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K. Hayasaka
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MA 13 - New Insights of Diagnosis and Update of Treatment (ID 674)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:S. Ishikura, H. Nakayama
- Coordinates: 10/17/2017, 15:45 - 17:30, Room 311 + 312
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MA 13.13 - Spread through Air Spaces Is a Prognostic Factor in Wedge Resection of Non-Small Cell Lung Cancer (ID 8439)
17:00 - 17:05 | Author(s): K. Hayasaka
- Abstract
- Presentation
Background:
Spread through air spaces (STAS), defined as “micropapillary clusters, solid nests, or single cells beyond the edge of the tumor into air spaces in the surrounding lung parenchyma” (Travis WD, et al. WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart, 2015), has been recognized as a pattern of tumor invasiveness. Because complete lymph node dissection and sufficient surgical margin lengths are difficult to obtain, wedge resection is associated with worse surgical outcomes than those of lobectomy. Because of the insufficient margin length associated with wedge resection, we speculated that STAS has a prognostic impact in wedge resection cases compared with segmentectomy cases. The aim of this study was to clarify the prognostic impact of STAS in patients with non-small cell lung cancer (NSCLC) who underwent wedge resection.
Method:
This was a retrospective study using our prospectively collected institutional database, established in May 2004. From May 2004 to May 2017, 1071 patients with NSCLC underwent complete resection. After excluding patients with pure ground glass opacity or multiple lung cancers and those who underwent lobectomy or preoperative therapy, we evaluated 196 patients with clinical stage IA cancer who underwent segmentectomy or wedge resection. TNM staging was performed according to the seventh edition. We assessed the prognostic impact of STAS on stage IA lung cancer cases who underwent wedge resection compared with segmentectomy.
Result:
Segmentectomy was performed in 110 patients and wedge resection in 86. The wedge resection cases were older (p<0.001) and had a higher CEA level (p=0.023). The frequencies of STAS were 14.5% and 18.6% in the segmentectomy and wedge resection cases, respectively (p=0.447). STAS was a significant prognostic factor for overall survival in the wedge resection cases on univariate (p=0.003) and multivariate (p=0.013) analyses, but it was not significant in the segmentectomy cases (p=0.597). STAS was a significant prognostic factor for disease-free survival in the wedge resection cases on univariate (p<0.001) and multivariate (p<0.001) analyses, but this was not the case in the segmentectomy cases (p=0.108). STAS was a significant prognostic factor for the recurrence-free rate in the wedge resection cases on univariate (p<0.001) and multivariate (p<0.001) analyses, but it was not significant in the segmentectomy cases (p=0.205).
Conclusion:
STAS is a prognosticator of poor survival outcomes in NSCLC patients who underwent wedge resection, but not in those who underwent segmentectomy. We speculate that NSCLC with STAS tends to have invasive characteristics, and wedge resection is not sufficient to improve survival outcomes in such patients.
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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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P3.16-053a - Surgical Outcome of Bronchoplasty in Non-small Cell Lung Cancer Patients (ID 9150)
09:30 - 09:30 | Author(s): K. Hayasaka
- Abstract
Background:
Bronchoplasty is regarded as an alternative surgical procedure to pneumonectomy for non-small cell lung cancer (NSCLC). Among the bronchoplasties, wedge bronchoplasty is associated with a better blood supply than sleeve bronchoplasty; however, the surgical outcomes for these procedures have not been evaluated. The aim of the current study was to compare the surgical outcomes of wedge and sleeve bronchoplasties.
Method:
This was a retrospective analysis of 36 patients with NSCLC who underwent bronchoplasties from January 2000 to June 2016. The indication for wedge or sleeve bronchoplasty was based on bronchoscopic and radiologic findings. In addition, we selected the procedure based on the intra-operative findings, including frozen section diagnosis. There were 17 patients (47%) who underwent wedge bronchoplasties and 19 patients (53%) who underwent sleeve bronchoplasties.
Result:
There were 29 males (81%) and 7 females (19%), with a median age of 69 years (range, 43-82 years). The median duration of follow-up was 56 months. In both groups, right upper lobectomies dominated the other lobes. There were 9 patients (53%) in the wedge bronchoplasty group and 10 patients (53%) in the sleeve bronchoplasty group. Concomitant vascular reconstruction was performed in 2 patients (12%) in the wedge bronchoplasty group and 2 patients (11%) in the sleeve bronchoplasty group (p=1.00). The covering of bronchial anastomosis was performed in 9 patients each in the wedge and sleeve bronchoplasty groups (53% and 47%, respectively; p=0.70). There were no severe complications related to anastomoses, such as bronchopleural fistulas and bronchial stenosis. There were no operative mortalities in either group. Post-operative recurrences developed in 6 patients (35%) in the wedge bronchoplasty group and 8 patients (42%) in the sleeve bronchoplasty group (p=0.52). Mediastinal lymph node recurrences were most common; specifically, there were 3 (18%) in the wedge bronchoplasty group and 4 (21%) in the sleeve bronchoplasty group (p=1.00). There were no hilar lymph node or surgical margin recurrences in either group. The 5-year overall survival was 87% in the wedge bronchoplasty group and 60% in the sleeve bronchoplasty group (p=0.07). The 5-year recurrence-free survival was 60% in the wedge bronchoplasty group and 53% in the sleeve bronchoplasty group (p=0.43).
Conclusion:
Surgical outcomes following wedge bronchoplasty were not inferior to sleeve bronchoplasty; however, additional cases are needed to establish the safety and survival benefit of wedge bronchoplasty in patients with NSCLC.
