Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, 150081, China.
Department of Pathology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, 150081, China.
Clin Nutr. 2023 Oct;42(10):1932-1939. doi: 10.1016/j.clnu.2023.08.002. Epub 2023 Aug 12.
Postoperative skeletal muscle loss (SM loss) was reported to be associated with a poor prognosis in early-stage non-small cell lung cancer (NSCLC). Small airway dysfunction (SAD) is a common but neglected respiratory abnormality. Little information is known about the association between preoperative SAD and postoperative SM loss in early-stage NSCLC. Therefore, this study aimed to investigate the correlation between preoperative SAD and SM loss after surgery in early-stage NSCLC patients.
There were 348 NSCLC patients with stages I-IIIA in this study from January 2017 to December 2020. All CT images were contrast-enhanced scans, and the skeletal muscle index (SMI) was measured using CT images. A 10.0% decrease in SMI over 12 months was determined as the cut-off value to define excessive SM loss. Logistic regression analyses were used to examine the relationship between SAD and SM loss.
This study included 348 subjects who underwent pulmonary operation (159 males and 189 females; mean age: 57.5 ± 8.8 years). 152 (43.7%) patients were identified as having SAD before surgery, and 179 patients (51.4%) were identified as having SM loss after 1 year. Moreover, a higher incidence of SAD was found in the SM loss group compared with that in the non-SM loss group (52.0% vs. 34.9%, p = 0.001). The patients with SAD were older, had larger tumor size, and had lower albumin levels. Furthermore, there were significant correlations between the lung function parameters manifesting SAD and the percentage change in SMI (for the forced expiratory flow when 75% of forced vital capacity has been exhaled (FEF), Pearson r=-0.107, p = 0.046; for FEF, r = -0.142, p = 0.008; and for FEF, r=-0.124, p = 0.021; respectively). However, no significant correlations were found between SMI and the lung function parameters reflecting proximal airway obstruction (p > 0.05). Logistic regression analysis revealed that preoperative SAD (HR, 2.465; 95% CI, 1.256-4.838; p = 0.009) was independent risk factor for postoperative SM loss in early-stage NSCLC. In addition, multivariable analysis revealed that SAD (HR, 1.816; 95% CI, 1.025-3.216, P = 0.041) were associated with postoperative complications.
Preoperative SAD is significantly associated with postoperative complications and SM loss in early NSCLC patients. Our results suggest that preoperative assessment of SAD may be useful for risk stratification of surgical candidates with potential for targeted interventions.
术后骨骼肌损失（SM 损失）与早期非小细胞肺癌（NSCLC）的预后不良有关。小气道功能障碍（SAD）是一种常见但被忽视的呼吸异常。关于早期 NSCLC 患者术前 SAD 与术后 SM 损失之间的关系，知之甚少。因此，本研究旨在探讨早期 NSCLC 患者术前 SAD 与术后 SM 损失之间的相关性。
本研究纳入了 2017 年 1 月至 2020 年 12 月期间的 348 例 I-IIIA 期 NSCLC 患者。所有 CT 图像均为增强扫描，使用 CT 图像测量骨骼肌指数（SMI）。SMI 在 12 个月内下降 10.0%被确定为定义过度 SM 损失的截止值。使用逻辑回归分析来检验 SAD 与 SM 损失之间的关系。
本研究纳入了 348 名接受肺手术的患者（男性 159 名，女性 189 名；平均年龄：57.5±8.8 岁）。术前 152 例（43.7%）患者存在 SAD，术后 1 年 179 例（51.4%）患者出现 SM 损失。此外，SM 损失组中 SAD 的发生率高于非 SM 损失组（52.0%比 34.9%，p=0.001）。患有 SAD 的患者年龄较大，肿瘤较大，白蛋白水平较低。此外，表现出 SAD 的肺功能参数与 SMI 的百分比变化之间存在显著相关性（对于呼气 75%用力肺活量时的强制呼气流量（FEF），Pearson r=-0.107，p=0.046；对于 FEF，r=-0.142，p=0.008；对于 FEF，r=-0.124，p=0.021；分别）。然而，反映近端气道阻塞的 SMI 与肺功能参数之间没有发现显著相关性（p>0.05）。逻辑回归分析显示，术前 SAD（HR，2.465；95%CI，1.256-4.838；p=0.009）是早期 NSCLC 患者术后 SM 损失的独立危险因素。此外，多变量分析显示，SAD（HR，1.816；95%CI，1.025-3.216，P=0.041）与术后并发症相关。
术前 SAD 与早期 NSCLC 患者的术后并发症和 SM 损失显著相关。我们的结果表明，术前 SAD 的评估可能对潜在的靶向干预的手术候选者的风险分层有用。
