Lee Jiyun, Moon Seok Whan, Choi Jung Suk, Hyun Kwanyong, Moon Young Kyu, Moon Mi Hyoung
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean J Thorac Cardiovasc Surg. 2020 Jun 5;53(3):93-103. doi: 10.5090/kjtcs.2020.53.3.93.
Risk assessment for pulmonary resection in patients with early-stage non-small-cell lung cancer (NSCLC) is important for minimizing postoperative morbidity. Depletion of skeletal muscle mass is closely associated with impaired nutritional status and limited physical ability. We evaluated the relationship between skeletal muscle depletion and early postoperative complications in patients with early-stage NSCLC.
Patients who underwent curative lung resection between 2016 and 2018 and who were diagnosed with pathological stage I/II NSCLC were included, and their records were retrospectively analyzed. The psoas volume index (PVI, cm/m) was calculated based on computed tomography images from routine preoperative positron emission tomography-computed tomography. Early postoperative complications, defined as those occurring within 90 days of surgery, were compared between the lowest sex-specific quartile for PVI and the remaining quartiles.
A strong correlation was found between the volume and the cross-sectional area of the psoas muscle (R=0.816). The overall rate of complications was 57.6% among patients with a low PVI and 32.8% among those with a normal-to-high PVI. The most common complication was prolonged air leak (low PVI, 16.9%; normal-to-high PVI, 9.6%), followed by pneumonia (low PVI, 13.6%; normal-to-high PVI, 7.9%) and recurrent pleural effusion (low PVI, 11.9%; normal-to-high PVI, 6.8%). The predictors of overall complications were low PVI (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.07-4.09; p=0.03), low hemoglobin level (OR, 0.686; 95% CI, 0.54-0.87; p=0.002), and smoking history (OR, 3.93; 95% CI, 2.03-7.58; p<0.001).
Low PVI was associated with a higher rate of early postoperative complications in patients with early-stage NSCLC.
对早期非小细胞肺癌（NSCLC）患者进行肺切除手术的风险评估对于将术后发病率降至最低至关重要。骨骼肌质量的消耗与营养状况受损和身体能力受限密切相关。我们评估了早期NSCLC患者骨骼肌消耗与术后早期并发症之间的关系。
纳入2016年至2018年间接受根治性肺切除术且被诊断为病理I/II期NSCLC的患者，并对其记录进行回顾性分析。基于术前常规正电子发射断层扫描-计算机断层扫描的计算机断层扫描图像计算腰大肌体积指数（PVI，cm/m）。比较PVI最低性别特异性四分位数组与其余四分位数组之间术后早期并发症（定义为术后90天内发生的并发症）的情况。
发现腰大肌体积与横截面积之间存在强相关性（R = 0.816）。PVI低的患者并发症总发生率为57.6%，PVI正常至高的患者为32.8%。最常见的并发症是持续漏气（PVI低，16.9%；PVI正常至高，9.6%），其次是肺炎（PVI低，13.6%；PVI正常至高，7.9%）和复发性胸腔积液（PVI低，11.9%；PVI正常至高，6.8%）。总体并发症的预测因素为低PVI（比值比[OR]，2.18；95%置信区间[CI]，1.07 - 4.09；p = 0.03）、低血红蛋白水平（OR，0.686；95% CI，0.54 - 0.87；p = 0.002）和吸烟史（OR，3.93；95% CI，2.03 - 7.58；p < 0.001）。
低PVI与早期NSCLC患者术后早期并发症发生率较高相关。
