Prognostic impact of preoperative osteopenia in elderly patients with lung cancer

Osteopenia was recently reported to be a factor contributing to a poorer prognosis in various cancers. However, its prognostic impact on non-small cell lung cancer (NSCLC) patients remains unclear. In the present study, we focused on osteopenia in elderly NSCLC patients and investigated survival outcomes.

This study included 315 NSCLC patients aged 75 years or older who had undergone radical lobectomy or segmentectomy at our institution between 2010 and 2023. Osteopenia was evaluated based on the average pixel density within a circle in the mid-vertebral core at the 11th thoracic vertebra on preoperative computed tomography.

Osteopenia was identified in 126 patients (40%). This osteopenia group had significantly poorer overall survival (OS) than the non-osteopenia group (5-year OS: 71.4%vs 81.0%, p = 0.026). Multivariable analysis revealed that Charlson comorbidity index (CCI) ≥ 2 (p = 0.020), Brinkman index (BI) ≥ 400 (p < 0.001), pathological Stage ≥ II (p < 0.001), and osteopenia (p = 0.016) were independent factors affecting OS. The cumulative incidence of non-lung cancer mortality was significantly higher in the osteopenia group than non-osteopenia group (5-year mortality rate: 16.9% vs. 6.4%, p = 0.005). In multivariable analysis, CCI ≥ 2 (p = 0.009), BI ≥ 400 (p < 0.008) and osteopenia (p = 0.001) were independent factors affecting non-lung cancer mortality.

Elderly patients with osteopenia have significantly poorer OS, and osteopenia was closely associated with non-lung cancer mortality. Screening for osteopenia may assist in identifying high-risk patients of non-lung cancer death and developing appropriate treatment strategies.