1
|
Iijima Y, Mizoguchi T, Ishikawa M, Iwai S, Motono N, Uramoto H. Impacts of perioperative hyponatremia relevant to outcomes and prognosis of non-small cell lung cancer in octogenarians. Surgery 2023; 173:1476-1483. [PMID: 37045621 DOI: 10.1016/j.surg.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/28/2023] [Accepted: 03/08/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND A recent study reported the effect of preoperative hyponatremia on postoperative outcomes of patients with non-small cell lung cancer. However, the influence of postoperative hyponatremia on postoperative outcomes has not been completely investigated. METHODS We retrospectively studied 75 octogenarians who underwent pulmonary surgery for non-small cell lung cancer between 2009 and 2018. We divided them into hyponatremic and non-hyponatremic groups, depending on preoperative and immediate postoperative serum sodium levels, and investigated their clinicopathological characteristics and outcomes. Disease-specific survival and cumulative incidence of relapse rates between the two groups were calculated and compared using the stratified Kaplan-Meier method. Univariable and multivariable analyses were performed to identify prognostic factors. RESULTS Preoperative hyponatremia was associated with 66.7% of postoperative respiratory and 88.9% of non-cardiovascular complications. The long-term prognosis of the postoperative hyponatremic group was significantly worse than that of their counterpart. The 3-year disease-specific survival and 3-year cumulative incidence of relapse rate were 55.9% and 46.2%, respectively, and the median observation period after surgery was 37.4 (interquartile range, 23.7-51.0) months for the entire cohort. Kaplan-Meier curves showed that hyponatremia was associated with worse disease-specific survival and cumulative incidence of relapse. Multivariable analysis identified hyponatremia as a factor that predicted unfavorable disease-specific survival and cumulative incidence of relapse. CONCLUSIONS Immediate postoperative hyponatremia is an independent predictor of non-small cell lung cancer outcomes among octogenarians. Preoperative hyponatremia was associated with a high frequency of postoperative respiratory and non-cardiovascular complications. Surgical indications in older patients with hyponatremia should be carefully considered with follow-up.
Collapse
Affiliation(s)
- Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan.
| | - Takaki Mizoguchi
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan
| |
Collapse
|
2
|
Iijima Y, Ishikawa M, Iwai S, Yamagata A, Motono N, Uramoto H. Is Overweight Related to the Prognosis of Octogenarians with Lung Cancer? Obes Surg 2022; 32:1279-1288. [DOI: 10.1007/s11695-022-05948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
|
3
|
Yuan Q, Du M, Loehrer E, Johnson BE, Gainor JF, Lanuti M, Li Y, Christiani DC. Postdiagnosis BMI Change Is Associated with Non-Small Cell Lung Cancer Survival. Cancer Epidemiol Biomarkers Prev 2021; 31:262-268. [PMID: 34728470 DOI: 10.1158/1055-9965.epi-21-0503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/24/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Body mass index (BMI) change after a lung cancer diagnosis has been associated with non-small cell lung cancer (NSCLC) survival. This study aimed to quantify the association based on a large-scale observational study. METHODS Included in the study were 7,547 patients with NSCLC with prospectively collected BMI data from Massachusetts General Hospital and Brigham and Women's Hospital/Dana-Farber Cancer Institute. Cox proportional hazards regression with time-dependent covariates was used to estimate effect of time-varying postdiagnosis BMI change rate (% per month) on overall survival (OS), stratified by clinical subgroups. Spline analysis was conducted to quantify the nonlinear association. A Mendelian Randomization (MR) analysis with a total of 3,495 patients further validated the association. RESULTS There was a J-shape association between postdiagnosis BMI change and OS among patients with NSCLC. Specifically, a moderate BMI decrease [0.5-2.0; HR = 2.45; 95% confidence interval (CI), 2.25-2.67] and large BMI decrease (≥2.0; HR = 4.65; 95% CI, 4.15-5.20) were strongly associated with worse OS, whereas moderate weight gain (0.5-2.0) reduced the risk for mortality (HR = 0.78; 95% CI, 0.68-0.89) and large weight gain (≥2.0) slightly increased the risk of mortality without reaching statistical significance (HR = 1.10; 95% CI, 0.86-1.42). MR analyses supported the potential causal roles of postdiagnosis BMI change in survival. CONCLUSIONS This study indicates that BMI change after diagnosis was associated with mortality risk. IMPACT Our findings, which reinforce the importance of postdiagnosis BMI surveillance, suggest that weight loss or large weight gain may be unwarranted.
Collapse
Affiliation(s)
- Qianyu Yuan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mulong Du
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Elizabeth Loehrer
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bruce E Johnson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Justin F Gainor
- Center for Thoracic Cancers, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.,Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Michael Lanuti
- Center for Thoracic Cancers, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Yi Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. .,Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
Sumiyoshi T, Uemura K, Kondo N, Okada K, Seo S, Otsuka H, Serikawa M, Ishii Y, Tsuboi T, Murakami Y, Takahashi S. Is surgery justified for elderly patients with extrahepatic cholangiocarcinoma? Reappraisal from a viewpoint of comorbidity and organ function. Surg Today 2021; 51:1787-1794. [PMID: 34420113 DOI: 10.1007/s00595-021-02340-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The benefit of surgery for older patients with extrahepatic cholangiocarcinoma (EHCC) has not been established and the differences in the general condition of younger vs. older patients remain unclear. METHODS Patients who underwent curative surgery for EHCC were divided into two groups according to age: those younger than 75 years old (younger group) and those aged 75 years or older (older group). We analyzed the clinical data of the two groups retrospectively. RESULTS Among the 116 patients analyzed, 45 (38.8%) were in the older group. Regarding comorbidity, only cardiac disease was significantly more common in the older patients; however, the cardiac function of the two groups was identical. There were no significant differences in the prevalence of kidney and lung disease, but renal function was significantly deteriorated and the incidence of the mixed ventilatory defect was significantly greater in the older group. The overall 5-year survival rates for the younger and older groups were 52.4% vs. 50.4% of all cholangiocarcinoma patients (p = 0.458), 42.4% vs. 51.3% of those with hilar cholangiocarcinoma (p = 0.718), and 69.0% vs. 49.1% of those with distal cholangiocarcinoma (p = 0.534), respectively. CONCLUSIONS Improved survival after surgery can be expected in well-selected older cholangiocarcinoma patients. Comorbidities were not necessarily reflected in organ function, with precise organ function assessment being more important when selecting surgical candidates.
Collapse
Affiliation(s)
- Tatsuaki Sumiyoshi
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kenichiro Uemura
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Naru Kondo
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kenjiro Okada
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shingo Seo
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroyuki Otsuka
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masahiro Serikawa
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Yasutaka Ishii
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Tomofumi Tsuboi
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Murakami
- Digestive Disease Center, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| |
Collapse
|
5
|
Influence of Postoperative Changes in Sarcopenia on Long-Term Survival in Non-Metastatic Colorectal Cancer Patients. Cancers (Basel) 2021; 13:cancers13102410. [PMID: 34067568 PMCID: PMC8156120 DOI: 10.3390/cancers13102410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The number of colorectal cancer survivors is increasing due to improvements in oncologic outcomes. Therefore, the risks of metachronous cancer and second cancer are also increased, as well as recurrences. The influence of muscle mass measured as sarcopenia on long-term survival has been studied recently in colorectal cancer patients. Sarcopenia is a factor controllable by lifestyle modification and has gained interest more recently. This study showed an influence of changes in sarcopenia on long-term oncologic outcomes in colorectal cancer and suggests a basis for further investigation of body composition factors, including sarcopenia. Abstract The effect of perioperative sarcopenic changes on prognosis remains unclear. We conducted a retrospective cohort study with 2333 non-metastatic colorectal cancer patients treated between January 2009 and December 2012 at the Asan Medical Center. The body composition at diagnosis was measured via abdominopelvic computed tomography (CT) using Asan-J software. Patients underwent CT scans preoperatively, as well as at 6 months–1 year and 2–3 years postoperatively. The primary outcome was the association between perioperative sarcopenic changes and survival. According to sarcopenic criteria, 1155 (49.5%), 890 (38.2%), and 893 (38.3%) patients had sarcopenia preoperatively, 6 months–1 year, and 2–3 years postoperatively, respectively. The 5-year overall survival (OS) (95.8% vs. 92.1%, hazard ratio (HR) = 2.234, p < 0.001) and 5-year recurrence-free survival (RFS) (93.2% vs. 86.2%, HR = 2.251, p < 0.001) rates were significantly lower in patients with preoperative sarcopenia. Both OS and RFS were lower in patients with persistent sarcopenia 2–3 years postoperatively than in those who recovered (OS: 96.2% vs. 90.2%, p = 0.001; RFS: 91.1% vs. 83.9%, p = 0.002). In multivariate analysis, postoperative sarcopenia was confirmed as an independent factor associated with decreased OS and RFS. Pre- and postoperative sarcopenia and changes in the condition during surveillance were associated with oncological outcomes.
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Systemic therapy for lung cancer is increasing in intensity and duration. European nutrition guidelines suggest screening for weight loss and malnutrition, however acknowledges there is a lack of evidence. We discuss current data round this issue and identify opportunities for further research. RECENT FINDINGS International guidelines now exist to aid the definition of weight loss in cancer, including cachexia, sarcopenia and malnutrition. These allow consistent definition of overlapping, but distinct clinical syndromes. Nutritional status can be assessed in a range of ways including questionnaires, functional assessments, blood markers, physical activity, weight and BMI. Weight loss is commonly associated with a proinflammatory state. Future treatment is likely to be a combination of dietetic support and pharmacological treatment of cachexia. SUMMARY There is a paucity of data on dietetic intervention. It is potentially quick, inexpensive and patient specific, using a holistic approach to aid patients who are malnourished or at risk of malnutrition. Lung cancer-related weight loss is common, further strategies are needed to effectively assess and intervene. Dietetic intervention has the potential to improve patients' quality of life and outcomes.
Collapse
|
7
|
Shepshelovich D, Xu W, Lu L, Fares A, Yang P, Christiani D, Zhang J, Shiraishi K, Ryan BM, Chen C, Schwartz AG, Tardon A, Wu X, Schabath MB, Teare MD, Le Marchand L, Zhang ZF, Field JK, Brenner H, Diao N, Xie J, Kohno T, Harris CC, Wenzlaff AS, Fernandez-Tardon G, Ye Y, Taylor F, Wilkens LR, Davies M, Liu Y, Barnett MJ, Goodman GE, Morgenstern H, Holleczek B, Brown MC, Liu G, Hung RJ. Body Mass Index (BMI), BMI Change, and Overall Survival in Patients With SCLC and NSCLC: A Pooled Analysis of the International Lung Cancer Consortium. J Thorac Oncol 2019; 14:1594-1607. [PMID: 31163278 PMCID: PMC6734935 DOI: 10.1016/j.jtho.2019.05.031] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/27/2019] [Accepted: 05/21/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The relationships between morbid obesity, changes in body mass index (BMI) before cancer diagnosis, and lung cancer outcomes by histology (SCLC and NSCLC) have not been well studied. METHODS Individual level data analysis was performed on 25,430 patients with NSCLC and 2787 patients with SCLC from 16 studies of the International Lung Cancer Consortium evaluating the association between various BMI variables and lung cancer overall survival, reported as adjusted hazard ratios (aHRs) from Cox proportional hazards models and adjusted penalized smoothing spline plots. RESULTS Overall survival of NSCLC had putative U-shaped hazard ratio relationships with BMI based on spline plots: being underweight (BMI < 18.5 kg/m2; aHR = 1.56; 95% confidence interval [CI]:1.43-1.70) or morbidly overweight (BMI > 40 kg/m2; aHR = 1.09; 95% CI: 0.95-1.26) at the time of diagnosis was associated with worse stage-specific prognosis, whereas being overweight (25 kg/m2 ≤ BMI < 30 kg/m2; aHR = 0.89; 95% CI: 0.85-0.95) or obese (30 kg/m2 ≤ BMI ≤ 40 kg/m2; aHR = 0.86; 95% CI: 0.82-0.91) was associated with improved survival. Although not significant, a similar pattern was seen with SCLC. Compared with an increased or stable BMI from the period between young adulthood until date of diagnosis, a decreased BMI was associated with worse outcomes in NSCLC (aHR = 1.24; 95% CI: 1.2-1.3) and SCLC patients (aHR=1.26 (95% CI: 1.0-1.6). Decreased BMI was consistently associated with worse outcome, across clinicodemographic subsets. CONCLUSIONS Both being underweight or morbidly obese at time of diagnosis is associated with lower stage-specific survival in independent assessments of NSCLC and SCLC patients. In addition, a decrease in BMI at lung cancer diagnosis relative to early adulthood is a consistent marker of poor survival.
Collapse
Affiliation(s)
- Daniel Shepshelovich
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre; University of Toronto, Toronto, Ontario, Canada; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lin Lu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Aline Fares
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre; University of Toronto, Toronto, Ontario, Canada
| | | | - David Christiani
- Environmental Health Department, Harvard TH Chan School of Public Health and Harvard Medical School, Boston, Massachusetts
| | - Jie Zhang
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Research Institute, Tokyo, Japan
| | - Brid M Ryan
- Centre for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Chu Chen
- Program in Epidemiology, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology and Department of Otolaryngology: Head and Neck Surgery, University of Washington, Seattle, Washington
| | - Ann G Schwartz
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - Xifeng Wu
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - M Dawn Teare
- University of Sheffield, Sheffield, United Kingdom
| | | | - Zuo-Feng Zhang
- University of California Los Angeles School of Public Health, California
| | - John K Field
- The Roy Castle Lung Cancer Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, United Kingdom
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nancy Diao
- Environmental Health Department, Harvard TH Chan School of Public Health and Harvard Medical School, Boston, Massachusetts
| | - Juntao Xie
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Takashi Kohno
- Division of Genome Biology, National Cancer Research Institute, Tokyo, Japan
| | - Curtis C Harris
- Centre for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - Angela S Wenzlaff
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - Yuanqing Ye
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fiona Taylor
- University of Sheffield, Sheffield, United Kingdom
| | | | - Michael Davies
- The Roy Castle Lung Cancer Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, United Kingdom
| | - Yi Liu
- PLA Hospital, Beijing, China
| | - Matt J Barnett
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
| | | | - M Catherine Brown
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre; University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre; University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.
| | - Rayjean J Hung
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Akashi K, Ebata T, Mizuno T, Yokoyama Y, Igami T, Yamaguchi J, Onoe S, Nagino M. Surgery for perihilar cholangiocarcinoma from a viewpoint of age: Is it beneficial to octogenarians in an aging society? Surgery 2018; 164:1023-1029. [PMID: 30082134 DOI: 10.1016/j.surg.2018.05.051] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/25/2018] [Accepted: 05/31/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Whether operative treatment provides benefits for elderly patients with perihilar cholangiocarcinoma is unknown. The aim of this study was to review resection of perihilar cholangiocarcinoma according to age and to clarify its value for octogenarians. METHODS Between April 1977 and December 2015, we reviewed consecutive patients who underwent resection for perihilar cholangiocarcinoma with a special focus on patient age. RESULTS During the study interval, 831 patients underwent resection for perihilar cholangiocarcinoma. The median age of the resected patients increased by 11 years over approximately 40 years. Before 2001, no octogenarians underwent operative intervention; however, the proportion of operations for octogenarians increased to 9% after 2010. Further analyses were performed on 643 resected patients between 2001 and 2015. The resectability rate was not different between the octogenarians and the other age groups (71% vs 72.4%). The Charlson Comorbidity Index and preoperative laboratory data were similar between the 2 groups. A less advanced tumor was a predominant feature in the octogenarians compared to the other age groups. Consequently, the procedure used in the octogenarians were less extensive, but the proportion of R0 resection was greater in the octogenarians than in the other age groups (95.% vs 78.3%, P = .008). The ratio of patients who died of other diseases was also greater among octogenarians (29% vs 6.0%, P < .001). Overall survival was similar between the 2 groups (41% vs 38.9% at 5 years). CONCLUSION Resection of perihilar cholangiocarcinoma can be performed with low mortality irrespective of age with careful patient selection and offers long-term survival even in octogenarians.
Collapse
Affiliation(s)
- Kumiko Akashi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| |
Collapse
|
9
|
Wang C, Guo M, Zhang N, Wang G. Association of body mass index and outcomes following lobectomy for non-small-cell lung cancer. World J Surg Oncol 2018; 16:90. [PMID: 29751759 PMCID: PMC5946486 DOI: 10.1186/s12957-018-1394-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/07/2018] [Indexed: 12/16/2022] Open
Abstract
Background Obesity and overweight have become increasingly prevalent, but no consensus has been reached regarding the effect of body mass index (BMI) on surgical outcomes. In this study, we sought to examine the influence of BMI on perioperative outcomes in a large cohort of patients with non-small-cell lung cancer (NSCLC) who underwent lobectomy. Methods A retrospective study was conducted in 1198 patients who underwent lobectomy for primary NSCLC at Shandong Provincial Hospital between November 2006 and January 2017. BMI was calculated using measured height and weight on admission and categorized as obese (≥ 30 kg/m2), overweight (25 to 29.9 kg/m2), normal (18.5 to 24.9 kg/m2), or underweight (< 18.5 kg/m2). Patients’ baseline characteristics and outcomes were abstracted from medical records following institutional review board approval. Endpoints included operative mortality, perioperative complications, and length of stay (LOS). Complications were divided into four groups as respiratory, cardiovascular, other, and overall. Logistic regression models were constructed to assess the association between BMI and adverse outcomes. Results When compared with normal BMI, obesity and overweight did not increase the risk of complications in any category, operative mortality, or prolonged LOS. In fact, the incidence of operative mortality and respiratory complications tended to be lower in overweight patients than in normal weight patients (P = 0.047 and P = 0.041, respectively). Conversely, underweight patients experienced significantly more operative mortality, respiratory complications, and prolonged LOS (P = 0.004, P = 0.011, and P = 0.003, respectively). Conclusions Obesity and overweight did not confer adverse surgical outcomes. Underweight patients presented increased risk of respiratory complications, perioperative death, and prolonged LOS. Thus, overweight and obesity should not be a relative contraindication for lobectomy. Meanwhile, nurses and surgeons should focus on perioperative management of underweight patients.
Collapse
Affiliation(s)
- Cui Wang
- School of Nursing, Shandong University, Jinan, China
| | - Min Guo
- School of Nursing, Shandong University, Jinan, China
| | - Nan Zhang
- School of Nursing, Shandong University, Jinan, China
| | - Gongchao Wang
- School of Nursing, Shandong University, Jinan, China.
| |
Collapse
|
10
|
Value of Preoperative Modified Body Mass Index in Predicting Postoperative 1-Year Mortality. Sci Rep 2018; 8:4614. [PMID: 29545522 PMCID: PMC5854572 DOI: 10.1038/s41598-018-22886-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/02/2018] [Indexed: 12/21/2022] Open
Abstract
Serum albumin and conventional BMI (cBMI) are commonly used indices of malnutrition status. Because cBMI does not reflect fluid accumulation, modified body mass index (mBMI, serum albumin × cBMI) is a more accurate measure of malnutrition status. This study investigated the association between preoperative mBMI and postoperative 1-year mortality, in comparison with serum albumin and cBMI. Medical records of 80,969 adult patients who underwent surgical procedures in a tertiary care hospital between 1 January, 2011 and 31 December, 2015 were retrospectively reviewed. Postoperative 1-year mortality increased with reduction in cBMI, mBMI, and albumin separately (P < 0.001). When considering interaction between cBMI and albumin, albumin was the only significant factor of postoperative 1-year mortality [odds ratio: 0.377, 95% confidence interval (0.245–0.579), P < 0.001], while cBMI or interaction (cBMI * albumin) was not significant (P > 0.05). Adjusted area under the curve (AUC) was highest (0.885) in the overall model (cBMI + albumin + cBMI * albumin); adjusted AUC between mBMI and albumin did not differ significantly (P = 0.558). Low albumin is the strongest independent predictor of postoperative 1-year mortality among the three variables (albumin, cBMI, mBMI). Adding cBMI to albumin does not increase the validity of the AUC of albumin.
Collapse
|