Ryota Nakamura1, Yoshihisa Inage2, Rika Tobita2, Satoshi Yoneyama2, Takeshi Numata3, Kyoko Ota3, Hidetoshi Yanai3, Takeo Endo3, Yukinori Inadome4, Shingo Sakashita5, Hiroaki Satoh6, Kenji Yuzawa2, Toru Terashima2. 1. Department of Surgery, National Hospital Organization Mito Medical Center, Ibaraki, Japan. Electronic address: ryo-naka@mail.goo.ne.jp. 2. Department of Surgery, National Hospital Organization Mito Medical Center, Ibaraki, Japan. 3. Department of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. 4. Department of Pathology, Institute of Clinical Medicine, University of Tsukuba. Tsukuba, Ibaraki, Japan. 5. Department of Pathology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. 6. Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Abstract
INTRODUCTION: Skeletal muscle depletion, referred to as sarcopenia, has recently been identified as a risk factor for poor outcomes in various malignancies. However, the prognostic significance of sarcopenia in patients with NSCLC after surgery has not been adequately determined. This study investigated the impact of sarcopenia in patients undergoing pulmonary resection for lung cancer. METHODS: This retrospective study consisted of 328 patients with pathologically confirmed NSCLC who underwent curative resection between January 2005 and April 2017. Preoperative computed tomography imaging at the third lumbar vertebrae level was assessed to measure the psoas muscle mass index (PMI, cm2/m2). Sarcopenia was defined as a cutoff value of PMI less than 6.36 cm2/m2 for males and 3.92 cm2/m2 for females, based on PMI values from "healthy" subjects. RESULTS: The median patient age was 71 years and 59% were male. Sarcopenia was present in 183 (55.8%) and was significantly related with increasing age (p < 0.001), being male (p < 0.001), smoking habit (p < 0.001), lower body mass index (p < 0.001), and postoperative major complication (Clavien-Dindo grade ≥3, p = 0.036). The prevalence of sarcopenia was higher in men than in women, and the prevalence increased with age in men, whereas the prevalence did not increase in females older than 70 years. The 5-year survival rate was 61% in patients with sarcopenia and 91% in those without. Multivariate analysis revealed that sarcopenia was an independent unfavorable prognostic factor (p = 0.019). CONCLUSIONS: Sarcopenia as determined using preoperative computed tomography could be used to predict postoperative major complication and prognosis in patients with resected NSCLC. Our results may provide some important information for preoperative management.
INTRODUCTION: Skeletal muscle depletion, referred to as sarcopenia, has recently been identified as a risk factor for poor outcomes in various malignancies. However, the prognostic significance of sarcopenia in patients with NSCLC after surgery has not been adequately determined. This study investigated the impact of sarcopenia in patients undergoing pulmonary resection for lung cancer. METHODS: This retrospective study consisted of 328 patients with pathologically confirmed NSCLC who underwent curative resection between January 2005 and April 2017. Preoperative computed tomography imaging at the third lumbar vertebrae level was assessed to measure the psoas muscle mass index (PMI, cm2/m2). Sarcopenia was defined as a cutoff value of PMI less than 6.36 cm2/m2 for males and 3.92 cm2/m2 for females, based on PMI values from "healthy" subjects. RESULTS: The median patient age was 71 years and 59% were male. Sarcopenia was present in 183 (55.8%) and was significantly related with increasing age (p < 0.001), being male (p < 0.001), smoking habit (p < 0.001), lower body mass index (p < 0.001), and postoperative major complication (Clavien-Dindo grade ≥3, p = 0.036). The prevalence of sarcopenia was higher in men than in women, and the prevalence increased with age in men, whereas the prevalence did not increase in females older than 70 years. The 5-year survival rate was 61% in patients with sarcopenia and 91% in those without. Multivariate analysis revealed that sarcopenia was an independent unfavorable prognostic factor (p = 0.019). CONCLUSIONS:Sarcopenia as determined using preoperative computed tomography could be used to predict postoperative major complication and prognosis in patients with resected NSCLC. Our results may provide some important information for preoperative management.
Authors: M P Petrova; I S Donev; M A Radanova; M I Eneva; E G Dimitrova; G N Valchev; V T Minchev; M S Taushanova; M V Boneva; T S Karanikolova; R B Gencheva; G A Zhbantov; A I Ivanova; C V Timcheva; B P Pavlov; V G Megdanova; B S Robev; N V Conev Journal: Clin Exp Immunol Date: 2020-08-26 Impact factor: 4.330