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K. Nagayama



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    P1.13 - Radiology/Staging/Screening (ID 699)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      P1.13-002 - New Clinical T Classification Is Associated with Pathological Stage I Invasive Adenocarcinoma with Solid Histologic Subtype (ID 9209)

      09:30 - 09:30  |  Author(s): K. Nagayama

      • Abstract
      • Slides

      Background:
      Recent studies have reported that sublobar resection is not inferior to lobectomy for small-sized non-invasive adenocarcinoma; however, the adequacy for small-sized invasive adenocarcinoma (IAD) remains unclear. We have reported that, in patients with pathological stage I IAD, the presence of ≥ 5% solid (SOL) histologic subtype is a significant predictor of recurrence, especially for the patients undergoing sublobar resection (Figure A). The objective of this study was to identify the clinical factors associated with the presence of SOL in patients with IAD.

      Method:
      We retrospectively reviewed patients with therapy-naïve, pathological stage I (≤2-cm) lung adenocarcinoma, who had undergone complete resection from 1998-2015. Each tumor was evaluated by comprehensive histologic subtyping according to the 2015 WHO classification and re-evaluated preoperative thin-sliced computed tomography to determine solid size and reclassified them according to the new TNM classification. We defined carcinoembryonic antigen (CEA) cut-off value as 2.2 ng/mL. Recurrence-free probability was estimated using the Kaplan-Meier method.

      Result:
      IAD patients with available image was 160 cases (94 male and 66 female, 96 smokers, and median age: 69 years). Clinical T classification in the 7th edition was T1a:142, T1b:17, T2a:1, and in the 8th edition Tis:17, T1mi:3, T1a:37, T1b:100, T1c:3. The presence of ≥ 5% solid component (SOL) was identified in 70 patients (44%). In patients with IAD, the presence of ≥ 5% SOL was associated with increased risk of recurrence compared to those with SOL <5% (P=0.001, Figure B). The presence of ≥ 5% SOL was significantly associated with sex, smoking, clinical T classification in the 8th edition, and high CEA level (P = 0.001, P < 0.001, P < 0.001, P = 0.013, respectively).

      Conclusion:
      In patients with pathological stage I IAD, clinical  T classification in the 8th edition, and high CEA level significantly correlated with the presence of ≥ 5% SOL, which was associated with recurrence after surgery. Figure 1



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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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      P3.16-028 - Necrosis Is a Predictor of Recurrence in Patients with Small Lung Adenocarcinoma ≦2cm (ID 10451)

      09:30 - 09:30  |  Author(s): K. Nagayama

      • Abstract

      Background:
      The prognostic significance of pathological necrosis in small lung adenocarcinoma has not been investigated. The purpose of this study is to investigate the prognostic role of pathological necrosis in patients with completely resected small lung adenocarcinoma ≦2cm.

      Method:
      All available tumor slides from patients with surgically resected lung adenocarcinoma ≦2cm in size (1998-2015) were retrospectively reviewed. Exclusion criteria: patients who received induction therapy and lung cancer surgery within preceding 2 years. Recurrence free probability and overall survival were assessed using the Kaplan-Meier method.

      Result:
      351 patients met inclusion criteria (48% women, median age 67yr (34-86 yrs), 50% never-smokers; 324 Stage IA, 27 Stage IB; 111 and 240 patients underwent sublobar resection and lobectomy, respectively). Presence of pathological necrosis was identified in 32 patients (9%). Presence of pathological necrosis was significantly associated with sex, smoking, clinical T classification in the 8[th] edition and pathological tumor size (p<0.01, p<0.001, p<0.01, p<0.001, respectively). Presence of pathological necrosis correlated with an increased risk of recurrence, compared with those without pathological necrosis (5-year RFP, 70.5%vs 93.8%; p<0.001). Presence of pathological necrosis did not affect OS (5-year OS, 80.8%vs 92.3%; p=0.21).Figure 1



      Conclusion:
      In patients with small lung adenocarcinoma ≦2cm, presence of pathological necrosis was significantly associated with increased risk of recurrence.