Sarcopenia in non-small cell lung cancer patients underwent pulmonary surgery: clinical outcome and cost effectiveness

Luca Frasca, Filippo Carannante, Filippo Longo, Valentina Marziali, Pierfilippo Crucitti


Background: Lung cancer is the leading cause of cancer death in several countries. Surgical resection is a potentially curative treatment for non-small cell lung cancer (NSCLC), but tumor-specific factors and patient physical factors are important for postoperative prognosis. We conducted a retrospective study to investigate the link between sarcopenia and postoperative outcomes of surgical resected lung cancer patients, using preoperative CT for lung cancer staging. We also took in consideration the impact of sarcopenia on the national health cost and five years overall survival rate.
Methods: Patients affected by NSCLC, stage I–IIIa, undergoing radical surgery with a mediastinal lymphadenectomy, were enrolled. Forty-two patients were considered suitable for the study, according to the inclusion and exclusion criteria. Among them, 28 were male and 14 female with average age of 72 years. The identification of Sarcopenia status was reached with the use of computed tomography (CT), with two slices at the level of the third lumbar level (L3), allowing the measure of the cross-sectional area from L3 to the iliac crest, expressed in cm2. We identified sarcopenic and non-sarcopenic patients, using the Sarcopenia Index.
Results: Of the 42 patients suitable for the study, 13 were sarcopenic (31%) and 29 were non-sarcopenic (69%). Days of hospitalizations are 10 days in sarcopenic patients and 8.5 days in non-sarcopenic patients. Duration of permanence of the thoracic drainage is 7 days in sarcopenic patients and 5 days in non-sarcopenic patients. This is related with increased healthcare costs for sarcopenic patients (statistically significant: P<0.0037). The five-year survival rate was 57% in patients with sarcopenia and 88% in those without (P<0.002).
Conclusions: Our study demonstrates the impact of sarcopenia in different ambits, from the clinical outcomes to the health expenditure. Preventing the insurgence of sarcopenia is essential to improve the postoperative outcomes, and for the Health System, to reduce healthcare-related costs.