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( Yunjoo Im ),( Byeong-ho Jeong ),( Kyungjong Lee ),( Hojoong Kim ),( O Jung Kwon ),( Sang-won Um ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Background: Current lung cancer staging system does not provide a definite guideline for lymphangitic tumor spread and it is debatable whether it is included in T or M descriptors. The purpose of this study is to evaluate the prognosis of lymphangitic tumor spread in patients with non-small cell lung cancer (NSCLC). Methods: The NSCLC patients with lymphangitic tumor spread detected on chest computed tomography scan during staging evaluation between 2000 and 2016 at Samsung Medical Center were included in the study. The subjects with metastasis (M1a/b/c) or incomplete staging evaluation were excluded. The location and extent of the lesion was classified as same, ipsilateral different and contralateral lobe in relation to the primary tumor. The overall survival (OS) of the subjects were compared with that of the subjects who had lung-to-lung metastasis without distant metastasis. Results: A total of 87 subjects were analyzed and the median age was 60 years. The 5-year OS rates of the subjects with lymphangitic tumor spread (n=87) and lung to lung metastasis (n=111) were 29% and 23%, respectively. The 5-year OS rates of lymphangitic tumor spread in the same (n=37), ipsilateral different (n=31) and contralateral (n=19) lobe were 48%, 19% and 11%, respectively. Compared with patients with lung-to-lung metastasis, those with lymphangitic tumor spread only in the same lobe had better OS (p = 0.027, hazard ratio for death, 0.57; 95% confidence interval, 0.35-0.94). This effect persisted after adjusting for potential confounders including smoking history, tumor histology and nodal stage. Conclusions: The subjects with lymphangitic tumor spread in the same lobe had better OS than those with lymphangitic tumor spread to the ipsilateral different or contralateral lobe or lung-to-lung metastasis. Lymphangitic tumor spread confined to the same lobe of the primary tumor seems to be T descriptor rather than M descriptor.
( Yunjoo Im ),( Hongseok Yoo ),( Jin Young Lee ),( Junseon Park ),( Gee Young Suh ),( Kyeongman Jeon ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-
Background As no gold standard diagnostic test exists, there is increasing awareness that biomarkers of sepsis including transcriptomic, metabolomic, proteomic studies are essential to understand the pathophysiology of sepsis. One of the most highly expressed microRNAs in exosomes, microRNA-223(miR-223) is effective messengers in modulating target gene expression in recipient cells by regulating oxide stress, inflammation, apoptosis, and endothelial function. Nonetheless, the association of exosomal miR-223 with severity and mortality of sepsis is not well known. Therefore, the overall levels of exosomal miR-223 in sepsis patients were assessed and whether these levels were associated with organ failure and mortality was evaluated in the present study. Method This was a prospective observational study on consecutive critically-ill patients admitted to the medical ICU of Samsung Medical Center between April 2014 and April 2019. A total of 130 patients admitted to the medical ICU and diagnosed with sepsis or septic shock were recruited. The overall levels of exosomal miR-223 was measured by real time PCR. Results Of 130 study patients, 86 (66%) patients were diagnosed with septic shock. Septic shock patients had higher exosomal miR- 223 level compared with sepsis patients (P = 0.042) and control (P < 0.001) (0.20 Ct value vs. 0.30 Ct value vs. 0.57 Ct value). A positive linear relationship was observed between exosomal miR-223 levels and Sequential Organ Failure Assessment score in the study cohorts (r value = 0.33). The area under the ROC curve was 0.94 in the relationship between exosomal miR-223 level and 28-day mortality. When patients were divided into two groups according to best cut-off level, a statistical difference in 28- and 90-day mortality between patients with high and low exosomal miR-223 was observed. Conclusion Elevated levels of exosomal miR-223 were associated with severity of organ failure and predictive of mortality in critically ill patients with sepsis.
Association of Exosomal CD63 with Severity of Organ Failure and Mortality in Patients with Sepsis
( Yunjoo Im ),( Hongseok Yoo ),( Jin Young Lee ),( Junseon Park ),( Gee Young Suh ),( Kyeongman Jeon ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-
Background Current sepsis biomarkers may be helpful in determining organ failure and evaluating patient clinical course; however, as no gold standard diagnostic test exists, there is increasing awareness that new sepsis biomarkers may be helpful in determining organ failure and evaluating the patient’s clinical course. CD63, one of the tetraspanin protein family members, ubiquitously enriched on exosomes, involves in signal transduction of various types of immune cells, and may contribute to immunometabolic mechanisms of cellular and organ dysfunction in sepsis. Nonetheless, the association of exosomal CD63 with severity and mortality of sepsis is not well known. Therefore, the overall levels of exosomal CD63 in sepsis patients were assessed and whether CD63 levels were associated with organ failure and mortality was evaluated in the present study. Methods This was a prospective, observational study using the Samsung Medical Center Registry of Critical Illness. Patients registered between April 2014 and January 2019 were included in the analysis. A total of 217 patients admitted to the medical ICU and diagnosed with sepsis or septic shock were recruited. CD63 was measured from precipitated exosomes by using anti-CD63 antibody. Results Among 217 patients with sepsis, 143 (66%) patients were diagnosed with septic shock. A trend of increased exosomal CD63 levels in control, sepsis, and septic shock groups was observed (6.6 μg/mL vs. 42 μg/mL vs. 90 μg/mL, P < 0.001). A positive linear relationship was observed between exosomal CD63 levels and Sequential Organ Failure Assessment score in the study cohorts (r value = 0.35). When patients were divided into two groups according to best cut-off level, a statistical difference in 28- and 90-day mortality between patients with high and low CD63 was observed. Conclusions Elevated levels of exosomal CD63 were associated with severity of organ failure and predictive of mortality in critically ill patients with sepsis.
( Yunjoo Im ),( Hongseok Yoo ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-
Background Lung cancer is a common comorbidity of idiopathic pulmonary fibrosis (IPF) and has poor outcomes. We aimed to determine the prevalence of and risk factors for postoperative pulmonary complications (PPCs) in IPF patients with non-small cell lung cancer (NSCLC) to select optimal candidates for surgical resection and to develop a novel scoring system to predict mortality among surgical candidates. Method In this retrospective study, we analyzed clinical data for 204 patients who were diagnosed with IPF and underwent curative resection for NSCLC between 1996 and 2020. Demographic, physiologic, surgical, and histologic characteristics were reviewed. Risk factors of PPCs development were determined by multivariate logistic regression analysis. Results Most of the study participants were male (n=183, 90%), and the median (interquartile range) age of our cohort was 68 (63-72) years. The proportion of T1/T2 or N0 tended to be higher among the patients. Squamous cell carcinoma was the most common (50%), followed by adenocarcinoma (40%). The majority of patients received lobectomy (88%) under videoassisted thoracic surgery (61%). Seventy-five patients (37%) had PPCs, like acute lung injury (n=29, 14%), pneumonia (n=19, 10%), pneumothorax (n=14, 7%) and prolonged air leak (n=13, 6%). Compared to patients without PPCs, those with PPCs were more likely to be older and heavier smoker, have lower FEV1, FVC, DLco, and lower serum albumin, underwent lobectomy, bilobectomy or pneumonectomy, and tended to have longer operation time (all p<0.05). On multivariate analysis, smoking history (former or current smoker), lower serum albumin, lower DLco, larger extent of surgery and longer operation time were independently associated with PPC risk. Conclusions PPCs frequently developed in patients with IPF who received curative resection for NSCLC. Smoking history (former or current smoker), serum albumin, DLco, extent of surgery and operation time were predictors of PPC development, which guide treatment decision-making in these patients.
( Sun Hye Shin ),( Hye Yun Park ),( Yunjoo Im ),( Sumin Shin ),( Genehee Lee ),( Byeong-ho Jeong ),( Kyungjong Lee ),( Sang-won Um ),( Hojoong Kim ),( O Jung Kwon ),( Jong Ho Cho ),( Hong Kwan Kim ),( 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0
Background Chronic obstructive pulmonary disease (COPD) is an established risk factor for lung cancer development, but remains largely undiagnosed and untreated before lung cancer surgery. This study aimed to evaluate the effect of perioperative bronchodilator therapy on lung function changes in patients with COPD who underwent surgical resection for non-small cell lung cancer (NSCLC). Methods Among patients with NSCLC who underwent surgical resection, patients with spirometry-defined COPD were retrospectively identified. Perioperative bronchodilator therapy was defined as use of long-acting muscarinic antagonist and/or long-acting beta-2 agonist both during the preoperative and postoperative period. Changes in forced expiratory volume in 1 s (FEV1) were compared between patients treated with and without perioperative bronchodilators. Results Among 268 patients with COPD, 112 (41.8%) received perioperative bronchodilator therapy, and 75% (84/112) were newly diagnosed with COPD ahead of lung cancer surgery. Declines in FEV1 after lung cancer surgery were alleviated by the administration of perioperative bronchodilator therapy, even after adjustments for surgical extent, thoracotomy, and preoperative baseline FEV1 (adjusted mean difference in FEV1 decline [95% CI] between patients without perioperative bronchodilator therapy and those with perioperative bronchodilator therapy ; -161.1 mL [-240.2, -82.0]; -179.2 mL [-252.1, -106.3]; -128.8 mL [-193.2, -64.4] at 1, 4, and 12 months after surgery, respectively) (Figure). Conclusions Perioperative treatment with bronchodilators were effective to preserve lung function, in particular FEV1, after surgical resection for NSCLC in COPD patients. An active diagnosis of COPD and treatment with bronchodilators are required for patients with NSCLC who were scheduled to undergo surgical resection.
Clinical Characteristics of Miliary Pulmonary Metastases in Non-small Cell Lung Cancer
( Hanmil Choi ),( Sang-won Um ),( Yunjoo Im ),( Byeong-ho Jeong ),( Kyungjong Lee ),( Hojoong Kim ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-
Purpose The prognosis of miliary pulmonary metastases (MPM), which are characterized as randomly disseminated, innumerable, and small metastatic nodules, has been considered as being poor. The purpose of this study is to evaluate the clinical characteristics and survival of MPM in patients with non-small cell lung cancer (NSCLC). Methods This retrospective study included NSCLC patients with MPM and non-miliary pulmonary metastases (NMPM) detected during staging evaluation between 2000 and 2020. MPM are defined as the presence of bilaterally distributed > 16 metastatic pulmonary nodules (<1cm in diameter), and NMPM are defined as the presence of £ 15 metastatic pulmonary nodules regardless of size. Baseline characteristics, genetic alterations and overall survival (OS) rates were compared between the two groups. Results Twenty-six subjects with MPM and 78 subjects with NMPM were analyzed. The MPM group showed higher tendency in the proportions of never smoker (69% vs 49%, p = 0.187) and adenocarcinoma histology (100% vs 81%, p = 0.054) compared with the NPMM group. The frequency of EGFR mutation was significantly higher in the MPM group (58%) than in the NMPM group (24%; p = 0.006). There was no significant difference in OS rates between the two groups (p = 0.893). However, among the MPM group, there was no significant difference in clinical characteristics and OS between <5mm vs ³5mm groups. Conclusion MPM in NSCLC were significantly related to the EGFR mutation. The OS rate of MPM group was not inferior to that of NMPM group. The presence of EGFR mutation should be thoroughly evaluated for NSCLC patients with initial presentation of MPM.