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K. Nakagawa
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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
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.13-005 - Is Tumor Size for the T4 Descriptor in Lung Cancer Staging Appropriate? (ID 8085)
09:30 - 09:30 | Author(s): K. Nakagawa
- Abstract
Background:
According to the 8th Edition of the TNM Classification of Lung Cancer, a tumor of >7 cm in diameter is upstaged to T4 from T3 based on the prognostic analysis of patients with pT1–4N0M0R0. However, there are two major problems with this classification. The first is selection bias; very few patients with non-size-based T4 undergo resection, whereas most patients with large tumors have surgery. The second is a diagnostic problem. Additional tumor nodules in a different ipsilateral lobe (pm2) are also T4 descriptors; however, multiple primary lung cancers may be misdiagnosed as T4 lung cancer with intrapulmonary metastasis.
Method:
A total of 378 patients with pT3–4N0–1M0 (according to the new classification) underwent complete or incomplete resection from 1992 to 2011. T4 was subdivided into invT4 (local invasion), multiple-pmT4 (pm2 with multiple nodules), single-pmT4 (single pm2), and sizeT4 (>7 cm).
Result:
The number of patients with invT4/multiple-pmT4/single-pmT4/sizeT4/T3 was 13/12/9/61/283; 5-year overall survival (OS) was 23%/25%/67%/46%/64%; and 5-year disease-free survival (DFS) was 15%/17%/67%/39%/55%, respectively. Patients with invT4 and multiple-pmT4 had poorer prognosis than those with sizeT4 in multivariate analysis (OS, hazard ratio = 2.6, p < 0.05; DFS, hazard ratio = 3.2, p < 0.01). Figure 1
Conclusion:
The extremely favorable outcome of single-pmT4 suggests the possibility of it being mixed up with multiple primary cancers. Non-size-based T4 patients had poorer prognosis than did sizeT4 patients even in surgical candidates, and the outcome of non-surgically treated patients seemed still worse. Tumors of >7 cm in diameter should not be treated the same as a non-size-based T4 and should be reclassified as T3b.
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P2.05 - Early Stage NSCLC (ID 706)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.05-016 - Clinical Importance and Application of New T Descriptors in the 8th TNM Classification for Pathological T0-1 Lung Adenocarcinoma (ID 9341)
09:30 - 09:30 | Author(s): K. Nakagawa
- Abstract
Background:
In the new TNM classification (8th), significant revision was made for pathological (p) T descriptors. Tumors, 3 cm or less in size, measuring invasive size, were subclassified into five categories, Tis, T1mi, T1a, T1b and T1c, termed T0-1 tumors here. Purpose of this study was to examine clinical importance of new pT descriptors and apply to indication criteria of limited surgery for pT0-1 lung adenocarcinoma.
Method:
We retrospectively reviewed pathological data of lung adenocarcinomas surgically resected between 2011 and 2016 at our institute, and reclassified them according to the new TNM classification. We found 874 tumors classified as pT0-1. We compared invasion-related factors such as lymph node (LN) metastasis, lymphatic and /or vascular invasion (LVI) and existence of lepidic component among the five T categories.
Result:
There were 154, 196, 195, 255 and 74 cases in the pTis, T1mi, T1a, T1b and T1c category, respectively. LN metastasis was found in 50 of 874 (6%) cases. LN metastasis rates were 0%, 2%, 10% and 27% in T1mi, T1a, T1b and T1c, respectively. In 108 of 874 cases, invasive size was equal to whole tumor size, meaning that they contain less of lepidic component. LN metastasis rates of the 108 cases were 13%, 13% and 27% in T1a, T1b and T1c, respectively, implying that LN metastasis of T1a diseases were much often with less lepidic component. In the 824 cases without LN metastases, LVI was observed in 156 (19%) cases. LVI rates were 1%, 21%, 39 and 46% in T1mi, T1a, T1b and T1c, respectively. In 89 of 824 cases, invasive size was equal to whole tumor size. LVI rates of the 89 cases were 31%, 54% and 54% in T1a, T1b and T1c, respectively, meaning that LVI rates were more frequent in T1a-c diseases with less lepidic component.
Conclusion:
LN metastasis was rare (2%) in T1a diseases, and they may be good candidates for limited surgery such as segmentectomy. However, T1a diseases with less lepidic component, showing 13% of LN metastasis, may be difficult to cure by limited surgery. On the other hand, in T1b and T1c diseases, LN metastasis rates did not significantly differ between cases with and without lepidic component. T1mi diseases, rarely showing LVI, can be managed same as Tis and cured by partial resection. Taken together, it is the most important to predict pathological T descriptors preoperatively accurately by imaging analysis for T0-1 lung adenocarcinoma.
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P3.13 - Radiology/Staging/Screening (ID 729)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.13-009 - Rapid Detection of Lung Cancer by Fluorescent Imaging using a γ-Glutamyltranspeptidase-activatable Fluorescent Probe (ID 8326)
09:30 - 09:30 | Author(s): K. Nakagawa
- Abstract
Background:
Visualizing the spread of cancer cells in lung cancer surgery is sometimes difficult. γ-Glutamyl-transpeptidase (GGT) is a cell surface-associated enzyme that is overexpressed in various type of human cancers. γ-Glutamyl hydroxymethyl rhodamine green (gGlu-HMRG), an activatable fluorescent probe, is non-fluorescent under a neutral pH and normal cellular environment. However, it becomes highly fluorescent upon reaction with GGT. We evaluated ex vivo fluorescent imaging of lung cancers using the GGT-activatable fluorescent probe.
Method:
Between April 2011 to November 2014, 116 resected cancer cells (91 primary lung cancers, 21 pulmonary metastases, and 4 pleural disseminations) were prospectively included in this study. Each tumor was analyzed by first taking a baseline image before gGlu-HMRG was sprayed onto the freshly resected specimen (termed N0; fluorescent intensity of normal lung, T0; that of lung cancer), and then by taking fluorescent images 30 min after spraying (N30 and T30) with the Maestro In-vivo imaging system (PerkinElmer Inc.). Positive fluorescent activity was defined as follows: in cases where fluorescence was observed only in tumor tissues, ΔN(=N30-N0) < 0 and ΔT(=T30-T0) < 0, in cases where fluorescence was observed in both normal and tumor tissues, ΔN > 0 and ΔT/ΔN > 1.
Result:
Figure 1In primary lung cancer, 61 of 91 (67%) cases rapidly developed fluorescent activity. In cases with pulmonary metastases, 15 of 21 (71.4%) cases showed positive fluorescent activity. Four disseminated pleural nodules all showed positive fluorescent activity (100%). Age, gender, tumor size, tumor marker, histology (adenocarcinoma (Ad) vs. non-Ad, squamous cell carcinoma (Sq) vs. non-Sq), pleural invasion, and angio-lymphatic invasion were not significant factors influencing fluorescent intensity.
Conclusion:
Fluorescence imaging with gGlu-HMRG may become one of the most powerful tools for accurate staging by rapidly detecting cancer cells and thus become highly useful for cancer resection.
