Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
ORAL ABSTRACT SESSIONS - TUESDAY, DECEMBER 6, 2016
SESSION OA09: LOCALLY ADVANCED NSCLC:
INNOVATIVE TREATMENT STRATEGIES
TUESDAY, DECEMBER 6, 2016 - 11:00-12:30
OA09.01 THE NUMBER OR THE POSITION IS THE MAIN PROGNOSTIC
FACTOR FOR N2 NSCLC? A VALIDATION OF NEW IASLC N STAGING
PROPOSAL
Sara Ricciardi, Pietro Bertoglio, Marco Lucchi, Vittorio Aprile, Carmelina
Zirafa, Alfredo Mussi
Department of Surgical Medical Molecular Pathology and Critical Care, Divison of
Thoracic Surgery, University Hospital of Pisa, Pisa/Italy
Background: The eighth edition of lung TNM does not change any N descriptors,
but it suggests some potential changes that might be used in the next edition.
In fact, N2 would be divided into three groups: pN2a1 (skip lymph-node
involvement), pN2a2 (single mediastinal station with hilar involvement)
and pN2b (multiple mediastinal involvement). The aim of this study was to
verify the value of this classification proposal analyzing our recent surgical
experience. Methods: We retrospectively selected all patients treated with
lobectomy, bilobectomy or pneumonectomy for T1/T2 N2 NSCLC (VII TNM
edition) in the period between 2006 and 2010. We excluded all patients who
underwent any kind of extended resection and who had another active tumor
at the time of operation. A systematic lymph-node dissection was always
carried out according to the IASLC guidelines. All patients were then restaged
according to the new IASLC proposal. Overall Survival (OS), Disease Free
Interval (DFI) and most important variables were analyzed. Results: Among 248
surgically treated pN2 patients, 108 entered our inclusion criteria. Pathology
report showed a majority of T2 tumors (67,6%) and in almost half of cases an
adenocarcinoma (50,9%); a mean number of 16,4 (DS 7,8) lymph-nodes were
resected (5,8 (DS 2,9) from the hilum and 10,6 (DS 5,9) from the mediastinum).
After restaging all cases with the new IASLC proposal we observed: 30 (27,8%)
pN2a1; 57 (52,8%) pN2a2 and 21 (19,4%) pN2b. With a median follow up of
93 months, the median overall survival of the entire cohort was 27 months.
pN2a1 had a significant better overall survival compared with the other two
groups (p=0,020); conversely no statistically significant difference was found
in OS between pN2a2 and pN2b. 1, 3 and 5-year survival for pN2a1, pN2a2
and pN2b were 90%, 81% and 71%; 53%, 37% and 24%; 45%, 26% and 19%
respectively. Concurrently DFI was significantly better for pN2a1 (p=0,025). At
univariate survival analysis age>65 years, more than 4 positive lymph nodes
and postoperative complications were statistically significant variables. At the
multivariate analysis only age and the number of positive lymphnodes were
independent prognostic factors of a worse survival. Conclusion: Our experience
partially validate the new proposal of IASLC of N2 staging. Patients with skip
lymph-node metastasis (pN2a1) have a statistically significant better prognosis.
Concurrently we observed and confirmed the important prognostic value of the
number of the involved lymph-node, which should be considered as well in the
next editions of the lung cancer staging system.
Keywords: n2 lung cancer, staging system, skip metastasis, NSCLC
OA09: LOCALLY ADVANCED NSCLC: INNOVATIVE TREATMENT STRATEGIES
TUESDAY, DECEMBER 6, 2016 - 11:00-12:30
OA09.02 SHOULD SURGERY BE PART OF THE MULTIMODALITY
TREATMENT FOR STAGE IIIB NON-SMALL CELL LUNG CANCER
Stephane Collaud 1 , Bastien Provost 1 , Dominique Fabre 1 , Sacha Mussot 1 ,
Benjamin Besse 2 , Olaf Mercier 1 , Elie Fadel 1
1 Marie Lannelongue Hospital, Le Plessis Robinson/France, 2 Department of Cancer
Medicine, Gustave Roussy, Villejuif/France
Background: Stage IIIB non-small cell lung cancer (NSCLC) is a heterogeneous
patient group, including T4N2 and T1-4N3 NSCLC. Traditionally, treatment
for stage IIIB consists in definitive chemoradiation. Surgical treatment
for stage IIIB NSCLC is used anecdotally in highly selected patients. Here,
we studied patient outcome who underwent surgical resection as part of
multimodality treatment for stage IIIB NSCLC. Methods: All patients from a
single institution who underwent surgery for stage IIIB between 2000 and
2015 were included. Surgical candidates were selected on a case-by-case
basis during multidisciplinary tumorboard conference. In general, N2-N3
diseases are not considered an absolute contraindication to surgery if
lymph node involvement is limited to a non-bulky single site, the tumor is
deemed completely resectable without major morbidity and the patient will
tolerate multimodality treatment. Mediastinal staging comprised cervical
mediastinoscopy, positron emission tomography coupled with CT from 2005
and endobronchial ultrasound guided fine-needle aspiration from 2011. Charts
were retrospectively reviewed and data analyzed. Survival was calculated
from the date of surgery until last follow-up. Univariate and multivariate
analysis were performed to identify prognostic factors. Results: From 2000
to 2015, 5416 patients underwent lung resection for NSCLC in our center. Sixty
patients (1%) underwent surgery for stage IIIB NSCLC. Forty-three were males
(72%). Median age was 58 years (from 22 to 79). Thirty-two patients had T4N2
NSCLC involving the carina (n=16, 50%), superior vena cava (n=4, 12%), carina
and superior vena cava (n=5, 16%), left atrium (n=5, 16%), pulmonary artery
(n=1, 3%) and spine (n=1, 3%). Twenty-eight patients had N3-disease, involving
supraclavicular (n=14, 50%) or contralateral mediastinal lymph nodes (n=14,
50%). Pneumonectomy was performed in 27 patients (45%). Twenty-nine
patients (48%) had induction therapy, consisting in chemotherapy alone for
all patients. Adjuvant therapy was administered to 52 patients (87%) and
consisted mostly of chemoradiation (n=35, 67%). Complete resection (R0) was
performed in 55 patients (92%). Post-operative mortality was 3% (n=2). Threeand
5-year overall survivals were 51% and 39%, respectively. Median survival
was 40 months. Median follow-up was 17 months. Results of the multivariate
analysis identified incomplete resection (p=0.008) and absence of adjuvant
treatment (p=0.032) as prognostic factors for poor survival. Conclusion: An
excellent 5-year survival of 39% was achieved in highly selected patients with
stage IIIB NSCLC and treated with multimodality including surgery. Patients
with stage IIIB NSCLC should therefore be discussed in a multidisciplinary
setting, including thoracic surgeons.
Keywords: stage IIIB, NSCLC, Surgery
OA09: LOCALLY ADVANCED NSCLC: INNOVATIVE TREATMENT STRATEGIES
TUESDAY, DECEMBER 6, 2016 - 11:00-12:30
OA09.03 RANDOMIZED CONTROLLED STUDY COMPARING
ADJUVANT VERSUS NEO-ADJUVANT CHEMOTHERAPY IN
RESECTABLE STAGE IB TO IIIA NSCLC
Xue-Ning Yang 1 , Wen-Zhao Zhong 1 , Xiao-Song Ben 2 , Hong-He Luo 3 , Changli
Wang 4 , Qun Wang 5 , Guibin Qiao 6 , Hong-Hong Yan 1 , Yi Long Wu 1
1 Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of
Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong
Academy of Medical Sciences, Guangzhou/China, 2 Department of Thoracic Surgery,
Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of
Translational Medicine in Lung Cancer, Guangdong General Hospital & Guangdong
Academy of Medical Sciences, Guangzhou/China, 3 Department of Thoracic
Surgery, The First Affiliated Hospital; Sun Yat-Sen University, Guangzhou/China,
4 Department of Thoracic Oncology, Tianjin Medical University Cancer Institute &
Hospital, Tianjin/China, 5 Department of Thoracic Surgery, Zhongshan Hospital,
Shanghai/China, 6 Department of Thoracic Surgery, General Hospital of Guangzhou
Military Command of P.L.A, Guangzhou/China
Background: Adjuvant chemotherapy is the standard of care for completely
resected stage II-IIIa non-small cell lung cancer (NSCLC). A few trials suggest
that neoadjuvant chemotherapy is a promising strategy for resectable NSCLC.
Indirect comparison meta-analysis of adjuvant versus neoadjuvant therapy
showed no difference in survival. This study was conducted to determine the
difference of disease-free survival(DFS) between adjuvant chemotherapy and
neoadjuvant chemotherapy among patients with resectable NSCLC. Methods:
Patients with clinical stage IB-IIIA NSCLC were eligible. Patients were randomly
assigned to 3 cycles adjuvant DC (Docetaxel: 75mg/m2, Carboplatin:AUC=5 on
day 1, every 3wk) after completely resection (lobectomy or pneomonectomy
with mediastinal lymphnode dissection, or 3 cycles neoadjuvant DC at the
same schedule followed by surgery 3-6 wk after chemotherapy. The primary
end point was 3 years DFS; secondary end points were 3ys and 5ys Overall
Survival(OS) and Safety. Planned sample size is 410. The trail was early closed
because slowly accrued. Results: Between March 2006 and May 2011,198
patients from 8 Institute were randomized to neoadjuvant arm (97 cases) or
adjuvant arm (101 cases). The median age was 58, male accounted for 80.3%,
Adenocarcinoma 48.5%, stage Ib, II a, II b and IIIa were 32.5%, 12.2%, 28.4% and
26.9% respectively. Two arms were balanced. 100% cases received neoadjuvant
chemotherapy and 87.4% finished the planned adjuvant chemotherapy. No
unexpected toxicities were seen and 41.2% of patients experienced grade 3-4
neutropenia. In neoadjuvant arm, the ORR was 34% and 12.4% patients
developed PD. No difference in postoperative complication was found
between two arms. Survival analysis show in Table 1
Copyright © 2016 by the International Association for the Study of Lung Cancer
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