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 chronic 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 five 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 six studies reporting 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<0.001). Sarcopenia was associated with worse survival in six of seven studies evaluating long-term outcomes following lung cancer resection (hazard ratio 2.31 [95% CI, 1.26-4.24], p=0.007). CONCLUSIONS Sarcopenia can be frequently detected in patients undergoing lung cancer surgery using CT-based muscle measurements. Sarcopenia was associated with greater risk for perioperative complications and worse long-term prognosis.