Prognostic value of body mass index and change in body weight in postoperative outcomes of lung cancer surgery

Nakagawa, Tatsuo; Toyazaki, Toshiya; Chiba, Naohisa; Ueda, Yoshimichi; Gotoh, Masashi

doi:10.1093/icvts/ivw175

Cited by 72 publications

(58 citation statements)

References 22 publications

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“…As we have shown, WL impacts the long-term survival of all patients, independently of TNM, and particularly of those with a lower BMI [24]. Patients with WL > 10% have a significantly lower survival than those with less pronounced WL [29]. Our results confirm few recent studies reporting the negative impact of low muscle mass on survival of operated lung cancers [10,30].…”

Section: Lower Bmi Weight Loss and Low Muscle Mass Negatively Impactsupporting

confidence: 86%

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Pre-Disease and Pre-Surgery BMI, Weight Loss and Sarcopenia Impact Survival of Resected Lung Cancer Independently of Tumor Stage

Icard

Schussler

Loi³

et al. 2020

Cancers

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Lower pre-surgery Body Mass Index (BMI) and low muscle mass impact negatively long-term survival of non-small cell lung cancer (NSCLC). We investigated their influence on survival after major lung resection for NSCLC. Methods: A retrospective analysis of a prospectively collected database was made on 304 consecutive patients. Results: Underweight, normal, overweight and obese patients represented 7.6%, 51.6%, 28.6%, and 12.6% of the pre-disease population. Weight loss and gain were recorded in 44.4% and 5% of patients, respectively. Low muscle mass was more frequently associated with BMI < 25 kg/m2 (p < 0.000001). Overall survival was positively affected by pre-disease (p = 0.036) and pre-surgery (p = 0.017) BMI > 25 kg/m2, and, even more, in case of BMI > 25 kg/m2 and increasing weight (p = 0.012). Long-term outcome was negatively influenced by low muscle mass (p = 0.042) and weight loss (p = 0.0052) as well as age (p = 0.017), ASA categories (p = 0.025), extent of resection (p = 0.0001), pleural invasion (p = 0.0012) and higher pathologic stage (p < 0.0001). Three stepwise multivariable models confirmed the independent favorable prognostic value of higher pre-disease (RR 0.66[0.49–0.89], p = 0.006) and pre-surgery BMI (RR 0.72[0.54–0.98], p = 0.034), and the absence of low muscle mass (RR 0.56[0.37–0.87], p = 0.0091). Conclusions: Body reserves assessed by simple clinical markers impact survival of surgically treated NSCLC. Strategies improving body fat and muscular mass before surgery should be considered.

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Section: Lower Bmi Weight Loss and Low Muscle Mass Negatively Impactsupporting

confidence: 86%

“…Weight loss is notably related to morbidity/mortality in hospitalized patients, especially if surgically treated [9,16,29]. It is also a predictive factor of shorter survival in patients with advanced inoperable lung cancers [12,26].…”

Section: Lower Bmi Weight Loss and Low Muscle Mass Negatively Impactmentioning

confidence: 99%

Pre-Disease and Pre-Surgery BMI, Weight Loss and Sarcopenia Impact Survival of Resected Lung Cancer Independently of Tumor Stage

Icard

Schussler

Loi³

et al. 2020

Cancers

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“…Nakagawa et al, whose study included patients with NSCLC at various stages, reported that patients with low body mass index (BMI) had poor prognosis after surgery (7). We hypothesized that sarcopenia was a predictor of postoperative prognosis in patients with localized NSCLC.…”

Section: Introductionmentioning

confidence: 95%

Sarcopenia is a novel poor prognostic factor in male patients with pathological Stage I non-small cell lung cancer

Tsukioka

Nishiyama

Izumi

et al. 2017

Japanese Journal of Clinical Oncology

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Objectives: Sarcopenia is the progressive loss of muscle mass and strength, and has a risk of adverse outcomes such as disability, poor quality of life and death. As prognosis depends not only on disease aggressiveness, but also on a patient's physical condition, sarcopenia can predict survival in patients with various cancer types. However, its effects on postoperative prognosis in patients with localized non-small cell lung cancers (NSCLC) have never been reported. Methods: We retrospectively investigated 215 male patients with pathological Stage I NSCLC. L3 muscle index is defined as the cross-section area of muscle at the third lumbar vertebra level, normalized for height, and is a clinical measurement of sarcopenia. We then investigated the effect of preoperative sarcopenia on their postoperative prognosis. Results: Our 215 subjects included 30 patients with sarcopenia. Sarcopenia was significantly associated with body mass index, nutritional condition, serum CYFRA 21-1 level and pathological stage, but not with preoperative respiratory function or performance status. Frequency of postoperative complications, length of postoperative hospital stay, thoracic drainage period or causes of death were not correlated with the presence of sarcopenia. The sarcopenia group had a significantly shorter median overall survival (32 months) than the no-sarcopenia group. Conclusion: Sarcopenia might not affect short-term outcomes in patients with early-stage lung cancer. Sarcopenia was a predictor of poor prognosis in male patients with Stage I NSCLC. As sarcopenic patients with NSCLC patients are at risk for significantly worse outcomes, their treatments require careful planning, even for those with Stage I disease.

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“…Male sex, advanced age, a low body mass index, body weight loss, and an advanced clinical stage of the lung cancer predict a poor prognosis in lung cancer patients with CPFE who have undergone surgery [10,11]. An elevated serum Krebs von den Lungen-6 (KL-6) level and an upper lobe mass are associated with a poor prognosis, and the serum KL-6 level at the time of the diagnosis is an independent prognostic determinant in lung cancer patients with CPFE [12].…”

Section: Introductionmentioning

confidence: 99%

The Preoperative Composite Physiologic Index May Predict Mortality in Lung Cancer Patients with Combined Pulmonary Fibrosis and Emphysema

Ueno

Kitaguchi²,

Shiina³

et al. 2017

Respiration

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Background: It remains unclear whether the preoperative pulmonary function parameters and prognostic indices that are indicative of nutritional and immunological status are associated with prognosis in lung cancer patients with combined pulmonary fibrosis and emphysema (CPFE) who have undergone surgery. Objective: The aim of this study is to identify prognostic determinants in these patients. Methods: The medical records of all patients with lung cancer associated with CPFE who had undergone surgery at Shinshu University Hospital were retrospectively reviewed to obtain clinical data, including the results of preoperative pulmonary function tests and laboratory examinations, chest high-resolution computed tomography (HRCT), and survival. Results: Univariate Cox proportional hazards regression analysis showed that a high pathological stage of the lung cancer, a higher preoperative serum carcinoembryonic antigen level, and a higher preoperative composite physiologic index (CPI) were associated with a high risk of death. Multivariate analysis showed that a high pathological stage of the lung cancer (HR: 1.579; p = 0.0305) and a higher preoperative CPI (HR: 1.034; p = 0.0174) were independently associated with a high risk of death. In contrast, the severity of fibrosis or emphysema on chest HRCT, the individual pulmonary function parameters, the prognostic nutritional index, the neutrophil-to-lymphocyte ratio, and the platelet-to-lymphocyte ratio were not associated with prognosis. In the Kaplan-Meier analysis, the log-rank test showed significant differences in survival between the high-CPI and the low-CPI group (p = 0.0234). Conclusion: The preoperative CPI may predict mortality and provide more powerful prognostic information than individual pulmonary function parameters in lung cancer patients with CPFE who have undergone surgery.

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Prognostic value of body mass index and change in body weight in postoperative outcomes of lung cancer surgery

Abstract: Low BMI and significant body weight loss before surgery have a negative effect on surgical outcomes for patients with non-small-cell lung cancer.

Cited by 72 publications

References 22 publications

Pre-Disease and Pre-Surgery BMI, Weight Loss and Sarcopenia Impact Survival of Resected Lung Cancer Independently of Tumor Stage

Pre-Disease and Pre-Surgery BMI, Weight Loss and Sarcopenia Impact Survival of Resected Lung Cancer Independently of Tumor Stage

Sarcopenia is a novel poor prognostic factor in male patients with pathological Stage I non-small cell lung cancer

The Preoperative Composite Physiologic Index May Predict Mortality in Lung Cancer Patients with Combined Pulmonary Fibrosis and Emphysema

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