Segmentectomy preserves better immune-nutritional status than lobectomy in patients with early-stage lung cancer

OBJECTIVES

This study aimed to compare the postoperative immune-nutritional status of patients undergoing segmentectomy and lobectomy for early-stage non-small-cell lung cancer.

METHODS

Patients with clinical stage 0-IA non-small-cell lung cancer who underwent lobectomy or segmentectomy were retrospectively analysed. Postoperative immune-nutritional indices (prognostic nutritional index, serum albumin levels and total lymphocyte count) at 1 month, 6 months, 1 year, 2 years and 3 years after surgery were compared using mixed effects linear models and mixed effects logistic regression models.

RESULTS

There were 164 and 210 patients in the lobectomy and segmentectomy groups, respectively. Postoperative prognostic nutritional index and albumin levels were significantly higher in the segmentectomy group than those in the lobectomy group (P < 0.001 and P < 0.001, respectively), despite the nonsignificant difference in the total lymphocyte count (P = 0.563). In 126 propensity score-matched pairs adjusted for confounding variables affecting postoperative nutritional status, postoperative prognostic nutritional index and albumin levels were significantly higher in the segmentectomy group than in the lobectomy group (P = 0.009 and P = 0.007, respectively). At each time point after surgery, these indices were higher in the segmentectomy group than in the lobectomy group at 1 month, 2 years and 3 years postoperatively. There were significantly more patients with lower immune-nutritional indices (prognostic nutritional index <45, albumin <4.0 g/dl) in the lobectomy group than in the segmentectomy group at 3 years postoperatively (P = 0.026 and P = 0.029, respectively), despite nonsignificant statistical differences throughout the study period (P = 0.219 and P = 0.113, respectively).

CONCLUSIONS

Patients who underwent segmentectomy showed better postoperative immune-nutritional status than those who underwent lobectomy.

Immune-Nutritional Status as a Novel Prognostic Predictor of Bell's Palsy

INTRODUCTION

The prognosis of Bell's palsy, idiopathic facial nerve palsy (FNP), is usually predicted by electroneuronography in subacute phase. However, it would be ideal to establish a reliable and objective examination applicable in acute phase to predict the prognosis of FNP. Immune-nutritional status (INS) calculated from peripheral blood examination is recently reported as the prognostic factor in various disease. However, the validity of INS as the prognostic factor in Bell's palsy is not well known. Thus, we conducted a retrospective study to investigate the usefulness of INS as prognostic predictors of Bell's palsy.

METHODS

We reviewed the medical records of 79 patients with Bell's palsy and divided into two groups as "complete recovery" and "incomplete recovery" groups. Clinical features such as severity of FNP and INS, including neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), prognostic nutritional index (PNI), and controlling nutrition status (CONUT) score, were assessed.

RESULTS

In univariate analysis, statistically significant differences were observed in clinical score of facial movement, NLR, LMR, PNI, and CONUT score at the initial examination between the two groups (p < 0.05). Furthermore, in multivariate analysis, statistically significant differences were also observed in facial movement score and PNI at the initial examination (p < 0.05).

CONCLUSION

Immune and nutritional condition play important roles in the pathogenesis of Bell's palsy, suggesting that INS would be one of the useful prognostic factors in Bell's palsy.