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P3.16-004 Surgery for Patients with Lung Cancer Associated with Interstitial Pneumonia
S2344 Demographic, clinical, and pathologic factors (sex, age, smoking index, Performance Status, preoperative carcinoembryonic antigen [CEA], surgical procedure, lymphadenectomy extent, histology, tumor differentiation, tumor size, pT factor, metastatic node site, and adjuvant chemotherapy) were analyzed using the log-rank test as univariate analyzes and a Cox proportional hazards regression model for multivariate analyzes to identify independent predictors of favorable disease-specific survival (DSS). Result: Of the 146 eligible patients, 113 were male and 33 were female. The median age and preoperative CEA were 67 years and 5.3 ng/mL, respectively. Lobectomy or greater resection and segmentectomy were performed in 140 and 6 patients, respectively. Tumor histology was adenocarcinoma in 58 patients, squamous cell carcinoma in 70, and others in 18. Node metastasis was identified in hilum only in 85 patients and mediastinum in 61. Adjuvant chemotherapy was performed in 61 patients (platinum doublet in 56 and tegafur/uracil in 5, respectively) and was not performed in 85. The 5-year DSS was 58%. The CEA 5.3 ng/mL (HR: 0.368), without mediastinal node metastasis (HR: 0.436), and platinum doublet adjuvant chemotherapy (HR: 0.491) were identified as significant predictors of favorable DSS. The 5-year DSS in patients with CEA 5.3 and >5.3 ng/mL were 73% vs 41%, respectively (p<0.001). The 5-year DSS in patients who underwent platinum doublet chemotherapy or none/ others were 67% vs 53%, respectively (p¼0.047). Conclusion: Even if NSCLC patients have lymph node metastasis, favorable postoperative prognosis may be expected in patients with low preoperative CEA. Platinum doublet adjuvant chemotherapy should be considered in patients with lymph node metastasis on pathological examination. Keywords: lymph node metastasis, Surgery, Locally Advanced Cancer
Journal of Thoracic Oncology
Vol. 12 No. 11S2
P3.16-003 The Clinical Significance of Immune-Nutritional Parameters in Surgically Resected Elderly Patients with Non-Small Cell Lung Cancer F. Shoji,1 N. Miura,2 T. Akamine,1 T. Matsubara,1 Y. Kozuma,1 N. Haratake,1 S. Takamori,1 M. Katsura,1 K. Takada,1 G. Toyokawa,1 T. Takenaka,2 K. Yamazaki,2 T. Okamoto,1 S. Takeo,2 Y. Maehara1 1Department of Surgery and Science, Kyushu University, Graduate School of Medical Sciences, Fukuoka/JP, 2Kyushu Medical Center, Fukuoka/JP Background: The world’s population is rapidly aging, and the age of patients with lung cancer will increase as well. The prognostic nutritional index (PNI), controlling nutritional status (CONUT), and the geriatric nutritional risk index (GNRI) are useful parameters for evaluating immune-nutritional status. We aimed to perform a multicenter retrospective study to investigate the correlations of these immunenutritional parameters with postoperative comorbidities or surgical outcomes of elderly patients with non-small cell lung cancer (NSCLC). Method: We selected 272 consecutive patients with NSCLC aged >75 years treated from January 2005 to December 2012 and evaluate three preoperative immune-nutritional parameters as potential predictive factors of postoperative comorbidities or as prognostic factors for surgically resected elderly patients with NSCLC. Result: Both PNI and GNRI as well as sex and preoperative respiratory comorbidities, were significantly associated with postoperative comorbidities (P ¼0.0287, 0.0443, 0.0191 and 0.0177, respectively). Multivariate analyzes showed that preoperative GNRI (P ¼ 0.0161) as well as sex (P < 0.0001), preoperative serum carcino embryonic antigen levels (P ¼ 0.0128), preoperative serum cytokeratin 19 fragment levels (P ¼ 0.0125), pleural invasion (P ¼ 0.0214) and lymphatic vessel invasion (P ¼ 0.0165) significantly affected overall survival (OS). Abnormal GNRI was significantly associated with histology (P ¼ 0.0419) and outcome (P ¼0.0077). In KaplaneMeier analysis of OS by preoperative GNRI, the abnormal GNRI group had significantly shorter OS than the normal GNRI group (5-year OS, 45.15% vs. 64.10%, P ¼ 0.0007, log-rank test). CONUT score did not have any correlation with postoperative comorbidities or surgical outcome. Conclusion: Preoperative GNRI is a novel preoperative predictor of postoperative comorbidities as well as a prognostic factor that may identify high-risk elderly patients with NSCLC. Keywords: non-small cell lung cancer, elderly patients, immune-nutritional parameters
P3.16-004 Surgery for Patients with Lung Cancer Associated with Interstitial Pneumonia Y. Azuma,1 H. Otsuka,1 T. Makino,1 S. Koezuka,1 K. Isobe,2 S. Sakamoto,2 N. Tochigi,3 K. Shibuya,3 S. Homma,2 A. Iyoda1 1 Division of Chest Surgery, Toho University School of Medicine, Tokyo/JP, 2 Division of Respiratory Medicine, Toho University School of Medicine, Tokyo/JP, 3Division of Surgical Pathology, Toho University School of Medicine, Tokyo/JP Background: Treatment of patients with lung cancer associated with interstitial pneumonia (IP) is difficult because of post-operative complications or treatment-related deaths. Indeed, post-operative acute exacerbation of IP in patients with lung cancer and IP is associated with a high mortality rate. In our institute, we have unified surgical methods and improved peri-operative management of such patients since 2013. In the current study, we retrospectively studied the clinical features, surgical methods, and peri-operative management, and analyzed the clinicopathologic features of patients with lung cancer associated with IP. Method: We selected patients with lung cancer associated with IP
November 2017 who underwent surgery from January 2004 to May 2017. A presumptive diagnosis of IP or an IP pattern on computed tomography (CT) was confirmed histologically by examination of resected specimens and/or the presence of the clinical diagnostic criteria. Acute exacerbation of IP was defined according to the guidelines of the Japanese Respiratory Society when the following criteria were fulfilled within 1 month: (1) increased respiratory distress; (2) fibrosis, newly developed ground glass opacity and infiltrative shadow on high-resolution computed tomography (HRCT); and (3) >10 Torr decrease in PaO2 under the same oxygenation conditions. (4) no evidence of pulmonary infection, heart failure, pneumothorax, and pulmonary embolism. We studied the following clinicopathologic features in patients with lung cancer associated with IP: gender, age, surgical methods, pathologic stages, mortality rate, and post-operative complications, including acute exacerbation of IP. Result: Fifty-three patients underwent surgery. The mean age was 70.8 years (50 males and 3 females). Forty-three, 1, and 9 patients underwent lobectomies, a segmentectomy, and partial resections, respectively. Twenty-three, 17, and 13 patients were stage I, II, and III, respectively. Eight patients had postoperative acute exacerbations of IP and there were three in-hospital deaths caused by acute exacerbations. Of note, there have been no inhospital deaths since 2013. Conclusion: It is possible to prevent severe post-operative complications in patients with lung cancer associated with IP with the aid of intra-operatively and optimal peri-operative management. Keywords: lung cancer, Interstitial pneumonia, Surgery
P3.16-005 Outcome, Mortality and Morbidity after Lung Cancer Thoracic Surgery F. Gradica,1 A. Cani,2 L. Lisha,3 D. Argjiri,4 F. Kokiqi,5 F. Gradica,6 I. Skenduli,3 E. Shehaj,2 V. Rexha,6 D. Lala7 1Thorax Surgery, University Hospital Shefqet Ndroqi, Tirana/AL, 2Anesteasie Reanimation, University Hospital Shefqet Ndroqi, Tirane/AL, 3Thorax Surgery, University Hospital Shefqet Ndroqi, Tirane/AL, 4Pneumology Department, University Hospital Shefqet Ndroqi, Tirana/AL, 5Anestesie Reanimation, University Hospital Shefqet Ndroqi, Tirane/AL, 6Pharmacy Service, University Hospital Shefqet Ndroqi, Tirane/AL, 7Stomatology Service, University Hospital Shefqet Ndroqi, Tirane/AL Background: Lung cancer is the most common form and cause of cancer death world-wide. Radical surgical resection, with or without adjuvant treatment, is still a prerequisite for cure. In European countries the proportion of patients who undergo surgery for this disease varies between 10 and 30% .Advances in operative and postoperative care have led to a decline in complications and mortality rates during the last two decades. In spite of different additional modes of treatment, survival is still poor. Method: The study comprised 388 consecutive patients referred to University Hospital of Lung Disease Tirane, from a defined population, during a 12-years period (20042017).There were in total 968 patients who underwent lung resection for bronchogenic carcinoma. There were 690 males and 278 females included 15-87 years with a mean age of 65.5 years. Postoperative events studied were divided into major and minor complications or death during the first 30 days after surgery. Result: Early mortality (within 30 days) after lung cancer surgery. During the study period an increasing number of women and of patients older than 70 years underwent surgery. The 30 day mortality rate was 3.4% (33 patients), 1.2% after single lobectomy (11 patients) and 3.1 % after pneumonectomy (22 patients).Major complications occurred in 48 patients (4.9%). Minor complications occurred in 75 patients (7.7%).Male gender, smoker, FEV1 70% of expected value, squamous cell carcinoma and pneumonectomy were risk factors predicting adverse outcome. Conclusion: Our results show low mortality and morbidity after lung cancer surgery. However, patients with reduced lung capacity and
Abstracts
S2345
those undergoing pneumonectomy should be treated with great care, as they run a considerable risk of major complications or death during the first 30 days postoperatively. Older age (>70 years) does not appear to be a contraindication to lung cancer surgery, but patients in this group should undergo careful preoperative evaluation. Keywords: outcome, Complications, after thoracic surgery
P3.16-006 Impact of Limited Resection or Omitted Adjuvant Therapy in Patients with Pathologic Stage II and III Non-Small-Cell Lung Cancer J.S. Cho, Y.D. Kim, H.Y. Ahn, H. I, J. Son Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan/KR Background: There is consensus for the treatment modalities of lung cancer. However, there were cases in which inadequate treatments were performed due to unavoidable reasons which could make different oncologic outcomes. So authors investigated factors affecting oncologic outcomes in patients with pathologic stage II and III lung cancer who underwent limited resection or omitted adjuvant therapy. Method: From January, 2010 to December, 2012, 231 patients underwent operation for non-small-cell lung cancer in our hospital. Of them, 63 patients who were diagnosed as pathologic stage II and III were enrolled in this research, and medical records of them were reviewed including demographic factors, treatment modalities, 5-year overall survival rate, 5-year recurrence and so on. Result: The mean age was 64.03±7.94 years old and preoperative performance status was good in all patients. The median follow-up duration was 58.7 [1.3, 88.4] months. Patients (group A) with resection more than lobectomy and adjuvant therapy were 50, patients (group B) with limited resection were 4, and patients with omitted adjuvant therapy were 13 (group C). 5-year overall survival rate of group A was 69.7% (stage IIA-84.4%, IIB-40.0%, IIIA-48.5%), but, all of group B were recurred and passed away. Of group C (stage IIA-9, IIB-1, IIIA-3), 5 were recurred and dead. Multi-variable analysis (Cox proportional hazard regression analysis) of prognostic factors for overall survival (OS) and recurrence (R) was performed, which showed limited resection (OS; hazard ratio 32.179, p¼0.001 and R; hazard ratio 61.337, p¼0.000) and pathologic stage (OS; hazard ratio 1.898, p¼0.017 and R; hazard ratio 1.517, p¼0.037) were presented as significant poor prognostic factors. And omitted adjuvant therapy didn’t significantly affect oncologic outcome, but had negative influence (OS; hazard ratio 8.102, p¼0.074 and R; hazard ratio 5.528, p¼0.13). Conclusion: This study has many weak points including small sample size, retrospective study and so on, but this study suggests that several factors affect prognosis in advanced stage non-small-cell lung cancer but, especially, the limited resection in advanced stage has been a significantly negative impact and should be considered carefully. Keywords: advanced non-small-cell lung cancer, omitted adjuvant therapy, limited resection
P3.16-007 Incidence and Outcomes of Positive Parenchymal Margins after Lung Resection e an Analysis of 1428 Cases P. Villeneuve,1 A. Kinio,2 C. Anstee,3 A. Seely,3 D. Maziak,3 F. Shamji,3 S. Sundaresan,3 S. Gilbert3 1Thoracic Surgery, The Ottawa Hospital, Ottawa/CA, 2Faculty of Medicine, The University of Ottawa, Ottawa/ON/CA, 3Thoracic Surgery, The Ottawa Hospital, Ottawa/ON/CA Background: Positive margins after pulmonary resection for cancer is an uncommon and challenging occurrence, with no consensus currently
Journal of Thoracic Oncology
Vol. 12 No. 11S2
P3.16-003 The Clinical Significance of Immune-Nutritional Parameters in Surgically Resected Elderly Patients with Non-Small Cell Lung Cancer F. Shoji,1 N. Miura,2 T. Akamine,1 T. Matsubara,1 Y. Kozuma,1 N. Haratake,1 S. Takamori,1 M. Katsura,1 K. Takada,1 G. Toyokawa,1 T. Takenaka,2 K. Yamazaki,2 T. Okamoto,1 S. Takeo,2 Y. Maehara1 1Department of Surgery and Science, Kyushu University, Graduate School of Medical Sciences, Fukuoka/JP, 2Kyushu Medical Center, Fukuoka/JP Background: The world’s population is rapidly aging, and the age of patients with lung cancer will increase as well. The prognostic nutritional index (PNI), controlling nutritional status (CONUT), and the geriatric nutritional risk index (GNRI) are useful parameters for evaluating immune-nutritional status. We aimed to perform a multicenter retrospective study to investigate the correlations of these immunenutritional parameters with postoperative comorbidities or surgical outcomes of elderly patients with non-small cell lung cancer (NSCLC). Method: We selected 272 consecutive patients with NSCLC aged >75 years treated from January 2005 to December 2012 and evaluate three preoperative immune-nutritional parameters as potential predictive factors of postoperative comorbidities or as prognostic factors for surgically resected elderly patients with NSCLC. Result: Both PNI and GNRI as well as sex and preoperative respiratory comorbidities, were significantly associated with postoperative comorbidities (P ¼0.0287, 0.0443, 0.0191 and 0.0177, respectively). Multivariate analyzes showed that preoperative GNRI (P ¼ 0.0161) as well as sex (P < 0.0001), preoperative serum carcino embryonic antigen levels (P ¼ 0.0128), preoperative serum cytokeratin 19 fragment levels (P ¼ 0.0125), pleural invasion (P ¼ 0.0214) and lymphatic vessel invasion (P ¼ 0.0165) significantly affected overall survival (OS). Abnormal GNRI was significantly associated with histology (P ¼ 0.0419) and outcome (P ¼0.0077). In KaplaneMeier analysis of OS by preoperative GNRI, the abnormal GNRI group had significantly shorter OS than the normal GNRI group (5-year OS, 45.15% vs. 64.10%, P ¼ 0.0007, log-rank test). CONUT score did not have any correlation with postoperative comorbidities or surgical outcome. Conclusion: Preoperative GNRI is a novel preoperative predictor of postoperative comorbidities as well as a prognostic factor that may identify high-risk elderly patients with NSCLC. Keywords: non-small cell lung cancer, elderly patients, immune-nutritional parameters
P3.16-004 Surgery for Patients with Lung Cancer Associated with Interstitial Pneumonia Y. Azuma,1 H. Otsuka,1 T. Makino,1 S. Koezuka,1 K. Isobe,2 S. Sakamoto,2 N. Tochigi,3 K. Shibuya,3 S. Homma,2 A. Iyoda1 1 Division of Chest Surgery, Toho University School of Medicine, Tokyo/JP, 2 Division of Respiratory Medicine, Toho University School of Medicine, Tokyo/JP, 3Division of Surgical Pathology, Toho University School of Medicine, Tokyo/JP Background: Treatment of patients with lung cancer associated with interstitial pneumonia (IP) is difficult because of post-operative complications or treatment-related deaths. Indeed, post-operative acute exacerbation of IP in patients with lung cancer and IP is associated with a high mortality rate. In our institute, we have unified surgical methods and improved peri-operative management of such patients since 2013. In the current study, we retrospectively studied the clinical features, surgical methods, and peri-operative management, and analyzed the clinicopathologic features of patients with lung cancer associated with IP. Method: We selected patients with lung cancer associated with IP
November 2017 who underwent surgery from January 2004 to May 2017. A presumptive diagnosis of IP or an IP pattern on computed tomography (CT) was confirmed histologically by examination of resected specimens and/or the presence of the clinical diagnostic criteria. Acute exacerbation of IP was defined according to the guidelines of the Japanese Respiratory Society when the following criteria were fulfilled within 1 month: (1) increased respiratory distress; (2) fibrosis, newly developed ground glass opacity and infiltrative shadow on high-resolution computed tomography (HRCT); and (3) >10 Torr decrease in PaO2 under the same oxygenation conditions. (4) no evidence of pulmonary infection, heart failure, pneumothorax, and pulmonary embolism. We studied the following clinicopathologic features in patients with lung cancer associated with IP: gender, age, surgical methods, pathologic stages, mortality rate, and post-operative complications, including acute exacerbation of IP. Result: Fifty-three patients underwent surgery. The mean age was 70.8 years (50 males and 3 females). Forty-three, 1, and 9 patients underwent lobectomies, a segmentectomy, and partial resections, respectively. Twenty-three, 17, and 13 patients were stage I, II, and III, respectively. Eight patients had postoperative acute exacerbations of IP and there were three in-hospital deaths caused by acute exacerbations. Of note, there have been no inhospital deaths since 2013. Conclusion: It is possible to prevent severe post-operative complications in patients with lung cancer associated with IP with the aid of intra-operatively and optimal peri-operative management. Keywords: lung cancer, Interstitial pneumonia, Surgery
P3.16-005 Outcome, Mortality and Morbidity after Lung Cancer Thoracic Surgery F. Gradica,1 A. Cani,2 L. Lisha,3 D. Argjiri,4 F. Kokiqi,5 F. Gradica,6 I. Skenduli,3 E. Shehaj,2 V. Rexha,6 D. Lala7 1Thorax Surgery, University Hospital Shefqet Ndroqi, Tirana/AL, 2Anesteasie Reanimation, University Hospital Shefqet Ndroqi, Tirane/AL, 3Thorax Surgery, University Hospital Shefqet Ndroqi, Tirane/AL, 4Pneumology Department, University Hospital Shefqet Ndroqi, Tirana/AL, 5Anestesie Reanimation, University Hospital Shefqet Ndroqi, Tirane/AL, 6Pharmacy Service, University Hospital Shefqet Ndroqi, Tirane/AL, 7Stomatology Service, University Hospital Shefqet Ndroqi, Tirane/AL Background: Lung cancer is the most common form and cause of cancer death world-wide. Radical surgical resection, with or without adjuvant treatment, is still a prerequisite for cure. In European countries the proportion of patients who undergo surgery for this disease varies between 10 and 30% .Advances in operative and postoperative care have led to a decline in complications and mortality rates during the last two decades. In spite of different additional modes of treatment, survival is still poor. Method: The study comprised 388 consecutive patients referred to University Hospital of Lung Disease Tirane, from a defined population, during a 12-years period (20042017).There were in total 968 patients who underwent lung resection for bronchogenic carcinoma. There were 690 males and 278 females included 15-87 years with a mean age of 65.5 years. Postoperative events studied were divided into major and minor complications or death during the first 30 days after surgery. Result: Early mortality (within 30 days) after lung cancer surgery. During the study period an increasing number of women and of patients older than 70 years underwent surgery. The 30 day mortality rate was 3.4% (33 patients), 1.2% after single lobectomy (11 patients) and 3.1 % after pneumonectomy (22 patients).Major complications occurred in 48 patients (4.9%). Minor complications occurred in 75 patients (7.7%).Male gender, smoker, FEV1 70% of expected value, squamous cell carcinoma and pneumonectomy were risk factors predicting adverse outcome. Conclusion: Our results show low mortality and morbidity after lung cancer surgery. However, patients with reduced lung capacity and
Abstracts
S2345
those undergoing pneumonectomy should be treated with great care, as they run a considerable risk of major complications or death during the first 30 days postoperatively. Older age (>70 years) does not appear to be a contraindication to lung cancer surgery, but patients in this group should undergo careful preoperative evaluation. Keywords: outcome, Complications, after thoracic surgery
P3.16-006 Impact of Limited Resection or Omitted Adjuvant Therapy in Patients with Pathologic Stage II and III Non-Small-Cell Lung Cancer J.S. Cho, Y.D. Kim, H.Y. Ahn, H. I, J. Son Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan/KR Background: There is consensus for the treatment modalities of lung cancer. However, there were cases in which inadequate treatments were performed due to unavoidable reasons which could make different oncologic outcomes. So authors investigated factors affecting oncologic outcomes in patients with pathologic stage II and III lung cancer who underwent limited resection or omitted adjuvant therapy. Method: From January, 2010 to December, 2012, 231 patients underwent operation for non-small-cell lung cancer in our hospital. Of them, 63 patients who were diagnosed as pathologic stage II and III were enrolled in this research, and medical records of them were reviewed including demographic factors, treatment modalities, 5-year overall survival rate, 5-year recurrence and so on. Result: The mean age was 64.03±7.94 years old and preoperative performance status was good in all patients. The median follow-up duration was 58.7 [1.3, 88.4] months. Patients (group A) with resection more than lobectomy and adjuvant therapy were 50, patients (group B) with limited resection were 4, and patients with omitted adjuvant therapy were 13 (group C). 5-year overall survival rate of group A was 69.7% (stage IIA-84.4%, IIB-40.0%, IIIA-48.5%), but, all of group B were recurred and passed away. Of group C (stage IIA-9, IIB-1, IIIA-3), 5 were recurred and dead. Multi-variable analysis (Cox proportional hazard regression analysis) of prognostic factors for overall survival (OS) and recurrence (R) was performed, which showed limited resection (OS; hazard ratio 32.179, p¼0.001 and R; hazard ratio 61.337, p¼0.000) and pathologic stage (OS; hazard ratio 1.898, p¼0.017 and R; hazard ratio 1.517, p¼0.037) were presented as significant poor prognostic factors. And omitted adjuvant therapy didn’t significantly affect oncologic outcome, but had negative influence (OS; hazard ratio 8.102, p¼0.074 and R; hazard ratio 5.528, p¼0.13). Conclusion: This study has many weak points including small sample size, retrospective study and so on, but this study suggests that several factors affect prognosis in advanced stage non-small-cell lung cancer but, especially, the limited resection in advanced stage has been a significantly negative impact and should be considered carefully. Keywords: advanced non-small-cell lung cancer, omitted adjuvant therapy, limited resection
P3.16-007 Incidence and Outcomes of Positive Parenchymal Margins after Lung Resection e an Analysis of 1428 Cases P. Villeneuve,1 A. Kinio,2 C. Anstee,3 A. Seely,3 D. Maziak,3 F. Shamji,3 S. Sundaresan,3 S. Gilbert3 1Thoracic Surgery, The Ottawa Hospital, Ottawa/CA, 2Faculty of Medicine, The University of Ottawa, Ottawa/ON/CA, 3Thoracic Surgery, The Ottawa Hospital, Ottawa/ON/CA Background: Positive margins after pulmonary resection for cancer is an uncommon and challenging occurrence, with no consensus currently