Clinical Impact and Risk Factors for Skeletal Muscle Loss After Complete Resection of Early Non-small Cell Lung Cancer
Clinical Impact and Risk Factors for Skeletal Muscle Loss After Complete Resection of Early Non-small Cell Lung Cancer
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早期非小细胞肺癌全切除术后骨骼肌丢失的临床影响及危险因素
DOI：
10.1245/s10434-017-6328-y
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发表时间：
2018-05-01
影响因子：
3.7
通讯作者：
Maehara, Yoshihiko
中科院分区：
文献类型：
--
作者：
Takamori, Shinkichi;Toyokawa, Gouji;Maehara, Yoshihiko
最近有报道称，通过骨骼肌面积（SMA）诊断的肌肉减少症与癌症患者预后不良之间存在关系。本研究旨在阐明早期非小细胞肺癌（NSCLC）患者术后SMA降低的临床意义。本研究选择了2005年至2010年期间在九州大学医院接受术前和术后（相似于1年）计算机断层扫描和肺叶切除术的101例病理学1期NSCLC患者。术后/术前比值定义为第12胸椎节段的术后标准化SMA（cm（2）/m（2））除以术前标准化SMA。术后/术前比值的截止值设定为0.9。该研究将31例患者（30.7%）归类为SMA降低。体能状态（PS）差与SMA降低显著相关（p = 0.048）。SMA降低的患者的无病生存期（DFS）（p < 0.001）和总生存期（OS）（p < 0.001）明显短于其他患者。发现SMA降低是DFS（p = 0.010）和OS（p = 0.0072）的独立预后因素。术后骨骼肌丢失的独立危险因素包括PS差（PS n> 1）和阻塞性肺功能障碍[用力呼气量（FEV）1% < 70%]，早期NSCLC患者术后骨骼肌丢失与术后不良结局显著相关。PS差、阻塞性运动障碍或两者兼有的患者需要精心的支持以维持其骨骼肌质量。未来的前瞻性研究可能会阐明体力活动和营养支持是否能改善术后预后。
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).This study selected 101 patients with pathologic stage 1 NSCLC who had undergone pre- and postoperative (similar to 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 (cm(2)/m(2)) 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.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 n> 1) and obstructive ventilatory impairment [forced expiratory volume (FEV) 1% < 70%].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.