Elsevier

Lung Cancer

Volume 101, November 2016, Pages 92-97
Lung Cancer

Clinical implications of sarcopenia in patients undergoing complete resection for early non-small cell lung cancer

https://doi.org/10.1016/j.lungcan.2016.08.007Get rights and content

Highlights

  • The first report on the relationship between sarcopenia and the outcome of patients with early-stage lung cancer.

  • Sarcopenia was associated with poor outcome of male patients with completely resected early-stage NSCLC.

  • Sarcopenia was associated with gender and body mass index (BMI) in patients with early-stage NSCLC.

Abstract

Objectives

Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength. We aimed to investigate sarcopenia in patients with stage I non-small cell lung cancer (NSCLC) who underwent complete resection, and the relationship of sarcopenia with clinicopathological factors.

Methods

All consecutive patients who underwent lung resection between January 2005 and December 2008 were enrolled in this retrospective study. Eligible patients were assigned to one of 2 groups according to the presence or absence of sarcopenia, as assessed by the sum of cross-sectional areas of skeletal muscles in the region of the third lumbar vertebra (L3) on preoperative computed tomography (CT).

Results

Sixteen of 52 male (30.8%) and 22 of 38 female (57.9%) patients were identified with sarcopenia (p = 0.01). Patients with sarcopenia were more likely to have a low body mass index (BMI) (p < 0.0001). Kaplan-Meier analysis showed that patients with sarcopenia had a significantly worse outcome than patients without sarcopenia (5-year-survival: 72.8% vs 85.8%, respectively, p = 0.028). Multivariate analysis found that sarcopenia was a significant independent prognostic factor (hazard ratio: 7.09, p = 0.0008).

Conclusions

Sarcopenia identified on a cross-sectional CT image of the L3 level was associated with poor outcome with completely resected early-stage NSCLC.

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.

Section snippets

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.

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