Clinical impact of preoperative adipopenia on postoperative outcomes in non-small cell lung cancer surgery.

BACKGROUND

This study aimed to clarify the relationship between preoperative adipopenia and clinicopathological factors, including sarcopenia and myosteatosis, in patients with surgically resected non-small cell lung cancer (NSCLC), and to evaluate short- and long-term outcomes.

METHODS

We analyzed 300 patients who underwent complete resection of p-Stage I-IIIA NSCLC via lobectomy. Body composition was assessed by computed tomography at the L3 vertebral level, with fat and muscle areas normalized to height to calculate the total fat (TFI), visceral fat (VFI), subcutaneous fat (SFI), and skeletal muscle (SMI) indices. Adipopenia and sarcopenia were defined as the sex-specific lowest quartiles of these indices. Muscle quality was evaluated by paravertebral muscle density (PVMD) in Hounsfield units, with low quality (myosteatosis) defined by established sex-independent thresholds.

RESULTS

The median age was 70 years; 184 patients were male. Median follow-up was 64 months. TFI, VFI, and SFI were strongly intercorrelated but showed limited correlation with SMI. Fat indices had weak-to-moderate negative correlations with PVMD. Adipopenia was not associated with postoperative complications. Overall survival (OS) was significantly worse in patients with adipopenia (TFI, VFI, SFI), whereas relapse-free survival was unaffected. Non-lung cancer-specific survival was significantly worse in males with adipopenia (TFI, VFI). In p-Stage I NSCLC, multivariable analysis identified adipopenia (VFI) and sarcopenia (SMI) as independent predictors of poor OS, regardless of myosteatosis.

CONCLUSIONS

Preoperative adipopenia independently predicts poor prognosis in p-Stage I NSCLC and may increase non-lung cancer-related mortality, particularly in males. Imaging-based body composition assessment may enhance perioperative risk and long-term outcome prediction.