Sarcopenia as a Predictor of Short- and Long-Term Outcomes in Patients Surgically Treated for Malignant Pleural Mesothelioma

Our plain-English summary of Sarcopenia as a Predictor of Short- and Long-Term Outcomes in Patients Surgically Treated for Malignant Pleural Mesothelioma, by E. Faccioli, S. Terzi, C. Giraudo, et al (Cancers, 2022).

The study

• Authors: E. Faccioli, S. Terzi, C. Giraudo, A. Zuin, A. Modugno, F. Labella, G. Zambello, G. Lorenzoni, M. Schiavon, D. Gregori, G. Pasello, F. Calabrese, A. Dell'Amore, F. Rea
• Journal: Cancers
• Published: 2022;14(15)
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Surgery for malignant pleural mesothelioma (MPM) should be reserved only for patients who have a good performance status. Sarcopenia, a well-known predictor of poor outcomes after surgery, is still underinvestigated in MPM. The aim of this study is to evaluate the role of sarcopenia as a predictor of short-and long-term outcomes in patients surgically treated for MPM. In our analysis, we included patients treated with a cytoreductive intent in a multimodality setting, with both pre- and post-operative CT scans without contrast available. We excluded those in whom a complete macroscopic resection was not achieved. Overall, 86 patients were enrolled. Sarcopenia was assessed by measuring the mean muscular density of the bilateral paravertebral muscles (T12 level) on pre-and post-operative CTs; a threshold value of 30 Hounsfield Units (HU) was identified. Sarcopenia was found pre-operatively in 57 (66%) patients and post-operatively in 61 (74%). Post-operative sarcopenic patients had a lower 3-year overall survival (OS) than those who were non-sarcopenic (34.9% vs. 57.6% p = 0.03). Pre-operative sarcopenia was significantly associated with a higher frequency of post-operative complications (65% vs. 41%, p = 0.04). The evaluation of sarcopenia, through a non-invasive method, would help to better select patients submitted to surgery for MPM in a multimodality setting.

In plain English

This single-center retrospective study from the University Hospital of Padua, Italy, looked at 86 patients who had surgery for malignant pleural mesothelioma between 1994 and 2021. All of them also had chemotherapy before surgery. Sarcopenia (muscle loss) was measured on CT scans as the density of the back muscles at the 12th thoracic vertebra; a value under 30 Hounsfield Units counted as sarcopenic. Before surgery, 57 patients (66%) were sarcopenic. Of these, 65% had complications after surgery, compared with 41% of non-sarcopenic patients (p = 0.04). Patients who were sarcopenic after surgery had lower overall survival (hazard ratio 1.96, 95% confidence interval 1.06 to 3.64). Their 3-year survival was 34.9%, against 57.6% for non-sarcopenic patients. This association remained after adjusting for disease stage (hazard ratio 1.75, 1.02 to 3.03). Relapse did not differ significantly between the two groups. Asbestos exposure was more frequent among patients who were sarcopenic before surgery. The authors concluded that sarcopenia before and after surgery negatively influenced outcomes. They named the small, mixed, single-center group as a limitation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: single-center retrospective study
• Who was studied: 86 patients (76% male, median age 66) operated on with curative intent for malignant pleural mesothelioma at the Thoracic Surgery Unit, University Hospital of Padua, Italy, selected from 305 operated between July 1994 and July 2021. All had neoadjuvant chemotherapy and 72 (84%) had adjuvant radiotherapy. Asbestos exposure was recorded in 52 (60.5%).
• Exposure: Sarcopenia, defined as mean density of the bilateral paravertebral muscles at T12 below 30 Hounsfield Units on non-contrast CT, assessed before and after surgery. Asbestos exposure was recorded as a patient characteristic, not studied as the main exposure.
• Main results:
  • Before surgery, 57 of 86 patients (66%) were sarcopenic. After surgery, 63 (74%) were sarcopenic according to the text, while the abstract and Table 3 give 61.
  • Patients sarcopenic before surgery more often had post-operative complications: 37 of 57 (65%) vs 12 of 29 (41%) without sarcopenia, p = 0.04. Length of hospital stay did not differ (median 14 vs 12 days, p = 0.9).
  • Patients sarcopenic after surgery had lower overall survival than non-sarcopenic patients (HR 1.96, 1.06 to 3.64, p = 0.03). 3-year survival was 34.9% vs 57.6%.
  • In multivariable analysis adjusted for pathological stage, post-operative sarcopenia remained a predictor of death (HR 1.75, 1.02 to 3.03, p = 0.04).
  • 3-year cumulative incidence of relapse was 81% in post-operative sarcopenic patients vs 74% in non-sarcopenic patients (p = 0.70). The difference was not significant.
  • Asbestos exposure was more frequent in patients sarcopenic before surgery: 40 of 57 (70%) vs 12 of 29 (42%), p = 0.037.
  • Pre-operative FVC between 60% and 87% was associated with lower mortality (HR 0.2, interval 0.114 to 0.417), as were certain TLC and VO2max ranges.
• The authors' conclusion: The authors concluded that both pre- and post-operative sarcopenia have a negative influence on clinical outcomes after surgery for malignant pleural mesothelioma. They said that assessing it on non-contrast chest CT could help select surgical candidates, and that larger prospective multicenter studies are needed.
• Limitations the authors state:
  • The study was single-center and retrospective, with relatively few patients and a mixed cohort receiving different treatment approaches.
  • Thoracic muscles are exercised by breathing and may not waste like abdominal or thigh muscles, so measuring them may introduce bias.
  • The skeletal muscle index, usually measured at the third lumbar vertebra, was not assessed.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Performance Status, Cytoreductive Surgery, CT Scan, Bilateral, Overall Survival.

Related studies

• Sarcopenia, Precardial Adipose Tissue and High Tumor Volume as Outcome Predictors in Surgically Treated Pleural Mesothelioma — O.G. Verhoek, L. Jungblut, et al. (2022)
• Cumulative asbestos exposure as a key predictor of long-term pleuropulmonary outcomes: insights from decades of follow-up — L. Štěpánek, M. Nakládalová, et al. (2025)
• Dose-Dependent Effect of Red Blood Cells Transfusion on Perioperative and Long-Term Outcomes in Peritoneal Surface Malignancies Treated with Cytoreduction and HIPEC — E. Nizri, S. Kusamura, et al. (2018)
• Short-term inhalation and in vitro tests as predictors of fiber pathogenicity — R.T. Cullen, B.G. Miller, et al. (1997)
• Quantitation and predictors of short-term mortality following extrapleural pneumonectomy, pleurectomy/decortication, and nonoperative management for malignant pleural mesothelioma — C. Wright, V. Verma, et al. (2020)
• Predictors of long-term survival following radical surgery for malignant pleural mesothelioma — A. Nakas, D. Waller (2014)

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