Abstract
Sarcopenia is among the most prevalent and serious cancer-related symptom, and is strongly correlated with a poor prognosis. Moreover, it reportedly predicts poor prognosis after surgery in patients with lung cancer. However, it is unclear whether sarcopenia directly affects post-operative recurrence. The purpose of this study was to evaluate whether sarcopenia can be a risk indicator for post-operative recurrence, and whether it suppresses anti-tumor immunity, in a cohort of patients with resected non-small cell lung cancer. This study retrospectively reviewed the data of 256 consecutive patients who underwent curative lobectomy and lymph node dissection for non-small cell lung cancer at our institution. The psoas muscle mass index was calculated as the total psoas muscle area at the third lumbar vertebral level/height2 (cm2/m2). Sarcopenia was defined by a psoas muscle mass index of under 5.03 cm2/m2 and 3.17 cm2/m2 in male and female patients, respectively. Post-operative prognosis and cumulative incidence of recurrence rates were calculated. The 5-year overall survival and disease-free survival rates post-surgery were 59.5% and 38.6%, respectively, in patients with sarcopenia versus 81.1% and 72.1%, respectively, in patients without sarcopenia (p < 0.001). The 5-year cumulative incidence of recurrence rate in patients with sarcopenia was significantly higher than those without sarcopenia (49.9% versus 22.4%, respectively) in every pathological stage. Pathological stages II and III (hazard ratio, 3.36; p = 0.004), histological type (hazard ratio, 2.31; p = 0.025), and sarcopenia (hazard ratio, 2.52; p = 0.001) were independent risk factors for post-operative recurrence according to multivariate analysis. Sarcopenia is a risk indicator for post-operative recurrence in patients with non-small cell lung cancer.
Highlights
Non-small cell lung cancer (NSCLC) is a major cause of cancer-related deaths globally [1]
The 5-year overall survival and disease-free survival rates post-surgery were 59.5% and 38.6%, respectively, in patients with sarcopenia versus 81.1% and 72.1%, respectively, in patients without sarcopenia (p < 0.001)
Several studies have recently reported that sarcopenia in patients with resectable cancers including gastric cancer [3], colorectal cancer [4], pancreatic cancer [5], hepatocellular carcinoma [6], endometrial cancer [7], renal cell carcinoma [8], and lung cancer [9] contributes to poor post-operative survival
Summary
Non-small cell lung cancer (NSCLC) is a major cause of cancer-related deaths globally [1]. Tumor characteristics, such as histology and TNM stage, and treatment factors, such as surgery and chemotherapy, have traditionally been considered important to determine cancer prognosis, recently, patient factors like sarcopenia have started gaining attention [2]. Sarcopenia is among the most prevalent and serious cancer-related symptom, and is strongly correlated with a poor prognosis It reportedly predicts poor prognosis after surgery in patients with lung cancer. The purpose of this study was to evaluate whether sarcopenia can be a risk indicator for post-operative recurrence, and whether it suppresses antitumor immunity, in a cohort of patients with resected non-small cell lung cancer
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