Computed Tomography-Assessed Skeletal Muscle Mass as a Predictor of Outcomes in Lung Cancer Surgery

Background: Sarcopenia is characterized by loss of skeletal muscle and strength, associated with aging, poor nutrition, sedentary lifestyle, and long-term illness. We sought to evaluate the current evidence on the prevalence of sarcopenia assessed by computed tomography (CT) imaging in patients undergoing lung cancer resection and its predictive value for perioperative and long-term outcomes.

Methods: We performed a systematic literature search of the PubMed/MEDLINE database to identify studies that examined CT-assessed muscle mass and outcomes of patients undergoing lung resection. Pooled odds ratio for complications and hazard ratio for survival with 95% confidence intervals (CI) were generated using the Mantel-Haenszel or inverse variance methods with random effects models.

Results: Nine observational studies met the inclusion criteria. Four studies measured skeletal muscle at the thoracic level (T5, T12, T8) and 5 studies at the lumbar level (L3). The prevalence of sarcopenia by CT skeletal muscle measurements ranged from 22.4% to 55.8%, with an average of 42.8% in 1010 patients. Four of 6 studies that reported perioperative outcomes were included in the meta-analysis, which showed higher risk of perioperative complications for patients with sarcopenia (odds ratio 2.51, 95% CI: 1.55-4.08, P < .001). Sarcopenia was associated with worse survival in 6 of 7 studies that evaluated long-term outcomes after lung cancer resection (hazard ratio 2.31, 95% CI: 1.26-4.24, P = .007).

Conclusions: Sarcopenia can be frequently detected in patients undergoing lung cancer resection with the use of CT-based muscle measurements. Sarcopenia was associated with greater risk of perioperative complications and worse long-term prognosis.