Low Thoracic Skeletal Muscle Area Predicts Morbidity After Pneumonectomy for Lung Cancer

Madariaga, Maria Lucia; Troschel, Fabian M.; Best, Till D.; Knoll, Sheila J.; Gaissert, Henning A.; Fintelmann, Florian J.

doi:10.1016/j.athoracsur.2019.10.041

Cited by 32 publications

(30 citation statements)

References 32 publications

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“…Patients were identified using prospectively maintained registries, the institutional sample of the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) at the MGH and the institutional cancer registry at HDB. Three exclusion criteria were applied (Figure 1): Patients without available chest CT scan within 90 days prior to pneumonectomy, 14,15 artifacts precluding assessment of sarcopenia at the T10 thoracic vertebral body, 16 and incomplete clinical data.…”

Section: Methodsmentioning

confidence: 99%

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Sarcopenia on preoperative chest computed tomography predicts cancer‐specific and all‐cause mortality following pneumonectomy for lung cancer: A multicenter analysis

et al. 2021

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Background Mortality risk prediction in patients undergoing pneumonectomy for non‐small cell lung cancer (NSCLC) remains imperfect. Here, we aimed to assess whether sarcopenia on routine chest computed tomography (CT) independently predicts worse cancer‐specific (CSS) and overall survival (OS) following pneumonectomy for NSCLC. Methods We included consecutive adults undergoing standard or carinal pneumonectomy for NSCLC at Massachusetts General Hospital and Heidelberg University from 2010 to 2018. We measured muscle cross‐sectional area (CSA) on CT at thoracic vertebral levels T8, T10, and T12 within 90 days prior to surgery. Sarcopenia was defined as T10 muscle CSA less than two standard deviations below the mean in healthy controls. We adjusted time‐to‐event analyses for age, body mass index, Charlson Comorbidity Index, forced expiratory volume in 1 second in % predicted, induction therapy, sex, smoking status, tumor stage, side of pneumonectomy, and institution. Results Three hundred and sixty‐seven patients (67.4% male, median age 62 years, 16.9% early‐stage) underwent predominantly standard pneumonectomy (89.6%) for stage IIIA NSCLC (45.5%) and squamous cell histology (58%). Sarcopenia was present in 104 of 367 patients (28.3%). Ninety‐day all‐cause mortality was 7.1% (26/367). After a median follow‐up of 20.5 months (IQR, 9.2–46.9), 183 of 367 patients (49.9%) had died. One hundred and thirty‐three (72.7%) of these deaths were due to lung cancer. Sarcopenia was associated with shorter CSS (HR 1.7, p = 0.008) and OS (HR 1.7, p = 0.003). Conclusions This transatlantic multicenter study confirms that sarcopenia on preoperative chest CT is an independent risk factor for CSS and OS following pneumonectomy for NSCLC.

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Section: Methodsmentioning

confidence: 99%

“…The explanatory variable was sarcopenia defined as muscle CSA at T10 two standard deviations below the mean of a healthy reference group reported by Derstine et al 9 We also explored associations with continuous muscle CSA (in 10 cm² steps) at T8, T10, and T12 13,15,18 …”

Section: Methodsmentioning

confidence: 99%

Sarcopenia on preoperative chest computed tomography predicts cancer‐specific and all‐cause mortality following pneumonectomy for lung cancer: A multicenter analysis

et al. 2021

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“…Seventeen (73%) were retrospective observational studies [17e33] and six (26%) had a prospective observational design [34e39]. The oldest publication dated from 2001 [36] and the most recent publications from 2020 [21,22,26,29]. Median sample size was 228 patients (ranging from 52 to 1011, with a total of 7522) and the mean age of the included patients ranged between 56 and 79 years.…”

Section: Study Selectionmentioning

confidence: 99%

“…One or more of the following surgical techniques were used in 22 of the included studies [17e29,31e39]: pneumonectomy, lobectomy, segmentectomy, bilobectomy, wedge resection, and thoracotomy. Preselection of participants by means of forced expiratory volume in 1 s, carbon monoxide lung diffusion capacity, or oxygen uptake at peak exercise was used in two studies [21,37] (9%) and preselection of participants by means of age in three studies [17,32,33] (13%).…”

Section: Study Selectionmentioning

confidence: 99%

Associations between pretreatment nutritional assessments and treatment complications in patients with stage I-III non-small cell lung cancer: A systematic review

Voorn

Beukers

Trepels

et al. 2022

Clinical Nutrition ESPEN

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“…In cancer patients undergoing surgery, length of stay and post-operative complications are important indicators of surgical morbidity. Sarcopenia has been independently associated with adverse post-operative outcomes including infections, complications, the longer length of hospital stay and risk of readmission following gastrectomy (177,178) , pancreatectomy (179) , oesophagectomy (180,181) , cystectomy (182) pneumonectomy (183,184) and colectomy (185–187) . Even in those without complications, length of stay has been shown to be significantly longer in patients with muscle abnormalities (188–190) .…”

Section: Why Malnutrition Matters: Impact On Surgical Outcomesmentioning

confidence: 99%

Impact of musculoskeletal degradation on cancer outcomes and strategies for management in clinical practice

Ryan

Sullivan

2020

Proc. Nutr. Soc.

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The prevalence of malnutrition in patients with cancer is one of the highest of all patient groups. Weight loss (WL) is a frequent manifestation of malnutrition in cancer and several large-scale studies have reported that involuntary WL affects 50–80% of patients with cancer, with the degree of WL dependent on tumour site, type and stage of disease. The study of body composition in oncology using computed tomography has unearthed the importance of both low muscle mass (sarcopenia) and low muscle attenuation as important prognostic indications of unfavourable outcomes including poorer tolerance to chemotherapy; significant deterioration in performance status and quality of life (QoL), poorer post-operative outcomes and shortened survival. While often hidden by excess fat and high BMI, muscle abnormalities are highly prevalent in patients with cancer (ranging from 10 to 90%). Early screening to identify individuals with sarcopenia and decreased muscle quality would allow for earlier multimodal interventions to attenuate adverse body compositional changes. Multimodal therapies (combining nutritional counselling, exercise and anti-inflammatory drugs) are currently the focus of randomised trials to examine if this approach can provide a sufficient stimulus to prevent or slow the cascade of tissue wasting and if this then impacts on outcomes in a positive manner. This review will focus on the aetiology of musculoskeletal degradation in cancer; the impact of sarcopenia on chemotherapy tolerance, post-operative complications, QoL and survival; and outline current strategies for attenuation of muscle loss in clinical practice.

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Low Thoracic Skeletal Muscle Area Predicts Morbidity After Pneumonectomy for Lung Cancer

Cited by 32 publications

References 32 publications

Sarcopenia on preoperative chest computed tomography predicts cancer‐specific and all‐cause mortality following pneumonectomy for lung cancer: A multicenter analysis

Sarcopenia on preoperative chest computed tomography predicts cancer‐specific and all‐cause mortality following pneumonectomy for lung cancer: A multicenter analysis

Associations between pretreatment nutritional assessments and treatment complications in patients with stage I-III non-small cell lung cancer: A systematic review

Impact of musculoskeletal degradation on cancer outcomes and strategies for management in clinical practice

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