Sarcopenia increases the risk of post-operative recurrence in patients with non-small cell lung cancer

Abstract

Background Sarcopenia is among the most prevalent and serious cancer-related symptom, and is strongly correlated with a poor prognosis. Moreover, it reportedly predicts poor prognosis after surgery in patients with lung cancer. However, it is unclear whether sarcopenia directly affects post-operative recurrence. The purpose of this study was to evaluate whether sarcopenia can be a risk indicator for post-operative recurrence, and whether it suppresses anti-tumor immunity, in a cohort of patients with resected non-small cell lung cancer. Methods This study retrospectively reviewed the data of 256 consecutive patients who underwent curative lobectomy and lymph node dissection for non-small cell lung cancer at our institution. The psoas muscle mass index was calculated as the total psoas muscle area at the third lumbar vertebral level/height2 (cm2/m2). Sarcopenia was defined by a psoas muscle mass index of under 5.03 cm2/m2 and 3.17 cm2/m2 in male and female patients, respectively. Post-operative prognosis and cumulative incidence of recurrence rates were calculated. Results The 5-year overall survival and disease-free survival rates post-surgery were 59.5% and 38.6%, respectively, in patients with sarcopenia versus 81.1% and 72.1%, respectively, in patients without sarcopenia (p < 0.001). The 5-year cumulative incidence of recurrence rate in patients with sarcopenia was significantly higher than those without sarcopenia (49.9% versus 22.4%, respectively) in every pathological stage. Pathological stages II and III (hazard ratio, 3.36; p = 0.004), histological type (hazard ratio, 2.31; p = 0.025), and sarcopenia (hazard ratio, 2.52; p = 0.001) were independent risk factors for post-operative recurrence according to multivariate analysis. Conclusion Sarcopenia is a risk indicator for post-operative recurrence in patients with non-small cell lung cancer.

Clinical utility of psoas muscle volume in assessment of sarcopenia in patients with early-stage non-small cell lung cancer

“…Kawaguchi et al showed that patients with NSCLC and sarcopenia had larger tumors and lymph nodes and more extensive vascular invasion than patients without sarcopenia, which is consistent with our ndings(Kawaguchi et al 2021). Sarcopenia can be divided into ''primary'' or agerelated sarcopenia when no other cause is evident other than aging itself, or ''secondary'' when one or more causes can be identi ed (Cruz-Jentoft et al 2010;Williams et al 2021).…”

Surgical risk and survival impact of octogenarian lung cancer patients compared to those of younger patients undergoing surgery

“…This was also a strong negative predictor in patients with lung cancer undergoing surgery (32). Recent publications mentioned a significant correlation between sarcopenia and lower oncological survival (cancerspecific and recurrence-free survival) among patients undergoing lung cancer surgery, which supports our results (33,34). Therefore, lower BMI, reflecting sarcopenia, was notable among octogenarians; an interventional approach, including perioperative positive nutritional support and © Current Challenges in Thoracic Surgery.…”

Computed tomography on lung cancer screening is useful for adjuvant comorbidity diagnosis in developing countries

“…Sarcopenia has a high impact on public health because it is associated with many comorbidities, such as osteoporosis [ 37 ]. One cohort demonstrated sarcopenia as a high risk factor for lung cancer recurrence, and also the tumours of patients with sarcopenia have higher malignant potential [ 13 ]. Imaging evaluations such as CT are considered to be the gold standard for its diagnosis, and they reduce the need for another test, but other modalities, such as DXA, are often preferred owing to their lower costs [ 37 ].…”

“…Other smoking-related diseases also identified in LCS studies and associated with lung cancer such as hepatic steatosis and sarcopenia were also considered in this study [ 12 , 13 ]. Sarcopenia is characterised by the loss of muscle mass and function and affects mainly elderly adults, such as those participating in our study [ 14 – 16 ].…”