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P1.08-031 Non-Small Cell Lung Cancer in Patients Aged 40 Years or Younger: Clinical, Surgical, and Long-Term Outcomes
January 2017
received chemo-radiation and underwent bronchoscopic debulking and are in follow up. Median pathological tumor size was 3 cm. Median number of node harvested was 10 (range 4-18) however none showed metastasis. None of the operated patient developed relapse and overall eight patients are alive after a median follow up of 18 months. Conclusion: Primary salivary gland type tumors of lung (PSGTTL) are low grade malignancy and greater awareness of these tumors is necessary to avoid misdiagnosis and delay in treatment. Aggressive anatomical lung resection with preservation of functional lung parenchyma offers optimal outcome in such patients. Keywords: adenoid cystic carcinoma, mucoepidermoid carcinoma, Primary salivary gland type tumors of lung
P1.08-030 Female Lung Cancer and Our Five Year Experience Topic: Epidemiologic Studies in Surgery for NSCLC Fatmir Caushi,1 Danjela Xhemalaj,2 Alban Hatibi,2 Ilir Skenduli,2 Irma Bani,2 Hasan Hafizi,3 Eljana Shima,2 Rinaldo Kortoci2 1Thoracic Surgery, University Hospital of Lung Diseases, Tirana/Albania, 2 Thoracic Surgery, University Hospital of Lung Diseases, Tirana/Albania, 3Pneumology, University Hospital of Lung Disease “shefqet Ndroqi”, Tirana/Albania Background: Lung cancer is one of the leading causes of mortality in the world. The incidence of lung cancer in females is increasing, in contrast to that seen in males. However, according to a lot of publications, lung cancer is almost six times more frequent in men than in women. The literature shows clearly that lung cancer in women differs from that in men in several aspects and environmental factors and lifestyle plays an important role in the female lung carcinogenesis. The objectives of this study were to evaluate clinic-morphologic features of lung cancer in women and the role of the surgery in their treatment. Methods: This was a descriptive retrospective study, conducted for five years. We analyzed all patients hospitalized diagnosed and treated for lung cancer and using Pearson Chi-Square test. Results: The ratio men to women for patients diagnosed with lung cancer was 8 to 1.The most common histotype was Adenocarcinoma 76%, Squamous cell carcinoma 11%, Small cell carcinoma 5%, others 8%.The average age was 57.5 with SD±12 years. 6% of females were in
Abstracts
S749
I stage, 22% of them were in II stage, 15% of them were in IIIA stage, 10% of them in IIIB stage and 47% in IV stage. Only 9% of our patients were smokers. Dyspnea was the main clinical sign, found in 67% of women. The standardized incidence of female lung cancer patients was 5/ 100.000. The surgery was performed in 20% of them meanwhile in men it was performed in 12.5% of cases. Conclusion: Most of women diagnosed with lung cancer were in advanced stages. Adenocarcinoma is the common histotype. This study shows that lung cancer in female is eight time less frequent in women than in men. Since the ratio men to women regarding to being operable is in the favor of women because they are diagnosed earlier comparing to men, women are more subject of surgery. Because the clinical signs of lung cancer are far from being specific, a substantial portion of lung cancer cases and deaths could be prevented by applying effective prevention measures, such as tobacco control and the use of early detection tests. Keywords: female lung cancer, Surgery
P1.08-031 Non-Small Cell Lung Cancer in Patients Aged 40 Years or Younger: Clinical, Surgical, and Long-Term Outcomes Topic: Epidemiologic Studies in Surgery for NSCLC Domenico Galetta, Alessandro Borri, Roberto Gasparri, Francesco Petrella, Lorenzo Spaggiari Division of Thoracic Surgery, European Institute of Oncology, Milan/Italy Background: Non-small cell lung cancer (NSCLC) in young patients is uncommon and has clinical characteristics different from that in older patients. We report the outcomes of a single institutional experience in the treatment of young patients with NSCLC. Methods: Records of patients with NSCLC operated on between 1998 and 2013 were retrospectively analyzed from a prospective database. We identify two groups: G1 with patients resected with intention-to-treat, and G2 who underwent only diagnostic surgical procedures due to advanced NSCLC. There were 47 patients (27 in G1, 13 men; and 20 in G2, 10 men) with a median age of 37 years in G1 (range, 16-40) and 38 years in G2 (range, 2440).Survival was calculated by using Kaplan-Meier method. Results: Induction treatment (IT) was administered in 17 patients in G1; no patient in G2 received IT. In G1, surgery included 3 wedges, 1 segmentectomy, 18
S750
lobectomies, 5 pneumonectomies; in G2, surgery included 3 explorative thoracotomies, 8 nodal biopsies, and 6 pleural biopsies. Histological diagnosis was adenocarcinoma in all the patients. Median tumor size was 22 mm (range, 5-125) in G1. Postoperative staging in G1 included 11 stage I, 4 stage II, and 12 stage III; all patients in G2 were stage IV and none was alive at 5year. Five-year overall survival and disease-free survival in G1 were 55% and 51%, respectively (median, 30 and 16 months, respectively). In G1 recurrence occurred in 12 patients most of them at extra-thoracic sites (9/12 [75%]). Factors associated with increased survival in G1 included IT (p¼.0002) and right side disease (p¼.01). At multivariate analysis in G1, IT [p¼.03 (95% CI: 0.670.89)] influenced long-term survival. Conclusion: In our experience, all young patients had adenocarcinoma with a predominance of women. Patients receiving pulmonary resection for curative intent had the best prognosis and among these, those receiving IT had the best long-term survival.
Journal of Thoracic Oncology
Vol. 12 No. 1S
analyses showed that younger age, wellemoderately differentiated histology, earlier pathologic stage, and presence of EGFR or ALK mutation were favorable prognostic factors for TTR. Locoregional recurrence was observed in 53.3% of ALK-positive patients, being significantly common in these patients than in EGFRand KRAS-positive patients. EGFR-positive patients mostly experienced pleural recurrence, the incidence of which was significantly higher in TN patients. Adrenal recurrence was observed in 7.2% of TN patients, but it was rarely identified in EGFR-positive patients. (Figure) Among EGFR-positive patients, the incidence of brain metastases was significantly higher in L858R cohort than in Del Ex19 cohort.
Keywords: young, lung tumor
P1.08-032 Impact of the Oncogenic Status on the Mode of Recurrence in Resected NonSmall Cell Lung Cancer Topic: Translational Studies Tetsuya Mizuno,1 Yasushi Yatabe,2 Shozo Sakata,1 Katsutoshi Seto,1 Hitoshi Dejima,1 Hiroaki Kuroda,1 Noriaki Sakakura,1 Yukinori Sakao1 1Division of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya/ Japan, 2Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya/Japan Background: Surgical resection is employed in patients with resectable non-small cell lung cancer (NSCLC). Despite complete resection, recurrence is sometimes observed. Oncogenic mutations promote initiation and progression of lung cancer, and mutation status predicts treatment outcome of advanced NSCLC; however, their impact on the recurrence patterns remain poorly understood. Methods: We retrospectively studied 401 patients showing recurrence after complete resection of NSCLC. Clinicopathological factors were reviewed for time to recurrence (TTR), and recurrence patterns were compared according to oncogenic status and examined according to EGFR mutational subtype. Results: Among 401 patients, 185 with EGFR mutation, 46 with KRAS mutation, 15 with ALK rearrangement, and 155 with triple negative mutation (TN) were identified. Multivariate analysis following univariate
Conclusion: In resected NSCLC, younger age, welle moderately differentiated histology, earlier pathologic stage, and presence of EGFR or ALK mutation were favorable factors for TTR, and distinct recurrence patterns were revealed according to oncogenic mutation status and mutational EGFR subtype. Our results may provide suggestions for developing a strategy for followup and adjuvant therapies after resection. Keywords: recurrence, oncogenic status
received chemo-radiation and underwent bronchoscopic debulking and are in follow up. Median pathological tumor size was 3 cm. Median number of node harvested was 10 (range 4-18) however none showed metastasis. None of the operated patient developed relapse and overall eight patients are alive after a median follow up of 18 months. Conclusion: Primary salivary gland type tumors of lung (PSGTTL) are low grade malignancy and greater awareness of these tumors is necessary to avoid misdiagnosis and delay in treatment. Aggressive anatomical lung resection with preservation of functional lung parenchyma offers optimal outcome in such patients. Keywords: adenoid cystic carcinoma, mucoepidermoid carcinoma, Primary salivary gland type tumors of lung
P1.08-030 Female Lung Cancer and Our Five Year Experience Topic: Epidemiologic Studies in Surgery for NSCLC Fatmir Caushi,1 Danjela Xhemalaj,2 Alban Hatibi,2 Ilir Skenduli,2 Irma Bani,2 Hasan Hafizi,3 Eljana Shima,2 Rinaldo Kortoci2 1Thoracic Surgery, University Hospital of Lung Diseases, Tirana/Albania, 2 Thoracic Surgery, University Hospital of Lung Diseases, Tirana/Albania, 3Pneumology, University Hospital of Lung Disease “shefqet Ndroqi”, Tirana/Albania Background: Lung cancer is one of the leading causes of mortality in the world. The incidence of lung cancer in females is increasing, in contrast to that seen in males. However, according to a lot of publications, lung cancer is almost six times more frequent in men than in women. The literature shows clearly that lung cancer in women differs from that in men in several aspects and environmental factors and lifestyle plays an important role in the female lung carcinogenesis. The objectives of this study were to evaluate clinic-morphologic features of lung cancer in women and the role of the surgery in their treatment. Methods: This was a descriptive retrospective study, conducted for five years. We analyzed all patients hospitalized diagnosed and treated for lung cancer and using Pearson Chi-Square test. Results: The ratio men to women for patients diagnosed with lung cancer was 8 to 1.The most common histotype was Adenocarcinoma 76%, Squamous cell carcinoma 11%, Small cell carcinoma 5%, others 8%.The average age was 57.5 with SD±12 years. 6% of females were in
Abstracts
S749
I stage, 22% of them were in II stage, 15% of them were in IIIA stage, 10% of them in IIIB stage and 47% in IV stage. Only 9% of our patients were smokers. Dyspnea was the main clinical sign, found in 67% of women. The standardized incidence of female lung cancer patients was 5/ 100.000. The surgery was performed in 20% of them meanwhile in men it was performed in 12.5% of cases. Conclusion: Most of women diagnosed with lung cancer were in advanced stages. Adenocarcinoma is the common histotype. This study shows that lung cancer in female is eight time less frequent in women than in men. Since the ratio men to women regarding to being operable is in the favor of women because they are diagnosed earlier comparing to men, women are more subject of surgery. Because the clinical signs of lung cancer are far from being specific, a substantial portion of lung cancer cases and deaths could be prevented by applying effective prevention measures, such as tobacco control and the use of early detection tests. Keywords: female lung cancer, Surgery
P1.08-031 Non-Small Cell Lung Cancer in Patients Aged 40 Years or Younger: Clinical, Surgical, and Long-Term Outcomes Topic: Epidemiologic Studies in Surgery for NSCLC Domenico Galetta, Alessandro Borri, Roberto Gasparri, Francesco Petrella, Lorenzo Spaggiari Division of Thoracic Surgery, European Institute of Oncology, Milan/Italy Background: Non-small cell lung cancer (NSCLC) in young patients is uncommon and has clinical characteristics different from that in older patients. We report the outcomes of a single institutional experience in the treatment of young patients with NSCLC. Methods: Records of patients with NSCLC operated on between 1998 and 2013 were retrospectively analyzed from a prospective database. We identify two groups: G1 with patients resected with intention-to-treat, and G2 who underwent only diagnostic surgical procedures due to advanced NSCLC. There were 47 patients (27 in G1, 13 men; and 20 in G2, 10 men) with a median age of 37 years in G1 (range, 16-40) and 38 years in G2 (range, 2440).Survival was calculated by using Kaplan-Meier method. Results: Induction treatment (IT) was administered in 17 patients in G1; no patient in G2 received IT. In G1, surgery included 3 wedges, 1 segmentectomy, 18
S750
lobectomies, 5 pneumonectomies; in G2, surgery included 3 explorative thoracotomies, 8 nodal biopsies, and 6 pleural biopsies. Histological diagnosis was adenocarcinoma in all the patients. Median tumor size was 22 mm (range, 5-125) in G1. Postoperative staging in G1 included 11 stage I, 4 stage II, and 12 stage III; all patients in G2 were stage IV and none was alive at 5year. Five-year overall survival and disease-free survival in G1 were 55% and 51%, respectively (median, 30 and 16 months, respectively). In G1 recurrence occurred in 12 patients most of them at extra-thoracic sites (9/12 [75%]). Factors associated with increased survival in G1 included IT (p¼.0002) and right side disease (p¼.01). At multivariate analysis in G1, IT [p¼.03 (95% CI: 0.670.89)] influenced long-term survival. Conclusion: In our experience, all young patients had adenocarcinoma with a predominance of women. Patients receiving pulmonary resection for curative intent had the best prognosis and among these, those receiving IT had the best long-term survival.
Journal of Thoracic Oncology
Vol. 12 No. 1S
analyses showed that younger age, wellemoderately differentiated histology, earlier pathologic stage, and presence of EGFR or ALK mutation were favorable prognostic factors for TTR. Locoregional recurrence was observed in 53.3% of ALK-positive patients, being significantly common in these patients than in EGFRand KRAS-positive patients. EGFR-positive patients mostly experienced pleural recurrence, the incidence of which was significantly higher in TN patients. Adrenal recurrence was observed in 7.2% of TN patients, but it was rarely identified in EGFR-positive patients. (Figure) Among EGFR-positive patients, the incidence of brain metastases was significantly higher in L858R cohort than in Del Ex19 cohort.
Keywords: young, lung tumor
P1.08-032 Impact of the Oncogenic Status on the Mode of Recurrence in Resected NonSmall Cell Lung Cancer Topic: Translational Studies Tetsuya Mizuno,1 Yasushi Yatabe,2 Shozo Sakata,1 Katsutoshi Seto,1 Hitoshi Dejima,1 Hiroaki Kuroda,1 Noriaki Sakakura,1 Yukinori Sakao1 1Division of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya/ Japan, 2Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya/Japan Background: Surgical resection is employed in patients with resectable non-small cell lung cancer (NSCLC). Despite complete resection, recurrence is sometimes observed. Oncogenic mutations promote initiation and progression of lung cancer, and mutation status predicts treatment outcome of advanced NSCLC; however, their impact on the recurrence patterns remain poorly understood. Methods: We retrospectively studied 401 patients showing recurrence after complete resection of NSCLC. Clinicopathological factors were reviewed for time to recurrence (TTR), and recurrence patterns were compared according to oncogenic status and examined according to EGFR mutational subtype. Results: Among 401 patients, 185 with EGFR mutation, 46 with KRAS mutation, 15 with ALK rearrangement, and 155 with triple negative mutation (TN) were identified. Multivariate analysis following univariate
Conclusion: In resected NSCLC, younger age, welle moderately differentiated histology, earlier pathologic stage, and presence of EGFR or ALK mutation were favorable factors for TTR, and distinct recurrence patterns were revealed according to oncogenic mutation status and mutational EGFR subtype. Our results may provide suggestions for developing a strategy for followup and adjuvant therapies after resection. Keywords: recurrence, oncogenic status