Department of Thoracic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan.
Department of Pulmonary and Respiratory Medicine, Chubu Rosai Hospital, Nagoya, Aichi, Japan.
Ann Surg Oncol. 2020 Feb;27(2):481-489. doi: 10.1245/s10434-019-07703-2. Epub 2019 Aug 12.
Pericardial fat (PF) has not been considered a prognostic biomarker for overall survival (OS) in lung cancer. This study was designed to elucidate the impact of PF on prognosis of resected non-small cell lung cancer patients.
We retrospectively reviewed a total of 349 patients who underwent lung resection and received high-resolution computed tomography in our institute. PF volume was calculated. PF extended vertically from the diaphragm to the bifurcation of the right main pulmonary artery. Propensity score matched analysis was used to compare OS between the high- and low-PF groups.
PF volume increased according to body mass index (p < 0.001). Receiver operating characteristics (ROC) curve analysis for 3-year OS showed the possibility of better predictivity of PF than body-mass index (area under the curve, 0.66 vs. 0.61, p = 0.010). Cutoff level of PF volume was determined based on the ROC with 122 cm. Five-year OS was poorer in the low-PF group (63.5% vs. 73.4%; p = 0.002). After propensity score matching, each group consisted of 89 cases. Five-year OS was poorer in the low-PF group (66.5% vs. 82.7%; p = 0.008). A Cox proportional hazards model showed low-PF volume was associated with poorer OS (hazard ratio, 2.14; p = 0.009). The number of respiratory-related deaths was higher in the low-PF group (10/89 vs. 2/89, p = 0.032).
Low-PF volume may be associated with poor OS with an increase in the number of respiratory-related deaths. Patients with low-PF volume require careful follow-up after surgery.
心包脂肪（PF）尚未被认为是肺癌总生存（OS）的预后生物标志物。本研究旨在阐明 PF 对接受肺切除术的非小细胞肺癌患者预后的影响。
我们回顾性分析了在我院接受肺切除术并接受高分辨率 CT 检查的 349 例患者。计算 PF 体积。PF 从膈肌向主肺动脉分叉处垂直延伸。采用倾向评分匹配分析比较高 PF 组和低 PF 组的 OS。
PF 体积随体重指数（BMI）增加而增加（p<0.001）。3 年 OS 的 ROC 曲线分析表明，PF 比 BMI 更有可能预测（曲线下面积，0.66 与 0.61，p=0.010）。根据 ROC 确定 PF 体积的截断值为 122cm。低 PF 组 5 年 OS 较差（63.5%比 73.4%；p=0.002）。经过倾向评分匹配，每组各有 89 例。低 PF 组 5 年 OS 较差（66.5%比 82.7%；p=0.008）。Cox 比例风险模型显示低 PF 体积与较差的 OS 相关（风险比，2.14；p=0.009）。低 PF 组的呼吸相关死亡人数较高（10/89 比 2/89，p=0.032）。
低 PF 体积可能与较差的 OS 相关，并增加呼吸相关死亡的数量。PF 体积低的患者术后需要密切随访。
