Nakada Takeo, Suyama Yu, Arakawa Satoshi, Tsukamoto Yo, Shibazaki Takamasa, Kinoshita Tomonari, Ohtsuka Takashi
Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, Nishishinbashi 3-19-18, Minatoku, Tokyo, 105-8471, Japan.
Gen Thorac Cardiovasc Surg. 2025 Mar;73(3):190-197. doi: 10.1007/s11748-024-02069-z. Epub 2024 Aug 3.
Sublobar resections for lung cancer are increasing worldwide. However, the prognostic significance of weight loss after sublobar resection remains unclear. We aimed to investigate the prognostic significance of weight loss after sublobar resection for lung cancer.
Patients who underwent sublobar resection for non-small cell lung cancer between January 2016 and June 2021 were analysed. The percentage weight change at 3, 6, and 12 months postoperatively was determined based on the preoperative weight. Patients were divided into two groups: those with or without weight loss ≥ 5%, referring to the diagnostic criteria for frailty, to assess prognosis. Subsequently, the prognosis-related timing of weight loss ≥ 5% and its risk factors were analyzed.
We reviewed 147 patients; 39 (26.5%) showed weight loss ≥ 5% within 1-year post-surgery. A total of 32 patients (21.8%) died, 13 from primary lung cancer and 19 from non-lung cancer causes. Cancer recurrence occurred in 22 patients (15.0%). Weight loss ≥ 5% within 1-year post-surgery was a poor prognostic factor for overall and recurrence-free survival (log-rank; p = 0.014 and 0.018, respectively). Additionally, weight loss ≥ 5% at 6-12 months postoperatively was associated with poor overall and recurrence-free survival (p < 0.05, both). In the multivariable analysis, an age-adjusted Charlson comorbidity index ≥ 4 was a predictive factor for weight loss ≥ 5% at 6-12 months postoperatively (odds ratio, 3.920; p = 0.023).
Weight loss ≥ 5% at 6-12 months postoperatively was associated with poor prognosis. Long-term nutritional management is important in the treatment plan of sublobar resection in high-risk patients.
在全球范围内，肺癌的肺叶下切除手术正在增加。然而，肺叶下切除术后体重减轻的预后意义仍不明确。我们旨在研究肺癌肺叶下切除术后体重减轻的预后意义。
分析了2016年1月至2021年6月期间接受非小细胞肺癌肺叶下切除手术的患者。根据术前体重确定术后3、6和12个月时的体重变化百分比。患者分为两组：体重减轻≥5%（参照衰弱的诊断标准）和未减轻的患者，以评估预后。随后，分析体重减轻≥5%的预后相关时间及其危险因素。
我们回顾了147例患者；39例（26.5%）在术后1年内体重减轻≥5%。共有32例患者（21.8%）死亡，13例死于原发性肺癌，19例死于非肺癌原因。22例患者（15.0%）出现癌症复发。术后1年内体重减轻≥5%是总体生存和无复发生存的不良预后因素（对数秩检验；p分别为0.014和0.018）。此外，术后6至12个月体重减轻≥5%与总体生存和无复发生存不良相关（两者p均<0.05）。在多变量分析中，年龄校正的Charlson合并症指数≥4是术后6至12个月体重减轻≥5%的预测因素（比值比，3.920；p=0.023）。
术后6至12个月体重减轻≥5%与预后不良相关。在高危患者的肺叶下切除治疗方案中，长期营养管理很重要。
