Adjuvant chemotherapy for pathological stage I non-small cell lung cancer with high-risk factors for recurrence: A multicenter study.

8500 Background: The role of adjuvant chemotherapy for pathological stage I non-small cell lung cancer (NSCLC) is controversial. The purpose of this study was to investigate the effect of adjuvant chemotherapy for pathological stage I NSCLC with high-risk factors for recurrence. Methods: Prospectively collected data from 1,278 patients with pathological stage I (8th edition) NSCLC undergoing lobectomy were retrospectively analyzed. High-risk factors for recurrence were determined by multivariable Cox proportional hazards model for recurrence-free survival (RFS). RFS, overall survival (OS), and cancer-specific survival (CSS) were compared between patients who received adjuvant chemotherapy and those who did not. Results: In multivariable analysis, age (≥70 y; hazard ratio [HR], 2.14), invasive component size ( > 2 cm; HR, 1.60), visceral pleural invasion (HR, 1.81), lymphatic permeation (HR, 1.67), and vascular invasion (HR, 2.78) were identified as independent factors for RFS. In patients with high-risk factors for recurrence such as invasive component size of > 2 cm, visceral pleural invasion, lymphatic permeation, or vascular invasion (high-risk group; n = 641), RFS was significantly different between patients who received adjuvant chemotherapy (n = 222; 5-y RFS, 81.4%) and those who did not (n = 418; 5-y RFS, 73.8%; P = 0.023). OS and CSS were also significantly better in patients who received adjuvant chemotherapy (5-y OS, 92.7%; 5-y CSS, 95.0%) than in those who did not (5-y OS, 81.7%; P < 0.0001; 5-y CSS, 89.5%; P = 0.012). In patients without any high-risk factors for recurrence (low-risk group; n = 637), RFS was not significantly different between patients who received adjuvant chemotherapy (n = 83; 5-y RFS, 98.1%) and those who did not (n = 554; 5-y RFS, 95.7%; P = 0.30). OS and CSS were also not significantly different between patients who received adjuvant chemotherapy (5-y OS, 98.0%; 5-y CSS, 100%) and those who did not (5-y OS, 95.6%; P = 0.35; 5-y CSS, 99.4%; P = 0.52). Conclusions: Adjuvant chemotherapy may improve survival in patients with pathological stage I NSCLC who have high-risk factors for recurrence such as invasive component size of > 2 cm, visceral pleural invasion, lymphatic permeation, or vascular invasion.

Lauren Histology and Lymphatic Permeation are Critical Prognostic Factors in Borrmann Type I Gastric Cancer

Macroscopic Borrmann type I is relatively rare in advanced gastric cancer, and its detailed prognostic traits are unknown. Among 5172 gastric cancer patients between 1971 and 2013, 114 cases with macroscopic Borrmann type I were identified (2.2%), among which 112 displayed clinicopathologic factors. Univariate prognostic factors with statistical significance were initially selected, which were further applied to the multivariate proportional hazards model. Recently, postoperative adjuvant chemotherapy was recommended for stage II/III gastric cancer patients. Results were as follows: (1) Five-year overall survival (OS) was 66% in Borrmann type I gastric cancer. Five-year relapse-free survival (RFS) was 100%, 87.1%, and 65.5% in stage IA, stage IB, and stage II/III, respectively. (2) Multivariate proportional hazard model for OS identified lymphatic permeation [hazard ratio (HR) = 4.8–7.5, P = 0.0021] and age (HR = 2.4, P = 0.026), while the multivariate analysis for RFS identified histology (HR = 3.5, P = 0.018) and lymphatic permeation (HR = 3.5–4.7, P = 0.049) as independent prognostic factors. (3) Recurrence was recognized more in liver of the intestinal type histology. Diffuse type histology with robust lymphatic invasion was all attributed to stage II/III, which occurred largely within 1 year and exhibited 49% RFS. Recurrence pattern of Borrmann Type I gastric cancer with intestinal type histology is unique, and patients with high risk for recurrences were enriched in diffuse type histology with robust lymphatic invasion.

Regional Node Distribution in Papillary Thyroid Cancer with Microscopic Metastasis

Background. Optimal neck lymphadenectomy in patients with papillary thyroid cancer (PTC) and microscopic lymph node metastasis needs to be defined in order to aid surgeons in their decision about the best way to proceed in these cases.Methods. Patients who underwent total thyroidectomy and lymphadenectomy at levels IIa to VI were divided into two groups: Group 1 (G1) with macroscopic metastasis detected before surgery and Group 2 (G2) with microscopic metastasis detected in sentinel node during surgery. Odds ratio (OR) was computed for age, sex, tumor size, multicentricity, capsular invasion, vascular/lymphatic permeation, and nodes with metastasis.Results. Primary tumor size was (G1 versus G2, respectively) 3.8 cm versus 1.98 cm (P<0.001); only lymphatic permeation was correlated to an increase in metastasis in lymph nodes 65.4% versus 25% (OR=5.6, p<0.001); metastatic frequency by region was IIa 18.5% versus 1.5%, III 24.3% versus 9.9%, IV 17.4% versus 18.1%, and VI 25.9% versus 71,2%. Metastasis to level V was found only in G1.Conclusion. Selective lymphadenectomy at levels III, IV, and VI is optimal for PTC patients without preoperative evidence of lymph node disease, but who present with lymph node microscopic metastasis in an intraoperative assessment.

Early-onset gastric cancer: A distinct clinical entity with a different prognosis?

22 Background: This study aimed to evaluate the early onset gastric cancer (EOGC), considered as gastric cancer in a patient younger than 45 years, as a distinct entity with a different prognosis. Methods: This study is related to 1,256 patients admitted with gastric or gastroesophageal junction carcinoma in our department between January 1988 and December 2008. There were 10.59% (133 cases) of EOGC in our series. The following clinical, pathological and staging parameters were studied: age, gender, tumor location, ressecability, type of resection surgery, type of resection, type of lymphadenectomy (Siewert and Japanese classifications), number of lymph nodes studied, tumor dimensions, macroscopic form, histological classification (Lauren and Ming), venous invasion, lymphatic permeation, perineural invasion, depth wall invasion (T), lymph node metastases (N) – TNM and Japanese classification and lymph node ratio – distance metastases (M) and stage. Results: Significant differences were observed in the type of resection surgery (p<0.001) and type of lymphadenectomy (p=0.008), with more radical surgery performed in EOGC patients. Some tumor characteristics also showed significant differences: tumor dimensions (p=0.004), with EOGC usually smaller; diffuse type according to Lauren's classification (p<0.001); infiltrative type according to Ming's classification (p=0.001); less venous invasion (p=0.005); less lymphatic permeation (p=0.029). There were no significant differences in the staging parameters. There were significant differences in the survival rate (p<0.001), with 5-year survival rate of 44% in patients with EOGC compared with 31% in older patients. Cox-regression analysis revealed that age was an independent prognostic factor (HR 2,166, 1,133-4,139 CI 95%, p = 0.019), as well as depth wall invasion (T) and lymph node ratio. Conclusions: In this study, EOGC revealed to be a distinct clinical entity that presented differences in various clinico-pathological parameters. Despite EOGC presented more aggressive pathological characteristics, there was a better survival in this group, probably because the physical status of younger patients which allowed a more aggressive treatment. No significant financial relationships to disclose.

Verification of the newly proposed T category (7th edition of the TNM classification) from a clinicopathologic viewpoint in non-small cell lung cancer

7533 Background: The proposed revision of the TNM classification by the International Association for the Study of Lung Cancer (IASLC) has been determined and validated based on the overall survival data. In the present study, we verified the T classification, which was the major point of revision regarding the newly proposed TNM classification, from a viewpoint of the clinico-pathologic findings at the primary tumor site. Methods: The medical records of 621 patients with primary non-small cell lung cancer (NSCLC) who underwent a complete resection at our institution from 1990 through 2003 were reviewed for the clinico-pathologic variables. The patients ranged in age from 31 to 87 years old with a mean of 66.4. The male:female ratio was 382:239. The adenocarcinoma:non-adenocarcinoma ratio was 449:220. Results: According to greatest dimension of the primary tumors, the 5-year postoperative survival was 77.8% for T1a (2cm>; n=168), 63.3% for T1b (3cm>; n=169), 46.4% for T2a (5cm>; n=205), 38.8% for T2b (7cm>; n=48), and 21.4% for T3 (7cm<; n=31) (p<0.001). The incidence of lymphatic permeation within the primary tumor was 12.5% for T1a, 17.2% for T1b, 29.8% for T2a, 35.4% for T2b, and 32.3% for T3 (T1b vs. T2a p<0.05). The incidence of vascular invasion within the primary tumor was 17.8% for T1a, 24.9% for T1b, 35.3% for T2a, 54.2% for T2b, and 64.5% for T3 (T1b vs. T2a, T2a vs. T2b, p<0.05). On the other hand, the incidence of pleural invasion of the primary tumor was 18.1 % for T1a, 29.4% for T1b, 49.3% for T2a, 47.3% for T2b, and 87.5% for T3 (T1a vs. T1b, T1b vs. T2a, T2b vs.T3, p<0.05). Significant differences were observed among the newly revised T subsets in at least one incidence of lymphatic permeation, vascular invasion or pleural invasion. Conclusions: The newly revised T classification, which is based mainly on the tumor dimension, is therefore considered both effective and appropriate for the pathological findings of the primary tumor. No significant financial relationships to disclose.