The role of lymphatic vascular invasion in the prognosis and determination of therapy in surgically resected non-small cell carcinoma of the lung.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7554-7554
Author(s):  
Malcolm M. DeCamp ◽  
Adin-Cristian Andrei ◽  
Satvik Ramakrishna ◽  
Laura Nyshel Medford-Davis ◽  
Julia Shelkey ◽  
...  
Keyword(s):  
Vascular Invasion ◽  
Total Population ◽  
Distant Recurrence ◽  
Small Cell ◽  
Matched Pairs ◽  
Prognostic Information ◽  
Factors Affecting ◽  
Distant Failure ◽  
Resected Nsclc ◽  
The Impact

7554 Background: Lymphatic-vascular invasion (LVI) is not currently considered in staging of non-small cell lung cancer (NSCLC). We assessed the impact of LVI on overall survival (OS), local/distant recurrence (LR/DR) and patterns of recurrence. Methods: 869 consecutive patients who underwent a definitive surgical resection ± adjuvant chemotherapy for NSCLC from 2000–2008 were qualified for analysis if they did not receive any adjuvant/neo-adjuvant radiotherapy, had at least three months of follow-up, and did not have a history of other cancers within 5 years. Tumors with LVI (N = 160) were compared to tumors without LVI (N = 705). LR/DR rates at 2,3, and 5 years were calculated by the methods of Kaplan-Meier. Association between LVI and OS and LR/DR were compared in the total population and in a propensity matched population (PS) by factors affecting OS and LR/DR (n=160 matched pairs). Results: OS, LR, and DR were significantly worse in patients with LVI in the total population and in the subset of patients matched by propensity score (Table). In the PS-matched pairs, LVI was associated with a greater number of N1 nodes involved, a longer length of stay, higher histologic grade, and higher T-stage. Patterns of local failure (P<.001) but not distant failure (P=.11) differed between patients with and without LVI. Tumors with LVI were 3-fold more likely to recur in ipsilateral mediastinal nodes. In a subset analysis of tumors < 4cm (n=121 PS matched pairs), LVI was also associated with higher LR, DR, a lower OS and a 4-fold risk of mediastinal nodal recurrence. Conclusions: Detection of LVI in resected NSCLC predicts aggressive biologic behavior and provides important prognostic information. LVI may help identify high-risk cohorts within discreet TNM stages who could benefit from adjuvant therapies. [Table: see text]

scholarly journals Multicentre study on the consistency of PD-L1 immunohistochemistry as predictive test for immunotherapy in non-small cell lung cancer

2019 ◽  
Vol 73 (7) ◽  
pp. 423-430
Author(s):  
Rogier Butter ◽  
Nils A 't Hart ◽  
Gerrit K J Hooijer ◽  
Kim Monkhorst ◽  
Ernst-Jan Speel ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Interobserver Variability ◽  
Small Cell ◽  
Predictive Test ◽  
Small Cell Lung ◽  
Resected Nsclc ◽  
Interlaboratory Variability ◽  
The Impact

AimsInvestigate the impact of interlaboratory- and interobserver variability of immunohistochemistry on the assessment of programmed death ligand 1 (PD-L1) in non-small cell lung cancer (NSCLC).MethodsTwo tissue microarrays (TMAs) were constructed from 50 (TMA-A) and 51 (TMA-B) resected NSCLC cases, and distributed among eight centres. Immunostaining for PD-L1 was performed using Agilent’s 22C3 pharmDx Assay (pharmDx) and/or a 22C3 laboratory developed test (LDT). The interlaboratory variability of staining- and interobserver variability of scoring for PD-L1 were assessed in selected critical samples (samples at the cut-off of positivity) and non-critical samples. Also, PD-L1 epitope deterioration in time in stored unstained slides was analysed. Krippendorff’s alpha values (0=maximal, 1=no variability) were calculated as measure for variability.ResultsFor interlaboratory variability of immunostaining, the percentage of PD-L1 positive cases among centres ranged 40%–51% (1% cut-off) and 23%–30% (50% cut-off). Alpha values at 1% cut-off were 0.88 (pharmDx) and 0.87 (LDT) and at 50% cut-off 0.82 (pharmDx) and 0.95 (LDT). Interobserver variability of scoring resulted in PD-L1 positive cases ranging 29%–55% (1% cut-off) and 14%–30% (50% cut-off) among pathologists. Alpha values were at 1% cut-off 0.83 (TMA-A) and 0.66 (TMA-B), and at 50% cut-off 0.77 (TMA-A) and 0.78 (TMA-B). Interlaboratory variability of staining was higher (p<0.001) in critical samples than in non-critical samples at 50% cut-off. Furthermore, PD-L1 epitope deterioration in unstained slides was observed after 12 weeks.ConclusionsThe results provide insight in factors contributing to variability of immunohistochemical assessment of PD-L1, and contribute to more reliable predictive testing for PD-L1.

Varying recurrence rates and risk factors associated with different definitions of local recurrence in patients with surgically resected stage I non-small cell lung cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7583-7583
Author(s):  
L. N. Medford-Davis ◽  
J. Varlotto ◽  
A. Recht ◽  
J. C. Flickinger ◽  
M. M. DeCamp
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Local Recurrence ◽  
Small Cell Lung Cancer ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Significant Risk ◽  
Small Cell ◽  
Small Cell Lung ◽  
Distant Failure

7583 Background: To examine the effects of different definitions of local recurrence on the reported patterns of failure and associated risk factors in patients undergoing potentially curative resection of Stage I non-small cell lung cancer (NSCLC). Methods: The study included 306 consecutive patients treated from 2000–2005 without radiotherapy. Local recurrence was defined as either: “radiation” (i.e., recurrences confined to the post-operative radiotherapy fields used in the Phase III trial of adjuvant radiotherapy by Trodella et al) (LRR), including the bronchial stump, staple line, the ipsilateral hilum, and ipsilateral mediastinum; or “comprehensive” (LRC), including these sites plus the ipsilateral lung and contralateral mediastinal and hilar nodes. Results: The median follow-up was 33 months. Proportions of LRC and LRR at 2, 3 and 5 years were 14%, 21% and 29%; and 7%, 12%, and 16%, respectively. Significant risk factors for LRC on multivariable analysis were diabetes, lymphatic vascular invasion and tumor size; significant factors for LRR were resection of less than a lobe and lymphatic vascular invasion. Distant (non-local) relapse proportions using these definitions at 2, 3 and 5 years were 10%, 12%, and 18%; and 14%, 19%, and 29%, respectively. Significant risk factors for distant failure were histology when using the LRC definitions and tumor size using the LRR definition. Conclusions: Local recurrence increased nearly two-fold when a broad definition was used, rather than a narrow one. The definition also affected which factors were significantly associated with both local and distant failure on multivariate analysis. Comparable definitions must be used when analyzing different series. No significant financial relationships to disclose.

Polymorphisms in the CASPASE Genes and Survival in Patients With Early-Stage Non–Small-Cell Lung Cancer

2009 ◽  
Vol 27 (34) ◽  
pp. 5823-5829 ◽  
Author(s):  
Seung Soo Yoo ◽  
Jin Eun Choi ◽  
Won-Kee Lee ◽  
Yi-Young Choi ◽  
Sin Kam ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Disease Free Survival ◽  
Small Cell ◽  
Small Cell Lung ◽  
Functional Polymorphisms ◽  
Resected Nsclc ◽  
The Impact

Purpose This study was conducted to determine the impact of potentially functional polymorphisms in the CASPASE (CASP) genes on the survival of early-stage non–small-cell lung cancer (NSCLC) patients. Patients and Methods Four hundred eleven consecutive patients with surgically resected NSCLC were enrolled. Nine potentially functional polymorphisms in the CASP3, CASP7, CASP8, CASP9, and CASP10 genes were investigated. The genotype and haplotype associations with overall survival (OS) and disease-free survival (DFS) were analyzed. Results Patients with the rs2227310 GG genotype had a significantly decreased OS and DFS compared with patients with the CC + CG genotype (adjusted hazard ratio [aHR] for OS, 1.67; 95% CI, 1.19 to 2.35; P = .003; aHR for DFS, 1.62; 95% CI, 1.19 to 2.22; P = .002). The rs4645981C>T genotype also had a significant effect on OS and DFS (under a recessive model; aHR for OS, 2.00; 95% CI, 1.04 to 3.85; P = .04; aHR for DFS, 2.76; 95% CI, 1.58 to 4.80; P = .0003). When the rs2227310 and rs4645981 genotypes were combined, patients with one or two bad genotypes had worse OS and DFS compared with those who had zero bad genotypes (aHR for OS, 1.75; 95% CI, 1.25 to 2.45; P = .001; aHR for DFS, 1.66; 95% CI, 1.23 to 2.26; P = .001). Conclusion The CASP7 rs2227310 and CASP9 rs4645981 polymorphisms may affect survival in early-stage NSCLC. The analysis of these polymorphisms can help identify patients at high risk for a poor disease outcome.

scholarly journals Intrahepatic cholangiocarcinoma: An international, multi-institutional analysis of prognostic factors and lymph node assessment.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 162-162 ◽  
Author(s):  
T. M. Pawlik ◽  
C. Pulitano ◽  
S. Alexandrescu ◽  
T. C. Gamblin ◽  
C. Ferrone ◽  
...  
Keyword(s):  
Lymph Node ◽  
Median Survival ◽  
Intrahepatic Cholangiocarcinoma ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Primary Liver Cancer ◽  
Margin Status ◽  
Prognostic Information ◽  
Factors Associated ◽  
The Impact

162 Background: Intrahepatic cholangiocarcinoma (ICC) is a rare and poorly understood primary liver cancer. The role of routine lymphadenectomy at the time of surgical resection remains poorly defined. We sought to identify factors associated with outcome following surgical management of ICC and examine the impact of lymph node (LN) assessment on survival. Methods: 411 patients who underwent curative intent surgery for ICC between 1973-2010 were identified from an international multi-institutional database. Clinical and pathologic data were evaluated using uni- and multivariate analyses. Results: Median tumor size was 6.5 cm. Most patients had a solitary tumor (55%) and no evidence of vascular invasion (64%). Resection involved ≥hemi-hepatectomy (74%) and margin status was R0 (82%). Overall median survival was 28 months and 5-year survival was 32%. Factors associated with adverse prognosis included positive margin status (HR=3.11; p<0.001), multiple lesions (HR=2.16; p=0.007) and vascular invasion (HR=2.13; p=0.01). Tumor size was not a prognostic factor (HR=1.05; p=0.08). Lymphadenectomy was performed in 233 (57%) patients; 87 (37%) had LN metastasis. LN metastasis was associated with worse outcome (median survival: N0 39 months vs. N1 21 months; p=0.02). Preoperative factors such as tumor size, number, and morphologic subtype did not predict presence of LN metastasis (all p>0.05); however, vascular invasion did (OR=2.24; p=0.003). Conclusions: While tumor size provides no prognostic information, tumor number, vascular invasion, and LN metastasis were associated with survival. Presence of LN metastasis cannot be predicted using preoperative tumor features. Lymphadenectomy should be routinely performed for ICC as up to one-quarter of patients will have LN metastasis. No significant financial relationships to disclose.

scholarly journals The Factors Affecting Poverty Rate in Central Java Province 2018-2020

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Solikhin Solikhin
Keyword(s):  
Human Development ◽  
Human Development Index ◽  
Total Population ◽  
Poverty Rate ◽  
Provincial Government ◽  
Factors Affecting ◽  
Development Index ◽  
Central Java ◽  
The Impact ◽  
Central Java Province

One of the Central Java Provincial Government programs is to reduce the number of people living in poverty. The Central Java Provincial Government target in 2020 was to lower poverty rate to below ten percent. Therefore, it is necessary to determine factors affecting the poverty rate in Central Java. This study aimed to analyze the effect of the Human Development Index, total population, Gross Regional Domestic Product (GDRP), and the impact of the Covid-19 pandemic on the poverty rate in regencies/municipalities in Central Java.  The study on the impact of the Covid-19 pandemic on the poverty rate in Central Java Province has never been carried out. This study was different from the previous studies. This study used panel data regression by using 2018-2020 data from Statistics Indonesia (BPS). In this study, the result of the best model selection was the random effect model. The result of this study indicated that Human Development Index (HDI) had a negative and significant effect, total population had a positive and insignificant, GRDP had a negative and significant effect, and the impact of Covid-19 pandemic had a positive and significant effect on the poverty rate. Keywords: Impact of Covid-19, Human Development Index, Population,                    Poverty Rate, Gross Regional Domestic Product.

scholarly journals Intrahepatic Cholangiocarcinoma: An International Multi-Institutional Analysis of Prognostic Factors and Lymph Node Assessment

2011 ◽  
Vol 29 (23) ◽  
pp. 3140-3145 ◽  
Author(s):  
Mechteld C. de Jong ◽  
Hari Nathan ◽  
Georgios C. Sotiropoulos ◽  
Andreas Paul ◽  
Sorin Alexandrescu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Median Survival ◽  
Intrahepatic Cholangiocarcinoma ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Relative Effect ◽  
Prognostic Information ◽  
Factors Associated ◽  
Tumor Number ◽  
The Impact

Purpose To identify factors associated with outcome after surgical management of intrahepatic cholangiocarcinoma (ICC) and examine the impact of lymph node (LN) assessment on survival. Patients and Methods From an international multi-institutional database, 449 patients who underwent surgery for ICC between 1973 and 2010 were identified. Clinical and pathologic data were evaluated using uni- and multivariate analyses. Results Median tumor size was 6.5 cm. Most patients had a solitary tumor (73%) and no vascular invasion (69%). Median survival was 27 months, and 5-year survival was 31%. Factors associated with adverse prognosis included positive margin status (hazard ratio [HR], 2.20; P < .001), multiple lesions (HR, 1.80; P = .001), and vascular invasion (HR, 1.59; P = .015). Tumor size was not a prognostic factor (HR, 1.03; P = .23). Patients were stratified using the American Joint Committee on Cancer/International Union Against Cancer T1, T2a, and T2b categories (seventh edition) in a discrete step-wise fashion (P < .001). Lymphadenectomy was performed in 248 patients (55%); 74 of these (30%) had LN metastasis. LN metastasis was associated with worse outcome (median survival: N0, 30 months v N1, 24 months; P = .03). Although patients with no LN metastasis were able to be stratified by tumor number and vascular invasion (N0; P < .001), among patients with N1 disease, multiple tumors and vascular invasion, either alone or together, failed to discriminate patients into discrete prognostic groups (P = .34). Conclusion Although tumor size provides no prognostic information, tumor number, vascular invasion, and LN metastasis were associated with survival. N1 status adversely affected overall survival and also influenced the relative effect of tumor number and vascular invasion on prognosis. Lymphadenectomy should be strongly considered for ICC, because up to 30% of patients will have LN metastasis.

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