Prognostic Benefit of Segmentectomy for Patients with Low Muscle Mass in Early-Stage Lung Cancer

Although segmentectomy is less invasive than lobectomy, little is known about the effect of these procedures on postoperative outcomes of patients with low muscle mass. This study examined the postoperative prognosis of patients with non-small cell lung cancer according to the surgical procedure type and preoperative muscle mass.

This study retrospectively reviewed data of patients who underwent lobectomy or segmentectomy for early-stage non-small cell lung cancer with ground glass opacity-dominant tumor up to 3 cm in size or solid-dominant tumor up to 2 cm in size between 2010 and 2020. The preoperative muscle mass was evaluated based on the height-adjusted erector spinae muscle mass on preoperative chest computed tomography images. The overall survival was compared between patients with low and high muscle mass in the lobectomy and segmentectomy groups. Multivariable analyses were performed to identify prognostic factors for overall survival.

The study enrolled 371 patients: 162 in the lobectomy group and 209 in the segmentectomy group. The 5-year overall survival was significantly poorer for the patients with low muscle mass than for those with high muscle mass in the lobectomy group (83.9 % vs. 91.9 %; p = 0.018), whereas no significant difference was observed in the segmentectomy group (93.5 % vs. 94.9 %; p = 0.54). In the several multivariable models, low muscle mass was an independent prognostic factor in the lobectomy group (hazard ratio [HR], range, 2.3-2.4; p value range, 0.027-0.042) but not in the segmentectomy group (HR range, 1.6-2.0; p value range, 0.19-0.36).

Segmentectomy should be actively considered for patients with low muscle mass because of its lower invasiveness.