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I. Opitz
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P1.09 - Mesothelioma (ID 695)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.09-009 - Evaluation of a Combined MicroRNA-Clinical Score as Prognostic Factor for Malignant Pleural Mesothelioma (ID 9245)
09:30 - 09:30 | Author(s): I. Opitz
- Abstract
Background:
In 2015, a 6-microRNA signature (miR-Score, Kirschner et al 2015) was demonstrated to show high prognostic accuracy in a series of surgical specimens (with and without induction chemotherapy) from patients with malignant pleural mesothelioma. In-depth analysis of matching pre- and post-chemotherapy tissue specimens has recently shown that a refined 2-miR-Score appears more suitable for use in diagnostic chemo-naïve specimens (Kirschner et al, WCLC 2016). Here, in addition to continued validation, we also aimed to further improve the prognostic accuracy by combining the 2-miR-Score with known clinical prognostic factors.
Method:
Binary logistic regression modelling was used to build a combined score consisting of the 2-miR-Score and the clinical prognostic factors age (<60 years vs >60 years at diagnosis), gender and histological subtype (epithelioid vs non-epithelioid). In addition, microRNA analysis (RT-qPCR) was performed in an additional 33 pairs of chemo-naïve (diagnostic biopsy) and chemo-treated (EPP) specimens. Accuracy of the investigated scores in predicting a good prognosis (>20 months survival post-surgery) was evaluated by ROC curve analysis.
Result:
Combining the refined 2-miR-Score with the clinical prognostic factors histological subtype and age at diagnosis, increased the overall accuracy of the 2-miR-Score in both chemo-naïve diagnostic (AUC=0.80; 95% CI: 0.65-0.95) and post-chemotherapy (AUC=0.86; 95% CI: 0.73-0.98) specimens. Addition of gender as clinical prognostic factor, did not result in further increases, hence this factor was not included in the combined score. Investigation of an additional set of 33 matched pairs of chemo-naïve and post-chemotherapy tissue samples, confirmed the improved prognostic accuracy of the combined score, with AUCs of 0.76 (95% CI: 0.59-0.92) and 0.79 (95% CI: 0.64-0.95) for chemo-naïve and post-Chemotherapy specimens, respectively. Furthermore, addition of the clinical factors resulted in an increase in specificity of the prognostic score from previously 55-65% to now 65-75%, while keeping sensitivities at the previous levels of 75-85%. Importantly, the combined microRNA-clinical Score did not only outperform the 2-miR-Score, but also the clinical factors alone.
Conclusion:
This validation has confirmed the prognostic potential of the novel 2-miR-Score. Furthermore, addition of known clinical prognostic factors was shown to result in a combined Score with increased prognostic accuracy. In addition to continued validation, in currently ongoing analyses we are also investigating combining the 2-miR-Score with our previously proposed multimodality prognostic score (MMPS; Opitz et al 2015).
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P3.09 - Mesothelioma (ID 725)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Mesothelioma
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.09-010 - 18 Years Single Center Experience of Surgical Resection of Malignant Pleural Mesothelioma After Induction Chemotherapy (ID 10010)
09:30 - 09:30 | Author(s): I. Opitz
- Abstract
Background:
Surgical resection of malignant pleural mesothelioma is discussed controversially. Using our data from nearly 2 decades of single center experience, and focusing on the shift from extrapleural pneumonectomy (EPP) to (extended) pleurectomy/decortication ((e)P/D) we compared the peri- and longterm outcomes of EPP and (e)P/D after induction chemotherapy.
Method:
In a retrospective analysis (September 1999 - June 2016) of our prospective database of mesothelioma patients 196 patients received mentioned multimodality therapy: 149 treated with EPP, 34 with eP/D and 13 with P/D. Major morbidity was defined as bleeding necessitating reoperation, patch failure, chylothorax, empyema, bronchopleural fistula (BPF), pulmonary embolism and acute respiratory distress syndrome (ARDS).
Result:
Both groups did not differ significantly in pT stage, hisotype, but in age and lymph node stadium. Overall 30-day and 90-day mortality were 4% and 8%, respectively. However, patients treated with (e)P/D the 30- and 90-day mortality was 0. Major morbidity was not significantly different between both groups with 37% (EPP) and 23% ((e)P/D), respectively. Patient’s characteristics, freedom from recurrence (FFR) and overall survival (OS) are demonstrated in figure 1.Figure 1
Conclusion:
Multimodality treatment with radical surgery is perfromed safely, (e)P/D known as the less invasive procedure than EPP, shows a longer OS whilst having a shorter FFR.
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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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P3.16-046 - Pneumonectomy After Induction/Neoadjuvant Treatment for NSCLC: Morbidity, Mortality and Long-Term Survival (ID 9562)
09:30 - 09:30 | Author(s): I. Opitz
- Abstract
Background:
To compare the effects of neoadjuvant/induction chemotherapy or chemoradiation on morbidity, mortality, and long-term survival in patients with locally advanced NSCLC undergoing pneumonectomy.
Method:
All pneumonectomies following neoadjuvant treatment performed for NSCLC between 2000 and 2016 were retrospectively reviewed. The study included 162 patients (28 females; median patient age, 55.4 years [range, 31–73]). Neoadjuvant treatment consisted of chemotherapy in 115 patients (71%, group I) and chemoradiation in 47 patients (29%, group II). Chemotherapy was cisplatin-based, and 2–6 cycles of treatment were completed. Radiotherapy was administered sequentially (dose, 45–60 Gy). Surgery was performed 3–6 weeks after neoadjuvant treatment. Both groups were assessed for 90-day mortality, morbidity, and long-term survival.
Result:
Right pneumonectomy was performed in 60 (37%) patients, and the procedure was completed in a standard manner in 64.2% of the patients. Morbidity was observed in 27.7% of the patients (27,8% in group I; 27.6% in group II,p=0.98). The incidence of bronchopleural fistula was 4.3% (4.2% in group I; 4.3% group II). The 90-days mortality rate was 3.1% (5 patients in group I, 0 in group II,p=0.17). The mortality rates for right and left pneumonectomy were 3.3 (2/60 patients) and 3% (3/102 patients), respectively (p=0.61). The 5-year survival rates were 46.2% in group I and 54.2% in group II, (P = 0.16).
Conclusion:
Pneumonectomy after neoadjuvant chemotherapy or chemoradiation appears to be safe with an acceptable morbidity, mortality, and long-term survival. Chemoradiation did not improve long-term survival compared to chemotherapy despite comparable 90-day mortality and postoperative morbidity.
