Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non‐small‐cell lung cancer

Abstract

Background Despite the associations of both preoperative sarcopenia and physical performance with post‐operative mortality in non‐small‐cell lung cancer (NSCLC), there have been no comprehensive studies of the impact of physical status on prognosis. This study was performed to investigate the prognostic significance of preoperative sarcopenia and physical performance in NSCLC. Methods This retrospective cohort study was performed in NSCLS patients undergoing curative lung resection at a university hospital between January 2014 and December 2017. The patients were divided into four groups according to the skeletal muscle index [sarcopenia (lowest sex‐specific tertile) and non‐sarcopenia] and 6 min walking distance (6MWD) [short distance (<400 m) and long distance (≥400 m)]. Sarcopenia was assessed by preoperative cross‐sectional areas of right and left paraspinous muscles at the level of the 12th thoracic vertebra from computed tomography images, and physical performance was determined by preoperative 6MWD. The primary and secondary endpoints were post‐operative overall survival (OS) and disease‐free survival (DFS). Results The 587 patients [mean age: 68.5 ± 8.8 years, 399 men (68%)] included in the study were divided into the non‐sarcopenia/long‐distance group (58%), sarcopenia/long‐distance group (26%), non‐sarcopenia/short‐distance group (9%), and sarcopenia/short‐distance group (7%). A total of 109 (18.6%) deaths and 209 (35.6%) combined endpoints were observed over a mean follow‐up of 3.1 ± 1.3 years. After adjusting for other covariates, the sarcopenia/short‐distance group showed significant associations with shorter OS (hazard ratio, 3.38; 95% confidence interval, 1.79–6.37; P < 0.001) and DFS (hazard ratio, 2.11; 95% confidence, 1.27–3.51; P = 0.004) compared with the non‐sarcopenia/long‐distance group on multivariate analyses. Although not significant, adding skeletal muscle index and 6MWD to the pre‐existing risk model increased the area under the curve on time‐dependent receiver operating characteristic curve analysis for OS and DFS, except within 2 years of surgery. Conclusions The presence of both preoperative paraspinous muscle sarcopenia and short distance in 6MWD had an adverse effect on post‐operative prognosis in patients with NSCLC, suggesting that preoperative assessment of thoracic sarcopenia and physical performance may be useful for risk stratification of surgical candidates with potential for targeted interventions.

Preoperative Master’s double two-step test may predict survival after lobectomy in patients with lung cancer

“…Third, for patients who could not walk well, the MDT might have a risk of falling and injury. According to a study of sarcopenia and the 6MWT [ 22 ], the proportion of patients ≥ 75 years old was 24% among those who could not walk a long distance. Therefore, roughly one quarter of the patients might not be able to complete the MDT.…”

Risk Assessment for Loss‐of‐Exercise Capacity After Lung Cancer Surgery: Current Advances in Surgery and Systemic Treatment

“…However, after identifying the factors associated with LEC in the previous study, the present study was the second step in successfully examining the impact of these factors on long‐term prognosis. Since LEC is expected to correlate with postoperative changes in nutritional status, body weight, and muscle mass [15, 23], interventions for these factors may also be important. The authors’ goal is not to examine the value of these prognostic factors, but to correctly assess the risk of LEC and explore ways to prevent it, and maintain patients’ daily lives.…”

“…According to current guidelines, exercise capacity is as important as pulmonary function tests in preoperative assessments [11,12]. In addition, physical status and exercise capacity have been found to be related to postoperative prognosis [13][14][15], and it is important to quantify and evaluate them appropriately. We previously identified the risk factors for loss-of-exercise capacity (LEC) 6 months after lung lobectomy and their optimal cutoff values by a prospective observational study using 12-m stair climbing time [16].…”

Correlation Between Bioelectrical Impedance Analysis and Chest CT-Measured Erector Spinae Muscle Area: A Cross-Sectional Study

“…However, for patients whose abnormalities are mainly restricted to the chest, the L3 level is not included on chest CT, and supplementary abdominal CT would result in both additional medical costs and radiation exposure. Thus, there is growing interest in the measurement of SMM at the level of the 12th thoracic vertebra (T12), which can be visualized not only on chest CT but also on abdominal CT. Of note, accumulating evidence indicates that the erector spinae muscle area at the T12 level (T12-ESA), used to identify thoracic low SMM, was also shown to be related to the muscle area at the L3 level ( 15 , 16 ). More importantly, low SMM in the chest CT was demonstrated to be linked to poorer survival in various clinical diseases such as lung cancer ( 17 ), trauma ( 15 ), idiopathic pulmonary fibrosis ( 18 ), and many more ( 19 ).…”