Sarcopenia on preoperative chest computed tomography predicts cancer‐specific and all‐cause mortality following pneumonectomy for lung cancer: A multicenter analysis

Abstract

Background Mortality risk prediction in patients undergoing pneumonectomy for non‐small cell lung cancer (NSCLC) remains imperfect. Here, we aimed to assess whether sarcopenia on routine chest computed tomography (CT) independently predicts worse cancer‐specific (CSS) and overall survival (OS) following pneumonectomy for NSCLC. Methods We included consecutive adults undergoing standard or carinal pneumonectomy for NSCLC at Massachusetts General Hospital and Heidelberg University from 2010 to 2018. We measured muscle cross‐sectional area (CSA) on CT at thoracic vertebral levels T8, T10, and T12 within 90 days prior to surgery. Sarcopenia was defined as T10 muscle CSA less than two standard deviations below the mean in healthy controls. We adjusted time‐to‐event analyses for age, body mass index, Charlson Comorbidity Index, forced expiratory volume in 1 second in % predicted, induction therapy, sex, smoking status, tumor stage, side of pneumonectomy, and institution. Results Three hundred and sixty‐seven patients (67.4% male, median age 62 years, 16.9% early‐stage) underwent predominantly standard pneumonectomy (89.6%) for stage IIIA NSCLC (45.5%) and squamous cell histology (58%). Sarcopenia was present in 104 of 367 patients (28.3%). Ninety‐day all‐cause mortality was 7.1% (26/367). After a median follow‐up of 20.5 months (IQR, 9.2–46.9), 183 of 367 patients (49.9%) had died. One hundred and thirty‐three (72.7%) of these deaths were due to lung cancer. Sarcopenia was associated with shorter CSS (HR 1.7, p = 0.008) and OS (HR 1.7, p = 0.003). Conclusions This transatlantic multicenter study confirms that sarcopenia on preoperative chest CT is an independent risk factor for CSS and OS following pneumonectomy for NSCLC.

Preoperative Pectoralis Muscle Index Predicts Distant Metastasis-Free Survival in Breast Cancer Patients

“…The muscle index on the different thoracic vertebral levels exhibited different predictive capacities for survival, due in part to the fact that pectoralis muscles at T4 support upper extremity and respiratory system function (40). However, there are some limitations in this study.…”

“…In contrast, one study found that patients with progressive disease had significantly lower SMI/T11 levels compared with stable disease in lung cancer (39). Similarly, another study reported that muscle mass at T8 level (not T10 level) was the best predictor of survival, and muscle mass at T12 showed no association with survival in lung cancer (40). In line with prior studies, our results revealed that PMI/T4 may be more helpful in survival prediction than SMI/T11 in patients with breast cancer.…”

Association Between Pretreatment Skeletal Muscle and Outcomes After CAR T-Cell Therapy

“…Body composition measures for the current study were acquired from CT images that were obtained as part of pretreatment clinical evaluation, a strategy that has been successfully used in other populations. 32 To date, studies that have linked these CT-based measurements to outcomes after cancer treatment have largely been in patients with solid malignancies, [9][10][11][12]33 including those with gastrointestinal cancers, because of the association between nutritional deficiencies and availability of abdominal imaging. We recently reported on the association between pretreatment skeletal muscle health and increased risk of acute toxicities in patients undergoing HCT for hematologic malignancies, including a higher risk of all-cause mortality.…”

“…Abnormal skeletal muscle measurements at baseline such as low muscle mass and resultant fat infiltration (myosteatosis) have been associated with adverse cancerrelated outcomes and all-cause mortality in patients with solid and hematologic malignancies, [9][10][11][12] including in those undergoing hematopoietic cell transplantation (HCT). [13][14][15] For patients undergoing CAR T-cell therapy, abnormally low skeletal muscle prior to CAR T-cell infusion may be of particular clinical relevance, given the increasing recognition of the role of muscle as a regulator of immune response.…”

AI-Supported Comprehensive Detection and Quantification of Biomarkers of Subclinical Widespread Diseases at Chest CT for Preventive Medicine

“…The composition of visceral and subcutaneous abdominal adipose tissue as a risk factor for cardiovascular events and a metabolic marker in cancer has been quantified together with hepatic steatosis [ 3 , 39 , 40 , 41 ]. Previous approaches have performed automated segmentation of abdominal body composition based on thresholding and region growing, in conjunction with probabilistic filtering of intensities and with active contours to increase robustness [ 42 , 43 ].…”