Multilevel Body Composition Analysis on Chest Computed Tomography Predicts Hospital Length of Stay and Complications After Lobectomy for Lung Cancer A Multicenter Study
Multilevel Body Composition Analysis on Chest Computed Tomography Predicts Hospital Length of Stay and Complications After Lobectomy for Lung Cancer A Multicenter Study
复制标题
DOI：
10.1097/sla.0000000000004040
复制
发表时间：
2022-05-01
影响因子：
9
通讯作者：
Fintelmann, Florian J.
中科院分区：
文献类型：
--
作者：
Best, Till D.;Mercaldo, Sarah F.;Fintelmann, Florian J.
目的：探讨胸廓体成分对肺癌肺叶切除术后预后的影响。总结和背景资料：术前识别有不良预后风险的患者允许治疗调整。身体成分对肺切除术结果的影响尚未在多中心环境中进行研究。方法：回顾性分析2014年至2017年在3个中心接受肺叶切除术治疗肺癌的958例连续患者。对第五、第八和第十胸椎体的肌肉和脂肪组织横截面积进行定量。从一个国家数据库中提取Pronecology收集的结果，以描述肌肉和脂肪组织总和与住院时间（LOS）、任何术后并发症数量和呼吸系统术后并发症数量之间的相关性，使用多变量回归。先验确定的协变量为1秒用力呼气量和肺一氧化碳弥散量预测值、年龄、性别、体重指数、种族、手术方式、吸烟状况、Zubrod和美国麻醉医师学会评分。结果：患者平均年龄为67岁，体重指数为27.4 kg/m2，65%的患者患有I期疾病。63%的患者接受了微创肺叶切除术。中位LOS为4天，34%的患者出现并发症。肌肉（使用30 cm（2）增量）是LOS（校正系数0.972; P = 0.002）、任何术后并发症（比值比0.897; P = 0.007）和术后呼吸系统并发症（比值比0.860; P = 0.010）的独立预测因子。肌源性肥胖也与LOS和不良结局相关。结论：术前胸部计算机断层扫描的身体成分是肺癌肺叶切除术后LOS和术后并发症的独立预测因素。
Objective: To investigate the impact of thoracic body composition on outcomes after lobectomy for lung cancer Summary and Background Data: Preoperative identification of patients at risk for adverse outcomes permits treatment modification. The impact of body composition on lung resection outcomes has not been investigated in a multicenter setting. Methods: A total of 958 consecutive patients undergoing lobectomy for lung cancer at 3 centers from 2014 to 2017 were retrospectively analyzed. Muscle and adipose tissue cross-sectional area at the fifth, eighth, and tenth thoracic vertebral body was quantified. Prospectively collected outcomes from a national database were abstracted to characterize the association between sums of muscle and adipose tissue and hospital length of stay (LOS), number of any postoperative complications, and number of respiratory postoperative complications using multivariate regression. A priori determined covariates were forced expiratory volume in 1 second and diffusion capacity of the lungs for carbon monoxide predicted, age, sex, body mass index, race, surgical approach, smoking status, Zubrod and American Society of Anesthesiologists scores. Results: Mean patient age was 67 years, body mass index 27.4 kg/m(2) and 65% had stage i disease. Sixty-three percent underwent minimally invasive lobectomy. Median LOS was 4 days and 34% of patients experienced complications. Muscle (using 30 cm(2) increments) was an independent predictor of LOS (adjusted coefficient 0.972; P = 0.002), any postoperative complications (odds ratio 0.897; P = 0.007) and postoperative respiratory complications (odds ratio 0.860; P = 0.010). Sarcopenic obesity was also associated with LOS and adverse outcomes. Conclusions: Body composition on preoperative chest computed tomography is an independent predictor of LOS and postoperative complications after lobectomy for lung cancer.