Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Department of Thoracic and Cardiovascular Surgery, Seoul National University
Bundang Hospital, Seongnam/Korea, Republic of
Background: Post-recurrence survival (PRS) after curative resection has
been considered a multifactorial process dependent on clinicopathological,
biological, and treatment modality in non-small cell lung cancer (NSCLC). The
aim of this study is to investigate the prognostic factors for PRS in patients
with completely resected stage III-N2 NSCLC. Methods: Two hundred fortyfive
patients who had complete resection for pathologic stage III-N2 NSCLC
between 2003 and 2014 were enrolled. First, a number of clinicopathological
factors were evaluated to find prognostic factors for recurrence by Cox
proportional hazards models. Second, the following additional data were
evaluated: presence of recurrent symptom, recurrence patterns, treatment
modality, use of targeted agents, and recurrence-free interval. The prognostic
effects of these factors were analyzed for PRS. Results: One hundred twentyfour
patients experienced recurrence during a median follow-up period of
36.3 months. Univariate analysis showed that vascular invasion, lymphatic
invasion, tumor size, number of positive lymph nodes (LNs), and multistation
N2 were poor prognostic factors for recurrence. Lymphatic invasion, tumor
size, and number of positive LNs were even worse independent prognostic
factors for recurrence by multivariate analysis. Of 124 recurred patients, 21
patients (17%) were symptomatic at the time of initial recurrence, and the
remaining 103 patients (83%) were asymptomatic. In these asymptomatic
patients, recurrence was detected by tumor markers in 3, computed
tomography (CT) in 80, or positron emission tomography-CT (PET/CT) in 20
patients. The mean recurrence-free interval was 14.0 months (≤ 12 months in
72, > 12 months in 52 patients). The patterns of recurrence were presented as
loco-regional recurrence in 37 (30%), distant metastasis in 33 patients (27%),
and both in 54 patients (43%). The types of initial treatment included surgery
in 15 (12%), chemotherapy in 68 (55%), radiotherapy in 19 (15%), and chemoradiation
in 16 patients (13%). The median duration of PRS was 30.5 (1-109)
months and the 2-year and 5-year of PRS were 54% and 23%, respectively.
Univariate analysis identified no symptom of recurrence, only LN metastasis
without distant organ metastasis, treatment modality, and a longer
recurrence-free interval as good prognostic factors, while no symptom and a
longer recurrence-free interval were independent prognostic factors for PRS
in a multivariate analysis. Conclusion: No symptom at the time of recurrence
and a longer recurrence-free interval were significant predictors of better PRS
in patients that have underwent complete resection of stage III-N2 NSCLC.
Keywords: stage III-N2, Post-recurrence survival, non-small cell lung cancer
POSTER SESSION 1 - P1.08: SURGERY
SURGERY FOR LOCALLY ADVANCED AND ADVANCED NSCLC –
MONDAY, DECEMBER 5, 2016
P1.08-067 THE FEASIBILITY OF LUNG SECOND SURGERY FOR 2ND
PRIMARY LUNG CANCER
Kazunori Hata, Kenji Suzuki, Takeshi Matsunaga, Kazuya Takamochi, Shiaki
Oh
Department of General Thoracic Surgery, Juntendo University School of Medicine,
Tokyo/Japan
Background: 2 nd primary lung cancer often has been encountered because of
improvement of treatment outcome for lung cancer. If close follow up was
performed after first surgery, 2 nd primary lung cancer often was detected in
early stage. And local therapy was indicated for this 2 nd primary lung cancer.
However, there is no rule whether stereotactic radiation therapy or surgery
should be chosen. The aim of this study was to evaluate the feasibility of
second surgery. Methods: We reviewed retrospectively 123 consecutive
patients with past history of lung resection who underwent second surgery
for 2 nd primary lung cancer between 2008 and 2015 at our institution. i)
These 123 cases were divided into 2 groups, contralateral and ipsilateral
surgery groups. The difference between two groups of surgical difficulties
(operation time and blood loss) and feasibility (post-operative complication
and length of hospital stay) were evaluated by using Mann-Whitney U-test
and Fisher’s exact test. ii) 82 cases who underwent contralateral surgery
was picked up and divided into 3 groups, both lobectomy, lobectomy
and limited surgery and both limited surgery. The difference between 3
groups of surgical difficulties and feasibility were evaluated by using same
methods. iii) Furthermore, 41 cases who underwent ipsilateral surgery
divided into 4 groups by procedure: completion pneumonectomy, lobectomy,
segmentectomy and wedge resection. The difference between 4 groups of
surgical difficulties and feasibility were evaluated by using same methods.
Results: i) Not only operation time (161min vs 123min, p