Tsukioka Takuma, Izumi Nobuhiro, Kyukwang Chung, Komatsu Hiroaki, Toda Michihito, Hara Kantaro, Nishiyama Noritoshi
Department of Thoracic Surgery, Osaka City University Hospital, Osaka, Osaka, Japan.
Ann Thorac Cardiovasc Surg. 2018 Jun 20;24(3):121-126. doi: 10.5761/atcs.oa.17-00215. Epub 2018 Feb 16.
We often experienced early recurrence in patients with completely resected N2-positive non-small-cell lung cancer (NSCLC). Loss of muscle mass is a poor prognostic factor in patients with several stages of NSCLC. This study aimed to investigate the relationship between preoperative loss of muscle mass and postoperative early recurrence in patients with N2-positive NSCLC.
We retrospectively analyzed 47 male patients with completely resected pathological N2-positive NSCLC. Early recurrence was defined as that diagnosed within 1 year after the operation. We used the L3 muscle index (cross-sectional area of muscle at the L3 level, normalized for height) as a clinical measurement of loss of muscle mass (cutoff value, 52.4 cm/m).
In all, 18 patients with early recurrence had significantly poorer outcomes compared with those without (P <0.01). In univariate analysis, loss of muscle mass (P = 0.023), carcinoembryonic antigen (CEA) level >5.0 ng/mL (P = 0.002), and absence of postoperative chemotherapy (P = 0.042) were predictors of postoperative early recurrence. In multivariate analysis, loss of muscle mass (P = 0.004) and CEA level >5.0 ng/mL (P = 0.001) were independent predictors.
Loss of muscle mass is an independent predictor of postoperative early recurrence in pathological N2-positive NSCLC patients.
我们经常在完全切除的N2期阳性非小细胞肺癌（NSCLC）患者中观察到早期复发。肌肉量减少是多个阶段NSCLC患者的不良预后因素。本研究旨在探讨N2期阳性NSCLC患者术前肌肉量减少与术后早期复发之间的关系。
我们回顾性分析了47例经病理证实为N2期阳性且已完全切除的男性NSCLC患者。早期复发定义为术后1年内诊断出的复发。我们使用L3肌肉指数（L3水平肌肉的横截面积，根据身高进行标准化）作为肌肉量减少的临床测量指标（临界值为52.4 cm/m）。
总体而言，18例早期复发患者的预后明显比未复发患者差（P<0.01）。在单因素分析中，肌肉量减少（P = 0.023）、癌胚抗原（CEA）水平>5.0 ng/mL（P = 0.002）以及未进行术后化疗（P = 0.042）是术后早期复发的预测因素。在多因素分析中，肌肉量减少（P = 0.004）和CEA水平>5.0 ng/mL（P = 0.001）是独立的预测因素。
肌肉量减少是病理N2期阳性NSCLC患者术后早期复发的独立预测因素。
