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Q.Q. Luo
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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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P2.05-018 - Video-Assisted Thoracoscopic Surgery vs Thoracotomy for Early-Stage Non-Small Cell Lung Cancer: Short-Term Outcomes of a Randomized Trial (ID 9974)
09:30 - 09:30 | Author(s): Q.Q. Luo
- Abstract
Background:
Video-assisted thoracoscopic surgery (VATS) has been rapidly gaining popularity worldwide in the treatment of early stage non–small cell lung cancer (NSCLC) because it is potentially less invasive. However, there has not been a large randomized controlled trial (RCT) to prove its superiority over thoracotomy. Therefore, a large multicenter RCT in China was designed and initialed in order to verify the role of VATS.
Method:
A non-inferiority phase 3 randomized controlled trial was undertaken at five tertiary centers in China. Patients aged 18-75 years who were diagnosed of clinically early-stage NSCLCs were randomized in a 1:1 ratio into VATS and thoracotomy groups. Radical lobectomy plus mediastinal lymph node dissection was the standard surgery as per protocol. The short-term outcomes including acute phase inflammatory reaction, performance status, postoperative pain, respiratory function and quality of life would be analyzed and reported in this article. Patients continue to be followed up for the primary endpoints (5-year overall and disease-free survival). This study is registered with the ClinicalTrials.gov, number NCT01102517.
Result:
Between January 2008 and March 2014, 508 patients were recruited and 481 were eligible for randomization. 236 patients were randomly assigned to the VATS group, while 245 to the thoracotomy group. Finally, 425 were eligible for analyses (215 and 210, respectively). For acute phase inflammatory reaction assessment, cytokines including IL-2、IL-4、IL-6、IL-10、TNF-α and IFN-γ were tested in different time points within 48 hours postoperatively. No significant difference was found between the 2 groups except IL-6 (P=0.0411). Patients who received VATS procedures had better daily Karnofsky performance status in the first week (P=0.0029). Visual analogue scale (VAS) was applied for pain assessment at the time points of postoperative day 1 to 7 and every 3 months within the first year. Our study showed VATS was superior to open procedures in pain control within the first week after surgery (P=0.0274). However, this benefit diminished within the year. Spirometry was tested at the time points of day 7, 1 and 3 months postoperatively. Both FEV1 and FVC were better preserved in VATS group throughout the time (P=0.0005). Finally, lung cancer symptom scale (LCSS) was used to evaluate the quality of life, and there was no significant difference demonstrated between the 2 groups within the first year after surgery.
Conclusion:
The short-term outcome of our trial has demonstrated that VATS may be superior to thoracotomy in the surgical treatment for NSCLC in terms of short-term performance status, pain control and respiratory function preservation.
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P3.02 - Biology/Pathology (ID 620)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.02-014a - Diagnostic Value of FR<sup>+</sup>-CTCs Detected by LT-PCR for Lung Cancer in SPN and Tumor Invasiveness in Adenocarcinoma (T≪3cm) (ID 8805)
09:30 - 09:30 | Author(s): Q.Q. Luo
- Abstract
Background:
To investigate the diagnostic value of folate receptor (FR)-positive circulating tumor cells (CTCs) detected by ligand-targeted polymerase chain reaction (LT-PCR) in distinguishing lung cancer from lung benign diseases in patients with solitary pulmonary nodules (SPN), and to identify the tumor invasiveness in lung adenocarcinomas of 3cm or smaller.
Method:
We enriched FR[+]-CTCs by immunomagnetic depletion of leukocytes and labeling with a conjugate of a tumor specific ligand folic acid and a synthesized oligonucleotide. The bounded conjugates were then analyzed by quantitative PCR (qPCR). Blood samples were collected from 319 lung cancer patients (257 adenocarcinoma patients), 120 benign patients. Including 257 lung adenocarcinoma patients, 41 were adnocarcinoma in situ (AIS), 53 were microinvasive adnocarcinoma (MIA), and 163 were invasive adnocarcinoma (INV). The clinicopathological characteristics were analyzed from medical records.
Result:
Patients were randomly assigned to a training set and a validation set. FR[+]-CTC levels of patients with lung cancer were significantly higher than patients with benign lung diseases (p=0.000). With a threshold of 8.74 CTC units, FR[+]-CTC showed a markedly sensitivity (training set, 72.05%; validation set, 74.36%) and specificity (training set, 80.9%; validation set 77.42%) in the diagnosis of lung cancer. When compared with established clinical biomarkers including carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), CA-125, squamous cell related antigen (SCC), and neuron-specific enolase (NSE), FR[+]-CTC showed the highest area under the receiver operative characteristic curve (training set, 0.754; validation set 0.765). With a threshold of 9.051 CTC units, FR[+]-CTC showed a comparable sensitivity (training set, 77.50%; validation set, 79.07%) and specificity (training set, 61.24%; validation set 60%) to CEA and CA-125 in distinguishing the AIS from INV. Notably, the combination of FR[+]-CTC with established clinical biomarkers including CEA, CYFRA21-1, CA-125, SCC and NSE could significantly improve the diagnostic efficiency.
Conclusion:
LT-PCR based FR[+]-CTC detection platform is reliable to be used as a biomarker for the diagnosis of lung cancer in patients with SPN, moreover, the FR[+]-CTC level might be a promising biomarker to identify the tumor invasiveness in lung adenocarcinomas of 3cm or smaller.
