Impact of preoperative computed tomography-determined quantity and quality of skeletal muscle on survival after resected non-small cell lung carcinoma

Objective: This study investigated the prognostic effect of preoperative skeletal muscle quantity and quality on survival after Non-Small Cell Lung Cancer (NSCLC) resection. Methods: This retrospective study consisted of patients with NSCLC who underwent curative lung cancer resection between 2015 and 2020. Skeletal muscle quantity and quality, as determined by paravertebral muscle index (PVMI) and paravertebral muscle density (PVMD), were measured at the level of the twelfth thoracic vertebra on preoperative images of computed tomography. The patients were divided into two subgroups as low and high according to sex-specific median PVMI and PVMD values. Overall survival (OS) rates were compared according to low and high PVMI and PVMD using the KaplaneMeier procedure, and prognostic factors after lung cancer resection were assessed using Cox's regression models. Results: The study comprised 180 patients, with 89 patients in the low PVMI and PVMD groups and 91 patients in the high PVMI and PVMD groups. The OS rates in patients with low PVMI were less than in those with high PVMI (log-rank p ¼ 0.037), with a median survival time of 52.5 months and 57.5 months, respectively. The OS rates in patients with low PVMD were less than in those with high PVMD (log-rank p < 0.001), with a median survival time of 50.8 months and 59.4 months, respectively. Low PVMI and low PVMD were independent prognostic factors of poor OS ([HR] ¼ 1.77, P ¼ 0.014; [HR] ¼ 1.84, P ¼ 0.038, respectively). Conclusion: Preoperative CT-determined low skeletal muscle quantity and quality have a poor prognostic effect on survival after NSCLC resection. Preoperative evaluation of these curable morphometric measures may shed light on pre-rehabilitation and nutritional support programs.