Sarcopenia as a Predictor of Short- and Long-Term Outcomes in Patients Surgically Treated for Malignant Pleural Mesothelioma

Abstract

Surgery for malignant pleural mesothelioma (MPM) should be reserved only for patients who have a good performance status. Sarcopenia, a well-known predictor of poor outcomes after surgery, is still underinvestigated in MPM. The aim of this study is to evaluate the role of sarcopenia as a predictor of short-and long-term outcomes in patients surgically treated for MPM. In our analysis, we included patients treated with a cytoreductive intent in a multimodality setting, with both pre- and post-operative CT scans without contrast available. We excluded those in whom a complete macroscopic resection was not achieved. Overall, 86 patients were enrolled. Sarcopenia was assessed by measuring the mean muscular density of the bilateral paravertebral muscles (T12 level) on pre-and post-operative CTs; a threshold value of 30 Hounsfield Units (HU) was identified. Sarcopenia was found pre-operatively in 57 (66%) patients and post-operatively in 61 (74%). Post-operative sarcopenic patients had a lower 3-year overall survival (OS) than those who were non-sarcopenic (34.9% vs. 57.6% p = 0.03). Pre-operative sarcopenia was significantly associated with a higher frequency of post-operative complications (65% vs. 41%, p = 0.04). The evaluation of sarcopenia, through a non-invasive method, would help to better select patients submitted to surgery for MPM in a multimodality setting.

Sarcopenia and Pleural Mesothelioma: The Current Knowledge

“…Faccioli et al assessed the significance of sarcopenia as a forecaster of short-and longterm results in subjects surgically managed for MPM [65]. In their study, they included subjects managed with a cytoreductive intent in a multimodality setting, having both preand post-operative CT scans without contrast available, and they excluded subjects who had not achieved complete macroscopic resection [65].…”

“…Faccioli et al assessed the significance of sarcopenia as a forecaster of short-and longterm results in subjects surgically managed for MPM [65]. In their study, they included subjects managed with a cytoreductive intent in a multimodality setting, having both preand post-operative CT scans without contrast available, and they excluded subjects who had not achieved complete macroscopic resection [65]. In total, 86 subjects [mean age: 66 (62-71 years), 76% males] participated in this study, and sarcopenia was evaluated by assessing the mean muscular density of the bilateral paravertebral muscles (T12 level) on pre-and post-operative CTs [65].…”

“…In their study, they included subjects managed with a cytoreductive intent in a multimodality setting, having both preand post-operative CT scans without contrast available, and they excluded subjects who had not achieved complete macroscopic resection [65]. In total, 86 subjects [mean age: 66 (62-71 years), 76% males] participated in this study, and sarcopenia was evaluated by assessing the mean muscular density of the bilateral paravertebral muscles (T12 level) on pre-and post-operative CTs [65]. Concerning their results, it was demonstrated that sarcopenia was present pre-operatively in 57 (66%) subjects and post-operatively in 61 (74%).…”

“…Concerning their results, it was demonstrated that sarcopenia was present pre-operatively in 57 (66%) subjects and post-operatively in 61 (74%). In addition, post-operative subjects with sarcopenia had a decreased 3-year overall survival (OS) in comparison with those who were non-sarcopenic (34.9% vs. 57.6% p = 0.03), while pre-operative sarcopenia was importantly related to an increased rate of post-operative adverse outcomes (65% vs. 41%, p = 0.04) [65]. They concluded that the assessment of sarcopenia utilizing a non-invasive manner would be of great importance to better pick subjects submitted to MPM operations [65].…”