Nagata Masashi, Ito Hiroyuki, Yoshida Tetsuo, Tokushige Akihiro, Ueda Shinichiro, Yokose Tomoyuki, Nakayama Haruhiko
Department of Thoracic Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan.
Department of General Surgery, Okinawa Kyodo Hospital, Naha, Japan.
J Thorac Dis. 2020 Mar;12(3):307-318. doi: 10.21037/jtd.2020.01.44.
Our previous report described how postoperative progression of sarcopenia predicted long-term prognosis after complete resection of non-small cell lung cancer (NSCLC) in heavy smokers. However, there are currently no effective means to treat progressive sarcopenia. In this study, we aimed to confirm our previous findings in a larger population and to identify factors associated with postoperative progression of sarcopenia to propose possible preventative measures.
This retrospective study analyzed the data of 1,095 patients who underwent curative lobar resection for NSCLC at Kanagawa Cancer Center. We divided patients into four groups according to sex and Brinkman index (BI) above or below 600. Six-month postoperative changes in the skeletal muscle index (SMI) were calculated and associations between clinicopathological factors including changes in SMI and mortality from postoperative 6 months were examined. Only in groups in which postoperative depletion of SMI was shown to be associated with the prognosis, we identified clinicopathological factors associated with depletive SMI.
The overall survival rates of 1,095 patients were 89.8% and 82.5% at 3 and 5 years, respectively. The median 6-month change in SMI was -3.4% (range, -22.3% to +17.9%). Multivariate analysis revealed that poor prognosis was independently predicted by a large reduction in the SMI (cut-off value: -10%) in males with a BI ≥600. In 391 heavy-smoking males, factors associated with a postoperative change in SMI ≤-10% were history of other cancers (including gastric cancer) low forced expiratory volume in one second (FEV 1.0, cut-off value: 1,870 mL), and prolonged operation time (cut-off value: 200 minutes).
Perioperative measures to prevent postoperative sarcopenia are appropriate for heavy smokers. We obtained some clues regarding countermeasures, one of which may be avoiding long-time operation. Further studies including clinical trials to assess perioperative anti-sarcopenia treatments, are needed.
我们之前的报告描述了肌肉减少症的术后进展如何预测重度吸烟者非小细胞肺癌（NSCLC）完全切除术后的长期预后。然而，目前尚无治疗进行性肌肉减少症的有效方法。在本研究中，我们旨在在更大的人群中证实我们之前的发现，并确定与肌肉减少症术后进展相关的因素，以提出可能的预防措施。
这项回顾性研究分析了在神奈川癌症中心接受NSCLC根治性肺叶切除术的1095例患者的数据。我们根据性别和Brinkman指数（BI）高于或低于600将患者分为四组。计算术后6个月骨骼肌指数（SMI）的变化，并检查包括SMI变化在内的临床病理因素与术后6个月死亡率之间的关联。仅在显示SMI术后减少与预后相关的组中，我们确定了与消耗性SMI相关的临床病理因素。
1095例患者的3年和5年总生存率分别为89.8%和82.5%。SMI的中位6个月变化为-3.4%（范围，-22.3%至+17.9%）。多变量分析显示，BI≥600的男性中，SMI大幅降低（临界值：-10%）可独立预测预后不良。在391例重度吸烟男性中，与术后SMI变化≤-10%相关的因素包括其他癌症病史（包括胃癌）、一秒用力呼气量低（FEV1.0，临界值：1870 mL）和手术时间延长（临界值：200分钟）。
预防术后肌肉减少症的围手术期措施适用于重度吸烟者。我们获得了一些关于对策的线索，其中之一可能是避免长时间手术。需要进一步开展包括评估围手术期抗肌肉减少症治疗的临床试验在内的研究。
