Pre-Disease and Pre-Surgery BMI, Weight Loss and Sarcopenia Impact Survival of Resected Lung Cancer Independently of Tumor Stage.

Unlabelled: Lower pre-surgery Body Mass Index (BMI) and low muscle mass impact negatively long-term survival of non-small cell lung cancer (NSCLC). We investigated their influence on survival after major lung resection for NSCLC.

Methods: A retrospective analysis of a prospectively collected database was made on 304 consecutive patients.

Results: Underweight, normal, overweight and obese patients represented 7.6%, 51.6%, 28.6%, and 12.6% of the pre-disease population. Weight loss and gain were recorded in 5% and 44.4% of patients, respectively. Low muscle mass was more frequently associated with BMI < 25 kg/m ( < 0.000001). Overall survival was positively affected by pre-disease ( = 0.036) and pre-surgery ( 0.017) BMI > 25 kg/m, and, even more, in case of BMI > 25 kg/m and increasing weight ( = 0.012). Long-term outcome was negatively influenced by low muscle mass ( = 0.042) and weight loss ( 0.0052) as well as age ( 0.017), ASA categories ( 0.025), extent of resection ( 0.0001), pleural invasion ( 0.0012) and higher pathologic stage ( < 0.0001). Three stepwise multivariable models confirmed the independent favorable prognostic value of higher pre-disease (RR 0.66[0.49-0.89], 0.006) and pre-surgery BMI (RR 0.72[0.54-0.98], 0.034), and the absence of low muscle mass (RR 0.56[0.37-0.87], 0.0091).

Conclusions: Body reserves assessed by simple clinical markers impact survival of surgically treated NSCLC. Strategies improving body fat and muscular mass before surgery should be considered.