Resection For Primary Lung Cancer Research Articles

Variation in length of hospital stay after lung cancer surgery in the Netherlands.

Length of stay (LOS) in the hospital after lung cancer surgery is influenced by patient characteristics, tumour characteristics, surgical technique and perioperative care. Our objective was to determine whether there were variation in LOS between hospitals that could not be accounted for by these known parameters. Residual variation in LOS would suggest important differences in perioperative care protocols and discharge criteria. This study analysed data from the Netherlands National Cancer Registry (NNCR) on 10195 anatomical lung resections for primary lung cancer from 2010 to 2015. Multivariable analysis was performed for multiple factors, using hierarchical linear regression analysis of the mean LOS. Information on comorbidity and socio-economic status was not available. Association between LOS and postoperative mortality was evaluated in multivariable logistic regression. The median LOS was 7 days (interquartile range 5-10 days), and the mean LOS was 8.3 days. LOS was negatively affected by larger resections, open surgery and advancing age. Histology and tumour stage had little influence. Overall, 30-day and 90-day mortality were 2.1% and 3.8%, respectively; 1.7% and 3.3% (not significant) in the group of hospitals with shorter LOS. After case-mix correction, residual between-hospital variation in the mean LOS was observed, ranging from 1.5 days shorter to almost 2.5 days longer. A clinically relevant between-hospital variation in LOS after lung cancer surgery is observed in the Netherlands. Although residual confounding by comorbidity or socio-economic status cannot be excluded, this variation is deemed to be largely due to differences in perioperative care protocols. Evaluation of best practices can help to improve perioperative care for lung surgery patients and optimize LOS.

Effect of combined epidural anaesthesia on tumor-infiltrating lymphocytes in lung adenocarcinoma: a prospective exploratory sub-analysis.

Regional anaesthesia may have advantages in preserving immune function. Tumor-infiltrating lymphocytes (TILs) are considered indicators of immune response in the tumor microenvironment and used as a prognostic marker in patients after cancer surgery. This study investigated the effects of combined epidural anaesthesia on the number of TILs in patients undergoing surgery for lung adenocarcinoma. Patients undergoing radical resection for primary lung cancer were randomized to receive either combined epidural-general anaesthesia (Epi-GA) or general anaesthesia (GA) in an ongoing randomized controlled trial (ChiCTR-TRC-14004136). Excised adenocarcinoma specimens from patients enrolled between 1 June 2015 and 30 November 2015 were selected for immunohistochemical staining of CD8 and FOXP3 molecules. The numbers of positive lymphocytes were counted and expressed as the number of cells per mm2 tumor area. One hundred and twenty-eight patients were recruited and randomized; 64 patients were included in immunohistochemistry analysis (37 received Epi-GA vs. 27 received GA). The number of CD8+ T cells was higher in the Epi-GA group than in the GA group (median [interquartile range]: 292.8 [198.0-418.3] vs. 204.7 [131.1-305.8], P = 0.036); whereas the number of FOXP3+ T cells was less in the Epi-GA group than in the GA group (37.6 [14.7-92.3] vs. 99.8 [68.9-168.3], P < 0.001). For patients undergoing surgery for lung adenocarcinoma under general anesthesia, use of epidural anaesthesia increased CD8+ T cells infiltration but decreased FOXP3+ T cells accumulation in tumor tissues. Epidural anaesthesia may affect TILs in a manner that preserves immune function.

A Case of Successful Pleurodesis Using 50% Glucose for Prolonged Air Leakage after Pulmonary Resection for Primary Lung Cancer Combined with Interstitial Pneumonia

近年，胸膜癒着療法に50%ブドウ糖液を用いた報告があり，当院でも施行している。症例は63歳女性，関節リウマチで通院中に胸部X線で異常陰影を指摘された。胸部CTで右肺下葉（S 6 ）に結節影を認めた。術前に確定診断に至らなかったが画像上原発性肺癌が疑われた。またCT上，両肺下葉背側優位に蜂巣肺所見を認め，KL-6の上昇と合わせ，間質性肺炎合併が疑われた。右下葉切除術を施行したが，術後に気漏の遷延を認め，6日目に50%ブドウ糖液を用いた胸膜癒着療法を施行した。発熱や疼痛，間質性肺炎の急性増悪は認めず，気漏が改善し，7日目にドレーン抜去が可能であった。病理診断は原発性肺癌（扁平上皮癌，pT2aN0M0 Stage I B）だった。背景肺は病理学的にも間質性肺炎（UIP）と診断された。間質性肺炎合併肺癌の術後の気漏に，50%ブドウ糖液を用いた胸膜癒着療法によって気漏の軽快を得た症例を経験した。

The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer

ObjectiveThe adoption of Enhanced Recovery After Surgery programs in thoracic surgery is relatively recent with limited outcome data. This study aimed to determine the impact of an Enhanced Recovery After Surgery pathway on morbidity and length of stay in patients undergoing lung resection for primary lung cancer. MethodsThis prospective cohort study collected data on consecutive patients undergoing lung resection for primary lung cancer between April 2012 and June 2014 at a regional referral center in the United Kingdom. All patients followed a standardized, 15-element Enhanced Recovery After Surgery protocol. Key data fields included protocol compliance with individual elements, pathophysiology, and operative factors. Thirty-day morbidity was taken as the primary outcome measure and classified a priori according to the Clavien-Dindo system. Logistic regression models were devised to identify independent risk factors for morbidity and length of stay. ResultsA total of 422 consecutive patients underwent lung resection over a 2-year period, of whom 302 (71.6%) underwent video-assisted thoracoscopic surgery. Lobectomy was performed in 297 patients (70.4%). Complications were experienced by 159 patients (37.6%). The median length of stay was 5 days (range, 1-67), and 6 patients (1.4%) died within 30 days of surgery. There was a significant inverse relationship between protocol compliance and morbidity after adjustment for confounding factors (odds ratio, 0.72; 95% confidence interval, 0.57-0.91; P < .01). Age, lobectomy or pneumonectomy, more than 1 resection, and delayed mobilization were independent predictors of morbidity. Age, lack of preoperative carbohydrate drinks, planned high dependency unit/intensive therapy unit admission, delayed mobilization, and open approach were independent predictors of delayed discharge (length of stay >5 days). ConclusionsIncreased compliance with an Enhanced Recovery After Surgery pathway is associated with improved clinical outcomes after resection for primary lung cancer. Several elements, including early mobilization, appear to be more influential than others.

Association Between PD-L1 Expression and Metabolic Activity on 18F-FDG PET/CT in Patients with Small-sized Lung Cancer.

We evaluated the metabolic characteristics of small-sized lung cancer using 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) with regard to programmed cell death ligand 1 (PD-L1) expression. PD-L1 expression was evaluated by immunohistochemistry with the antibody clone SP142 in 263 patients with surgically resected primary small-sized lung cancer. Specimens with <5% tumor membrane staining were considered negative. We examined the association between the frequency of PD-L1 expression and the maximum standardized uptake value (SUVmax) in preoperative 18F-FDG PET/CT. Among patients with non-small cell lung cancer (NSCLC), the SUVmax was significantly higher in those with PD-L1 expression than in those without (p<0.0001). However, there was no correlation between SUVmax and PD-L1 expression in patients with neuroendocrine tumors (p=0.9638). Multivariate analysis revealed that smoking and a high SUVmax were independent predictors of PD-L1 expression. PD-L1 expression was related to high glucose metabolism in small-sized NSCLC.

National Analysis of Unplanned Readmissions After Thoracoscopic Versus Open Lung Cancer Resection

Hospital readmissions are viewed as a mark of inferior health care quality and are penalized. Unplanned postoperative readmission reason and timing after lung resection are not well understood. We examine related, unplanned readmissions after thoracoscopic versus open anatomic lung resections to identify opportunities to improve patient care. We analyzed the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data set, 2012 to 2015, characterizing 30-day related, unplanned postoperative readmissions after anatomic lung resections for primary lung cancer. Risk-adjusted comparison of readmission after thoracoscopic and open resection was performed using propensity matching. Patients (n= 9,510) underwent anatomic lung resections; 4,935 (51.9%) were thoracoscopic resections and 4,575 (48.1%) were open resections. Of the thoracoscopic patients, 10.9% experienced one or more complications, versus 19.4% of patients with open resection (p < 0.0001). Of the thoracoscopic patients 5.5% experienced related, unplanned readmissions versus 7.2% of the patients with open resection (p < 0.001). 24.8% of complications after thoracoscopic approach occurred after discharge, versus 15.5% after open approach (p < 0.0001). Timing of unplanned readmission was similar for both groups. The propensity-matched odds ratio of risk of readmission after thoracoscopic versus open resection was 1.16 (95% confidence interval, 0.949 to 1.411, p= 0.15). Open anatomic lung resections for primary lung cancer had nearly twice the complication rate but only a slightly higher readmission rate than thoracoscopic resection. More complications occurred after discharge after thoracoscopic than open resections. Most readmissions occurred within 2 weeks after both thoracoscopic and open resections. Risk-adjusted comparison identified no statistically significant difference in risk of related, unplanned readmission after thoracoscopic versus open resections. Future studies should focus on identification of processes of care to decrease complications and unplanned readmissions after lung cancer resection.

P3.16-029 Recurrence within a Year after Complete Resection of Primary Lung Cancer

P3.16-029 Recurrence within a Year after Complete Resection of Primary Lung Cancer

Metabolic characteristics of programmed cell death-ligand 1-expressing lung cancer on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography.

Programmed cell death‐1 (PD‐1) and programmed cell death‐ligand 1 (PD‐L1) have been identified as novel targets of immunotherapy of lung cancer. In present study, we evaluated the metabolic characteristics of lung cancer by using 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT) with regard to PD‐L1 protein expression. PD‐L1 protein expression was evaluated by immunohistochemistry with the antibody clone SP142 in 579 surgically resected primary lung cancer patients. Cases with less than 5% tumor membrane staining were considered negative. We examined the association between the frequency of PD‐L1 protein expression and the maximum standardized uptake value (SUVmax) in preoperative 18F‐FDG PET/CT. The cut‐off values for SUVmax were determined by receiver operating characteristic curve analyses. The SUVmax was significantly higher in nonsmall cell lung cancer (NSCLC) patients with PD‐L1 protein expression compared with those without PD‐L1 protein expression (P < 0.0001). However, there was no correlation between SUVmax and PD‐L1 protein expression in patients with neuroendocrine tumors (P = 0.6545). Multivariate analysis revealed that smoking, the presence of pleural invasion, and high SUVmax were independent predictors of PD‐L1 positivity. PD‐L1‐expressing NSCLC had a high glucose metabolism. The SUVmax in preoperative 18F‐FDG PET/CT was a predictor of PD‐L1 protein expression in patients with NSCLC.

Surgical Resection and Outcome of Synchronous and Metachronous Primary Lung Cancer in Breast Cancer Patients.

Women with breast cancer are at increased risk of subsequent primary malignancies, specifically lung cancer. The aim of this study was to report the frequency of lung cancer in patients with breast cancer, and patients' characteristics and surgical outcomes. We investigated 1,066 consecutive female patients undergoing surgical resection for breast cancer and 666 undergoing surgical resection for lung cancer. Lung cancer with breast cancer was observed in 14 patients (1.3% of breast cancer and 2.1% of lung cancer cases; mean age=65 years), and 3/14 (21.4%) patients were smokers. Sixteen lung cancer lesions in 14 patients were adenocarcinomas and one was squamous cell carcinoma. All 14 patients were alive at the time of this report; 4/14 (28.6%) patients had recurrent breast cancer and 1/14 (7.1%) had recurrent lung cancer. In synchronous cases, 5/6 (83.3%) patients received concomitant surgery for both breast cancer and lung cancer. Patients' postoperative courses were uneventful. In metachronous cases, eight patients had lung cancer a mean of 33 months after breast cancer surgery. All eight patients received adjuvant therapies and 4/8 (50%) patients received adjuvant therapies for recurrent breast cancer, including chemotherapy, radiotherapy, hormonal therapy, and anti-HER2 therapy. All patients had early-stage lung adenocarcinoma and underwent surgical resection. Concomitant surgery for synchronous lung and breast cancer was feasible and safe. In metachronous cases, lung cancers tended to be detected within 3 years after surgery for breast cancer. Careful follow-up for postoperative breast cancer may contribute to the detection of early-stage lung cancer.

Risk Factors Associated with Interval Time between Initial Non-Small Cell Lung Cancer (NSCLC) Diagnosis and Development of Brain Metastases

Lung cancer remains the leading cause of brain metastases (BM). Our goal is to identify potential NSCLC risk factors associated with decreased time to BM. We retrospectively reviewed all NSCLC patients with BM treated with radiotherapy at a single institution from 1997 to 2015. Interval time (IT) to BM development was defined as pathological diagnosis of NSCLC to radiographic diagnosis of BM. Patients were stratified by clinical stage of initial NSCLC diagnosis. Stage 4 patients with BM present on initial staging MRI were excluded from the study. Prognostic factors were analyzed through the Kaplan-Meier method and Cox proportional hazards model. Survival curves were calculated with the Kaplan-Meier method using development of BM as the primary endpoint. A cohort of 109 patients were included in this study for analysis. Median IT for the entire cohort was 23 months. On Kaplan-Meier analysis for IT clinical stage at primary diagnosis, tumor histology, and surgical history showed significant differences between groups Stage III patients had median IT of 22 months and stage IV patients had median IT of 16 months compared to stage I patients with a median IT of 62 months. Non-adenocarcinoma histology had a median IT of 9 months compared to adenocarcinoma histology with a median IT of 25 months. Patients with no surgical resection of primary lung cancer had a median IT of 16 months compared to patients who underwent surgical resection with a median IT of 46 months. On univariate analysis stage III, stage IV, nodal-status of N2 disease, nodal-status of N3 disease, no surgical resection of primary lung cancer, and non-adenocarcinoma tumor histology were associated with decreased IT. On multivariate analysis stage III, stage IV, no surgical resection of primary lung cancer, and non-adenocarcinoma tumor histology were associated with decreased IT. Clinical stage, tumor histology, and surgical history could be associated with timing to BM development in NSCLC patients and should be further investigated to better characterize patients at risk for developing brain metastases at a shorter time interval.

Paravertebral Block Does Not Reduce Cancer Recurrence, but Is Related to Higher Overall Survival in Lung Cancer Surgery: A Retrospective Cohort Study.

Postoperative analgesic methods are suggested to have an impact on long-term prognosis after cancer surgery through opioid-induced immune suppression. We hypothesized that regional analgesia that reduces the systemic opioid requirement would be related to lower cancer recurrence and higher overall survival compared to intravenous patient-controlled analgesia (PCA) for lung cancer surgery. Records for all patients who underwent open thoracotomy for curative resection of primary lung cancer between 2009 and 2013 in a tertiary care hospital were retrospectively analyzed. Patients were divided by postoperative analgesic methods: PCA (n = 574), thoracic epidural analgesia (TEA, n = 619), or paravertebral block (PVB, n = 536). Overall and recurrence-free survivals were compared among 3 analgesic methods via a multivariable Cox proportional hazard model and a log-rank test after adjusting confounding factors using propensity score matching (PSM). Analgesic method was associated with overall survival (P= .0015; hazard ratio against TEA [95% confidence intervals]: 0.58 [0.39-0.87] for PCA, 0.60 [0.45-0.79] for PVB). After confounder adjustment using PSM, PVB showed higher overall survival than PCA (log-rank P= .0229) and TEA (log-rank P= .0063) while PCA and TEA showed no difference (log-rank P= .6). Hazard ratio for PVB was 0.66 [0.46-0.94] against PCA and 0.65 [0.48-0.89] against TEA after PSM. However, there was no significant association between the analgesic methods and recurrence-free survival (P= .5; log-rank P with PSM = .5 between PCA and TEA, .5 between PCA and PVB, .1 between TEA and PVB). Pain-control methods are not related to cancer recurrence. However, PVB may have a beneficial effect on overall survival of patients with lung cancer.

Prognostic Impact of Margin Distance and Tumor Spread Through Air Spaces in Limited Resection for Primary Lung Cancer

The aim of this study was to investigate the relationship between clinicopathological prognostic factors, including surgical margin distance and tumor spread through air spaces (STAS), and recurrence after limited resection for primary lung cancer. We identified 508 cases of limited resection (12.8%) and examined their clinicopathological features. Using Cox regression analysis, we examined the significant prognostic factors for recurrence of limited resection. Finally, we conducted a histopathological evaluation of tumor STAS. Multivariate Cox analysis showed that the risk for local recurrence was significantly associated with STAS (hazard ratio= 12.24, p= 0.001) and a tumor margin less than 1.0 cm (hazard ratio= 6.36, p= 0.02). However, the presence of tumor STAS was not significantly associated with distant recurrence (p= 0.98). This lack of association of STAS with distant recurrence may be due to the small number of distant recurrences. In all, 76 cases (15.0%) (60 adenocarcinomas, nine squamous cell carcinomas, and seven others) were positive for STAS. The morphological STAS patterns were 12 single cells, 45 small cell clusters, and 19 large nests. There was no significant relationship between the recurrence rate and morphological STAS pattern. The STAS-positive group was associated with the presence of micropapillary (p= 0.002) and/or solid components (p= 0.008) in patients with adenocarcinoma and with lymphovascular and pleural invasion (p < 0.001). The presence of STAS and tumor margins less than 1.0 cm are significant risk factors for local recurrence in early-stage lung cancer after limited resection. Thus, the presence of tumor STAS might be a pathological prognostic factor for patients with lung cancer who have undergone limited resection. However, the pathological and molecular significance of STAS remain to be clarified.

1144O - Phase III randomized controlled trial of adjuvant chemoimmunotherapy in patients with resected primary lung cancer

1144O - Phase III randomized controlled trial of adjuvant chemoimmunotherapy in patients with resected primary lung cancer

Clinical significance of tumor cavitation in surgically resected early-stage primary lung cancer

ObjectivesThe prognostic impact of tumor cavitation is unclear in patients with early-stage primary lung cancer. The aim of the present study was to examine the clinicopathological features and prognoses of patients with pathological stage I–IIA (p-stage I–IIA) primary lung cancers harboring tumor cavitation. This study was conducted according to the eighth edition of the TNM classification for lung cancer. Materials and methodsWe examined 602 patients with p-stage I–IIA primary lung cancer out of 890 patients who underwent pulmonary resection from January 2007 through March 2014 and searched for the presence of tumor cavitation, which is defined as the presence of air space within the primary tumor. ResultsA total of 59 out of the 602 patients had tumor cavitation (10%). Compared with patients without tumor cavitation, those with tumor cavitation had a significantly higher frequency of the following characteristics: high serum carcinoembryonic antigen (CEA) level (≥5ng/ml, p=0.027), interstitial pneumonia (p=0.0001), high SUVmax value on FDG-PET scan (≥4.2, p=0.023), tumors located in the lower lobe (p=0.024), large tumor size (>3cm, p=0.002), vascular invasion (66% vs 17%, p<0.0001) and non-adenocarcinoma histology (p=0.025). The overall survival period of patients with tumor cavitation was significantly shorter than that of patients without tumor cavitation (log-rank test: p<0.0001, 5-year OS rate: 56% vs 81%). Tumor cavitation was found to be an independent and significant factor associated with poor prognosis in the multivariate analysis (hazard ratio: 1.76, 95% confidence interval: 1.02–3.10, p=0.042). ConclusionsTumor cavitation is an independent factor for poor prognosis in patients with resected p-stage I–IIA primary lung cancer. Based on our analyses, patients with tumor cavitation should be regarded as a separate cohort that requires more intensive follow-up.

Report from the European Society of Thoracic Surgeons Database 2017: patterns of care and perioperative outcomes of surgery for malignant lung neoplasm.

The European Society of Thoracic Surgeons (ESTS) registry was created 10 years ago and represents an international database collecting thoracic surgery procedures from European contributors. The purpose of the present report was to offer an overview of baseline and surgical characteristics and outcomes of patients submitted to lung resections for malignant lung disease as derived from the ESTS registry. We retrieved data about all lung resections from 2007 to 2016 performed for primary and metastatic (secondary) lung cancer. We evaluated the baseline characteristics and the surgical management of this population. Within the subgroup of patients affected by primary lung cancer, we described the preoperative mediastinal staging management and the final pathological stage of disease. Finally, we analysed the morbidity and mortality rates for the cohort of patients submitted to anatomic lung resections for primary or secondary lung cancer. Outcomes were also evaluated in relation to several risk factors: type of resection, age, comorbidity, predicted postoperative forced expiratory volume in 1 s and surgical approach. We selected 62 774 patients submitted to lung resections (male 66.5%, median age 64 years). For the entire population, median predicted postoperative forced expiratory volume in 1 s was 73.3% (interquartile range: 59, 87.6), 33.8% of patients had cardiac comorbidities and 17.3% had other comorbidities. Among the patients with primary lung cancer (51 931 patients), 50.8% had Stage I disease and 23.2% Stage II disease; preoperative invasive mediastinal staging was performed in 70.3% of patients with computed tomography scan nodal enlargement and positron emission tomography scan nodal uptake. After anatomical lung resection (51 756 patients), overall morbidity was 18.5% and mortality (30 days or in-hospital) was 2.6%. Extent of resection, age ≥75 years, presence of cardiac comorbidity, predicted postoperative forced expiratory volume in 1 s <70% and open approach instead of video-assisted thoracic surgery were associated with worse outcomes. The results of the present report represent reliable European benchmarks for comparing the activities and outcomes of single institutions and surgeons at an international level.

Exhaustive preoperative staging increases survival in resected adrenal oligometastatic non-small-cell lung cancer: a multicentre study.

Adrenal oligometastatic non-small-cell lung cancer is rare, and surgical management remains controversial. We performed a multicentre, retrospective study from January 2004 to December 2014. The main objective was to evaluate survival in patients who had undergone adrenalectomy after resection of primary lung cancer. Secondary objectives were to determine prognostic, survival and recurrence factors. Fifty-nine patients were included. Forty-six patients (78%) were men. The median age was 58 years [39-75 years]. Twenty-six cases (44%) showed synchronous presentation, and 33 cases (56%) had a metachronous presentation. The median time to onset of metastasis was 18.3 months [6-105 months]. The 5-year overall survival rate was 59%; the median survival time was 77 months [0.6-123 months]. A recurrence was observed in 70% of the population. Mediastinal lymph node invasion (P = 0.035) is a detrimental prognostic factor of survival. After exhaustive staging, patients with adrenal oligometastatic non-small-cell lung cancer benefit from bifocal surgery.

Abstract 5517: Antitumor effect of LRIG1, negative regulator of ErbB, in lung cancer harboring mutant-EGFR

Abstract Introduction: EGFR is a member of the ErbB family of tyrosine kinase receptors (RTKs) and plays important roles in the pathogenesis of certain human cancers. In non-small cell lung cancer (NSCLC), mutations in EGFR gene are commonly known as oncogenic driver mutation and targeted for treatment. Leucine rich repeat and immunoglobulin-like domain protein-1 (LRIG1) is a cell surface protein and known as a negative regulator of ErbB family. In brain tumor, LRIG1 was reported to downregulate not only wild-type EGFR, but also EGFRvIII, mutant-type EGFR. But there has been no report about the relationship between LRIG1 and EGFR mutation in the kinase domain frequently found in lung cancer. In this study, we investigate the role of LRIG in EGFR mutant lung cancer from the view point of its effect on signal transduction and cell proliferation and invasion. Method: We examined the LRIG1 expression levels in lung cancer cell lines and the surgically resected primary lung cancer tissues by quantitative PCR assay. We made stable clone of EGFR-mutant cell line (HCC827; exon19del E746-A750) overexpressing GFP tagged LRIG1, and compared with stable clone overexpressing GFP alone. Results: The LRIG1 expression levels in lung cancer cell lines and the surgically resected primary lung cancer tissues were much lower than that in normal bronchial epithelial cells and their normal tissues, respectively. The introduction of LRIG1 decreased EGFR expression and their phosphorylation in EGFR-mutant cell line. LRIG1 strongly suppressed cell proliferation, invasion and migration of EGFR-mutant cell line. In addition, a phospho-RTK array revealed that LRIG1 also downregulated the other RTKs, such as HER2, HER3, MET, and IGF-1R. Conclusion: Our findings demonstrates that LRIG1 decreases the expression and phosphorylation of mutant-EGFR protein and has strong anti-tumor effect in lung cancer harboring EGFR mutation. These findings suggest the importance of LRIG1 related studies to develop a novel strategy for EGFR mutant cancers. Citation Format: Hidejiro Torigoe, Shinichi Toyooka, Masakiyo Sakaguchi, Kazuhiko Shien, Hiromasa Yamamoto, Junichi Soh, Hiroaki Asano, Shuta Tomida, Kazunori Tsukuda, Shinichiro Miyoshi. Antitumor effect of LRIG1, negative regulator of ErbB, in lung cancer harboring mutant-EGFR [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5517. doi:10.1158/1538-7445.AM2017-5517

Brain imaging before primary lung cancer resection: a controversial topic.

ObjectiveInternational and national recommendations for brain imaging in patients planned to undergo potentially curative resection of non-small-cell lung cancer (NSCLC) are variably implemented throughout the United Kingdom [Hudson BJ, Crawford MB, and Curtin J et al (2015) Brain imaging in lung cancer patients without symptoms of brain metastases: a national survey of current practice in England Clin Radiol https://doi.org/10.1016/j.crad.2015.02.007]. However, the recommendations are not based on high-quality evidence and do not take into account cost implications and local resources. Our aim was to determine local practice based on historic outcomes in this patient cohort.MethodsThis retrospective study took place in a regional thoracic surgical centre in the United Kingdom. Pathology records for all patients who had undergone lung resection with curative intent during the time period January 2012–December 2014 were analysed in October 2015. Electronic pathology and radiology reports were accessed for each patient and data collected about their histological findings, TNM stage, resection margins, and the presence of brain metastases on either pre-operative or post-operative imaging. From the dates given on imaging, we calculated the number of days post-resection that the brain metastases were detected.Results585 patients were identified who had undergone resection of their lung cancer. Of these, 471 had accessible electronic radiology records to assess for the radiological evidence of brain metastases. When their electronic records were evaluated, 25/471 (5.3%) patients had radiological evidence of brain metastasis. Of these, five patients had been diagnosed with a brain metastasis at initial presentation and had undergone primary resection of the brain metastasis followed by resection of the lung primary. One patient had been diagnosed with both a primary lung and a primary bowel adenocarcinoma; on review of the case, it was felt that the brain metastasis was more likely to have originated from the bowel cancer. One had been clinically diagnosed with a cerebral abscess while the radiology had been reported as showing a metastatic deposit. Of the remaining 18/471 (3.8%) patients who presented with brain metastases after their surgical resection, 12 patients had adenocarcinoma, four patients had squamous cell carcinoma, one had basaloid, and one had large-cell neuroendocrine. The mean number of days post-resection that the brain metastases were identified was 371 days, range 14–1032 days, median 295 days (date of metastases not available for two patients).ConclusionThe rate of brain metastases identified in this study was similar to previous studies. This would suggest that preoperative staging of the central nervous system may change the management pathway in a small group of patients. However, for this group of patients, the change would be significant either sparing them non-curative surgery or allowing aggressive management of oligometastatic disease. Therefore, we would recommend pre-operative brain imaging with MRI for all patients undergoing potentially curative lung resection.

FDG PET/CT Overcomes Discordance Between Clinical and Pathologic TNM Classification of Small-size Primary Lung Cancer: Influence on Postoperative Prognosis

IntroductionWe aimed to determine the concordance between the clinical stage (c-stage) and pathologic stage (p-stage) for patients with small-size lung cancer. Additionally we searched for prognostic factors other than the TNM stage. Patients and MethodsWe retrospectively reviewed the preoperative multidetector computed tomography (CT) and positron emission tomography/CT reports, surgical records, and pathologic reports of patients with primary lung cancer ≤ 3 cm. The Union for International Cancer Control TNM seventh edition classification of c-stage and p-stage were compared. The tumors were classified into multiple subgroups by concordance or discordance between the c-stage and p-stage. Disease-free survival (DFS) was assessed using survival analysis to assess the tumor characteristics that were predictive of prognosis. ResultsA total of 289 surgically resected primary lung cancers were evaluated. The concordance between c-stage and p-stage was 65.4%, with moderate reproducibility (kappa coefficient, 0.467). The upstaging rate from c-stage I to p-stage II-IV was 9.4%, and these patients had significantly worse DFS than those with a concordant stage I classification (P < .001). The main reason for upstaging was an underestimation of metastases to the hilar lymph nodes (n = 7) or mediastinal lymph nodes (n = 11). A multivariate Cox proportional hazards model showed that the significant predictive factors for DFS were p-stage (hazard ratio, 1.342; P = .003) and maximum standardized uptake value on positron emission tomography/CT (hazard ratio, 12.162; P = .001). ConclusionThe concordance rate between c-stage and p-stage for small primary lung cancers had moderate reproducibility. Discordance between c-stage I and p-stage II-IV significantly affected DFS. The maximum standardized uptake value of the primary lesion was an independent prognostic factor, and combining it with c-stage might improve the prediction of therapeutic outcomes.

Surgical Outcomes of Non-small Cell Lung Cancer in Patients with a History of Pancreaticobiliary Cancer.

To determine the efficacy of surgery for non-small cell lung cancer in patients who had previously undergone surgery for pancreaticobiliary cancer. Seven patients who underwent pulmonary resection for primary lung cancer after curative surgery for pancreaticobiliary cancer at our Institution from 2006 to 2016 were retrospectively evaluated. Five patients had metachronous and two patients had synchronous cancer of pancreaticobiliary and lung origin. The median time between surgeries for the two cancers was 35 months. All patients underwent complete resection of both cancers. The 5-year survival was 68.6% after pulmonary resection. Two patients had recurrence after lung surgery, with a mean recurrence-free interval of 6.5 months. Surgery should be considered for lung cancer in patients who have undergone curative surgery for pancreaticobiliary cancer.