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Clinical Impact and Risk Factors for Skeletal Muscle Loss After Complete Resection of Early Non-small Cell Lung Cancer

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

Abstract

Background

A relationship between sarcopenia diagnosed by skeletal muscle area (SMA) and poor prognosis in cancer patients has recently been reported. This study aimed to clarify the clinical significance of postoperatively decreased SMA in patients with early non-small cell lung cancer (NSCLC).

Methods

This study selected 101 patients with pathologic stage 1 NSCLC who had undergone pre- and postoperative (~ 1 year) computed tomography scans and lobectomy between 2005 and 2010 at Kyushu University Hospital. The post/pre ratio was defined as the postoperative normalized SMA (cm2/m2) at the 12th thoracic vertebra level divided by the preoperative normalized SMA. The cutoff value for the post/pre ratio was set at 0.9.

Results

The study classified 31 patients (30.7%) as having decreased SMA. Poor performance status (PS) was significantly associated with decreased SMA (p = 0.048). The patients with decreased SMA had a significantly shorter disease-free survival (DFS) (p < 0.001) and overall survival (OS) (p < 0.001) than the other patients. Decreased SMA was found to be an independent prognostic factor for DFS (p = 0.010) and OS (p = 0.0072). The independent risk factors for skeletal muscle loss included poor PS (PS ≥ 1) and obstructive ventilatory impairment [forced expiratory volume (FEV) 1% < 70%].

Conclusions

Skeletal muscle loss after surgery is significantly associated with postoperative poor outcomes for patients with early NSCLC. Patients with poor PS, obstructive ventilatory impairment, or both need careful support to maintain their skeletal muscle mass. Future prospective studies may clarify whether physical activity and nutritional support improve postoperative prognosis.

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Acknowledgment

We thank J. L. Croxford, PhD, and Alison Sherwin, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this report.

Disclosure

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Shinkichi Takamori MD, Gouji Toyokawa PhD, Tatsuro Okamoto PhD, Fumihiko Kinoshita MD, Yuka Kozuma MD, Taichi Matsubara MD, Naoki Haratake MD, Takaki Akamine MD, Kazuki Takada PhD, Masakazu Katsura MD, Fumihiko Hirai PhD, Fumihiro Shoji PhD, Tetsuzo Tagawa PhD & Yoshihiko Maehara PhD

  2. Clinical Research Institute, National Kyushu Cancer Center, Fukuoka, Japan

    Mototsugu Shimokawa PhD

  3. Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Yoshinao Oda PhD

  4. Department of Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Hiroshi Honda PhD

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  1. Shinkichi Takamori MD
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  2. Gouji Toyokawa PhD
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Corresponding author

Correspondence to Gouji Toyokawa PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Electronic supplementary material 1 (DOCX 48 kb) Supplementary Table 1. Patient characteristics.

10434_2017_6328_MOESM2_ESM.tiff

Electronic supplementary material 2 (TIFF 2788 kb) Supplementary Fig. 1 Detailed analyses of survival probabilities according to changes in skeletal muscle area (SMA) before and after surgery (approximately one year). All patients were classified into a ‘SMA-greatly decreased’ (post/pre ratio < 0.9), ‘SMA-slightly decreased’ (0.9 ≤ post/pre ratio ≤ 0.95), and ‘SMA-equal’ groups (post/pre ratio > 0.95). (a) The degree of poor disease-free survival depended on the extent of decrease in SMA (p = 0.003). (b) The degree of poor overall survival depended on the extent of the decrease in SMA (p = 0.004).

10434_2017_6328_MOESM3_ESM.tiff

Electronic supplementary material 3 (TIFF 2788 kb) Supplementary Fig. 2. Subgroup analysis of the change in normalized skeletal muscle area at the level of the 12th thoracic vertebrae before and after surgery (approximately 1 year) according to sex. (a) In men, the mean preoperative normalized skeletal muscle area was 12.33 cm2/m2, and decreased to 11.34 cm2/m2 (p = 0.047). (b) In women, the mean preoperative normalized skeletal muscle area was 11.22 cm2/m2, and decreased to 10.68 cm2/m2 postoperatively (p = 0.200).

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Takamori, S., Toyokawa, G., Okamoto, T. et al. Clinical Impact and Risk Factors for Skeletal Muscle Loss After Complete Resection of Early Non-small Cell Lung Cancer. Ann Surg Oncol 25, 1229–1236 (2018). https://doi.org/10.1245/s10434-017-6328-y

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  • DOI: https://doi.org/10.1245/s10434-017-6328-y

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