New Proposals for Lung Cancer Staging Akif Turna, MD, PhD, FETCS Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.

Slides:

Advertisements

Similar presentations

Advances and Emerging Therapy for Lung Cancer

Advertisements

Post-operative Radiotherapy for Esophageal Cancer Parag Sanghvi, M.D., M.S.P.H. Department of Radiation Medicine Esophageal Care Conference 3/26/2007.

Zeroing in on Non-Small Cell Lung Cancer: Integrating Targeted Therapies into Practice.

Tumor Markers Lecture one By Dr. Reem Sallam. Objectives  To briefly introduce cancers, their incidence, some common terms, and staging system.  To.

Joint Hospital Surgical Grand Round KL FOK NDH/AHNH Department of Surgery.

Tumor Markers Lecture one By Dr. Waheed Al-Harizi.

HKS Tumore HKS Tumore Epigenetics in glioma - MGMT, ABCB1 and ABCG2 methylation in glioma Moritz C. Oberstadt, PhD.

Ji Young Lee, MD, PhD, David Marchetti, MD, M Steven Piver, MD Department of Obstetrics and Gynecology Sisters of Charity Hospital, Buffalo, NY The Clinical.

Genetic Variations in the PI3K/PTEN/AKT/mTOR Pathway are Associated with Clinical Outcomes in Esophageal Cancer Patients Treated with Chemoradiotherapy.

ERCC 1 isoform expression and DNA repair in NSCLC

Multimodality therapy for locally advanced thymomas: a cohort study of prognostic factors from a European multicentric database Dr. GIOVANNI LEUZZI Department.

LUNG ADENOCARCINOMAS. CLINICOPATHOLOGICAL STUDY WITH RESPECT TO THE UPCOMING NEW CLASSIFICATION AND EGFR-KRAS MUTATION ANALYSIS IMPLICATIONS. First author:

Ovarian Clear Cell Carcinomas - from the eyes of biological markers Speaker: Cheng MH Modulator: Twu NF Date: Jan 15, 2007.

What is the Preferable Treatment Option for T1/T2 Low Rectal Cancer? Christopher H. Crane, M.D. Program Director, GI Section Department of Radiation Oncology.

NSCLC stage IIIA type of chemotherapy ? Swiss tumor board Bern – Dr. Christian Monnerat Département Pluridisciplaire d’Oncologie – Hôpital Neuchâtelois.

Gene Expression Signatures for Prognosis in NSCLC, Coupled with Signatures of Oncogenic Pathway Deregulation, Provide a Novel Approach for Selection of.

First Author: Radu Cristina Co-Authors: Stefan Anda Tripon Florin Crauciuc George Coordinators: Banescu Claudia, MD Demian Smaranda, MD The importance.

Supplementary Figure 2: Representative Kaplan-Meier plots of overall survival considering alterations erbB signaling pathway genes and p53 in lung cancer.

Approaching early stage disease

Personalized medicine in lung cancer R4 김승민. Personalized Medicine in Lung Cancer patients with specific types and stages of cancer should be treated.

Adjuvant and Neoadjuvant Therapy in Non- Small Cell Lung Cancer Seminars in Oncology 2oo5;32 (suppl 2):S9-S15 Kyung Hee Medical Center Department of Thoracic.

Lung cancer Gene Kukuy, MD Cardiothoracic Surgery.

Surgical Treatment and Prognosis of Primitive Neuroectodermal Tumors of the Thorax Adalet Demir, MD, Mehmet Zeki Gunluoglu, MD, Nergiz Dagoglu, MD, Akif.

Treatment of Stage I and II Non-small Cell Lung Cancer

Comparison between Pathologic Characteristics of Her2 Negative and Positive Breast Cancer in a Single Cancer Center in Jordan DR Majdi A. Al Soudi, MD,

R. Michelle Sarin, MD Mentor: Jeffrey Fowler, MD

Prognosis of younger patients in non-small cell lung cancer

Prognostic and Predictive Markers of Benefit from Adjuvant Chemotherapy in Early- Stage Non-small Cell Lung Cancer Ana Belén Custodio, MD, José Luis González-Larriba,

Introduction. For Pulmonologists by Pulmonologists: Diagnosis of NSCLC in an Age of Biomarkers.

Ratio of Metastatic Lymph Nodes to Total Number of Nodes Resected is Prognostic for Survival in Esophageal Carcinoma Clive J. Kelty, MB, ChB, PhD, FRCSEd,

Treatment of Stage I and II Non-small Cell Lung Cancer

Effect of tumor size on prognosis in patients with non–small cell lung cancer: The role of segmentectomy as a type of lesser resection Morihito Okada,

Surgical–pathologic factors affect long-term outcomes in stage IB (pT2 N0 M0) non– small cell lung cancer: A heterogeneous disease Chung-Ping Hsu, MD,

Quality of life after tailored combined surgery for stage I non–small-cell lung cancer and severe emphysema Eugenio Pompeo, MD, Enrico De Dominicis,

Molecular Analysis-Based Treatment Strategies for the Management of Non-small Cell Lung Cancer Howard West, MD, Rogerio Lilenbaum, MD, David Harpole,

Tumor Necrosis as a Prognostic Factor for Stage IA Non-Small Cell Lung Cancer Seong Yong Park, MD, Hyun-Sung Lee, MD, PhD, Hee-Jin Jang, MD, Geon Kook.

Significance of P53 and Rb protein expression in surgically treated non-small cell lung cancers Yung-Chie Lee, MD, PhD, Yih-Leong Chang, MD, Shi-Ping.

Case 1: Introduction. Adjuvant Therapy: Should It Be Considered in Older Patients With NSCLC?

Clinical Prognosis of Superior Versus Basal Segment Stage I Non-Small Cell Lung Cancer Yoshinori Handa, MD, Yasuhiro Tsutani, MD, PhD, Norifumi Tsubokawa,

Yih-Leong Chang, MD, Chen-Tu Wu, MD, Yung-Chie Lee, MD, PhD

Abstracts Journal of Thoracic Oncology

Handling and Evaluation of Breast Cancer Biopsy

Tetsuya Mitsudomi, MD, Hirohito Tada, MD Journal of Thoracic Oncology

Brian N. Arnold, MD, Daniel C. Thomas, MD, MPH, Joshua E

Aberrant Wnt1/β-Catenin Expression is an Independent Poor Prognostic Marker of Non- small Cell Lung Cancer After Surgery Xianhua Xu, MD, Ping-Li Sun,

Prevalence, Prognostic Implications, and Survival Modulators of Incompletely Resected Non–Small Cell Lung Cancer in the U.S. National Cancer Data Base

Mediastinal Lymph Node Examination and Survival in Resected Early-Stage Non– Small-Cell Lung Cancer in the Surveillance, Epidemiology, and End Results.

Intratumoral Lymphatic Vessel Involvement is an Invasive Indicator of Completely Resected Pathologic Stage I Non-small Cell Lung Cancer Masahiko Harada,

Prognostic Significance of Surgical-Pathologic N1 Lymph Node Involvement in Non- Small Cell Lung Cancer Adalet Demir, MD, Akif Turna, MD, PhD, FETCS,

Sesion de Controversias nº 5 Conclusiones Carlos Camps

Quality Improvement and Molecular Profiling in Advanced Non-Small Cell Lung Cancer.

Results of surgical intervention for p-stage IIIA (N2) non–small cell lung cancer: Acceptable prognosis predicted by complete resection in patients with.

Prognostic and Predictive Markers of Benefit from Adjuvant Chemotherapy in Early- Stage Non-small Cell Lung Cancer Ana Belén Custodio, MD, José Luis González-Larriba,

Surgical Therapy for Bilateral Multiple Primary Lung Cancer

Valerie W Rusch, MD, Ennapadam S Venkatraman, PhD

Treated with Neoadjuvant Therapy

Selective Mediastinal Lymphadenectomy for Clinico-Surgical Stage I Non–Small Cell Lung Cancer Morihito Okada, MD, PhD, Toshihiko Sakamoto, MD, PhD, Tsuyoshi.

Pathologic N1 non-small cell lung cancer: Correlation between pattern of lymphatic spread and prognosis Alessandro Marra, MD, PhD, Ludger Hillejan, MD,

Lewis Y antigen expression and postoperative survival in non–small cell lung cancer Fumihiro Tanaka, MD, Ryo Miyahara, MD, Yohsuke Ohtake, MD, Kazuhiro.

Carcinoma of the esophagus: Prognostic significance of histologic type

Edwin van Velzen, MD, Aart Brutel de la Rivière, MD, PhD, Hans J

Neal S Goldstein, MD The Annals of Thoracic Surgery

Nonanatomic prognostic factors in resected nonsmall cell lung carcinoma: the importance of perineural invasion as a new prognostic marker Adnan Sayar,

Completely Resected Non-Small Cell Lung Cancer: Reconsidering Prognostic Value and Significance of N2 Metastases Marc Riquet, MD, PhD, Patrick Bagan,

The tp53 genotype but not immunohistochemical result is predictive of response to cisplatin-based neoadjuvant therapy in stage III non–small cell lung.

Prognostic impact of large cell neuroendocrine histology in patients with pathologic stage Ia pulmonary non–small cell carcinoma Akira Iyoda, MD, Kenzo.

Biomarkers in Early-Stage Non–Small-Cell Lung Cancer: Current Concepts and Future Directions Mauricio Burotto, MD, Anish Thomas, MD, Deepa Subramaniam,

DO NOT POST #4054 Gene expression Difference (GED) Revealed Immune Function Gene UP- or Down-regulation as Tumor-associated Inflammatory Cell (TAIC) Infiltration.

Survival of Patients With Unsuspected pN2 Non-Small Cell Lung Cancer After an Accurate Preoperative Mediastinal Staging Carme Obiols, MD, Sergi Call,

Presentation transcript:

New Proposals for Lung Cancer Staging Akif Turna, MD, PhD, FETCS Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey

Presentation Scheme - Conventional Staging of Lung Cancer - New Staging Proposals - Non-anatomical staging - Histopathological Staging - Molecular Staging - Pathologically tailored surgical therapy - Genotypically tailored surgical therapy - Future directions

Lung Cancer - The Number one cause of cancer deaths worldwide deaths from NSCLC occured in 2006 in US - M1 and N2-3 indicated poorer survival, futile surgery

Conventional Staging (6th)

Survival Rates in Resected Non-Small Cell Lung Cancer

Survival Curves of Patients with Thyroid Carcinoma According to Stages

Text Survivals in Melanoma Patients

Text Staging in Melanoma

New Staging Proposal

Text n=100869

Text New T Definitions (T1)

Text New T Definitions (T2-T4)

Recursive Partitioning

Text Sample Size in 7th Staging Proposal

Text 7th Staging Proposal- Lymph Nodes: WHY IS THAT NOT DIFFERENT?

Text Survival According to N1 type

Text Multiple N1 and Multiple N2 Involvement

Anatomical Proposals

Text

New Proposals for Lymph Node Locations

Text New Proposals for Lymph Node Locations

Histopathological Staging

Histopathological Factors ‣ Histological type ‣ Grade ‣ Lymphatic Invasion ‣ Blood vessel invasion ‣ Necrosis ‣ Cytokeratin expression

Text

Poncelet et al., 2008, EJCTS

Molecular Staging

Role of p53 ✦ TP53 gene alterations are present in about 50% of NSCLC and their prognostic implications have been evluated in diverse clinical studies. ✦ Tumor response to anticancer therapies has been recognized to be largely based on apoptosis induction ✦ Active p53 has emerged as an important modulator of DNA-damage-induced apoptosis.

EGFR

Molecular Markers of Prognosis - p53 - EGFR - erbB2 - ERCC1 - RRM1 - PTEN - ErbB-1 - cyclin A - PCNA -p16 -RASS1A -FHIT -k-ras -DNA methylation

Molecular Markers of Prognosis - Volm and colleagues found that diminished expression of fas, ERbB-1, cyclin A and PCNA coincided with long term survival - Two multi-institutional trials (ACOSOG and CALGB 9761) indicate that DNA methylation profiles are associated with tumor histology and stage, as well as response to therapy and overall survival in lung cancer patients.

Excision Repair Cross Complemantation Group 1 (ERCC1) ✦ Protein component of nucleotide excision repair complex ✦ This complex reognizes and repairs cisplatin- induced DNA adducts ✦ Therefore it is thought to be important for resistance to platinum agents.

Olaussen et. al, NEJM, 2006

Chen HY, et al. NEJM, 2007

Survival Based on ERCC1 expression ERCC1+, median: 86 months p=0.01 ERCC1-, median: 44 months

Zheng et. al, NEJM

Pathologically Tailored Surgical Therapy?

Neadjuvant Therapy: Routine or Selective?

Text Kandioler-Eckerberger D, et al. J Thorac Cardiovasc Surg;1999

Molecularly Tailored Surgical Therapy? Lee et al., Lung Cancer, 2007

Genotypically Tailored Surgical Therapy?

Genotypically Tailored Therapy ✦ Fas-1377 A/G polymorphism was investigated ✦ There was no relationship between Fas-1377 G-A polymorphism and lung cancer, but smoking seemed to increase the possibility of inducing lung cancer in AG genotypes more than other genotypes.

Genotypically Tailored Surgical Therapy ?

Relationship between polymorphisims of gene encoding microsomal epoxide hydrolase and lung cancer

Text NCCN- Guideline-2009

Survival According to ERCC1 expression in Neoadjuvant Chemotherapy Administered Patients Text

Postoperative Complications and Survival Song et al., Annals of Thoracic Surgery, 2007

Future Studies ✦ Molecular mechanisms associated with ERCC1 ✦ Randomized studies regarding molecularly tailored surgical therapies. ✦ Clinical studies based on genomics and proteomics ✦ Large studies with molecular PET markers.

Acknowledgements Nur Ürer, Nur Büyükpınarbaşılı, Ilhan Yaylım, Zelal Erkisi, Ali Kılıçgün Turgay Isbir