Sarcopenia in Resected NSCLC: Effect on Postoperative Outcomes

Nakamura, Ryota; Inage, Yoshihisa; Tobita, Rika; Yoneyama, Satoshi; Numata, Tomohiro; Ota, Kyoko; Yanai, Hidetoshi; Endo, Takeo; Inadome, Yukinori; Sakashita, Shingo; Satoh, Hiroaki; Yuzawa, Kenji; Terashima, Toru

doi:10.1016/j.jtho.2018.04.035

Cited by 111 publications

(116 citation statements)

References 41 publications

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“…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]. Low muscle mass was mostly observed in underweight and normal weight patients (66% and 39% respectively), less frequently in overweight (21%), and rarely in obese patients (9.5%).…”

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

confidence: 85%

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: 85%

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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“…Sarcopenia is the loss of muscle mass and function. Some reports have defined sarcopenia using the psoas muscle index (PMI) calculated from CT imaging at the level of the third lumbar vertebra . However, there is no agreed cutoff value that defines sarcopenia, with authors of the reports each establishing their own definition.…”

Section: Methodsmentioning

confidence: 99%

Risk factors and cancer recurrence associated with postoperative complications after thoracoscopic lobectomy for clinical stage I non‐small cell lung cancer

et al. 2019

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Background Minimally invasive thoracoscopic lobectomy is the recommended surgery for clinical stage I non‐small cell lung cancer (NSCLC). The purpose of this study was to identify the risk factors, including sarcopenia, for postoperative complications in patients undergoing a complete single‐lobe thoracoscopic lobectomy for clinical stage I NSCLC, as well as the impact of complications on disease‐free survival. Methods We retrospectively investigated 173 patients with pathologically‐diagnosed NSCLC who underwent curative thoracoscopic lobectomies between April 2013 and March 2018. Sarcopenia was assessed using the psoas muscle index calculated from preoperative computed tomography images at the third lumbar vertebral level. Results Complications developed in 38 (22%) patients, including 21 with prolonged air leak. In univariate analysis, the significant risk factors for complications were advanced age, male sex, higher Charlson Comorbidity Index (CCI) score, lower cholinesterase, lower albumin, higher creatinine level, pleural adhesion, operative time ≥ five hours, nonadenocarcinoma cancer, and larger tumor size. Multivariate analysis showed that age ≥ 75 years (P = 0.002) and pleural adhesion (P = 0.026) were significant independent risk factors for complications. Compared with the patient group without complications, postoperative complications were independently associated with shorter disease‐free survival (P = 0.01). Conclusions Advanced age and pleural adhesion were independent risk factors for complications after complete single‐lobe thoracoscopic lobectomies for clinical stage I NSCLC, and postoperative complications were statistically associated with poor prognosis. Surgical teams should ensure an experienced surgeon leads the operation for patients at higher risk to avoid prolonged postoperative hospitalization and a possible poor prognosis.

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“…2 Although there is growing interest regarding the deleterious effects of sarcopenia on tolerance to chemotherapy and prognosis, data specifically related to lung cancer patients is lacking. The prevalence of sarcopenia is reported to occur in lung cancer patients at a range of 46-79% [3][4][5][6][7][8][9][10] and is likely dependent on age, smoking habits, 9 duration of the disease, different body mass index (BMI) 11 and gender. 4,8,10,12 To our knowledge only a few papers have investigated the clinical consequences of sarcopenia in patients with lung cancer but the results are have not been homogeneous.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of sarcopenia is reported to occur in lung cancer patients at a range of 46-79% [3][4][5][6][7][8][9][10] and is likely dependent on age, smoking habits, 9 duration of the disease, different body mass index (BMI) 11 and gender. 4,8,10,12 To our knowledge only a few papers have investigated the clinical consequences of sarcopenia in patients with lung cancer but the results are have not been homogeneous. [5][6][7][8]13,14 Regarding the prognostic value of skeletal muscle radiodensity (SMD), only one study by Sjoblom et al showed that SMD had a statistically significant negative prognostic value in non-small cell lung cancer (NSCLC) patients, 15 a finding also reported in other types of tumors.…”

Section: Introductionmentioning

confidence: 99%

Single‐institution study of correlations between skeletal muscle mass, its density, and clinical outcomes in non‐small cell lung cancer patients treated with first‐line chemotherapy

et al. 2018

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BackgroundSarcopenia and muscle tissue degradation are hallmarks of the majority of chronic diseases, including non‐small cell lung cancer (NSCLC). A computed tomography scan could be an easy modality to estimate the skeletal muscle mass through cross‐sectional image analysis at the level of the third lumbar vertebra.MethodsBaseline skeletal muscle mass (SMM) was evaluated through the skeletal muscle index (SMI), together with skeletal muscle radiodensity (SMD), in NSCLC patients undergoing first‐line chemotherapy to evaluate correlations with safety and clinical outcomes. When SMIs at different time points were available, further comparison was made between patients with worse and improved SMIs.ResultsAmong 81 stage IV NSCLC patients, 28 had low SMM and 23 had low SMD. There were no significant differences in univariate analysis of progression‐free survival (PFS) between patients with baseline low and non‐low SMM (P = 0.06388) or between patients with low and non‐low SMD (P = 0.9126). Baseline low SMM, however, proved a significant predictor of shorter PFS in multivariate analysis (hazard ratio 0.54, 95% confidence interval 0.31–0.93; P = 0.0278), but not low SMD. There were no differences in overall survival (OS) between patients with baseline low and non‐low SMM or low and non‐low SMD. No differences in PFS and OS between evaluable patients with worse or improved SMI were found. A significant difference in hematological toxicities between patients with baseline low and non‐low SMM (P = 0.0358) was observed.ConclusionsLow SMM is predictive of shorter PFS, while consecutive changes in muscular mass do not seem to be a predictor of PFS or OS. The role of muscle radiodensity remains a matter of debate.

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Sarcopenia in Resected NSCLC: Effect on Postoperative Outcomes

Abstract: 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.

Cited by 111 publications

References 41 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

Risk factors and cancer recurrence associated with postoperative complications after thoracoscopic lobectomy for clinical stage I non‐small cell lung cancer

Single‐institution study of correlations between skeletal muscle mass, its density, and clinical outcomes in non‐small cell lung cancer patients treated with first‐line chemotherapy

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