed.
Result:
Clinical summary: A 38-year-old woman had no history of smoking and no respiratory symptoms. Chest computed tomography revealed a well-demarcated peripheral part-solid nodule measuring 3.8cm in the right lower lobe. Transbronchial biopsy was performed and the diagnosis was synovial sarcoma (SYT-SSX1 variants). She underwent thoracoscopic right lower lobectomy and systematic lymph node dissection. Pathological findings: The cut surface of the resected specimen showed a smooth walled cyst measuring 2.7 × 2.0 cm containing necrotic tissue. The histological examination revealed a widespread coagulative necrosis of tumor cells with peripheral granulation. Only a few regenerated residual tumor cells were observed.
Conclusion:
This is the first report of spontaneous regression of primary pulmonary synovial sarcoma. Although the mechanism is unknown, blood flow obstruction after the transbronchial biopsy may affect the tumor regression.
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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
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.17-009 - Clinical Significance of Preoperative Neutrophil-Lymphocyte Ratio in Patients with Thymic Epithelial Tumor Undergoing Surgery (ID 9381)
09:30 - 09:30 | Author(s): M. Inoue
- Abstract
Background:
Preoperative neutrophil-lymphocyte ratio (NLR), which is an inflammatory marker, has been reportedly associated with a poor prognosis in patients with various cancers. This study aimed to investigate the clinical significance of preoperative NLR in patients with surgically resected thymic epithelial tumor.
Method:
A retrospective review was conducted of 64 patients who underwent surgical resection for thymic epithelial tumor between January 2000 and April 2017. Preoperative NLR was calculated as peripheral blood neutrophil (cells/m[3]) divided by lymphocyte (cells/m[3]). Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal value for NLR predicting recurrence. Univariate analysis was performed to assess the association between preoperative NLR and relevant clinicopathological variables. Recurrence-free survival (RFS) after first surgery was calculated using the Kaplan-Meier method.
Result:
The median follow-up period was 66 months. The patients were 32 men and 32 women with a median age of 60 years. The WHO classification was type A (n=10), AB (n=20), B1 (n=9), B2 (n=12), B3 (n=8), and thymic carcinoma (n=5). The patients were classified into two groups according to preoperative NLR: high NLR (≥2.1, n=29) and low NLR (<2.1, n=35) group. Univariate analysis showed that aggressive histology (B2/B3 and thymic carcinoma) and a lower incidence of myasthenia gravis were significantly correlated with high NLR. The RFS rate of the high NLR group was significantly poorer than that of the low NLR group (5- and 10-year RFS rates: 82.6% vs 93.2% and 48.3% vs 93.2%, p=0.034).Figure 1
Conclusion:
Preoperative high NLR value was significantly associated with aggressive histology (type B2/B3 thymoma and thymic carcinoma) and a lower incidence of myasthenia gravis. Preoperative high NLR could be a predictorof poor outcome in patients undergoing surgical resection of thymic epithelial tumor.
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P2.01 - Advanced NSCLC (ID 618)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)
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P2.01-067 - Treatment of the Patients with Oncological Emergencies with Massive Pleural Effusion at the First Hospital Visit (ID 9108)
09:00 - 09:00 | Author(s): M. Inoue
- Abstract
Background:
Massive pleural effusion may cause the oncological emergencies in the patients with advanced lung cancer. We describe here the treatment experience of patients with the massive pleural effusion at the first visit.
Method:
Three patients had massive pleural effusion at the first visit from April 2016 to March 2017. We report these 3 patients treated with carboplatin, pemetrexed, and/or bevacizumab.
Result:
All of 3 patients urgently received the continuous chest tube drainage for several days (Table 1). Pleural effusion was examined for cytology. Patient A received pleurodesis therapy because of negative fluid cytology, while she was examined by CT guided needle biopsy. Patient B and C revealed malignant adenocarcinoma cytology in pleural effusion. Both of two received additional biopsy for EGFR-mutation and ALK-translocation. Patient A waited the result of the pathology of adenocarcinoma, EGFR-mutation of negative, and ALK-translocation of negative for 24 days. She received the chemotherapy of carboplatin and pemetrexed with pregressive disease and died of locally advanced lung cancer after 1 course of chemotherapy followed 20 days best supportive care. Patient B and C quickly began the first line chemotherapy of carboplatin, pemetrexed, and bevacizumab without waiting the result of EGFR-mutation and ALK-translocation. Patient B received the six-course of chemotherapy with partial remission, followed the one course of the maintenance chemotherapy of pemetrexed and bevacizumab, however, he died of brain metastasis 183 days after the first chemotherapy. Patient C received the six courses of chemotherapy, followed pemetrexed and bevacizumab maintenance therapy, and is living with partial remission more than 130 days.Table 1
Age Sex Pleural effusion cytology Additional pathology EGFR-mutation Period to the first chemotherapy 1st line chemotherapy Prognosis Patient A 77 F Class I Dissemination, adenocarcinoma wild 25 days Carboplation, Pemetrexed Dead, 58 days, Locally advancement Patient B 60 M Class IV Lung, adenocarcinoma wild 8 days Carboplatin, Pemetrexed, Bevaxizumab Dead, 183 days Brain metastasis Patient C 69 F Class IV Dissemination, Adenocarcinoma L858R 4 days Carboplatin, Pemetrexed, Bevaxizumab Alive, 130 days, PR
Conclusion:
Carboplatin, pemetrexed and bevcizumab treatment was well-tolerable in the patients with the oncological emergencies of massive pleural effusion. We should start the first line treatment as soon as possible. Two weeks of waiting period are so long for the patients with advanced lung cancer.
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P2.16 - Surgery (ID 717)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.16-016 - Surgical Treatment of Indeterminate Lung Nodules (ID 9795)
09:30 - 09:30 | Author(s): M. Inoue
- Abstract
Background:
Recently, the improvement of ability of Computed tomography (CT) scans permits us to identify a large number of small peripheral, undefined pulmonary lesions that require a diagnosis. Although the large majority of these cases are benign, diagnostic approaches to discriminate benign nodules from malignant nodules remain most-unsatisfactory. So we often have to perform thoracoscopic resection with the primary objective of diagnosis. In this study, we examined the clinicopathological findings in the cases of indeterminate pulmonary nodules in which thoracoscopic or open excisional biopsy was performed.
Method:
From a single institutional database, a total of 253 patients diagnosed with lung cancer or suspected lung cancer underwent resection between January 2014 and March 2017. In 155 patients, a histological diagnosis was not obtained preoperatively. This study was intended for 108 patients diagnosed with lung cancer after surgery among the 155 indeterminate pulmonary nodules.
Result:
Out of 155, 108 patients were diagnosed as primary lung cancer by intraoperative frozen section or postoperative pathological examination. Twenty-six patients were diagnosed as metastatic lung tumors, and 21 patients were diagnosed as other, such as benign inflammatory changes. Surgical resection of indeterminate lung nodules (mean diameter 20.6mm, range 3 to 53 mm) were performed in 108 primary lung cancer cases, which represented 52.4% of the 206 resections for lung cancer performed during the study period. There were 57 men and 51 women with an average age of 70.6 years old (47-91 years old). A biopsy needle (13cases) or wedge resection (61cases) was used to the methods of intraoperative diagnosis. The remaining 34 cases performed a final pathological examination after surgery without intraoperative diagnosis. Nineteen small pulmonary nodules that include ground-glass attenuation required preoperative computed tomography-guided lipiodol marking to identify the position of a nodule. The postoperative stage was 0 in 17 patients （16％）, IA in 66 （61％）, IB in 11 （10％）, IIA in 1 （1％）, IIA in 3 （3％）, IIIA in 8 （7％）, and IV in 2 （2％）.
Conclusion:
The small pulmonary nodules that include ground-glass attenuation are tricky to diagnose. When CT findings are highly suggestive of lung cancer, we think that positive lung biopsy under thoracoscopic surgery is necessary to detect lung cancer.
