Significance of preoperative evaluation of skeletal muscle index and immune-nutritional status for patients with early-stage non-small cell lung cancer

Preoperative myosteatosis as a novel prognostic biomarker after anatomical lung resection for non-small cell lung cancer

PURPOSE

Myosteatosis, or excessive deposition of adipose tissue within skeletal muscle, has been widely used to explain an impaired muscle quality. This study aimed to investigate the association between preoperative myosteatosis and surgical outcomes in patients with non-small-cell lung cancer (NSCLC).

METHODS

We retrospectively examined 492 patients who underwent anatomical lung resection for stages I-III NSCLC between January 2014 and December 2022. The patients were divided into low- and high-paraspinal muscle density (MD) groups based on the lowest quartile cutoff value of MD on contrast-enhanced computed tomography, with the low-MD group defined as having myosteatosis.

RESULTS

The five-year overall survival (OS) and recurrence-free survival (RFS) rates were significantly lower in the myosteatosis group than in the control group (59.1% vs. 86.8%, P < 0.001; 52.0% vs. 72.6%, P < 0.001, respectively). A multivariate analysis identified myosteatosis as an independent predictor of OS (hazard ratio [HR], 2.809; 95% confidence interval [CI], 1.781-4.430; P < 0.001) and RFS (HR, 1.894; 95%CI, 1.340-2.678; P < 0.001). There was a significant correlation between myosteatosis and prolonged air leak postoperatively (P = 0.039).

CONCLUSION

Perioperative nutritional and exercise interventions facilitate changes in body composition, which may improve the outcomes in patients with lung cancer undergoing anatomical resection.

Significance of preoperative evaluation of modified advanced lung cancer inflammation index for patients with resectable non-small cell lung cancer

OBJECTIVES

Body composition and systemic inflammation/nutrition have been identified as important clinical factors in cancer patients. The modified advanced lung cancer inflammation index (mALI), which combines body composition and systemic inflammation/nutrition, is defined as appendicular skeletal muscle index × serum albumin/neutrophil-lymphocyte ratio. This retrospective study aimed to investigate associations between preoperative mALI and surgical outcomes in non-small cell lung cancer (NSCLC) patients.

METHODS

We examined 665 patients with resectable stage I-III NSCLC who underwent pulmonary resection. Patients were divided into low-mALI (n = 168) and high-mALI (n = 497) based on the lower quartile. Kaplan-Meier curves and Cox regression analysis were used to assess the prognostic value of mALI. We then performed 1:1 propensity score matching (PSM) for high- and low-mALI to further investigate impacts on survival.

RESULTS

Overall survival (OS) and recurrence-free survival (RFS) were both significantly poorer in the low-mALI group than in the high-mALI group (58.2% vs. 79.6%, P < 0.001; 48.8% vs. 66.7%, P < 0.001, respectively). Multivariate analysis revealed low-mALI as an independent predictor of OS (hazard ratio [HR], 2.116; 95% confidence interval (CI) 1.458-3.070; P < 0.001) and RFS (HR, 1.634; 95% CI 1.210-2.207; P = 0.001). After PSM, low-mALI remained as an independent predictor of OS (HR, 2.446; 95% CI 1.263-4.738; P = 0.008) and RFS (HR 1.835; 95% CI 1.074-3.137; P = 0.026).

CONCLUSION

Preoperative mALI appears to offer an independent predictor of poor surgical outcomes as a simple, routinely available, and inexpensive biomarker in patients with resectable NSCLC.