Martini Katharina, Chassagnon Guillaume, Fournel Ludovic, Prieto Mathilde, Hoang-Thi Trieu-Nghi, Halm Nara, Bobbio Antonio, Revel Marie-Pierre, Alifano Marco
Radiology Department, APHP Centre - Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Diagnostic and Interventional Radiology, University Hospital Sarcopenia as Independent Risk Factor of Postpneumonectomy Respiratory Failure, ARDS and Mortality, Zurich, Rämistrasse 100, 8008 Zurich, Switzerland.
Radiology Department, APHP Centre - Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; University of Paris, Paris, France.
Lung Cancer. 2020 Nov;149:130-136. doi: 10.1016/j.lungcan.2020.09.009. Epub 2020 Sep 28.
Sarcopenia is associated with poor outcome in cancer-patients. However, the methods to define sarcopenia are not entirely standardized. We compared several morphometric measurements of sarcopenia and their prognostic value in short-term-outcome prediction after pneumonectomy.
Consecutive lung-cancer patients undergoing pneumonectomy from January 2007 to December 2015 and having a pre-operative computed tomography (CT) scan were retrospectively included. Sarcopenia was assessed by the following CT-based parameters measured at the level of the third lumbar vertebra: cross-sectional Total Psoas Area (TPA), cross-sectional Total Muscle Area (TMA), and Total Parietal Muscle Area (TPMA), defined as TMA without TPA. Measures were obtained for entire muscle surface, as well as by excluding fatty infiltration based on CT attenuation. Findings were stratified for gender, and a threshold of 33rd percentile was set to define sarcopenia. Acute Respiratory Failure (ARF), Acute Respiratory Distress Syndrome (ARDS), and 30-day mortality were assessed as parameters of short-term-outcome.
Two hundred thirty-four patients with pneumonectomy (right, n = 107; left, n = 127) were analysed. Postoperative mortality rate was 9.0 % (21/234), 17.1 % of patients (40/234) experienced ARF requiring re-intubation, and 10.3 % (24/234) had ARDS. All parameters describing sarcopenia gave significant results; the best discriminating parameter was TMA after excluding fat (p < 0.001). While right sided pneumonectomy and sarcopenia were independently associated to the three short-term outcome parameters, Charlson Comorbidity Index only independently predicted ARF.
Sarcopenia defined as the sex-related 33rd percentile of fat-excluded TMA at the level of the third lumbar vertebra is the most discriminating parameter to assess short-term-outcome in patients undergoing pneumonectomy.
肌肉减少症与癌症患者的不良预后相关。然而，定义肌肉减少症的方法并不完全标准化。我们比较了几种肌肉减少症的形态测量方法及其在肺切除术后短期预后预测中的预后价值。
回顾性纳入2007年1月至2015年12月接受肺切除术且术前行计算机断层扫描（CT）的连续肺癌患者。在第三腰椎水平通过以下基于CT的参数评估肌肉减少症：横断面腰大肌总面积（TPA）、横断面总肌肉面积（TMA）和顶叶总肌肉面积（TPMA，定义为TMA减去TPA）。测量整个肌肉表面，并根据CT衰减排除脂肪浸润。研究结果按性别分层，并设定第33百分位数的阈值来定义肌肉减少症。评估急性呼吸衰竭（ARF）、急性呼吸窘迫综合征（ARDS）和30天死亡率作为短期预后的参数。
分析了234例接受肺切除术的患者（右侧，n = 107；左侧，n = 127）。术后死亡率为9.0%（21/234），17.1%的患者（40/234）发生需要再次插管的ARF，10.3%（24/234）发生ARDS。所有描述肌肉减少症的参数均得出显著结果；最佳鉴别参数是排除脂肪后的TMA（p < 0.001）。虽然右侧肺切除术和肌肉减少症与三个短期预后参数独立相关，但Charlson合并症指数仅独立预测ARF。
在第三腰椎水平将排除脂肪的TMA的性别相关第33百分位数定义为肌肉减少症，是评估肺切除患者短期预后的最具鉴别力的参数。
