Effect of sarcopenia on the prognosis of patients with early non-small cell lung cancer after surgery and postoperative chemotherapy_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Manman , GE Xiaoxiao ,  LI Xiangyang

Department of Respiratory Medicine, Huadong Hospital, Fudan University, Shanghai 200040, P. R. China;

Corresponding author：

LI Xiangyang, Email: lixiangyang820@hotmail.com

Keywords：

Sarcopenia; non-small cell lung cancer; lobectomy; prognosis; chemotherapy

DOI：

10.7507/1671-6205.202104103

Video：

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Objective To investigate the prognostic value of sarcopenia in patients with early non-small cell lung cancer (NSCLC) after surgery and chemotherapy. Methods This study included 592 patients with early non-small cell lung cancer who received lung cancer resection from January 2014 to December 2015, and they were divided into two groups: 473 patients received surgery alone (the surgery group), 119 patients received chemotherapy after surgery (the postoperative chemotherapy group), and the two groups were divided into sarcopenia group and non-sarcopenia group. General clinical data, laboratory data, and imaging data of these patients were compared. Results The median follow-up time of 592 patients was 69.1 months [95% confidential interval (CI) 64.9 - 78.2], and 110 patients were with sarcopenia (18.6%). Multivariate analysis showed that sarcopenia was an independent adverse prognostic factor in the surgery group [hazard ratio (HR) 6.56; 95%CI 1.86 to 14.78; P=0.01]. For patients undergoing postoperative chemotherapy, skeletal muscle mass index was reduced after chemotherapy, and sarcopenia was an independent predictor of poor prognosis (HR 5.77; 95%CI 0.96 to 20.60; P<0.05). Conclusions Sarcopenia is an independent poor prognostic factor for patients with early NSCLC undergoing surgery and postoperative chemotherapy. Assessment of sarcopenia before surgery and postoperative chemotherapy is helpful to improve the prognosis of patients with early NSCLC.

Citation： LIU Manman, GE Xiaoxiao, LI Xiangyang. Effect of sarcopenia on the prognosis of patients with early non-small cell lung cancer after surgery and postoperative chemotherapy. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(6): 417-424. doi: 10.7507/1671-6205.202104103 Copy

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6.	Yang M, Shen Y, Tan L, et al. Prognostic value of sarcopenia in lung cancer: a systematic review and meta-analysis. Chest, 2019, 156(1): 101-111.
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11.	Nishimura JM, Ansari AZ, D Souza DM, et al. Computed tomography-assessed skeletal muscle mass as a predictor of outcomes in lung cancer surgery. Ann Thorac Surg, 2019, 108(5): 1555-1564.
12.	Derstine BA, Holcombe SA, Ross BE, et al. Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population. Sci Rep, 2018, 8(1): 11369.
13.	Gomez-Perez SL, Haus JM, Sheean P, et al. Measuring abdominal circumference and skeletal muscle from a single cross-sectional computed tomography image. J Parenter Enteral Nutr, 2015, 40(3): 308-318.
14.	Liu X, Ji W, Zheng K, et al. The correlation between skeletal muscle index of the L3 vertebral body and malnutrition in patients with advanced lung cancer. BMC Cancer, 2021, 21(1): 1148.
15.	Nelke C, Dziewas R, Minnerup J, et al. Skeletal muscle as potential central link between sarcopenia and immune senescence. EBioMedicine, 2019, 49: 381-388.
16.	Conlon KC, Lugli E, Welles HC, et al. Redistribution, hyperproliferation, activation of natural killer cells and CD8 T cells, and cytokine production during first-in-human clinical trial of recombinant human interleukin-15 in patients with cancer. J Clin Oncol, 2015, 33(1): 74-82.
17.	Pedersen L, Idorn M, Olofsson GH, et al. Voluntary running suppresses tumor growth through epinephrine- and IL-6-dependent NK cell mobilization and redistribution. Cell Metab, 2016, 23(3): 554-562.
18.	Bauer J, Morley JE, Schols AMWJ, et al. Sarcopenia: a time for action. An SCWD Position Paper. J Cachexia Sarcopenia Muscle, 2019, 10(5): 956-961.
19.	Rosero ID, Ramírez-Vélez R, Lucia A, et al. Systematic review and meta-analysis of randomized, controlled trials on preoperative physical exercise interventions in patients with non-small-cell lung cancer. Cancers, 2019, 11(7): 944.
20.	Avancini A, Sartori G, Gkountakos A, et al. Physical activity and exercise in lung cancer care: will promises be fulfilled?. Oncologist, 2020, 25(3): e555-e569.
21.	Cavalheri V, Granger CL. Exercise training as part of lung cancer therapy. Respirology, 2020, 25 Suppl 2: 80-87.

1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Pakkala S, Ramalingam SS. Personalized therapy for lung cancer: striking a moving target. JCI Insight, 2018, 3(15): e120858.
3. Pawlik TM, Gleisner AL, Cameron JL, et al. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery, 2007, 141(5): 610-618.
4. Ghysen K, Vansteenkiste J. Immunotherapy in patients with early stage resectable non small cell lung cancer. Curr Opin Oncol, 2019, 31(1): 13-17.
5. Fukushima H, Takemura K, Suzuki H, et al. Impact of sarcopenia as a prognostic biomarker of bladder cancer. Int J Mol Sci, 2018, 19(10): 2999.
6. Yang M, Shen Y, Tan L, et al. Prognostic value of sarcopenia in lung cancer: a systematic review and meta-analysis. Chest, 2019, 156(1): 101-111.
7. Nakamura R, Inage Y, Tobita R, et al. Sarcopenia in resected NSCLC: effect on postoperative outcomes. J Thorac Oncol, 2018, 13(7): 895-903.
8. Kim EY, Lee HY, Kim KW, et al. Preoperative computed tomography-determined sarcopenia and postoperative outcome after surgery for non-small cell lung cancer. Scand J Surgery, 2018, 107(3): 244-251.
9. 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肿瘤学分会肺癌临床诊疗指南(2021版). 中华医学杂志, 2021, 101(23): 1725-1757.
10. Ruffini E, Fang W, Guerrera F, et al. The International Association for the Study of Lung Cancer Thymic Tumors Staging Project: The Impact of the Eighth Edition of the Union for International Cancer Control and American Joint Committee on Cancer TNM Stage Classification of Thymic Tumors. J Thorac Oncol, 2020, 15(3): 436-447.
11. Nishimura JM, Ansari AZ, D Souza DM, et al. Computed tomography-assessed skeletal muscle mass as a predictor of outcomes in lung cancer surgery. Ann Thorac Surg, 2019, 108(5): 1555-1564.
12. Derstine BA, Holcombe SA, Ross BE, et al. Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population. Sci Rep, 2018, 8(1): 11369.
13. Gomez-Perez SL, Haus JM, Sheean P, et al. Measuring abdominal circumference and skeletal muscle from a single cross-sectional computed tomography image. J Parenter Enteral Nutr, 2015, 40(3): 308-318.
14. Liu X, Ji W, Zheng K, et al. The correlation between skeletal muscle index of the L3 vertebral body and malnutrition in patients with advanced lung cancer. BMC Cancer, 2021, 21(1): 1148.
15. Nelke C, Dziewas R, Minnerup J, et al. Skeletal muscle as potential central link between sarcopenia and immune senescence. EBioMedicine, 2019, 49: 381-388.
16. Conlon KC, Lugli E, Welles HC, et al. Redistribution, hyperproliferation, activation of natural killer cells and CD8 T cells, and cytokine production during first-in-human clinical trial of recombinant human interleukin-15 in patients with cancer. J Clin Oncol, 2015, 33(1): 74-82.
17. Pedersen L, Idorn M, Olofsson GH, et al. Voluntary running suppresses tumor growth through epinephrine- and IL-6-dependent NK cell mobilization and redistribution. Cell Metab, 2016, 23(3): 554-562.
18. Bauer J, Morley JE, Schols AMWJ, et al. Sarcopenia: a time for action. An SCWD Position Paper. J Cachexia Sarcopenia Muscle, 2019, 10(5): 956-961.
19. Rosero ID, Ramírez-Vélez R, Lucia A, et al. Systematic review and meta-analysis of randomized, controlled trials on preoperative physical exercise interventions in patients with non-small-cell lung cancer. Cancers, 2019, 11(7): 944.
20. Avancini A, Sartori G, Gkountakos A, et al. Physical activity and exercise in lung cancer care: will promises be fulfilled?. Oncologist, 2020, 25(3): e555-e569.
21. Cavalheri V, Granger CL. Exercise training as part of lung cancer therapy. Respirology, 2020, 25 Suppl 2: 80-87.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of sarcopenia on the prognosis of patients with early non-small cell lung cancer after surgery and postoperative chemotherapy

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