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99PD LYMPHATIC OR VASCULAR INVASION FACTOR IS AN IMPORTANT PROGNOSTIC FACTOR IN PATIENTS WITH PATHOLOGICAL STAGE IA LUNG ADENOCARCINOMA LESS THAN 20mm IN DIAMETER
S44 2 proteins are down-regulated in the adjacent normal lung tissue, including ATP synthase and crystallin aB (HSP20 like-protein). The up-regulated proteins may be the new targets of chemotherapy for NSCLC. 99PD LYMPHATIC OR VASCULAR INVASION FACTOR IS AN IMPORTANT PROGNOSTIC FACTOR IN PATIENTS WITH PATHOLOGICAL STAGE IA LUNG ADENOCARCINOMA LESS THAN 20 mm IN DIAMETER H. Haneda, H. Niwa, M. Tanahashi, S. Moriyama, E. Suzuki, N. Yoshii Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan Background: In Japan surgical intervention for small adenocarcinoma of the lung have increased according to the recent development of computed tomography. In these, some patients were not promised to a long term survival. It is important to classify the groups with poor prognosis in small adenocarcinoma of the lung. This study was conducted to evaluate the prognostic factors in pathological stage IA adenocarcinoma of the lung less than 20 mm in diameter. Methods: We retrospectively analyzed 219 patients with pT1N0M0 adenocarcinoma less than 20 mm in diameter treated by a complete resection between 1992 and 2007. The analysis of postoperative prognosis was conducted by clinicopathological factors (gender, age, tumor size, differentiation, Noguchi’s classification, and lymphatic or vascular invasion [LVI]). We evaluated lymphatic invasion and vascular invasion using D2-40 stain and Elastica Masson stain, respectively. Results: The 5-year survival rate was 91.0% for all patients. Univariate analysis identified differentiation (moderately and poorly), Noguchi’s classification (type D F) and LVI(+) as significant prognostic factors that adversely affected overall survival. Multivariate analysis identified only LVI as an independent predictor for survival. 5-year survival rates were 98.3% for 176 patients with LVI( ) and 75.3% for 43 patients with LVI(+). Conclusions: LVI is the most significant prognostic factor in pathological stage IA adenocarcinoma of the lung less than 20 mm in diameter. Histological findings for lymphatic and vascular invasion should be considered for postoperative practical management of patients with pathological stage IA adenocarcinoma of the lung less than 20 mm in diameter. 100PD ANALYSIS OF RISK FACTORS FOR RADICALLY RESECTED STAGE IB NON-SMALL CELL LUNG CANCER M. Beshay1 , M. Reymond1 , R.A. Schmid2 1 General Thoracic Surgery, Evangelic Hospital Bielefeld, Centre of Pulmonary Dieases, Bielefeld, Germany, 2 General Thoracic Surgery, University Hospital Berne, Berne, Switzerland Background: Prognosis of pathological stage IB non small lung cancer (NSCLC) is reported to be good. But, about 20 40% of patients die due to surgery, recurrent disease, distant metastasis or non cancer related causes. We retrospectively analyzed the risk factors in completely resected NSCLC stage IB. Methods: The medical records of 94 patients who underwent radical surgery for stage IB NSCLC in both centers from October 2000 to October 2007 were retrospectively analyzed. Data were obtained from medical records, family doctor and direct patients contacts. Treatment failure was divided into three categories; (a) local recurrence related death, (b) metastases related death, (c) non cancer related death. Results: There were 58 males; the median age was 68 year. The median follow up period was 42.6 months. 5-year overall survival rate was 68%. Surgery related mortality rate was 0%. Perioperative mortality rate was 3%. 12 patients (13%) died of distant metastasis (six patients with pleural and other lung
Early and locally advanced NSCLC metastases, 3 with cerebral metastases, 2 patients with bone metastases, and one patient with liver metastases). Six patients died of local recurrence (6%). Microvascular invasion was a significant risk factor for recurrence (p = 0.002). The invasion of the parietal pleura (p = 0.014) and the size of the tumor more than 8 cm (p = 0.031) were significant factors for distant metastases. Ten patients died due to non cancer related factors; 5 patients died of respiratory insufficiency (4 of them had post pneumonectomy empyema), 3 patients died of cardiac diseases, 2 patients died of renal insufficiency and second tumor. In multivariate analysis the post operative cardiopulmonary complications (p = 0.013) and post pneumonectomy empyema (p = 0.036) were significant risk factors for non cancer related death. Conclusions: In pathological stage IB NSCLC, microvascular invasion was a risk factor for recurrence related death. The size of the tumor and invasion of the parietal pleura were significant factors in metastases related death. Cardiopulomonary complications and post pneumonektomy empyema were significant risk factors for non cancer related death. 101PD ACCURACY OF PRE-OPERATIVE DIAGNOSIS IN THE MANAGEMENT OF BRONCHIOLOALVEOLAR CARCINOMA ARE SUBLOBAR RESECTIONS FEASIBLE? H. Shaker, M.A. Khan, H. Elsayed Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom Background: Bronchioloalveolar carcinoma (BAC) is a rare subtype of lung cancer that has distinctive features that warrants its separation from other subtypes. Diagnosis requires separating BAC from the more aggressive ‘adenocarcinoma with bronchioloalveolar features’ (Adeno/BAC). Recent evidence suggests sublobar lung resections may be safely performed in certain peripheral BACs [1]. This requires accurate preoperative histological confirmation of BAC and a ground glass appearance (GGA) on CT scanning. We investigated the accuracy of preoperative diagnosis of BAC and the feasibility for limited resections in our institution where our current policy is to perform lobar resections. Methods: A retrospective casenote analysis was performed on patients who had a surgical intervention for BAC or adeno/BAC over a 12 year period (1996 to 2008). Results: Of 33 casenotes analysed, 17 (51%) patients had preoperative histology. Fourteen of these patients had peripheral lesions and 3 presented with consolidated lobes. Preoperatively 12 (70%) patients had BAC histology, 4 (23%) had adeno/BAC and 1 (7%) had non-BAC adenocarcinoma. Postoperatively 5 (29%) patients had BAC, 7 (42%) had adeno/BAC and 5 (29%) had non-BAC adenocarcinoma. Overall concordance was 24%. Five patients with peripheral lesions had both preoperative BAC histology and radiological GGA. Only one of these had BAC histology postoperatively. Of 11 confirmed BAC cases among all 33 patients, 3 (27%) had peripheral lesions and 8 (73%) had consolidated lobes. Conclusions: Accuracy of preoperative histological diagnosis of BAC was low. GGA was not useful in differentiating BAC from adeno/BAC. Most of our BAC patients did not present with peripheral lesions. Only one patient (3% of the whole group) may have benefitted from a limited resection in retrospect. Limited resection of suspected BAC lesions would not be justified in our group of patients. Reference(s) [1] Arenberg D; American College of Chest Physicians. Bronchioloalveolar lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007 Sep; 132(3 Suppl): 306S 313S.
Early and locally advanced NSCLC metastases, 3 with cerebral metastases, 2 patients with bone metastases, and one patient with liver metastases). Six patients died of local recurrence (6%). Microvascular invasion was a significant risk factor for recurrence (p = 0.002). The invasion of the parietal pleura (p = 0.014) and the size of the tumor more than 8 cm (p = 0.031) were significant factors for distant metastases. Ten patients died due to non cancer related factors; 5 patients died of respiratory insufficiency (4 of them had post pneumonectomy empyema), 3 patients died of cardiac diseases, 2 patients died of renal insufficiency and second tumor. In multivariate analysis the post operative cardiopulmonary complications (p = 0.013) and post pneumonectomy empyema (p = 0.036) were significant risk factors for non cancer related death. Conclusions: In pathological stage IB NSCLC, microvascular invasion was a risk factor for recurrence related death. The size of the tumor and invasion of the parietal pleura were significant factors in metastases related death. Cardiopulomonary complications and post pneumonektomy empyema were significant risk factors for non cancer related death. 101PD ACCURACY OF PRE-OPERATIVE DIAGNOSIS IN THE MANAGEMENT OF BRONCHIOLOALVEOLAR CARCINOMA ARE SUBLOBAR RESECTIONS FEASIBLE? H. Shaker, M.A. Khan, H. Elsayed Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom Background: Bronchioloalveolar carcinoma (BAC) is a rare subtype of lung cancer that has distinctive features that warrants its separation from other subtypes. Diagnosis requires separating BAC from the more aggressive ‘adenocarcinoma with bronchioloalveolar features’ (Adeno/BAC). Recent evidence suggests sublobar lung resections may be safely performed in certain peripheral BACs [1]. This requires accurate preoperative histological confirmation of BAC and a ground glass appearance (GGA) on CT scanning. We investigated the accuracy of preoperative diagnosis of BAC and the feasibility for limited resections in our institution where our current policy is to perform lobar resections. Methods: A retrospective casenote analysis was performed on patients who had a surgical intervention for BAC or adeno/BAC over a 12 year period (1996 to 2008). Results: Of 33 casenotes analysed, 17 (51%) patients had preoperative histology. Fourteen of these patients had peripheral lesions and 3 presented with consolidated lobes. Preoperatively 12 (70%) patients had BAC histology, 4 (23%) had adeno/BAC and 1 (7%) had non-BAC adenocarcinoma. Postoperatively 5 (29%) patients had BAC, 7 (42%) had adeno/BAC and 5 (29%) had non-BAC adenocarcinoma. Overall concordance was 24%. Five patients with peripheral lesions had both preoperative BAC histology and radiological GGA. Only one of these had BAC histology postoperatively. Of 11 confirmed BAC cases among all 33 patients, 3 (27%) had peripheral lesions and 8 (73%) had consolidated lobes. Conclusions: Accuracy of preoperative histological diagnosis of BAC was low. GGA was not useful in differentiating BAC from adeno/BAC. Most of our BAC patients did not present with peripheral lesions. Only one patient (3% of the whole group) may have benefitted from a limited resection in retrospect. Limited resection of suspected BAC lesions would not be justified in our group of patients. Reference(s) [1] Arenberg D; American College of Chest Physicians. Bronchioloalveolar lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007 Sep; 132(3 Suppl): 306S 313S.