Surgical resection remains the gold standard of treatment for early-stage lung cancer. Several risk models exist to predict postoperative morbidity and mortality. Psoas muscle sarcopenia has already successfully been used for morbidity prediction in lung transplantation and is not yet included in the available risk scores for pulmonary resections. We hypothesized that the skeletal muscle index and mediastinal adipose tissue might also have an impact on postoperative outcomes after primary surgery for primary lung cancer. The institutional database was queried for patients with primary lung cancer who were treated with primary lobectomy or segmentectomy between February 2009 and November 2018. In total, 311 patients were included for analysis. Patients receiving neo-/adjuvant chemotherapy or with a positive nodal status were excluded to rule out any morbidity or mortality due to (neo-)adjuvant treatment. Sarcopenia was defined as a skeletal muscle index of <34.4 cm2/m2for women and <45.4 cm2/m2for men. Mediastinal adipose tissue was defined with a radiodensity of −150 to −30 Hounsfield units. Sarcopenia was diagnosed in 78 (25.1%) of the 311 patients. Male patients were significantly more likely to suffer from sarcopenia (31.5% vs. 18.1%,p= 0.009). Comorbidities, lung function, tumour histology, pathologic tumour staging, mediastinal adipose tissue and age did not differ between groups with or without sarcopenia. Sarcopenic patients had a significantly longer length of stay, with 13.0 days vs. 9.5 (p= 0.003), and a higher rate of any postoperative complications (59.0% vs. 44.6%,p= 0.036). There was no difference in recurrence rate. Five-year overall survival was significantly better in the patient cohort without sarcopenia (75.6% vs. 64.5%,p= 0.044). Mediastinal adipose tissue showed no significant impact on length of stay, postoperative complications, recurrence rate, morbidity or survival. Sarcopenia, quantified with the skeletal muscle index, is shown to be a risk factor for postoperative morbidity and reduced survival in primary lung cancer. Efforts should be taken to pre-emptively screen for sarcopenia and start countermeasures (e.g., physical prehabilitation, protein-rich nutrition, etc.) during the preoperative workup phase.
手术切除仍是早期肺癌治疗的金标准。现有多种风险模型用于预测术后并发症发生率和死亡率。腰大肌肌肉减少症已成功应用于肺移植术后并发症预测，但尚未纳入现有肺切除手术风险评分体系。我们假设骨骼肌指数与纵隔脂肪组织可能对原发性肺癌初次手术后的预后产生影响。通过检索机构数据库，纳入2009年2月至2018年11月期间接受肺叶切除或肺段切除术的原发性肺癌患者，共311例纳入分析。为排除新辅助/辅助治疗相关并发症或死亡率的干扰，研究排除了接受新辅助/辅助化疗或淋巴结阳性的患者。肌肉减少症定义为女性骨骼肌指数<34.4 cm²/m²，男性<45.4 cm²/m²。纵隔脂肪组织定义为CT值在-150至-30亨氏单位的区域。311例患者中78例（25.1%）诊断为肌肉减少症。男性患者肌肉减少症发生率显著更高（31.5% vs 18.1%，p=0.009）。两组患者在合并症、肺功能、肿瘤组织学类型、病理分期、纵隔脂肪组织及年龄方面无统计学差异。肌肉减少症患者住院时间显著延长（13.0天 vs 9.5天，p=0.003），总体术后并发症发生率更高（59.0% vs 44.6%，p=0.036）。两组复发率无显著差异。非肌肉减少症患者五年总生存率显著更优（75.6% vs 64.5%，p=0.044）。纵隔脂肪组织对住院时间、术后并发症、复发率、发病率及生存率均无显著影响。研究表明，通过骨骼肌指数量化的肌肉减少症是原发性肺癌术后并发症增加和生存率降低的风险因素。建议在术前评估阶段积极开展肌肉减少症筛查，并实施针对性干预措施（如体能预康复、高蛋白营养支持等）。
肿瘤(癌症)患者之家