Daffrè Elisa, Prieto Mathilde, Martini Katharina, Hoang-Thi Trieu-Nghi, Halm Nara, Dermine Hervè, Bobbio Antonio, Chassagnon Guillaume, Revel Marie Pierre, Alifano Marco
Department of Thoracic Surgery, Paris Centre University Hospitals, AP-HP, 75014 Paris, France.
Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
Cancers (Basel). 2021 Apr 14;13(8):1888. doi: 10.3390/cancers13081888.
There is no standardization in methods to assess sarcopenia; in particular the prognostic significance of muscular fatty infiltration in lung cancer patients undergoing surgery has not been evaluated so far. We thus performed several computed tomography (CT)-based morphometric measurements of sarcopenia in 238 consecutive non-small cell lung-cancer patients undergoing pneumonectomy from 1 January 2007 to 31 December 2015. Sarcopenia was assessed by the following CT-based parameters: 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 performed at the level of the third lumbar vertebra and were obtained for the entire muscle surface, as well as by excluding fatty infiltration based on CT attenuation. Findings were stratified for gender, and a threshold of the 33rd percentile was set to define sarcopenia. Furthermore, we assessed the possibility of being sarcopenic at both the TPA and TPMA level, or not, by taking into account of not fatty infiltration. Five-year survival was 39.1% for the whole population. Lower TPA, TMA, and TPA were associated with lower survival at univariate analysis; taking into account muscular fatty infiltration did not result in more powerful discrimination. Being sarcopenic at both psoas and parietal muscle level had the optimum discriminating power. At the multivariable analysis, being sarcopenic at both psoas and parietal muscles (considering the whole muscle areas, including muscular fat), male sex, increasing age, and tumor stage, as well as Charlson Comorbidity Index (CCI), were independently associated with worse long-term outcomes. We conclude that sarcopenia is a powerful negative prognostic factor in patients with lung cancer treated by pneumonectomy.
评估肌肉减少症的方法尚无标准化；特别是，肌肉脂肪浸润在接受手术的肺癌患者中的预后意义迄今尚未得到评估。因此，我们对2007年1月1日至2015年12月31日期间连续接受肺叶切除术的238例非小细胞肺癌患者进行了基于计算机断层扫描（CT）的肌肉减少症形态学测量。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）和总壁层肌肉面积（TPMA），TPMA定义为TMA减去TPA。测量在第三腰椎水平进行，获取整个肌肉表面的测量值，并根据CT衰减排除脂肪浸润。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。此外，我们通过考虑无脂肪浸润情况，评估了在TPA和TPMA水平是否存在肌肉减少症的可能性。整个人群的五年生存率为39.1%。在单变量分析中，较低的TPA、TMA和TPA与较低的生存率相关；考虑肌肉脂肪浸润并未导致更强的鉴别力。腰大肌和壁层肌肉水平均存在肌肉减少症具有最佳鉴别力。在多变量分析中，腰大肌和壁层肌肉均存在肌肉减少症（考虑整个肌肉面积，包括肌肉脂肪）、男性、年龄增加、肿瘤分期以及查尔森合并症指数（CCI）与较差的长期预后独立相关。我们得出结论，肌肉减少症是接受肺叶切除术治疗的肺癌患者的一个强大的负面预后因素。
