Icard Philippe, Schussler Olivier, Loi Mauro, Bobbio Antonio, Lupo Audrey Mansuet, Wislez Marie, Iannelli Antonio, Fournel Ludovic, Damotte Diane, Alifano Marco
Thoracic Surgery Department, Paris Center University Hospitals, AP-HP, 75014 Paris, France.
Medical School, Inserm UMR 1199, Biology and Innovative Therapies of Locally Advanced Cancers University Caen Normandie, 14032 Caen, France.
Cancers (Basel). 2020 Jan 22;12(2):266. doi: 10.3390/cancers12020266.
Lower pre-surgery Body Mass Index (BMI) and low muscle mass impact negatively long-term survival of non-small cell lung cancer (NSCLC). We investigated their influence on survival after major lung resection for NSCLC.
A retrospective analysis of a prospectively collected database was made on 304 consecutive patients.
Underweight, normal, overweight and obese patients represented 7.6%, 51.6%, 28.6%, and 12.6% of the pre-disease population. Weight loss and gain were recorded in 5% and 44.4% of patients, respectively. Low muscle mass was more frequently associated with BMI < 25 kg/m ( < 0.000001). Overall survival was positively affected by pre-disease ( = 0.036) and pre-surgery ( 0.017) BMI > 25 kg/m, and, even more, in case of BMI > 25 kg/m and increasing weight ( = 0.012). Long-term outcome was negatively influenced by low muscle mass ( = 0.042) and weight loss ( 0.0052) as well as age ( 0.017), ASA categories ( 0.025), extent of resection ( 0.0001), pleural invasion ( 0.0012) and higher pathologic stage ( < 0.0001). Three stepwise multivariable models confirmed the independent favorable prognostic value of higher pre-disease (RR 0.66[0.49-0.89], 0.006) and pre-surgery BMI (RR 0.72[0.54-0.98], 0.034), and the absence of low muscle mass (RR 0.56[0.37-0.87], 0.0091).
Body reserves assessed by simple clinical markers impact survival of surgically treated NSCLC. Strategies improving body fat and muscular mass before surgery should be considered.
术前较低的体重指数（BMI）和低肌肉量对非小细胞肺癌（NSCLC）的长期生存有负面影响。我们研究了它们对NSCLC肺大部切除术后生存的影响。
对前瞻性收集的数据库中的304例连续患者进行回顾性分析。
体重过轻、正常、超重和肥胖患者分别占病前人群的7.6%、51.6%、28.6%和12.6%。分别有5%和44.4%的患者记录有体重减轻和体重增加。低肌肉量更常与BMI<25kg/m相关（<0.000001）。病前（=0.036）和术前（0.017）BMI>25kg/m对总生存有积极影响，而且，在BMI>25kg/m且体重增加的情况下影响更大（=0.012）。低肌肉量（=0.042）、体重减轻（0.0052）以及年龄（0.017）、美国麻醉医师协会（ASA）分级（0.025）、切除范围（0.0001）、胸膜侵犯（0.0012）和更高的病理分期（<0.0001）对长期预后有负面影响。三个逐步多变量模型证实了较高的病前BMI（风险比[RR]0.66[0.49 - 0.89]，=0.006）和术前BMI（RR 0.72[0.54 - 0.98]，=0.034）具有独立的良好预后价值，以及不存在低肌肉量（RR 0.56[0.37 - 0.87]，=0.0091）。
通过简单临床指标评估的身体储备影响手术治疗的NSCLC的生存。应考虑在手术前改善身体脂肪和肌肉量的策略。
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