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2017·EATTS
01
Diagnosis of Respiratory Sarcopenia for Stratifying Postoperative Risk in Non-Small Cell Lung Cancer
Changbo Sun1 2, Yoshifumi Hirata3, Takuya Kawahara4, Mitsuaki Kawashima2, Masaaki Sato2, Jun Nakajima2, Masaki Anraku2.
1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
2 Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
3 Department of Thoracic and Thyroid Surgery, Kyorin University School of Medicine, Tokyo, Japan.
4 Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan.
Background:
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).
Methods:
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. 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 < 0.001). 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 < 0.001), as did the risk of delayed recovery after surgery (P for trend < 0.001). 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 < 0.001). 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 = 0.01) 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:
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.
[CITATION]: Sun C, Hirata Y, Kawahara T, et al. Diagnosis of Respiratory Sarcopenia for Stratifying Postoperative Risk in Non-Small Cell Lung Cancer. JAMA Surg. 2024 Oct 30.
[DOI]: 10.1001/jamasurg.2024.4800.
[IF]:15.7
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胸“星”外科学术团队成员 李金芳 译
背景
目的
方法
结果
结论
Figure 3. Associations of Pre-Respiratory Sarcopenia and Respiratory Sarcopenia With Short-Term Postoperative Outcomes. A, The risk of postoperative complications gradually increased from 16.4% in the normal status group to 22.0% in the pre-respiratory sarcopenia group and 30.0% in the respiratory sarcopenia group (increased P for trend < 0.001, Cochrane-Armitage test). B, The length of hospital stay after surgery was shorter in the normal status group (median [IQR], 7 [6-10] days) than in the pre-respiratory sarcopenia group (median [IQR], 9 [7-12] days) and respiratory sarcopenia group (median [IQR], 9 [7-16] days) (linear P for trend < 0.001, Jonckheere-Terpstra test). Dashed lines denote medians, and dotted lines denote IQRs.
Figure 4. Associations of Normal Status, Pre-Respiratory Sarcopenia, and Respiratory Sarcopenia With Long-Term Postoperative Outcomes. A and B, Patients with pre-respiratory sarcopenia or respiratory sarcopenia exhibited worse 5-year overall survival than those with a normal status for both stage I to IIIA and stage I non-small cell lung cancer (NSCLC) (all P < 0.001). C and D, Patients with pre-respiratory sarcopenia or respiratory sarcopenia also had worse 5-year cancer-specific survival than those with a normal status for both stage I to IIIA (P < 0.001) and stage I (P = 0.01) NSCLC.
Table. Multivariable Analysis According to Overall Survival
2017·EATTS
02
The prognostic value of lymphovascular invasion for stage I lung adenocarcinoma based on the presence of ground-glass opacity
Jooae Choe1, Sang Min Lee1, Sohee Park1, Sehoon Choi2, Kyung-Hyun Do1, Joon Beom Seo1
1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
2 Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Objectives:
There is still a debate regarding the prognostic implication of lymphovascular invasion (LVI) in stage I lung adenocarcinoma. Ground-glass opacity (GGO) on CT is known to correlate with a less invasive or lepidic component in adenocarcinoma, which may influence the strength of prognostic factors. This study aimed to explore the prognostic value of LVI in stage I lung adenocarcinoma based on the presence of GGO.
Methods:
Stage I lung adenocarcinoma patients receiving lobectomy between 2010 and 2019 were retrospectively categorized as GGO-positive or GGO-negative (solid adenocarcinoma) on CT. Multivariable Cox regression analyses were performed for disease-free survival (DFS) and overall survival (OS) to evaluate the prognostic significance of pathologic LVI based on the presence of GGO.
Results:
Of 924 patients included (mean age, 62.5 ± 9.2 years; 505 women), 525 (56.8%) exhibited GGO-positive adenocarcinoma and 116 (12.6%) were diagnosed with LVI. LVI was significantly more frequent in solid than GGO-positive adenocarcinoma (20.1% vs. 6.9%, P < 0.001). Multivariable analysis identified LVI and visceral pleural invasion (VPI) as significant prognostic factors for shorter DFS among solid adenocarcinoma patients (LVI, hazard ratio (HR): 1.89, P = 0.004; VPI, HR: 1.65, P = 0.003) but not GGO-positive patients (P = 0.76 and P = 0.87). In contrast, LVI was not a significant prognostic factor for OS in either group (P > 0.05).
Conclusion:
In stage I lung adenocarcinoma, pathologic LVI was associated with DFS only in patients with solid lung adenocarcinoma.
[CITATION]: Choe J, Lee SM, Park S, et al. The prognostic value of lymphovascular invasion for stage I lung adenocarcinoma based on the presence of ground-glass opacity, European Radiology, 2024 Sep 16.
[DOI]: 10.1007/s00330-024-11048-0.
[IF]: 4.7
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胸“星”外科学术团队成员 何贤 译
目的
方法
结果
结论
Figure 2. Kaplan–Meier survival curves in patients with stage I adenocarcinoma for disease-free survival stratified based on the presence of pathologic lymphovascular invasion.
Table 2. Prognostic factors for disease-free survival in all stage I lung adenocarcinoma patients (n = 924) according to univariable and multivariable Cox regression analyses.
2017·EATTS
