Diagnosis of Respiratory Sarcopenia for Stratifying Postoperative Risk in Non-Small Cell Lung Cancer.

IF 15.7 1区 医学 Q1 SURGERY
Changbo Sun, Yoshifumi Hirata, Takuya Kawahara, Mitsuaki Kawashima, Masaaki Sato, Jun Nakajima, Masaki Anraku
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引用次数: 0

Abstract

Importance: Physical biomarkers for stratifying patients with lung cancer into subtypes suggestive of outcomes are underexplored.

Objective: To investigate the clinical utility of respiratory sarcopenia for optimizing postoperative risk stratification in patients with non-small cell lung cancer (NSCLC).

Design, setting, and participants: This retrospective cohort study reviewed consecutive patients undergoing lobectomy and mediastinal lymph node dissection for NSCLC at 2 institutions in Tokyo, Japan, between 2009 and 2018. Eligible patients underwent electronic computed tomography image analysis. Follow-up began at the date of surgery and continued until death, the last contact, or March 2022. Data analysis was performed from April 2022 to March 2023.

Main outcomes and measures: Respiratory sarcopenia was identified by poor respiratory strength (peak expiratory flow rate) and was confirmed by a low pectoralis muscle index (PMI; pectoralis muscle area/body mass index). Patients with poor peak expiratory flow rate but normal PMI received a diagnosis of pre-respiratory sarcopenia. Short-term and long-term postoperative outcomes were compared among patients with a normal status, pre-respiratory sarcopenia, and respiratory sarcopenia. Group differences were analyzed using the Kruskal-Wallis test and Pearson χ2 test for continuous and categorical data, respectively. Survival differences were compared using the log-rank test. Univariable and multivariable analyses were conducted using the Cox proportional hazards model.

Results: Of a total of 1016 patients, 806 (497 men [61.7%]; median [IQR] age, 69 [64-76] years) were eligible for electronic computed tomography image analysis. The median (IQR) duration of follow-up for survival was 5.2 (3.6-6.4) years. Respiratory strength was more closely correlated with PMI than pectoralis muscle radiodensity (Pearson r2, 0.58 vs 0.29). Respiratory strength and PMI declined with aging simultaneously (both P for trend < .001). Pre-respiratory sarcopenia was present in 177 patients (22.0%), and respiratory sarcopenia was present in 130 patients (16.1%). The risk of postoperative complications escalated from 82 patients (16.4%) with normal status to 39 patients (22.0%) with pre-respiratory sarcopenia to 39 patients (30.0%) with respiratory sarcopenia (P for trend < .001), as did the risk of delayed recovery after surgery (P for trend < .001). Compared with patients with normal status or pre-respiratory sarcopenia, patients with respiratory sarcopenia exhibited worse 5-year overall survival (438 patients [87.2%] vs 133 patients [72.9%] vs 85 patients [62.5%]; P for trend < .001). Multivariable analysis identified respiratory sarcopenia as a factor independently associated with increased risk of mortality (hazard ratio, 1.83; 95% CI, 1.15-2.89; P = .01) after adjustment for sex, age, smoking status, performance status, chronic heart disease, forced expiratory volume in 1 second, diffusing capacity for carbon monoxide, C-reactive protein, albumin, carcinoembryonic antigen, histology, and pathologic stage.

Conclusions and relevance: This study identified individuals at higher risk of poor outcomes by screening and staging respiratory sarcopenia. The early diagnosis of respiratory sarcopenia could optimize management strategies and facilitate longitudinal care in patients with NSCLC.

非小细胞肺癌术后风险分层之呼吸道肌营养不良症诊断
重要性:用于对肺癌患者进行亚型分层的物理生物标志物尚未得到充分探索:研究呼吸道肌肉疏松对优化非小细胞肺癌(NSCLC)患者术后风险分层的临床实用性:这项回顾性队列研究回顾了 2009 年至 2018 年间在日本东京两家医疗机构接受肺叶切除术和纵隔淋巴结清扫术治疗 NSCLC 的连续患者。符合条件的患者接受了电子计算机断层图像分析。随访从手术当日开始,直至死亡、最后一次联系或 2022 年 3 月。数据分析于2022年4月至2023年3月进行:呼吸肌疏松症通过呼吸强度(呼气峰流速)差来识别,并通过胸肌指数(PMI;胸肌面积/体重指数)低来确认。呼气峰流速较低但胸肌指数正常的患者被诊断为呼吸前肌少症。研究人员比较了状态正常、呼吸肌疏松症前期和呼吸肌疏松症患者的术后短期和长期疗效。对于连续数据和分类数据,分别采用 Kruskal-Wallis 检验和 Pearson χ2 检验分析组间差异。生存率差异采用对数秩检验进行比较。采用 Cox 比例危险度模型进行单变量和多变量分析:在总共 1016 名患者中,有 806 人(497 名男性[61.7%];中位数[IQR]年龄为 69 [64-76] 岁)符合电子计算机断层图像分析条件。生存随访时间的中位数(IQR)为 5.2(3.6-6.4)年。呼吸强度与 PMI 的相关性比胸肌放射密度更密切(Pearson r2,0.58 vs 0.29)。随着年龄的增长,呼吸强度和 PMI 同时下降(趋势结论和相关性均为 P):本研究通过对呼吸肌疏松症进行筛查和分期,确定了不良预后风险较高的人群。呼吸肌疏松症的早期诊断可优化管理策略,促进 NSCLC 患者的纵向护理。
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来源期刊
JAMA surgery
JAMA surgery SURGERY-
CiteScore
20.80
自引率
3.60%
发文量
400
期刊介绍: JAMA Surgery, an international peer-reviewed journal established in 1920, is the official publication of the Association of VA Surgeons, the Pacific Coast Surgical Association, and the Surgical Outcomes Club.It is a proud member of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications.
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