Postoperative Sarcopenia and Association with Recurrence in Resected Early-Stage Non-Small Cell Cancer

We hypothesize that reduction in skeletal muscle volume between the time of surgery and the first postoperative surveillance CT scan is associated with recurrence in resected patients with early-stage non-small cell lung cancer (NSCLC).

Patients who underwent lung resection for pT1-2aN0 NSCLC between 2010 and 2021 were identified. Exclusion criteria included neoadjuvant or adjuvant therapy, missing CT scan data, and steroid use. Volumetric body composition analysis was performed with Data Analysis Facilitation Suite software using preoperative and initial postoperative surveillance CT scans. A Cox proportional hazards model was used to examine the association between body composition changes and recurrence.

Overall, 233 patients were examined, including 63% (147 of 233) women with a median BMI of 27 (interquartile range [IQR] 23 to 30) kg/m 2 , and a median tumor size of 1.6 (IQR 1.3 to 2.2) cm. Disease recurrence was observed in 14% (33 of 233), and the median time to recurrence was 15 (IQR 9 to 25) months. In patients that recurred, median skeletal muscle percent change was -3.6% (IQR -9.26 to 1.23) and 1.99% (IQR -4.6 to 11.4) in nonrecurrent patients. On univariable analysis, loss in skeletal muscle volume >1% was associated with worse disease-free survival (hazard ratio 2.93, 95% CI 1.42 to 6.04, p = 0.004). On multivariable analysis, after controlling for sex, age, race, BMI, pack years, forced expiratory volume in 1 second, histology, tumor size, number of nodes, procedure type, and comorbidities, this association persisted (hazard ratio 3.16, 95% CI 1.44 to 6.94, p = 0.004).

Loss in skeletal muscle volume on first surveillance CT scan is associated with recurrence after resection of early-stage NSCLC.