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Combination of Skeletal Muscle Mass and Density Predicts Postoperative Complications and Survival of Patients With Non-Small Cell Lung Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Few studies have assessed the comprehensive skeletal muscle depletion associated with loss of muscle quantity (sarcopenia) and reduced muscle quality in cancer patients. This study aimed to clarify the impact of skeletal muscle depletion on outcomes after non-small cell lung cancer surgery.

Methods

Data for 341 patients with pathologic stages 1 to 3A non-small cell lung cancer who underwent lobectomy and mediastinal lymph node dissection from 2009 to 2013 were retrospectively reviewed. The integrative pectoralis muscle index (IPMI) was assessed by multiplying the normalized pectoralis muscle area (area/body mass index) and mean radiodensity on chest images. Postoperative outcomes were compared among sex-specific quartiles of IPMI. The trend of continuous and categorical variables was analyzed using the Jonckheere–Terpstra test and the Cochrane–Armitage test, respectively.

Results

Respiratory strength declined with decreasing quartiles of IPMI (P < 0.001). The risk of major complications escalated with the decrease of IPMI among four quartiles (7.1 %, 16.7 %, 18.4 %, and 22.4 %; P = 0.008). The hospital stay was prolonged for patients with reduced IPMI (P = 0.001). Patients in the lowest and highest quartiles had the worst and best 5-year overall survival, respectively, compared with those in the two intermediate quartiles of IPMI (67.0 %, 87.9 %, and 81.2 %, respectively; P=0.001). Multivariate analysis identified the lowest quartile of IPMI as an independent poor prognostic factor (hazard ratio, 1.88; 95 % confidence interval, 1.11–3.19; P = 0.020).

Conclusion

Comprehensive skeletal muscle profiling, including morphometric mass and componential density on chest imaging, has the potential to refine risk stratification and prognostication in non-small cell lung cancer.

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Acknowledgments

Changbo Sun received a Japan-China Sasakawa Medical fellowship from the Sasakawa Memorial Health Foundation. The remaining authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Thoracic Surgery, the University of Tokyo Graduate School of Medicine, Tokyo, Japan

    Changbo Sun MD, Masaki Anraku MD, PhD, Takahiro Karasaki MD, PhD, Chihiro Konoeda MD, PhD, Kentaro Kitano MD, PhD, Masaaki Sato MD, PhD & Jun Nakajima MD, PhD

  2. Department of Thoracic Surgery, the First Hospital of China Medical University, Shenyang, China

    Changbo Sun MD

  3. Biostatistics Division of Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan

    Takuya Kawahara PhD, MPH

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  1. Changbo Sun MD
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  2. Masaki Anraku MD, PhD
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  5. Chihiro Konoeda MD, PhD
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  8. Jun Nakajima MD, PhD
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Correspondence to Masaki Anraku MD, PhD.

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Sun, C., Anraku, M., Kawahara, T. et al. Combination of Skeletal Muscle Mass and Density Predicts Postoperative Complications and Survival of Patients With Non-Small Cell Lung Cancer. Ann Surg Oncol 29, 1816–1824 (2022). https://doi.org/10.1245/s10434-021-11024-8

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