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

Abstract

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.

Preoperative low skeletal muscle mass as a risk factor for pharyngocutaneous fistula and decreased overall survival in patients undergoing total laryngectomy

“…In hepatopancreatobiliary cancer, low SMM is associated with reduced OS . In patients with resectable early stage non‐small‐cell lung cancer, low SMM is associated with poor short‐term and long‐term outcomes after surgery . Low SMM has also been associated with prolonged hospital stay and increased health care‐related costs.…”

“…14 In patients with resectable early stage non-small-cell lung cancer, low SMM is associated with poor short-term and long-term outcomes after surgery. 27,28 Low SMM has also been associated with prolonged hospital stay and increased health care-related costs. A recent study in 452 patients undergoing abdominal surgery for cancer of the alimentary tract showed that patients with low SMM had a significantly longer hospital stay and significantly higher hospital costs than patients with normal SMM.…”

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

“…Several studies have reported that sarcopenia was associated with poor prognosis in lung cancer, but most of these included patients with advanced stage cancer . According to a rare report about sarcopenia in stage I NSCLC patients, sarcopenia was associated with poor prognosis in men but was not associated with postoperative complications . Another report, which defined sarcopenia using the erector spinae and pectoralis muscles, suggested that sarcopenia was not associated with the overall complication rate after lobectomies (mostly performed using the VATS approach) .…”

Sarcopenia is a predictor of outcomes after lobectomy

“…Suzuki et al examined 90 consecutive patients undergoing lung resection for stage I NSCLC, and using L3MI to assess for sarcopenia, found that sarcopenia was an independent prognostic factor for survival as patient with a low muscle mass had a significant decrease in 5-year overall survival (20). Tsukioka et al reported on 215 male patients with pathological stage I NSCLC, and used a calculated L3MI derived from an equation using BSA to define sarcopenia; in their report, sarcopenia did not affect short-term outcomes, but was associated with a shorter median overall survival (21).…”

“…CT imaging has been found to correlate well with other methods of evaluating muscle mass, which is useful as CT imaging is routinely done prior to resection (19). In lung cancer, recent studies have found evidence that sarcopenia is an independent risk factor for decreased overall survival (20,21). In those studies, assessment of muscle mass was done at the level of L3, which sometimes necessitates a CT scan lower than routinely performed to evaluate chest pathology.…”