Ponholzer Florian, Groemer Georg, Ng Caecilia, Maier Herbert, Lucciarini Paolo, Kocher Florian, Öfner Dietmar, Gassner Eva, Schneeberger Stefan, Augustin Florian
Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Department of Internal Medicine V: Hematology and Oncology, Medical University Innsbruck, 6020 Innsbruck, Austria.
Cancers (Basel). 2023 Nov 30;15(23):5666. doi: 10.3390/cancers15235666.
Surgical resection remains the gold standard of treatment for early-stage lung cancer. Several risk models exist to predict postoperative morbidity and mortality. Psoas muscle sarcopenia has already successfully been used for morbidity prediction in lung transplantation and is not yet included in the available risk scores for pulmonary resections. We hypothesized that the skeletal muscle index and mediastinal adipose tissue might also have an impact on postoperative outcomes after primary surgery for primary lung cancer. The institutional database was queried for patients with primary lung cancer who were treated with primary lobectomy or segmentectomy between February 2009 and November 2018. In total, 311 patients were included for analysis. Patients receiving neo-/adjuvant chemotherapy or with a positive nodal status were excluded to rule out any morbidity or mortality due to (neo-)adjuvant treatment. Sarcopenia was defined as a skeletal muscle index of <34.4 cm/m for women and <45.4 cm/m for men. Mediastinal adipose tissue was defined with a radiodensity of -150 to -30 Hounsfield units. Sarcopenia was diagnosed in 78 (25.1%) of the 311 patients. Male patients were significantly more likely to suffer from sarcopenia (31.5% vs. 18.1%, = 0.009). Comorbidities, lung function, tumour histology, pathologic tumour staging, mediastinal adipose tissue and age did not differ between groups with or without sarcopenia. Sarcopenic patients had a significantly longer length of stay, with 13.0 days vs. 9.5 ( = 0.003), and a higher rate of any postoperative complications (59.0% vs. 44.6%, = 0.036). There was no difference in recurrence rate. Five-year overall survival was significantly better in the patient cohort without sarcopenia (75.6% vs. 64.5%, = 0.044). Mediastinal adipose tissue showed no significant impact on length of stay, postoperative complications, recurrence rate, morbidity or survival. Sarcopenia, quantified with the skeletal muscle index, is shown to be a risk factor for postoperative morbidity and reduced survival in primary lung cancer. Efforts should be taken to pre-emptively screen for sarcopenia and start countermeasures (e.g., physical prehabilitation, protein-rich nutrition, etc.) during the preoperative workup phase.
手术切除仍然是早期肺癌治疗的金标准。现有多种风险模型用于预测术后发病率和死亡率。腰大肌少肌症已成功用于肺移植的发病率预测，但尚未纳入肺切除可用的风险评分中。我们假设骨骼肌指数和纵隔脂肪组织可能也会对原发性肺癌初次手术后的术后结果产生影响。查询机构数据库中2009年2月至2018年11月期间接受初次肺叶切除术或肺段切除术治疗的原发性肺癌患者。总共纳入311例患者进行分析。排除接受新辅助/辅助化疗或淋巴结阳性的患者，以排除（新辅助）治疗导致的任何发病率或死亡率。少肌症定义为女性骨骼肌指数<34.4 cm/m，男性<45.4 cm/m。纵隔脂肪组织定义为放射密度为-150至-30亨氏单位。311例患者中有78例（25.1%）被诊断为少肌症。男性患者患少肌症的可能性显著更高（31.5%对18.1%，P = 0.009）。有或无少肌症的组之间在合并症、肺功能、肿瘤组织学、病理肿瘤分期、纵隔脂肪组织和年龄方面无差异。少肌症患者的住院时间明显更长，分别为13.0天对9.5天（P = 0.003），任何术后并发症的发生率更高（59.0%对44.6%，P = 0.036）。复发率无差异。无少肌症的患者队列5年总生存率明显更好（75.6%对64.5%，P = 0.044）。纵隔脂肪组织对住院时间、术后并发症、复发率、发病率或生存率无显著影响。用骨骼肌指数量化的少肌症被证明是原发性肺癌术后发病和生存率降低的一个危险因素。应努力在术前检查阶段对少肌症进行前瞻性筛查并开始采取对策（如物理预康复、富含蛋白质的营养等）。
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