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Skeletal Muscle Index is Associated with Long Term Outcomes After Lobectomy for Non-Small Cell Lung Cancer
Lindsay J. Nitsche, BS, Andrew Ray, PT, PhD, Madeline Tiadjeri, BS, Victor McCutcheon, BS, John Hall, BS, Mark W. Hennon, MD, FACS, Sai Yendamuri, MD, FACS.
Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.

OBJECTIVE: Skeletal muscle indices have been associated with improved peri-operative outcomes after surgical resection of non-small-cell lung cancer (NSCLC). It is unclear if these indices can predict long term outcomes.
METHODS: All patients undergoing lobectomy without neoadjuvant therapy were included. Preoperative CT scans were used to quantify skeletal muscle index (SMI) at L4 using Slice-O-Matic software. Univariate and multivariate associations between SMI and long-term outcomes (overall survival (OS), recurrence-free survival (RFS), and disease-specific survival (DSS) were assessed using Kaplan Meier and Cox multivariable analyses.
RESULTS: N=496. Most patients (>90%) underwent VATS lobectomy. Mean SMI was 47.226 (SD=11.094). SMI was negatively associated with age (R=-0.2; P<0.05) and positively associated with body mass index (R=0.46; P<0.05). SMI (continuous variable) was associated with OS (HR=0.98; P=0.02), DSS (HR=0.98; P=0.02) and RFS (HR=0.98; P=0.08) on univariate analyses. Multivariable analyses after consideration of age, gender, race, smoking status, stage, histology, FEV1(% predicted), American Society of Anesthesiology (ASA) score showed an association between higher SMI and improved OS (HR=0.97; P=0.001), DSS (HR = 0.97; P<0.001) and RFS (HR=0.97; P=0.01). Using median SMI as cutoff, high SMI was associated with OS and DSS, but not RFS, in a statistically significant manner (Figure 1).
CONCLUSIONS: Skeletal muscle index is associated with improved long term outcomes after surgical resection of NSCLC. Further studies are needed to understand the biological basis of this observation. This study provides additional rationale for design and implementation of rehabilitation trials after surgical resection, in order to gain durable oncologic benefit.


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