Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ann Thorac Surg. 2020 Mar;109(3):914-920. doi: 10.1016/j.athoracsur.2019.09.035. Epub 2019 Oct 23.
Preoperative skeletal muscle loss was reported to be associated with a postoperative poor prognosis in non-small cell lung cancer (NSCLC) patients. The aim of this study was to elucidate the relationship between the change in skeletal muscle mass after surgery and the postoperative outcomes in NSCLC patients.
The data were analyzed for 204 NSCLC patients who had undergone curative lung resection and whose preoperative and postoperative (1-year) computed tomographic images were available. The skeletal muscle area (SMA) at the 12th thoracic vertebra level was used. Postoperative/preoperative ratio was defined as postoperative normalized SMA (cm/m) divided by preoperative normalized SMA. The cutoff value was set to a postoperative/preoperative ratio of 0.9. The neutrophil-lymphocyte ratio, the platelet-lymphocyte ratio, modified Glasgow prognostic score, and prognostic nutritional index were used to estimate change in the nutritional status.
There were 70 patients (34.3%) classified into the SMA-decreased group. Low body mass index was significantly associated with the SMA-decreased patients (P = .019). The SMA-decreased status was an independent prognostic factor for poor overall survival (P < .001) and disease-free survival (P = .001). The SMA-decreased status was significantly associated with the postoperative exacerbation of the neutrophil-lymphocyte ratio (P = .009), platelet-lymphocyte ratio (P = .026), modified Glasgow prognostic score (P = .003), and prognostic nutritional index (P = .013).
Skeletal muscle loss after surgery is significantly associated with poor postoperative outcomes in NSCLC patients. Further studies investigating the clinical impact of postoperative nutritional intervention are needed.
术前骨骼肌减少与非小细胞肺癌（NSCLC）患者术后预后不良相关。本研究旨在阐明手术后骨骼肌质量变化与 NSCLC 患者术后结局之间的关系。
对 204 例接受根治性肺切除术且术前和术后（1 年）有 CT 图像的 NSCLC 患者进行数据分析。使用第 12 胸椎水平的骨骼肌面积（SMA）。术后/术前比值定义为术后标准化 SMA（cm/m）除以术前标准化 SMA。将截值设定为术后/术前比值为 0.9。中性粒细胞-淋巴细胞比、血小板-淋巴细胞比、改良格拉斯哥预后评分和预后营养指数用于估计营养状况的变化。
有 70 例患者（34.3%）被归入 SMA 减少组。低 BMI 与 SMA 减少患者显著相关（P=.019）。SMA 减少状态是总生存期（P<.001）和无病生存期（P=.001）不良的独立预后因素。SMA 减少状态与术后中性粒细胞-淋巴细胞比（P=.009）、血小板-淋巴细胞比（P=.026）、改良格拉斯哥预后评分（P=.003）和预后营养指数（P=.013）的恶化显著相关。
手术后骨骼肌丢失与 NSCLC 患者术后不良结局显著相关。需要进一步研究术后营养干预的临床影响。
