Development and application of a risk prediction nomogram for sarcopenia one year after surgery in early-stage...

Postoperative sarcopenia is a prevalent complication in early-stage non-small cell lung cancer (NSCLC) patients, adversely affecting their prognosis. Accordingly, identifying individuals at risk of sarcopenia is crucial for appropriate assessment and treatment. This research sought to determine predictors of sarcopenia one year after minimally invasive pulmonary resection (post-sarcopenia) in early-stage NSCLC patients and to create and validate a clinical screening model for this condition.

This study involved patients who had video-assisted thoracoscopic lobectomy or sublobectomy between January 2018 and December 2020, with chest computed tomography (CT) conducted at 1 year postoperatively. Post-sarcopenia was diagnosed by calculating the skeletal muscle index from the skeletal muscle area measured at the T12 vertebral level using cross-sectional CT scans. Subjects were randomly divided into training and validation sets. The training set underwent univariate and multivariate analyses to identify risk factors for post-sarcopenia and establish a risk score for predicting the development of post-sarcopenia. The risk score's effectiveness was assessed through the area under the receiver operating characteristic curve (AUC), calibration, and decision curve analysis (DCA) in both cohorts.

The study included 251 patients (mean age 64.4 years; 63.75% female), divided into a training set (n = 175) and a validation set (n = 76). Six variables were identified as independent predictors and incorporated into the post-sarcopenia risk score: gender, body mass index, surgical method, prolonged air leak, C-reactive protein, and postoperative albumin. The risk score demonstrated good discriminatory ability for predicting post-sarcopenia, achieving an average AUC of 0.89 (95% CI: 0.84-0.94) in the training set and 0.84 (95% CI: 0.74-0.93) in the validation set, along with satisfactory calibration (all p > 0.05). The DCA demonstrated the net benefit of the risk score across various risk thresholds in both cohorts.

The developed and validated post-sarcopenia risk score demonstrates strong predictive ability for identifying patients at risk of sarcopenia following minimally invasive pulmonary resection for early-stage NSCLC patients. This risk score can assist clinicians in enhancing post-sarcopenia screening, evaluating patient prognosis, and formulating targeted strategies.