Lee Ji Hyun, Kang Danbee, Lee Junghee, Jeon Yeong Jeong, Park Seong Yong, Cho Jong Ho, Choi Yong Soo, Kim Jhingook, Shim Young Mog, Kong Sunga, Kim Hong Kwan, Cho Juhee
From the Department of Radiology (J.H.L.) and Department of Thoracic and Cardiovascular Surgery (J.L., Y.J.J., S.Y.P., J.H.C., Y.S.C., J.K., Y.M.S., H.K.K.), Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 115 Irwon-ro, Gangnam-gu, Seoul 06355, Korea (D.K., J.L., S.Y.P., S.K., J.C.); Center for Clinical Epidemiology, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea (D.K., J.C.); Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Korea (J.L., Y.M.S., S.K., H.K.K., J.C.); and Department of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md (J.C.).
Radiology. 2025 Jan;314(1):e241507. doi: 10.1148/radiol.241507.
Background A comprehensive assessment of skeletal muscle health is crucial to understanding the association between improved clinical outcomes and obesity as defined by body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) in lung cancer, but limited studies have been conducted on this topic. Purpose To investigate the association between BMI-defined obesity and survival in patients with non-small cell lung cancer who underwent curative resection, with a specific focus on the status of skeletal muscle assessed at CT. Materials and Methods This retrospective study investigated Korean patients with non-small cell lung cancer who underwent curative resection between January 2008 and December 2019. Patients were classified into nonobese (BMI <25) or obese (BMI ≥25) groups. Skeletal muscle status was assessed at CT at the level of the third lumbar vertebrae. Low skeletal muscle mass (LSMM) was defined as the sex-specific lowest quartile. Cox regression analysis was used to evaluate the associations of BMI and muscle status with overall survival. Results A total of 7076 patients (mean age, 62.5 years ± 9.7 [SD]; 4081 male) were included, of whom 2512 (35.5%) had a BMI greater than or equal to 25 (obese group). In the setting of absent LSMM and myosteatosis, patients in the obese group had longer overall survival compared with patients in the nonobese group (hazard ratio [HR], 0.77; 95% CI: 0.66, 0.90; = .001). The associations between obesity and lower mortality were observed only in male patients (HR, 0.72; 95% CI: 0.60, 0.85; < .001) and patients who had ever smoked (HR, 0.71; 95% CI: 0.60, 0.85; < .001) who were without LSMM and myosteatosis, with effect differing according to sex and smoking status ( value range, <.001 to .02 for interaction). Conclusion Obesity is associated with improved overall survival in patients with non-small cell lung cancer after curative resection when skeletal muscle mass and radiodensity are preserved. © RSNA, 2025 See also the editorial by Vannier in this issue.
全面评估骨骼肌健康对于理解肺癌患者临床结局改善与肥胖（以体重指数（BMI；计算方法为千克体重除以身高米数的平方）定义）之间的关联至关重要，但关于这一主题的研究有限。
调查接受根治性切除的非小细胞肺癌患者中BMI定义的肥胖与生存之间的关联，特别关注CT评估的骨骼肌状态。
这项回顾性研究调查了2008年1月至2019年12月期间接受根治性切除的韩国非小细胞肺癌患者。患者被分为非肥胖（BMI<25）或肥胖（BMI≥25）组。在CT上于第三腰椎水平评估骨骼肌状态。低骨骼肌质量（LSMM）定义为按性别划分的最低四分位数。采用Cox回归分析评估BMI和肌肉状态与总生存的关联。
共纳入7076例患者（平均年龄62.5岁±9.7[标准差]；4081例男性），其中2512例（35.5%）BMI大于或等于25（肥胖组）。在无LSMM和肌肉衰减的情况下，肥胖组患者的总生存期长于非肥胖组患者（风险比[HR]，0.77；95%可信区间：0.66，0.90；P = 0.001）。仅在无LSMM和肌肉衰减的男性患者（HR，0.72；95%可信区间：0.60，0.85；P < 0.001）和曾经吸烟的患者（HR，0.71；95%可信区间：0.60，0.85；P < 0.001）中观察到肥胖与较低死亡率之间的关联，且效应因性别和吸烟状态而异（交互作用P值范围为<0.001至0.02）。
在根治性切除术后的非小细胞肺癌患者中，当骨骼肌质量和放射密度得以保留时，肥胖与总生存期改善相关。©RSNA，2025 另见本期Vannier的社论。
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