Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
retrospective study, and therefore prospective trials are required for further
verification.
Keywords: gender, Non-small-cell lung cancer, adjuvant chemotherapy
POSTER SESSION 1 - P1.05: EARLY STAGE NSCLC
NEOADJUVANT AND ADJUVANT CHEMOTHERAPY –
MONDAY, DECEMBER 5, 2016
P1.05-054 ADJUVANT CHEMOTHERAPY UPTAKE IN PATIENTS
WITH NSCLC AFTER COMPLETE RESECTION: SINGLE INSTITUTION/
SINGLE AREA EXPERIENCE
Vitezslav Kolek 1 , Ivona Grygarkova 1 , Juraj Kultan 1 , Petr Jakubec 1 , Marek
Szkorupa 2 , Jiri Klein 2 , Cestmir Neoral 2 , Josef Skarda 3 , Tomas Tichy 3 , Zdenek
Kolar 3
1 Dept. of Respiratoty Medicine, University Hospital, Olomouc/Czech Republic,
2 Dept. of Surgery, University Hospital, Olomouc/Czech Republic, 3 Dept. of
Molecular Pathology, University Hospital, Olomouc/Czech Republic
Background: Adjuvant chemotherapy (AC) is recommended in patients (pts)
with stages IB (tumour of ≥4 cm in diameter), IIA, IIB, and IIIA of non-small cell
lung cancer (NSCLC) after complete resection. According to metaanalyses it
prolongs survival of pts in good PS and age less than 75 years. The selection of
patients is influenced by the limited profit of AC, possible toxicity and the lack
of predictive biomarkers. There are only few retrospective studies describing
routine utilization of AC in specified areas. Presented AC uptake in stages II
and III varies from 20 % to 24% in Canada and USA. . Methods: A retrospective
study of AC uptake in pts with NSCLC from a Moravian region with 600.000
inhabitants was conducted, evaluation period was 2006-2013. Treatment
strategy of all patients was discussed by surgeons and pneumo-oncologists
on the interdisciplinary tumour boards before and after surgery. Uptake
and compliance of AC was evaluated according to age, sex, TNM stages, type
of surgery and other cofactors. AC was given in regimens using doublets of
platinum with vinorelbine (rarely gemcitabine or paclitaxel). Vinorelbine was
applied both intravenously (25 mg/m 2 ) and orally (60 - 80 mg/m 2 ). The choice
of cisplatinum (80mg/m 2 ) or carboplatinum (AUC 5) was based on patient
preference, PS and comorbidities. . Results: Out of all 1557 pts with lung
cancer, NSCLC was present in 1293 pts. 308 pts underwent curative-intent
surgery and complete resection was achieved in 295 pts. 226 pts were pts with
stages IB, II and IIIA and AC was applied in 183 pts (80.1%), in 34 (18.6 %) pts
together with neoadjuvant chemotherapy. AC was not applied in 43 (19.9 %)
pts after radical surgery due to worse PS, comorbidities, complications after
surgery or patient´s refusal. The mean age of pts with AC was 65 years, 66,7%
were men, 48,9 % women, 49,9 % were current smokers, 40,0% ex-smokers
and 10,1 % non-smokers. Age, sex and smoking habits were not statistically
different between pts with and without AC. Compliance with AC was very
good, 82% of pts accomplished planned therapy. Conclusion: The optimal
uptake of AC in routine practice depends on the intensive communication
between the patient, surgeons and pneumoocologists. The individual decision
is important in a context to the patients´ health status, tumour parameters
and the potential risk/ benefit of therapy. Study was supported by grant AZV
16-32318A
Keywords: non-small cell lung cancer - surgery - adjuvant chemotherapy
-utilization in practice
POSTER SESSION 1 - P1.05: EARLY STAGE NSCLC
RECURRENCE –
MONDAY, DECEMBER 5, 2016
P1.05-055 RISK FACTORS OF POSTOPERATIVE RECURRENCE IN
STAGE IA AND IB PATIENTS
Fumihiko Hoshi 1 , Akira Sakurada 1 , Toru Hasumi 2 , Tetsu Sado 2 , Masafumi
Noda 1 , Yasushi Matsuda 1 , Shunsuke Eba 1 , Hideki Mitomo 1 , Takeo Togo 1 ,
Masato Katahira 1 , Yoshinori Okada 1
1 Tohoku University Hospital, Miyagi/Japan, 2 Sendai Medical Center, Sendai/Japan
Background: The 5-year survival rates of the patients with pathological stage
IA and IB NSCLC have been reported 86-93% and 67-84%, respectively. Among
stage I disease, patients with stage IA of tumor diameter over 20 mm as well
as stage IB are recommended to take oral UFT as adjuvant chemotherapy for
2 years in Japan. Even after complete resection and such adjuvant therapy,
we still observe recurrence at a certain rate. Identifying clinicopathological
factors which is associated with recurrence would be beneficial to establish
alternative strategy. The purpose of this study is to identify the predictive
factors for recurrence in the patients with stage I NSCLC. Methods: A total
of 742 stage I NSCLC patients who underwent complete resection in our
hospital from 1996 to 2012 were retrospectively analyzed. Medical records
of these patients were reviewed carefully. The median age was 66.4 years
with 512 stage IA and 281 stage IB. Histopathologically, there were 590
adenocarcinoma, 150 squamous cell carcinoma, 32 large cell carcinoma,
and 21 other histology cases. (Surgical procedure was segmentectomy,
lobectomy, and pneumonectomy for 46, 588, and 8 patients, respectively.
Clinicopathological factors such as smoking history, histology, pathological
vascular invasion (v), and lymphatic vessel invasion (ly) were analyzed.
Results: Recurrence occurred in 132 cases. Multivariate analysis showed
that T factor, v(+), ly(+), and smoking history have statistical significance
with recurrence. n pT1a and T2a cases, there were no statistical significance
between recurrence and pathological ly(+) and/or v(+). But only in T1b cases,
ly(+) and/or v(+) had statistical significance with recurrence. Conclusion: We
identified that T factor, v, ly, and smoking history were predictive factors for
recurrence in stage IA and IB NSCLC patients. Because of good prognosis, pT1b
patients whose both v and ly were negative may not take UFT as adjuvant
chemotherapy.
Keywords: NSCLC, stage IA and stage IB, recurrence
POSTER SESSION 1 - P1.05: EARLY STAGE NSCLC
RECURRENCE –
MONDAY, DECEMBER 5, 2016
P1.05-056 INCREASED RISK OF POSTOPERATIVE RECURRENCE IN
EGFR-POSITIVE STAGE IA TO IB INVASIVE LUNG ADENOCARCINOMA
Masaoki Ito 1 , Yoshihiro Miyata 1 , Kei Kushitani 2 , Tomoharu Yoshiya 1 , Yasuhiro
Tsutani 1 , Kazuo Konishi 1 , Yukio Takeshima 2 , Morihito Okada 1
1 Department of Thoracic Surgery, Hiroshima University Hospital, Hiroshima/Japan,
2 Department of Pathology, Hiroshima University Hospital, Hiroshima/Japan
Background: Somatic mutations of EGFR represent one of the most frequent
genetic aberrations in lung adenocarcinoma and response to tyrosine kinase
inhibitors (TKIs) has been favourable in EGFR-positive and advanced lung
adenocarcinoma patients. The prognostic significance of EGFR mutations as
oncogenic driver mutations in early-stage lung adenocarcinoma has yet to
be determined. We aimed to evaluate the oncological significance of EGFR
mutations in early-stage lung adenocarcinoma Methods: Four hundred and
seventy-three consecutive lung adenocarcinoma patients who underwent
surgical resection for pathological N0M0 disease, between January 2007 and
December 2013, were retrospectively reviewed. The prognostic significance of
EGFR mutation status was evaluated in 407 cases from these patients. Overall
survival (OS) and recurrence-free interval (RFI) curves were estimated using
the Kaplan-Meier method and compared using a log-rank test. Univariate
and multivariate analyses were performed using a Cox proportional hazards
model. Results: There was no statistical significance in the 5-year OS (89.3
vs. 95.3%, P = .20, HR = 1.605) or RFI (86.5 vs. 93.5%, P = .06, HR = 1.956) rates
between the EGFR-positive (n=183) and EGFR-negative (n=224) groups.
Considering the risk of recurrence and positive EGFR mutation status, OS and
RFI rates were subsequently calculated among specific histological subtypes.
After adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma
(MIA), and invasive mucinous adenocarcinoma (IMA) cases were excluded,
all analysed cases were ≤5.0 cm in tumour diameter and were classified as
pathological Stage IA-IB. Among specific histological subtypes, the 5-year
RFI (81.5 vs. 92.4%, P = .04, HR = 2.160) but not OS rate (86.8 vs. 94.3%, P =
.31, HR = 1.499) was significantly poorer in EGFR-positive cases compared
to EGFR-negative cases. Univariate analysis, excluding AIS, MIA, and IMA,
identified a pathological tumour size of >3.0 cm, a highly malignant subtype
(micropapillary or solid predominant adenocarcinoma), pleural/lymphatic/
vascular invasion, and a positive EGFR mutation status as significant negative
predictive factors for RFI. Multivariate analysis confirmed pleural invasion
and a positive EGFR mutation status as independent negative predictive
factors for RFI. Conclusion: EGFR mutation status is a predictive factor for
postoperative recurrence in early-stage lung adenocarcinoma, with the
exception of AIS, MIA, and IMA. The risk of recurrence should be considered
with EGFR mutation status and predominant histological subtype in resected
early-stage lung adenocarcinoma patients.
Keywords: Early-stage, Surgery, EGFR, Adenocarcinoma
POSTER SESSION 1 - P1.05: EARLY STAGE NSCLC
RECURRENCE –
MONDAY, DECEMBER 5, 2016
P1.05-057 PREDICTION OF EARLY RECURRENCE IN PATIENTS WITH
STAGE I AND II NON-SMALL CELL LUNG CANCER USING FDG PET
QUANTIFICATION
Michael Arvanitakis 1 , Irene Burger 2 , Seraina Steiger 3 , Beate Sick 4 , Walter
Weder 1 , Sven Hillinger 1
Copyright © 2016 by the International Association for the Study of Lung Cancer
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