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Sarcopenia as a Predictor of Short- and Long-Term Outcomes in Patients Surgically Treated for Malignant Pleural
Eleonora Faccioli1, Stefano Terzi1, Chiara Giraudo2
1Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy.
Abstract:
Surgery for malignant pleural mesothelioma (MPM) should be reserved only for patients who have a good performance status. Sarcopenia, a well-known predictor of poor outcomes after surgery, is still underinvestigated in MPM. The aim of this study is to evaluate the role of sarcopenia as a predictor of short-and long-term outcomes in patients surgically treated for MPM. In our analysis, we included patients treated with a cytoreductive intent in a multimodality setting, with both pre- and post-operative CT scans without contrast available. We excluded those in whom a complete macroscopic resection was not achieved. Overall, 86 patients were enrolled. Sarcopenia was assessed by measuring the mean muscular density of the bilateral paravertebral muscles (T12 level) on pre-and post-operative CTs; a threshold value of 30 Hounsfield Units (HU) was identified. Sarcopenia was found pre-operatively in 57 (66%) patients and post-operatively in 61 (74%). Post-operative sarcopenic patients had a lower 3-year overall survival (OS) than those who were non-sarcopenic (34.9% vs. 57.6% p = 0.03). Pre-operative sarcopenia was significantly associated with a higher frequency of post-operative complications (65% vs. 41%, p = 0.04). The evaluation of sarcopenia, through a non-invasive method, would help to better select patients submitted to surgery for MPM in a multimodality setting.
Insights
Sarcopenia, a measure of muscle loss, predicts worse outcomes in patients undergoing surgery for malignant pleural mesothelioma (MPM). Identifying sarcopenia pre-operatively can improve patient selection for this aggressive cancer treatment.
Area of Science:
- Thoracic Surgery
- Oncology
- Radiology
Background:
- Malignant pleural mesothelioma (MPM) surgery requires careful patient selection based on performance status.
- Sarcopenia, a predictor of surgical outcomes, is understudied in MPM patients.
- This study investigates sarcopenia's role in predicting outcomes for surgically treated MPM patients.
Purpose of the Study:
- To evaluate sarcopenia as a predictor of short- and long-term outcomes in patients undergoing cytoreductive surgery for MPM.
- To assess the association between pre-operative and post-operative sarcopenia and patient outcomes.
Main Methods:
- Retrospective analysis of 86 MPM patients who underwent cytoreductive surgery.
- Sarcopenia assessment using pre- and post-operative CT scans at the T12 level, measuring paravertebral muscle density (threshold: 30 HU).
- Exclusion of patients without complete macroscopic resection.
Main Results:
- Sarcopenia was prevalent, found in 66% pre-operatively and 74% post-operatively.
- Post-operative sarcopenia was linked to significantly lower 3-year overall survival (34.9% vs. 57.6%, p=0.03).
- Pre-operative sarcopenia correlated with a higher incidence of post-operative complications (65% vs. 41%, p=0.04).
Conclusions:
- Sarcopenia is a significant predictor of poor short- and long-term outcomes in surgically treated MPM patients.
- Non-invasive CT-based sarcopenia evaluation can aid in selecting suitable candidates for MPM surgery.
- Integrating sarcopenia assessment into pre-operative evaluation may optimize treatment strategies and patient selection.
