早期肺癌患者行经胸腔镜手术后肌肉衰减患者与非肌肉衰减患者的患者报告结局分析

Early Postoperative Patient-Reported Outcomes of Sarcopenia Versus Nonsarcopenia in Patients Undergoing Video-Assisted Thoracoscopic Surgery for Lung Cancer

ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

分区:医学2区 / 外科2区肿瘤学3区

发表日期:2025 Feb

作者: Jieke Liu, Dongyan Li, Huijie Ma, Yong Li, Xing Wei, Wei Dai, Qiuling Shi, Qiang Li, Peng Zhou, Xiang Wang, Haomiao Qing

DOI: 10.1245/s10434-024-16140-9

摘要

本研究旨在比较接受经胸腔镜手术（VATS）治疗肺癌的肌肉衰减与非肌肉衰减患者的早期术后患者报告结局。本研究数据来自2017年11月至2020年1月的前瞻性纵向研究（CN-PRO-Lung 1）。通过术前CT在L3椎体水平测量骨骼肌指数，根据既定阈值确定肌肉衰减。症状严重度和功能障碍状态通过0-10评分的MD安德森肺癌症状清单（MDASI-LC）评估，分别在基线、术后住院期间和出院后每周进行。比较肌肉衰减组与非肌肉衰减组的症状严重度、功能状态及术后临床结局。共纳入125例接受VATS的肺癌患者，其中肌肉衰减患者34例（27.2%）。肌肉衰减患者在出院时报告中度至重度疼痛（P=0.002）和疲劳（P=0.027）更严重，恢复时间也更长（疼痛：P=0.002；疲劳：P=0.007）。此外，两组在术后临床结局方面无显著差异（所有P>0.05）。肌肉衰减患者在VATS治疗肺癌过程中，疼痛和疲劳更明显，症状恢复时间更长，但临床结局无差异。

Abstract

To compare early postoperative patient-reported outcomes between sarcopenic and nonsarcopenic patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer.The data used in this study were acquired from a longitudinal prospective study (CN-PRO-Lung 1) between November 2017 and January 2020. Skeletal muscle index was measured at L3 vertebral level on preoperative computed tomography to identify sarcopenia based on an established threshold. Symptoms severity and status of functional impairments were reported as proportions of patients with clinically relevant moderate-to-severe scores on 0-10 scales, which were measured by using the MD Anderson Symptom Inventory-Lung Cancer at baseline, daily postoperative hospitalization, and weekly after discharge up to 4 weeks. Symptom severity, functional status, and postoperative clinical outcomes were compared between the sarcopenia and nonsarcopenia groups.This study included 125 patients undergoing VATS for lung cancer. Sarcopenia was identified in 34 (27.2%) patients. Sarcopenic patients reported more moderate-to-severe pain (P = 0.002) at discharge and more moderate-to-severe fatigue (P = 0.027) during the 4 weeks after discharge. Besides, sarcopenic patients had a longer recovery time from both pain (P = 0.002) and fatigue (P = 0.007) than nonsarcopenic patients. Meanwhile, no significant between-group difference was found in the postoperative clinical outcomes (all P > 0.05).Sarcopenic patients undergoing VATS for lung cancer may have more pain and fatigue, as well as longer symptoms recovery time than nonsarcopenic patients during the early postoperative period.