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Significance of preoperative evaluation of skeletal muscle index and immune-nutritional status for patients with early-stage non-small cell lung cancer

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Abstract

Objectives

Sarcopenia involves several mechanisms, including age-related changes, nutritional deficiencies, and inflammation, and is associated with unfavorable clinical outcomes. However, the significance of skeletal muscle index (SMI) and immune-nutritional status for patients with early-stage non-small cell lung cancer (NSCLC) remains unclear. This retrospective study was performed to investigate associations between preoperative SMI based on computed tomography (CT) at the L1 level and immune-nutritional status, and whether these factors correlated with surgical outcomes.

Methods

We retrospectively investigated 386 patients with stage I–II NSCLC who underwent curative anatomical pulmonary resection. SMI was assessed on CT at the L1 level and patients were divided into low-SMI (n = 97) and high-SMI (n = 289) groups. We examined the significance of SMI for postoperative outcomes and evaluated correlations between SMI and clinical characteristics, including immune-nutritional status.

Results

Low SMI was significantly associated with body mass index and geriatric nutritional risk index. Five-year overall survival rate was significantly lower in the low-SMI group (66.0%) than in the high-SMI group (82.2%, P = 0.004). Multivariate analysis revealed SMI (hazard ratio [HR] 1.850; 95% confidence interval [CI] 1.091–3.135; P = 0.022) and prognostic nutritional index (PNI) (HR 2.031; 95% CI 1.231–3.352; P = 0.006) as independent predictors of overall survival. Low SMI correlated significantly with postoperative complications (P = 0.024).

Conclusions

Low preoperative SMI based on CT at the L1 level appears associated with poor prognosis and postoperative complications among patients with early-stage NSCLC. PNI is also an independent prognostic factor for surgical outcomes.

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Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We wish to thank radiology technician Jun Kobayashi from Nagaoka Red Cross Hospital for providing advice on CT image analysis and FORTE Science Communications (https://www.forte-science.co.jp) for English language editing.

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No funding was received for this study.

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Authors and Affiliations

  1. Division of General Thoracic Surgery, Nagaoka Red Cross Hospital, 2-297-1 Senshu, Nagaoka City, Niigata, 940-2085, Japan

    Seijiro Sato, Mao Sato & Hirohiko Shinohara

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  1. Seijiro Sato
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  2. Mao Sato
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Correspondence to Seijiro Sato.

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Sato, S., Sato, M. & Shinohara, H. Significance of preoperative evaluation of skeletal muscle index and immune-nutritional status for patients with early-stage non-small cell lung cancer. Gen Thorac Cardiovasc Surg 71, 354–362 (2023). https://doi.org/10.1007/s11748-022-01899-z

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