The association between thoracic sarcopenia and survival is gender specific in early-stage lung cancer

Abstract

Background: Sarcopenia, as measured at the 3rd lumbar (L3) level, has been shown to prognosticate survival in cancer patients. However, many patients with early-stage non-small cell lung cancer (NSCLC) do not undergo abdominal imaging. We hypothesized that preoperative thoracic sarcopenia is associated with survival in patients undergoing lung resection for early-stage NSCLC.Methods: Patients who underwent anatomic resection for NSCLC between 2010-2019 were retrospectively identified. Exclusion criteria included induction therapy, less than 90 days of follow-up, and absence of computed tomography (CT) imaging. Cross sectional skeletal muscle area was calculated at the fifth thoracic vertebra (T5), twelfth thoracic vertebra (T12), and L3 level. Gender-specific lowest quartile values and previously defined values were used to define sarcopenia. Overall survival and disease-free survival were assessed using the Kaplan-Meier method.Results: Overall, 221 patients met inclusion criteria with a median body mass index (BMI) of 26.5 kg/m 2 [interquartile range (IQR), 23.3-29.9 kg/m 2 ], age of 69 years (IQR, 62.4-74.9 years), and follow-up of 46.9 months (IQR,. At the T5 level, sarcopenic males demonstrated worse overall survival [median 41.0 (IQR, 13.8-53.7) vs. 42.0 (IQR, 23.1-55.1) months, P=0.023] and disease-free survival [median 15.8 (IQR,) months, P=0.007] when compared to non-sarcopenic males.There was no difference in survival between sarcopenic and non-sarcopenic females when assessed at T5. Sarcopenia at T12 or L3 was associated with worse overall survival (P<0.05).Conclusions: Sarcopenia at T5 is associated with worse survival in males, but not females. When using upper thoracic vertebral levels to assess for sarcopenia, it is necessary to account for gender.

The process to overcome lung cancer sarcopenia

“…They also investigated the association of T12MI and L3MI with prognosis in the same cohort. Low T12MI and L3MI showed a poor prognosis in all patients, regardless of sex ( 4 ). These results indicate that the muscle area at L3 and T12 is optimal for diagnosing sarcopenia and predicting prognosis.…”

Nutritional indices for screening sarcopenia before adult cardiac surgery

“…Areas were manually measured by outlining bilateral psoas muscle borders through an INFINITT PACS ® (INFINITT Healthcare, Seoul, Korea) using a computer ( Figure 1 ). Sarcopenia in this study was defined as a psoas muscle index in the lowest sex-specific quartile by referring to the literatures because no international cut-off value of psoas muscle mass index was available for sarcopenia ( 1 , 10 - 12 ).…”