P1.22: Temporal Survival Improvement for Stage-II (T3N0M0) Lung Adenocarcinoma After Pulmonary Lobectomy

Morphological analysis of blood vessels near lung tumors using 3-D quantitative CT

BACKGROUND

Improved visualization of lung cancer-associated vessels is vital.

OBJECTIVE

To evaluate the efficacy of 3-D quantitative CT in lung cancer-associated pulmonary vessel assessment.

METHODS

Vascular CT changes were assessed visually and using FACT-Digital lung TM software (n = 162 patients, 178 controls). The total number of pulmonary vessels (TNV) and mean lumen area of pulmonary vessels (MAV) vertical to cross-sections of fifth/sixth-generation bronchioles were measured.

RESULTS

Visual investigation revealed fewer ipsilateral pulmonary vascular abnormalities in lung cancer (151/162) than did quantitative CT (162/162), and required more time (3.2±1.5 vs. 2.5±1.3 min) (P < 0.05). CT measurements revealed that the TNV vertical to the fifth-generation bronchial cross-section of the ipsilateral, contralateral, and control groups was 14.58±4.75, 9.58±3.74, and 10.22±4.07 and the MAV in these groups was 99.70±26.20, 58.76±29.29, and 57.76±18.32, respectively. The TNV vertical to the sixth-generation bronchial cross-section of the ipsilateral, contralateral, and control groups was 16.64±5.14, 11.59±4.06, and 11.75±4.16 and the MAV was 110.22±31.47, 67.62±30.41, and 60.24±16.18, respectively. The TNV and MAV in ipsilateral lung cancer tissues exceeded those in the contralateral side and control group tissues (P < 0.001).

CONCLUSIONS

Automated 3-D quantitative CT could successfully characterize pulmonary vessels and their lung cancer-associated changes.

Lobectomy for non-small cell lung carcinoma: a nationwide study of short- and long-term survival

INTRODUCTION

Lobectomy is the standard curative treatment for non-small cell carcinoma (NSCLC) of the lung. Most studies on lobectomy have focused on short-term outcome and 30-day mortality. The aim of this study was to determine both short-term and long-term surgical outcome in all patients who underwent lobectomy for NSCLC in Iceland over a 24-year period.

MATERIAL AND METHODS

The study involved 489 consecutive patients with NSCLC who underwent lobectomy with curative intent in Iceland, 1991-2014. Patient demographics, pTNM stage, rate of perioperative complications, and 30-day mortality were registered. Overall survival was analyzed with the Kaplan?Meier method. The Cox proportional hazards model was used to evaluate factors that were prognostic of overall mortality. To study trends in survival, the study period was divided into six 4-year periods. The median follow-up time was 42 months and no patients were lost to follow-up.

RESULTS

The average age of the patients was 67 years and 53.8% were female. The pTNM disease stage was IA in 148 patients (30.0%), IB in 125 patients (25.4%), IIA in 96 patients (19.5%), and IIB in 50 patients (10.1%), but 74 (15.0%) were found to be stage IIIA, most often diagnosed perioperatively. The total rate of major complications was 4.7%. Thirty-day mortality was 0.6% (three patients). One- and 5-year overall survival was 85.0% and 49.2%, respectively, with 3-year survival improving from 48.3% to 72.8% between the periods 1991-1994 and 2011-2014 (p = .0004). Advanced TNM stage and age were independent negative prognostic factors for all-cause mortality, and later calendar year and free surgical margins were independent predictors of improved survival.

CONCLUSIONS

The short-term outcome of lobectomy for NSCLC in this population-based study was excellent, as reflected in the low 30-day mortality and low rate of major complications. The long-term survival was acceptable and the overall 3-year survival had improved significantly during the study period.