Clinical implications of sarcopenia in patients undergoing complete resection for early non-small cell lung cancer
Introduction
Lung cancer is the leading cause of cancer death in most countries. Surgery is the best therapeutic modality for achieving a cure for patients with early-stage lung cancer. However, the outcome of patients with non-small cell lung cancer (NSCLC) who undergo complete resection has been reported to be worse than the outcome of patients with other definitively treated early-stage cancers; the 5-year postoperative survival rate of patients with stage IA NSCLC has ranged from 73% to 82%, which indicates that recurrent disease developed in more than 20% to 30% of stage IA patients [1], [2].
Prognostic information on patients with early stage NSCLC who will undergo surgical resection is important for deciding on follow-up methods or on whether to administer postoperative adjuvant treatment. Many prognostic factors have been investigated for lung cancer patients, and many disease-related factors have been identified, including pathological stage (tumor size, tumor invasion, and lymph node metastases). However, factors related to the physical status of a patient have also been reported to be important predictors of postoperative outcomes.
Among the parameters of physical status, the performance status (PS) and smoking history are well validated factors that are associated with the postoperative outcomes of patients with early-stage lung cancer, as well as the outcomes of patients with advanced-stage lung cancer [3]. In addition, the nutritional status of a patient has been reported to be an important predictor of postoperative fitness. Poor nutritional status is associated with a low activity-of-daily-living (ADL) score, which may impair patient compliance with anticancer treatment, consequently resulting in unfavorable postoperative survival. Recent studies have shown that a lung cancer patient’s body status, including low body weight and low body mass index (BMI), predicts unfavorable surgical outcomes for both survival and postoperative morbidities [4], [5].
Sarcopenia is a syndrome that is characterized by progressive and generalized loss of skeletal muscle mass and strength. It carries a risk of adverse outcomes such as physical disability, poor quality of life, and mortality [6]. Sarcopenia was first evaluated to predict the treatment outcomes associated with functional impairment in patients with geriatric syndrome. Several recent studies have shown that sarcopenia has prognostic significance for surgical and nonsurgical patients with malignant disease, including cancers of the esophagus, colon, pancreas, liver, urinary tract, and female reproductive tract. The impact of sarcopenia on the surgical outcomes of patients with lung cancer has not been reported. We therefore investigated sarcopenia in patients with stage I NSCLC who underwent complete resection. To determine the clinical implications of sarcopenia in patients with early-stage lung cancer, we assessed the relationship of sarcopenia with clinicopathological factors.
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Patients
All consecutive patients (n = 137) who underwent lung resection with curative intent as the initial treatment in the Department of Surgery II, Kyushu University Hospital, between January 2005 and December 2008, were enrolled in this retrospective study. Among those patients, a total of 90 patients whose CT scans were available for assessment at the L3 level were finally investigated. Curative resection was defined as complete macroscopic removal of the tumor. All patients underwent preoperative
Relationship between sarcopenia and the clinicopathological characteristics of patients with stage I non-small cell lung cancer
We evaluated sarcopenia among the eligible patients using the cut-off value. Sixteen of 52 male (30.8%) and 22 of 38 female patients (57.9%) were identified with sarcopenia (p = 0.01). Table 1 shows the patients’ clinicopathological characteristics according to patients with and without sarcopenia. Patients with sarcopenia were more likely to have low BMI (p < 0.0001). There were no significant differences in the rates of postoperative complications, duration of chest drainage, and duration of
Discussion
In this study we demonstrated that sarcopenia, which was defined as depletion of muscle mass, was significantly associated with poor postoperative outcome of patients with early NSCLC, especially among male patients. In the analysis of the relationship between sarcopenia and the clinicopathological characteristics of these surgical patients, only gender and body mass index (BMI) were related to sarcopenia. To our best knowledge, this is the first report on the relationship between sarcopenia
Conflict of interest
None declared.
Acknowledgement
We thank Mototsugu Shimokawa for a statistical review.
References (27)
- et al.
The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours
J. Thorac. Oncol.
(2007) - et al.
Japanese lung cancer registry study of 11,663 surgical cases in 2004: demographic and prognosis changes over decade
J. Thorac. Oncol.
(2011) - et al.
Performance status and smoking status are independent favorable prognostic factors for survival in non-small cell lung cancer: a comprehensive analysis of 26,957 patients with NSCLC
J. Thorac. Oncol.
(2010) - et al.
The influence of nutritional status on complications after operations for lung cancer
Ann. Thorac. Surg.
(2001) - et al.
Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study
Lancet Oncol.
(2008) - et al.
Clinically relevant determinants of body composition, function and nutritional status as mortality predictors in lung cancer patients
Lung Cancer
(2014) - et al.
Definition and classification of cancer cachexia: an international consensus
Lancet Oncol.
(2011) - et al.
Central tenet of cancer cachexia therapy: do patients with advanced cancer have exploitable anabolic potential
Am. J. Clin. Nutr.
(2013) - et al.
Obesity in breast cancer–what is the risk factor?
Eur. J. Cancer
(2015) - et al.
The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathologic TNM stage in surgically managed non-small cell lung cancer
J. Thorac. Oncol.
(2009)
The causes and consequences of cancer-associated malnutrition
Eur. J. Oncol. Nurs.
A propensity-matched comparison of survival after lung resection in patients with a high versus low body mass index
Eur. J. Cardiothorac. Surg.
Sarcopenia: European consensus on definition and diagnosis: report of the european working group on sarcopenia in older people
Age Ageing
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