Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, Japan.
Ann Surg Oncol. 2018 May;25(5):1229-1236. doi: 10.1245/s10434-017-6328-y. Epub 2018 Jan 11.
A relationship between sarcopenia diagnosed by skeletal muscle area (SMA) and poor prognosis in cancer patients has recently been reported. This study aimed to clarify the clinical significance of postoperatively decreased SMA in patients with early non-small cell lung cancer (NSCLC).
This study selected 101 patients with pathologic stage 1 NSCLC who had undergone pre- and postoperative (~ 1 year) computed tomography scans and lobectomy between 2005 and 2010 at Kyushu University Hospital. The post/pre ratio was defined as the postoperative normalized SMA (cm/m) at the 12th thoracic vertebra level divided by the preoperative normalized SMA. The cutoff value for the post/pre ratio was set at 0.9.
The study classified 31 patients (30.7%) as having decreased SMA. Poor performance status (PS) was significantly associated with decreased SMA (p = 0.048). The patients with decreased SMA had a significantly shorter disease-free survival (DFS) (p < 0.001) and overall survival (OS) (p < 0.001) than the other patients. Decreased SMA was found to be an independent prognostic factor for DFS (p = 0.010) and OS (p = 0.0072). The independent risk factors for skeletal muscle loss included poor PS (PS ≥ 1) and obstructive ventilatory impairment [forced expiratory volume (FEV) 1% < 70%].
Skeletal muscle loss after surgery is significantly associated with postoperative poor outcomes for patients with early NSCLC. Patients with poor PS, obstructive ventilatory impairment, or both need careful support to maintain their skeletal muscle mass. Future prospective studies may clarify whether physical activity and nutritional support improve postoperative prognosis.
骨骼肌面积（SMA）诊断的肌肉减少症与癌症患者的不良预后之间存在关联。本研究旨在明确早期非小细胞肺癌（NSCLC）患者术后 SMA 减少的临床意义。
本研究选择了 2005 年至 2010 年在九州大学医院接受术前和术后（约 1 年）计算机断层扫描和肺叶切除术的 101 例病理分期为 1 期 NSCLC 患者。术后/术前比定义为第 12 胸椎水平的术后归一化 SMA（cm/m）除以术前归一化 SMA。将术后/术前比的截止值设定为 0.9。
研究将 31 例患者（30.7%）归类为 SMA 减少。较差的表现状态（PS）与 SMA 减少显著相关（p=0.048）。与其他患者相比，SMA 减少的患者无病生存（DFS）（p<0.001）和总生存（OS）（p<0.001）显著缩短。SMA 减少被发现是 DFS（p=0.010）和 OS（p=0.0072）的独立预后因素。骨骼肌丢失的独立危险因素包括较差的 PS（PS≥1）和阻塞性通气障碍[用力呼气量（FEV）1%<70%]。
早期 NSCLC 患者手术后骨骼肌丢失与术后不良结局显著相关。PS 差、阻塞性通气障碍或两者兼有的患者需要小心支持以维持其骨骼肌质量。未来的前瞻性研究可能会阐明体力活动和营养支持是否可以改善术后预后。
