2024 Asia Conference on Lung Cancer (ACLC) - Poster & ePosters-PP02.50

PP02.50 - Chihiro Takemura

Pdf Summary

The study investigates the predictive role of preoperative genetic mutations in detecting occult lymph node (LN) metastasis in clinical N0 (cN0) early-stage non-small cell lung cancer (NSCLC) and their influence on surgical treatment strategies. Occult LN metastasis, representing pathological LN involvement not detected via preoperative imaging, poses significant challenges in surgical decision-making for NSCLC patients. The retrospective study evaluated 644 patients who underwent lobectomy or segmentectomy, with LN dissection, between May 2017 and April 2024, focusing on their clinicopathological characteristics and genetic mutations.<br /><br />Key findings denote a significant association between genetic factors, particularly EGFR mutations and ALK rearrangements, and increased incidence of occult LN metastasis in cN0 NSCLC patients. The study highlights the necessity of incorporating comprehensive genetic analysis into standard clinical practice to enhance personalized treatment and improve patient outcomes.<br /><br />Results indicate that smoking history, sex, age, CEA levels, clinical stage, SUV max values, and specific histological types play crucial roles in predicting occult LN metastasis. Prognostically, Recurrence-Free Survival (RFS) was notably longer in patients without occult LN metastasis and in those harboring EGFR and ALK mutations compared to others. Interestingly, the data suggests that segmentectomy may not be sufficient for high-risk patients with genetic mutations, thus advocating lobectomy for better outcomes, highlighting a potential shift in surgical approaches for affected individuals.<br /><br />The study underscores the importance of preoperative genomic profiling to tailor neoadjuvant therapies and improve NSCLC management, as demonstrated by the Phase III NeoADAURA study emphasizing osimertinib's role in improving pathologic response rates in resectable EGFR-mutant NSCLC. Overall, these findings advocate for the strategic use of genetic profiling in refining surgical decisions and enhancing therapeutic interventions for NSCLC patients with a high risk of occult LN metastasis.

Keywords

genetic mutations

occult lymph node metastasis

non-small cell lung cancer

surgical treatment strategies

EGFR mutations

ALK rearrangements

personalized treatment

Recurrence-Free Survival

genomic profiling

NeoADAURA study