CT-Derived Body Composition Values and Complications After Pneumonectomy in Lung Cancer Patients: Time for a Sex-Related Analysis?

Abstract

PurposeThis study aimed to assess if CT-derived body composition values and clinical characteristics are associated with the risk of postsurgical complications in men and women who underwent pneumonectomy for lung cancer.Materials and MethodsPatients who underwent pneumonectomy between 2004 and 2008 were selected. The ethics committee approved this retrospective study with waiver of informed content. Main clinical data collected were sex, age, weight and height to calculate body mass index (BMI), albumin, C-reactive protein, smoking status, side, sarcopenia, presurgical treatments, reoperation, and complications within 30 days after pneumonectomy, classified as: lung complications, cardiac complications, other complications, and any complication. From an axial CT image at the level of L3, automatic segmentations were performed to calculate skeletal muscle area (SMA), skeletal muscle density, subcutaneous adipose tissue, and visceral adipose tissue. Skeletal muscle index was calculated as SMA/square height. Univariate and multivariate logistic regression analyses were performed to estimate the risk of any complication, both on the total population and in a by sex subgroup analysis. All tests were two tailed and considered significant at 5% level.ResultsA total of 107 patients (84 men and 23 women) were included. Despite no significant differences in BMI, there were significant differences of body composition values in muscle and adipose tissue parameters between men and women, with women being significantly more sarcopenic than men (p = 0.002). Separate analyses for men and women showed that age and SMA were significantly associated with postoperative complications in men (p = 0.03 and 0.02, respectively).ConclusionsBody composition measurements extracted from routine CT may help in predicting complications after pneumonectomy, with men and women being different in quantity and distribution of muscle and fat, and men significantly more prone to postpneumonectomy complications with the increase of age and the decrease of skeletal muscle area.

Visceral Obesity in Non-Small Cell Lung Cancer

“…Besides surveying CT-based visceral fat measurements and associating them with some important demographic and pathological variables in NSCLC, our study demonstrates the practicability and encourages the use of routine CT data to include visceral obesity as an examined factor in lung cancer research. Visceral adiposity is also of relevance in immediate clinical care of lung cancer for its influence on pulmonary function [ 30 ] and outcomes such as post-pneumonectomy complications [ 31 ] and radiation pneumonitis [ 32 ].…”

“…We also wanted to point out the practicability of measuring visceral obesity by examining routinely collected radiological data using facile software-based methods. CT image data and workflow that are used for visceral obesity examination can be simultaneously used to measure other body composition features, such as skeletal muscle area [ 31 ], which may also have biomarker value in clinical care and research. With advances in image analysis, including incorporation of deep-learning-based approaches [ 40 ], it is possible that in the very near future, visceral obesity metrics will be automatically and accurately generated within radiology viewer applications themselves.…”

Increased adipose tissue is associated with improved overall survival, independent of skeletal muscle mass in non‐small cell lung cancer

“…11 Computed tomography (CT) is considered the gold standard for assessing body composition, allowing non-invasive and objective simultaneous quantification of the amount of skeletal muscle and adipose tissue at the desired anatomical level. 12 Chest CT is routinely performed in NSCLC patients during the initial diagnosis and follow-up assessment and may be the best option for the regular assessment of thoracic skeletal muscle and fat. 13 Previous studies have shown that sarcopenia, which is indicated by reduced pectoralis muscle mass on CT, is significantly associated with poor OS in NSCLC.…”

Body composition as a predictor of chemotherapy-related toxicity in pancreatic cancer patients: A systematic review

“…Body composition assessment may include evaluation of muscle mass by skeletal muscle area (SMA) and skeletal muscle index (SMI), as well as assessment of fat distribution by subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). Body composition has been shown to correlate with prognosis in many cancer subtypes, including ovarian ( 6 ), lung ( 7 ), bladder ( 8 ) and pancreatic malignancies ( 9 ). Furthermore, in some cancer types, sarcopenia increases the toxicity of chemotherapy ( 10 , 11 ), likely because drug dosing is largely based on the body surface area, that takes into account only the patient’s height and weight but ignores the relative quantity and distribution of muscle and fat.…”