title: Body Mass Index and Total Psoas Area Affect Outcomes in Patients Undergoing Pneumonectomy for Cancer.
abstract: BACKGROUND
  Hypothesizing that morphometric measurements are reliable markers of fitness in patients with lung cancer requiring aggressive surgical intervention, the purpose of this study was to assess their impact on postoperative outcome and long-term survival in patients with non-small cell lung cancer (NSCLC) requiring pneumonectomy.
  
  
  METHODS
  Height, weight, and body mass index (BMI), as well as usual clinical, laboratory (including C-reactive protein [CRP] concentrations), and pathologic data were retrospectively retrieved from files of 161 consecutive patients treated by pneumonectomy for NSCLC, whose preoperative computed tomographic (CT) scans were available in the Picture Archive and Communication System (PACS) of the hospital. Cross-sectional areas of right and left psoas areas (measured by CT scan at the L3 level), perirenal fat thickness, and anterior subcutaneous tissue thickness at the left renal vein level were also assessed.
  
  
  RESULTS
  BMI and total psoas area were strongly and directly correlated (p = 0.0000001), whereas BMI was inversely related to CRP levels. Sarcopenia (total psoas area ≤33rd percentile) was associated with high CRP levels (>20 mg/L) (p = 0.010). Factors associated with 90-day mortality included older age (p = 0.000045), lower body weight (p = 0.032), and BMI less than or equal to 25 kg/m2(p = 0.013). At univariate analysis, long-term outcome was negatively affected by a nonsquamous cell histologic type (p = 0.011), pathologic stage IIIB-IV (p =0.026), CRP levels greater than 20 mg/L (p = 0.017), BMI less than or equal to 25 kg/m2(p = 0.010), and total psoas area less than or equal to the 33rd percentile (p = 0.029). Multivariate analysis showed the independent prognostic value of both BMI and total psoas area.
  
  
  CONCLUSIONS
  BMI less than or equal to 25 kg/m2and total psoas cross-sectional area less than or equal to the 33rd percentile are prognostic determinants in patients with NSCLC requiring pneumonectomy.
authors.affiliation: Department of Thoracic Surgery, Paris Centre University Hospitals, Paris, France.
authors.forename: Remi
authors.initials: R
authors.lastname: Hervochon
authors.affiliation: Department of Thoracic Surgery, Paris Centre University Hospitals, Paris, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bobbio
authors.affiliation: Department of Radiology, Paris Centre University Hospitals, Paris, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Guinet
authors.affiliation: Department of Pathology, Paris Centre University Hospitals, Paris, France; University Paris Descartes, Paris, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Mansuet-Lupo
authors.affiliation: Department of Chest Disease and Intensive Care, Paris Centre University Hospitals, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rabbat
authors.affiliation: Department of Thoracic Surgery, Paris Centre University Hospitals, Paris, France; University Paris Descartes, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Régnard
authors.affiliation: University Paris Descartes, Paris, France; Department of Chest Disease and Intensive Care, Paris Centre University Hospitals, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.affiliation: Department of Pathology, Paris Centre University Hospitals, Paris, France; University Paris Descartes, Paris, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Damotte
authors.affiliation: Department of Surgery, Nice University Hospital, Nice, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
authors.affiliation: Department of Thoracic Surgery, Paris Centre University Hospitals, Paris, France; University Paris Descartes, Paris, France. Electronic address: marco.alifano@aphp.fr.
authors.forename: Marco
authors.initials: M
authors.lastname: Alifano
mesh_terms: D015992:Body Mass Index; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011013:Pneumonectomy; D011379:Prognosis; D016658:Psoas Muscles / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed