Phenotypic characterization and prevalence of preoperative respiratory sarcopenia in Chinese patients with resectable early-stage non-small cell lung cancer: A two-center cross-sectional study.

BACKGROUND

Respiratory sarcopenia (RS) has been associated with adverse postoperative outcomes in non-small cell lung cancer (NSCLC), but its preoperative profile in Chinese surgical patients remains unclear.

METHODS

This two-center cross-sectional study included 320 surgical patients with stage I-II resectable NSCLC. RS was operationalized using peak expiratory flow rate and pectoralis muscle index with sex-specific cutoffs reported in a Japanese surgical cohort. Systemic sarcopenia was assessed according to the 2019 Asian Working Group for Sarcopenia criteria. Logistic regression identified factors associated with RS; Venn diagrams depicted overlap with systemic sarcopenia components; postoperative recovery indicators were descriptively compared as exploratory measures.

RESULTS

In this adenocarcinoma-dominant cohort (97.5%), preoperative RS was identified in 15.6% of patients. Older age (OR = 1.25 per 5-year increase, P = 0.012), higher body fat percentage (OR = 1.29 per 5% increase, P = 0.029), and higher lymphocyte count (OR = 1.92 per 1 × 109/L increase, P = 0.034) were positively associated with RS, whereas higher handgrip strength was inversely associated with RS (OR = 0.69 per 5-kg increase, P = 0.006). Isolated respiratory impairment without systemic sarcopenia components occurred in 26.0% of RS cases. RS patients had longer postoperative length of stay and chest tube duration, and higher drainage volumes than non-RS patients (all P < 0.05).

CONCLUSIONS

Preoperative RS was identified in approximately one in six patients and only partially overlapped with systemic sarcopenia. Pragmatic respiratory-specific assessment may complement conventional sarcopenia screening, but standardized definitions, population-specific thresholds, and prospective validation are needed.