Katharina Martini1, Guillaume Chassagnon2, Ludovic Fournel3, Mathilde Prieto3, Trieu-Nghi Hoang-Thi4, Nara Halm5, Antonio Bobbio6, Marie-Pierre Revel2, Marco Alifano7. 1. Radiology Department, APHP Centre - Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Diagnostic and Interventional Radiology, University Hospital Sarcopenia as Independent Risk Factor of Postpneumonectomy Respiratory Failure, ARDS and Mortality, Zurich, Rämistrasse 100, 8008 Zurich, Switzerland. 2. Radiology Department, APHP Centre - Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; University of Paris, Paris, France. 3. University of Paris, Paris, France; Department of Thoracic Surgery, APHP Centre - Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France. 4. Radiology Department, APHP Centre - Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Department Diagnostic Imaging, Vinmec International Hospital - Central Park, Ho Chi Minh City, Viet Nam. 5. Radiology Department, APHP Centre - Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France. 6. Department of Thoracic Surgery, APHP Centre - Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France. 7. University of Paris, Paris, France; Department of Thoracic Surgery, APHP Centre - Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France. Electronic address: marco.alifano@aphp.fr.
Abstract
OBJECTIVES: Sarcopenia is associated with poor outcome in cancer-patients. However, the methods to define sarcopenia are not entirely standardized. We compared several morphometric measurements of sarcopenia and their prognostic value in short-term-outcome prediction after pneumonectomy. MATERIAL AND METHODS: Consecutive lung-cancer patients undergoing pneumonectomy from January 2007 to December 2015 and having a pre-operative computed tomography (CT) scan were retrospectively included. Sarcopenia was assessed by the following CT-based parameters measured at the level of the third lumbar vertebra: cross-sectional Total Psoas Area (TPA), cross-sectional Total Muscle Area (TMA), and Total Parietal Muscle Area (TPMA), defined as TMA without TPA. Measures were obtained for entire muscle surface, as well as by excluding fatty infiltration based on CT attenuation. Findings were stratified for gender, and a threshold of 33rd percentile was set to define sarcopenia. Acute Respiratory Failure (ARF), Acute Respiratory Distress Syndrome (ARDS), and 30-day mortality were assessed as parameters of short-term-outcome. RESULTS: Two hundred thirty-four patients with pneumonectomy (right, n = 107; left, n = 127) were analysed. Postoperative mortality rate was 9.0 % (21/234), 17.1 % of patients (40/234) experienced ARF requiring re-intubation, and 10.3 % (24/234) had ARDS. All parameters describing sarcopenia gave significant results; the best discriminating parameter was TMA after excluding fat (p < 0.001). While right sided pneumonectomy and sarcopenia were independently associated to the three short-term outcome parameters, Charlson Comorbidity Index only independently predicted ARF. CONCLUSIONS: Sarcopenia defined as the sex-related 33rd percentile of fat-excluded TMA at the level of the third lumbar vertebra is the most discriminating parameter to assess short-term-outcome in patients undergoing pneumonectomy.
OBJECTIVES:Sarcopenia is associated with poor outcome in cancer-patients. However, the methods to define sarcopenia are not entirely standardized. We compared several morphometric measurements of sarcopenia and their prognostic value in short-term-outcome prediction after pneumonectomy. MATERIAL AND METHODS: Consecutive lung-cancerpatients undergoing pneumonectomy from January 2007 to December 2015 and having a pre-operative computed tomography (CT) scan were retrospectively included. Sarcopenia was assessed by the following CT-based parameters measured at the level of the third lumbar vertebra: cross-sectional Total Psoas Area (TPA), cross-sectional Total Muscle Area (TMA), and Total Parietal Muscle Area (TPMA), defined as TMA without TPA. Measures were obtained for entire muscle surface, as well as by excluding fatty infiltration based on CT attenuation. Findings were stratified for gender, and a threshold of 33rd percentile was set to define sarcopenia. Acute Respiratory Failure (ARF), Acute Respiratory Distress Syndrome (ARDS), and 30-day mortality were assessed as parameters of short-term-outcome. RESULTS: Two hundred thirty-four patients with pneumonectomy (right, n = 107; left, n = 127) were analysed. Postoperative mortality rate was 9.0 % (21/234), 17.1 % of patients (40/234) experienced ARF requiring re-intubation, and 10.3 % (24/234) had ARDS. All parameters describing sarcopenia gave significant results; the best discriminating parameter was TMA after excluding fat (p < 0.001). While right sided pneumonectomy and sarcopenia were independently associated to the three short-term outcome parameters, Charlson Comorbidity Index only independently predicted ARF. CONCLUSIONS:Sarcopenia defined as the sex-related 33rd percentile of fat-excluded TMA at the level of the third lumbar vertebra is the most discriminating parameter to assess short-term-outcome in patients undergoing pneumonectomy.
Authors: Oliver Guido Verhoek; Lisa Jungblut; Olivia Lauk; Christian Blüthgen; Isabelle Opitz; Thomas Frauenfelder; Katharina Martini Journal: Diagnostics (Basel) Date: 2022-01-03