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Young Saing Kim



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    P1.17 - Treatment of Early Stage/Localized Disease (ID 188)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.17-34 - Prognostic Significance of Preoperative CT-Determined Sarcopenia and Radiodensity in Resected Non-Small Cell Lung Cancer (ID 1551)

      09:45 - 18:00  |  Author(s): Young Saing Kim

      • Abstract

      Background

      Sarcopenia, reduced skeletal muscle mass, is associated with poor prognosis in advanced non-small cell lung cancer (NSCLC) patients. The purpose of this study was to evaluate predictive value of CT–determined skeletal muscle area on prognosis after curative resection of NSCLC.

      Method

      For a total 272 NSCLC patients (male=164, mean age=63±10 years) that underwent surgery between 2011 and 2016, skeletal muscle (CT Hounsfield unit: −29 to 150 HU) at the level of the third lumbar vertebra (L3) was assessed using preoperative CT images. Sarcopenia was defined as L3 muscle index of <55 cm2/m2 for men and of <39 cm2/m2 for women. Moreover, skeletal muscle was subsequently classified as abnormal muscle (-29 to <30HU) and normal muscle (30 to 150 HU) by radiodensity. Data on clinical characteristics, disease-free survival (DFS), and overall survival (OS) were retrospectively collected.

      Result

      The prevalence of sarcopenia was 22.4% for all study subjects, 32.9% for men, and 6.5% for women. Using a maximal chi-squared method determined optimal cut-off to determine unhealthy muscle (proportion of abnormal muscle >24.5%), the prevalence of patient with unhealthy muscle was 84.2% (78.7% for male and 92.6% for female). There was no significant difference in the prevalence of unhealthy muscle between sarcopenia and non-sarcopenia patients (86.9% vs. 83.4%, p = 0.690). No significant difference was observed between the 3-year DFS rate (77.0% vs 67.0%, p = 0.142) or 3-year OS rate (84.8% vs 87.9%, p = 0.576) between patients with and without sarcopenia. However, patients with unhealthy muscle tends to have shorter 3-year DFS rate (67.2% vs 79.4%, p = 0.094) and 3-year OS rate (86.1% vs 92.6%, p = 0.176). In the multivariable analysis, unhealthy muscle was one of independent indicator to predict a 3-year DFS rate (HR, 2.072, p=0.044), along with pathologic T stage (HR, 3.348, p<0.001), pathologic N stage (HR, 3.401, p<0.001), and R1 resection (HR, 3.804, p=0.033).

      Conclusion

      Radiodensity based muscle quantification is associated with shorter DFS in resected lung cancer. Further research is warranted to establish whether muscle measures should be integrated into routine practice to improve prognostic accuracy.

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    P2.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 187)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.16-27 - Longitudinal Skeletal Muscle Changes in Patients with Advanced Squamous Cell Lung Cancer (ID 1560)

      10:15 - 18:15  |  Presenting Author(s): Young Saing Kim

      • Abstract

      Background

      Cancer cachexia is a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass. Skeletal muscle depletion is prevalent in lung cancer patients and is associated with poor prognosis. This study analyzed the changes in skeletal muscle mass until the end of life in patients with advanced squamous cell lung cancer (SQCLC).

      Method

      This retrospective study consisted of 70 consecutive patients who underwent palliative chemotherapy for SQCLC and died between September 2010 and March 2015. A cross-sectional area of muscle at the level of the first lumbar vertebra (L1) was measured using computed tomography scans. An artificial intelligence algorithm was developed and used for serial assessment of muscle area. Sarcopenia was defined as a L1 skeletal muscle index of ≤ 46 cm2/m2 for men and ≤ 29 cm2/m2 for women. Median interval between last scans and deaths was 1.3 months (95% CI, 0.9 to 1.7).

      Result

      The median age was 69 years and 82% of patients were male. Sarcopenia was present in 58 patients (76%) at baseline. Median overall survival was 8.7 months (95% CI, 5.9 to 11.5). All patients experienced net muscle loss over the disease trajectory. Mean percentage loss of skeletal muscle between the first and last scans were 16.5±11.0%; mean decrease of muscle area was 17.28±13.00 cm2 (p < 0.001) at a rate of 2.64±2.36 cm2/month. Skeletal muscle loss was accelerated over time. Patients lost an average of 1.64±1.02 cm2, 2.00±1.52 cm2, 2.91±2.69 cm2, and 4.82±4.59 cm2 skeletal muscle per month during the last 12, 9, 6, and 3 months, respectively (p < 0.001). Patients losing skeletal muscle at ≥ 3.24 cm2/month (upper tertile) had shorter overall survival compared with patients who lost muscle at slower rate (median, 5.7 vs. 12.0 months; p < 0.001).

      Conclusion

      Patients with advanced SQCLC lose significant amount of skeletal muscle until death. The rate of muscle mass reduction is faster at the end of life. Patients who lose muscle at the higher rate have shorter survival time.