Sarcopenia predicts poor postoperative outcome in elderly patients with lung cancer

  • Yo KawaguchiEmail author
  • Jun Hanaoka
  • Yasuhiko Ohshio
  • Keigo Okamoto
  • Ryosuke Kaku
  • Kazuki Hayashi
  • Takuya Shiratori
  • Makoto Yoden
Original Article



Sarcopenia gradually progress with age; hence, it is necessary to define sarcopenia to predict postoperative outcomes in elderly patients with lung cancer. The purpose of this study is to propose a definition of sarcopenia in elderly patients with lung cancer, and to demonstrate the post operative outcomes.


Using computed tomography scans, the cross-sectional area (cm2) of the psoas muscle at the third lumbar vertebral level was measured. The psoas area was normalized for height. The psoas muscle mass index was calculated as total psoas muscle area at L3 level/height2 (cm2/m2).


A total of 173 patients aged > 75 years of age received lobectomy for non-small cell lung cancer in our hospital. We defined sarcopenia as the psoas muscle mass index under 3.70 cm2/m2 in males and 2.50 cm2/m2 in females, based on the morbidity rate. The postoperative complication rate was significantly higher in patients with sarcopenia (62.5%) than in those without sarcopenia (22.7%). The 5-year survival rate was 26.5% in patients with sarcopenia, and 66.3% in patients without sarcopenia.


In elderly lung cancer patients, sarcopenia was observed to be a high risk for morbidity and predicted poor prognosis.


Sarcopenia Lung cancer Elderly patients Surgery 


Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest that exist with any companies/organizations whose products or services may be discussed in this article.


  1. 1.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Agin. 2010;39(4):412–23.CrossRefGoogle Scholar
  2. 2.
    Fearson KC. Cancer cachexia and fat-muscle physiology. N Eng J Med. 2011;365(6):565–7.CrossRefGoogle Scholar
  3. 3.
    Harimoto N, Yoshizumi T, Shimokawa M, Sakata K, Kimura K, Itouh S, et al. Sarcopenia is a poor prognostic factor following hepatic resection in patients aged 70 years and older with hepatocellular carcinoma. Hepatol Res. 2016;46(12):1247–55.CrossRefGoogle Scholar
  4. 4.
    Villasenor A, Ballard-Barbash R, Baumgartner K, Baumgartner R, Bernstein L, McTieman A, et al. Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study. J Cancer Surviv. 2012;6(4):398–406.CrossRefGoogle Scholar
  5. 5.
    Levolger S, van Vugt JL, de Bruin RW, Ijzermans JN. Systematic review of sarcopenia in patients operated on for gastrointestinal and hepatopancreatobiliary malignancies. Br J Surg. 2015;102(12):1448–58.CrossRefGoogle Scholar
  6. 6.
    Suzuki Y, Okamoto T, Fujishita T, Katsura M, Akamine T, Takamori S, et al. Clinical implications of sarcopenia in patients undergoing complete resection for early non-small cell lung cancer. Lung Cancer. 2016;101:92–7.CrossRefGoogle Scholar
  7. 7.
    Tsukioka T, Nishiyama N, Izumi N, Mizuguchi S, Komatsu H, Okada S, et al. Sarcopenia is novel poor prognostic factor in male patients with pathological stage I non-small lung cancer. Jpn J Clin Oncol. 2017;47(4):363–8.CrossRefGoogle Scholar
  8. 8.
    Nakamura R, Inage Y, Tobita R, Yoneyama S, Numata T, Ota K, et al. Sarcopenia in resected NSCLC: effect on postoperative outcomes. J Thorac Oncol. 2018;13(7):895–903.CrossRefGoogle Scholar
  9. 9.
    Berry MF, Onaitis MW, Tong BC, Harpole DH, D’Amico TA. A model for morbidity after lung cancer resection in octogenarians. Eur J Cardiothoracic Surg. 2011;39(6):989–94.CrossRefGoogle Scholar
  10. 10.
    Kawaguchi Y, Hanaoka J, Ohshio Y, Igarashi T, Kataoka Y, Okamoto K, et al. A risk score to predict postoperative complications after lobectomy in elderly lung cancer patients. Gen Thorac Cardiovasc Surg. 2018;66(9):537–42.CrossRefGoogle Scholar
  11. 11.
    Hamaguchi Y, Kaido T, Okumura S, Kobayashi A, Hammad A, Tamai Y, et al. Proposal for new diagnostic criteria for low skeletal muscle mass based on computed tomography imaging in Asian adults. Nutrition. 2016;32:1200–5.CrossRefGoogle Scholar
  12. 12.
    Miller JA, Harris K, Roche C, Dhillon S, Battoo A, Demmy T, et al. Sarcopenia is a predictor of outcomes after lobectomy. J Thorac Dis. 2018;10(1):432–40.CrossRefGoogle Scholar
  13. 13.
    Hervochon R, Bobbio A, Guinet C, et al. Body mass index and total psoas area affect outcomes in patients undergoing pneumonectomy for cancer. Ann Thorac Surg. 2017;103(1):287–95.CrossRefGoogle Scholar
  14. 14.
    Reisinger KW, Derikx JP, Vugt JL, Meyenfeldt MV, Hulsewe KW, Damink WO, et al. Sarcopenia is associated with an increased inflammatory response to surgery in colorectal cancer. Clin Nutr. 2016;35(4):924–7.CrossRefGoogle Scholar
  15. 15.
    Benzo R, Wigle D, Novotony P, Wetzstein M, Nichols F, Shen RK, et al. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Lung Cancer. 2011;74(3):441–5.CrossRefGoogle Scholar
  16. 16.
    Landi F, Marzetti E, Martone AM, Bernabei R, Onder G. Exercise as a remedy for sarcopenia. Curr Opin Clin Nutr Metab Care. 2014;17(1):25–31.Google Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  • Yo Kawaguchi
    • 1
    • 2
    Email author
  • Jun Hanaoka
    • 1
  • Yasuhiko Ohshio
    • 1
  • Keigo Okamoto
    • 1
  • Ryosuke Kaku
    • 1
  • Kazuki Hayashi
    • 1
  • Takuya Shiratori
    • 1
  • Makoto Yoden
    • 1
  1. 1.Division of General Thoracic Surgery, Department of SurgeryShiga University of Medical ScienceOtsuJapan
  2. 2.Division of General Thoracic SurgeryKusatsu General HospitalKusatsuJapan

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