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( Daegeun Lee ),( Hye Yun Park ),( Byeong-ho Jeong ),( Kyungjong Lee ),( Hojoong Kim ),( O Jung Kwon ),( Jong Ho Cho ),( Sang-won Um ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.0
Background The role of 6 min-walk test (6MWT) and cardiopulmonary exercise test (CPET) for preoperative evaluation of non-small cell lung cancer (NSCLC) has not been well established in Asian population. This retrospective study investigated the correlation between the exercise tests and their effect on postoperative cardiopulmonary complications and treatment outcomes. Methods We included the subjects with stage I-II NSCLC who received lobectomy or greater extent surgery and underwent 6MWT and CPET simultaneously due to reduced pulmonary function, which was defined as predicted postoperative (ppo) FEV1 or ppoDLCO <60%. Study population was classified into four different groups according to the cut-values of the 6MWD and VO2max for risk stratification. Postoperative pulmonary complications (PPCs), postoperative cardiac complications (PCCs), and all-cause mortality were investigated. Results Between 2015 and 2020, a total of 191 subjects were enrolled. Median values of the 6MWD and VO2max were 462 m and 23.3 mL/kg/min, respectively and the 6WMD was well correlated with the VO2max (r=0.409, p<0.001). The cut-off values of 450 m for the 6MWD and 20 mL/kg/min for the VO2max were identified as optimal ones for risk stratification. The rates of PCCs and all-cause mortality were significantly different among the four groups (p=0.005 and p=0.001). However, no difference was found in PPCs among the four groups. On multivariate analysis, a greater exercise capacity (6MWD ≥450 m and VO2max ≥20 mL/kg/min) was significantly associated with a low rate of PCCs (adjusted OR, 0.40; 95% CI, 0.19-0.84; p=0.016), and a decreased all-cause mortality (aOR, 0.26; 95% CI, 0.08-0.79; p=0.017). Conclusions Exercise capacity was associated with PCCs and all-cause mortality in patients with NSCLC who underwent surgical resection. Indicators of 6MWT and CPET can help to select the optimal surgical candidates for NSCLC patients with reduced pulmonary function.
S-324 Pleural recurrence after Transthoracic Lung Biopsy in Stage I Non-Small Cell Lung Cancer
( Daegeun Lee ),( Seong Mi Moon ),( Kyung Jong Lee ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Background: Transthoracic needle biopsy (TTNB) is a useful modality for pathologic diagnosis of lung cancer. A risk of pleural dissemination after TTNB has been reported but remains a controversial issue. This study aimed to investigate whether the TTNB procedure increases the risk of pleural recurrence after curative resection and to identify the risk factors of pleural dissemination.?Methods: We retrospectively reviewed the clinical outcomes of p-stage I non-small cell lung cancer (NSCLC) patients who received curative lung resection for treatment between January 2009 and December 2010 at Samsung Medical Center. Patients who had double primary cancer and underwent limited resection due to poor lung function were excluded. Patients were divided into two groups, TTNB or non-TTNB, according to the procedure received before surgery. Kaplan-Meier analysis and log-rank test, and univariate and multivariate Cox regression analyses were used to determine the association between TTNB and pleural recurrence and identify the risk factors.?Results: Of the total 469 patients, 251 underwent TTNB before curative surgery, while the remaining 218 underwent bronchoscopic or open lung biopsy or had a clinical diagnosis. Of the 26 patients with ipsilateral pleural recurrence, 23 patients were in the TTNB group (23/251, 9.2%), whereas the remaining patient was in the non-TTNB group (3/218, 1.4%). Kaplan-Meier analysis showed that the TTNB group had lower pleural recurrence-free survival than the non-TTNB group(p<0.001). Multivariate Cox analysis revealed, TTNB (adjusted hazard ratio[HR], 5.102; 95% CI, 1.502 to 17.327; p=0.009), microscopic lymphatic invasion (adjusted HR, 2.765; 95% CI 1.226 to 6.232; p=0.014), and microscopic visceral pleural invasion (adjusted HR, 2.693; 95% CI 1.177 to 6.164; p=0.019) were risk factors for ipsilateral pleural recurrence.?Conclusions: The TTNB procedure was related to and increased the risk of ipsilateral pleural recurrence in stage I NSCLC after curative resection. Microscopic lymphatic invasion and visceral pleural invasion also increased the risk of ipsilateral pleural recurrence in this study.