Body Mass Index and Total Psoas Area Affect Outcomes in Patients Undergoing Pneumonectomy for Cancer
Body Mass Index and Total Psoas Area Affect Outcomes in Patients Undergoing Pneumonectomy for Cancer
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DOI：
10.1016/j.athoracsur.2016.06.077
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发表时间：
2017-01-01
影响因子：
4.6
通讯作者：
Alifano, Marco
中科院分区：
文献类型：
--
作者：
Hervochon, Remi;Bobbio, Antonio;Alifano, Marco
背景假设形态测量是需要积极手术干预的肺癌患者健康的可靠标志，本研究的目的是评估其对需要肺切除术的非小细胞肺癌（NSCLC）患者术后结局和长期生存的影响。身高，体重，体重指数（BMI），以及通常的临床，实验室（包括C-反应蛋白[CRP]浓度），和病理学数据回顾性检索的文件，连续161例接受肺切除术治疗的非小细胞肺癌，其术前计算机断层扫描（CT）扫描可在图片存档和通信系统（PACS）的医院。同时评估左右腰大肌的横截面积（通过L3水平的CT扫描测量）、肾周脂肪厚度和左肾静脉水平的前皮下组织厚度。BMI和腰大肌总面积呈强正相关（p = 0.0000001），而BMI与CRP水平呈负相关。肌肉减少症（总腰肌面积20 mg/L）（p = 0.010）。与90天死亡率相关的因素包括年龄较大（p = 0.000045）、体重较轻（p = 0.032）和BMI小于或等于25 kg/m2（p = 0.013）。在单变量分析中，非鳞状细胞组织学类型对长期预后有负面影响（p = 0.011），病理分期IIIB-IV（p = 0.026），CRP水平大于20 mg/L（p = 0.017），BMI小于或等于25 kg/m2（p = 0.010），腰大肌总面积小于或等于第33百分位数（p = 0.029）。多因素分析显示BMI和腰大肌总面积是独立的预后价值。BMI小于或等于25 kg/m2和腰大肌总横截面积小于或等于第33百分位数是需要肺切除术的NSCLC患者的预后决定因素。(C)2017胸外科医师协会
Background. Hypothesizing that morphometric measurements are reliable markers of fitness in patients with lung cancer requiring aggressive surgical intervention, the purpose of this study was to assess their impact on postoperative outcome and long-term survival in patients with non-small cell lung cancer (NSCLC) requiring pneumonectomy.Methods. Height, weight, and body mass index (BMI), as well as usual clinical, laboratory (including C-reactive protein [CRP] concentrations), and pathologic data were retrospectively retrieved from files of 161 consecutive patients treated by pneumonectomy for NSCLC, whose preoperative computed tomographic (CT) scans were available in the Picture Archive and Communication System (PACS) of the hospital. Cross-sectional areas of right and left psoas areas (measured by CT scan at the L3 level), perirenal fat thickness, and anterior subcutaneous tissue thickness at the left renal vein level were also assessed.Results. BMI and total psoas area were strongly and directly correlated (p = 0.0000001), whereas BMI was inversely related to CRP levels. Sarcopenia (total psoas area 20 mg/L) (p = 0.010). Factors associated with 90-day mortality included older age (p = 0.000045), lower body weight (p = 0.032), and BMI less than or equal to 25 kg/m(2) (p = 0.013). At univariate analysis, long-term outcome was negatively affected by a nonsquamous cell histologic type (p = 0.011), pathologic stage IIIB-IV (p = 0.026), CRP levels greater than 20 mg/L (p = 0.017), BMI less than or equal to 25 kg/m2 (p = 0.010), and total psoas area less than or equal to the 33rd percentile (p = 0.029). Multivariate analysis showed the independent prognostic value of both BMI and total psoas area.Conclusions. BMI less than or equal to 25 kg/m2 and total psoas cross-sectional area less than or equal to the 33rd percentile are prognostic determinants in patients with NSCLC requiring pneumonectomy. (C) 2017 by The Society of Thoracic Surgeons