Impact of respiratory sarcopenia on postoperative outcomes in non-small cell lung cancer: A propensity-score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Tian ¹ , ZHU Mengyao ¹ , YAO Zhiyuan ¹ , WANG Zhuzhu ² , YUAN Ligong ¹ ,  LI Congling ¹

1. Department of Thoracic Surgery, Pulmonary and Mediastinal Subspecialty, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, P. R. China;
2. School of Nursing, Anhui Medical University, Hefei, 230601, P. R. China;

Corresponding?author：

LI Congling, Email: 402644670@qq.com

Keywords：

Non-small cell lung cancer; respiratory sarcopenia; propensity-score matching; postoperative recovery

DOI：

10.7507/1007-4848.202509087

Video：

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Objective To evaluate the impact of preoperative respiratory sarcopenia (RS) on postoperative outcomes in patients with non-small cell lung cancer (NSCLC). Methods A retrospective cohort study was conducted involving NSCLC patients who underwent surgery in the Department of Thoracic Surgery at the First Affiliated Hospital of the University of Science and Technology of China between March 2023 and February 2024. Patients were divided into an RS group or a non-RS group based on peak expiratory flow rate and pectoral muscle index. Propensity-score matching (PSM) was performed at a 1:4 ratio to adjust for age, gender, body mass index, smoking history, comorbidities, surgical approach, tumor maximum diameter, and lymph node metastasis status. Postoperative outcome measures were compared between the matched groups. Multivariate regression analysis was conducted to assess the independent impact of RS on postoperative outcomes. Results A total of 1074 patients were included before matching. After matching, 175 patients were enrolled, comprising 154 males (88.0%) and 21 females (12.0%), with a mean age of (62.70±9.03) years. Among them, 128 patients were in the RS group and 47 in the non-RS group. After PSM, compared with the non-RS group, the RS group demonstrated significantly shorter time to first ambulation [MD=4.000, 95%CI (3.000, 5.000), P<0.001], shorter chest tube retention time [MD=1.000, 95%CI (0.000, 1.000), P=0.006], and postoperative hospital stay [MD=1.000, 95%CI (1.000, 2.000), P<0.001], and significantly increased incidence of respiratory discomfort symptoms within 1 year postoperatively [RR=3.585, 95%CI (1.758, 7.308), P<0.001]. Multivariate regression analysis revealed that preoperative coexisting RS was an independent risk factor for prolonged time to first ambulation (P<0.001) and increased thoracic drainage volume on postoperative day 1 (P=0.005). Conclusion Preoperative RS in patients with NSCLC directly leads to delayed early postoperative ambulation and increased early thoracic drainage volume. However, no significant impact of preoperative RS on long-term postoperative outcomes was observed, indicating that respiratory muscle mass and function represent potential targets for interventions aimed at improving surgical outcomes.

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14.	Furukawa Y, Miyamoto A, Asai K, et al. Respiratory muscle strength as a predictor of exacerbations in patients with chronic obstructive pulmonary disease. Respirology, 2025, 30(5): 408-416.
15.	Han DJ, Na KJ, Yun T, et al. Effects of respiratory sarcopenia on the postoperative course in elderly lung cancer patient: a retrospective study. J Cardiothorac Surg, 2025, 20(1): 71.
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17.	Nagano A, Wakabayashi H, Maeda K, et al. Respiratory sarcopenia and sarcopenic respiratory disability: concepts, diagnosis, and treatment. J Nutr Health Aging, 2021, 25(4): 507-515.
18.	Moriyama T, Tokunaga M, Hori R, et al. Probable respiratory sarcopenia decreases activities of daily living in older patients hospitalized with respiratory diseases: a cross-sectional study. Prog Rehabil Med, 2024, 9: 20240014.
19.	da Costa Teixeira LA, de Carvalho Bastone A, Soares LA, et al. Physical and inflammatory aspects associated to respiratory sarcopenia in community-dwelling older women. Sci Rep, 2025, 15(1): 18310.
20.	Liu J, Li D, Ma H, et al. Early postoperative patient-reported outcomes of sarcopenia versus nonsarcopenia in patients undergoing video-assisted thoracoscopic surgery for lung cancer. Ann Surg Oncol, 2025, 32(2): 801-810.
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22.	Shinohara S, Otsuki R, Kobayashi K, et al. Impact of sarcopenia on surgical outcomes in non-small cell lung cancer. Ann Surg Oncol, 2020, 27(7): 2427-2435.
23.	Lan Y, Ke Y, Sun D, et al. Associations of muscle-related metrics with respiratory disease in Chinese adults: a prospective cohort study. J Cachexia Sarcopenia Muscle, 2025, 16(1): e13650.
24.	Martínez-Arnau FM, Onfría-Vivas R, Buigues C, et al. Effects of leucine administration in sarcopenia: a randomized and placebo-controlled clinical trial. Nutrients, 2020, 12(4): 932.
25.	Kiss N, Loeliger J, Findlay M, et al. Clinical oncology society of Australia: position statement on cancer-related malnutrition and sarcopenia. Nutr Diet, 2020, 77(4): 416-425.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. 國家衛生健康委. 《健康中國行動-癌癥防治行動實施方案(2023-2030年)》解讀. (2023-11-15).5-09-13]. National Health Commission. Interpretation of the “Healthy China Action Plan for Cancer Prevention and Control (2023-2030)”. (2023-11-15) [2025-09-13].
3. Brunelli A, Tariq J, Mittal A, et al. Self-reported dyspnoea and shortness of breathing deterioration in long-term survivors after segmentectomy or lobectomy for early-stage lung cancer. Eur J Cardiothorac Surg, 2024, 65(5): ezae200.
4. Tanaka S, Ozeki N, Mizuno Y, et al. Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non-small-cell lung cancer. J Cachexia Sarcopenia Muscle, 2021, 12(3): 646-656.
5. Shu X, Song Q, Huang X, et al. Sarcopenia and risk of postoperative pneumonia: a systematic review and meta-analysis. J Nutr Health Aging, 2025, 29(3): 100457.
6. Lin TY, Chen YF, Wu WT, et al. Impact of sarcopenia on the prognosis and treatment of lung cancer: an umbrella review. Discov Oncol, 2022, 13(1): 115.
7. Jogiat U, Jimoh Z, Turner SR, et al. Sarcopenia in lung cancer: a narrative review. Nutr Cancer, 2023, 75(7): 1485-1498.
8. Martini K, Chassagnon G, Fournel L, et al. Sarcopenia as independent risk factor of postpneumonectomy respiratory failure, ARDS and mortality. Lung Cancer, 2020, 149: 130-136.
9. Kera T, Kawai H, Hirano H, et al. Definition of respiratory sarcopenia with peak expiratory flow rate. J Am Med Dir Assoc, 2019, 20(8): 1021-1025.
10. Sato S, Miyazaki S, Tamaki A, et al. Respiratory sarcopenia: a position paper by four professional organizations. Geriatr Gerontol Int, 2023, 23(1): 5-15.
11. Sun C, Hirata Y, Kawahara T, et al. Diagnosis of respiratory sarcopenia for stratifying postoperative risk in non-small cell lung cancer. JAMA Surg, 2025, 160(1): 66.
12. 宋春花, 程好晴, 崔久嵬, 等. 中國腫瘤住院患者肌肉減少癥調查報告. 腫瘤代謝與營養電子雜志, 2024, 11(5): 638-650.Song CH, Cheng HQ, Cui JW, et al. The prevalence of sarcopenia in hospitalized cancer patients in China. Electron J Metab Nutr Cancer, 2024, 11(5): 638-650.
13. Troschel FM, Jin Q, Eichhorn F, et al. Sarcopenia on preoperative chest computed tomography predicts cancer-specific and all-cause mortality following pneumonectomy for lung cancer: a multicenter analysis. Cancer Med, 2021, 10(19): 6677-6686.
14. Furukawa Y, Miyamoto A, Asai K, et al. Respiratory muscle strength as a predictor of exacerbations in patients with chronic obstructive pulmonary disease. Respirology, 2025, 30(5): 408-416.
15. Han DJ, Na KJ, Yun T, et al. Effects of respiratory sarcopenia on the postoperative course in elderly lung cancer patient: a retrospective study. J Cardiothorac Surg, 2025, 20(1): 71.
16. Yu H, Chen K, Chen Q, et al. Influence of probable respiratory sarcopenia on chronic lung diseases: a population-based cohort study of community-dwelling Chinese older adults. Front Med (Lausanne), 2025, 12: 1617808.
17. Nagano A, Wakabayashi H, Maeda K, et al. Respiratory sarcopenia and sarcopenic respiratory disability: concepts, diagnosis, and treatment. J Nutr Health Aging, 2021, 25(4): 507-515.
18. Moriyama T, Tokunaga M, Hori R, et al. Probable respiratory sarcopenia decreases activities of daily living in older patients hospitalized with respiratory diseases: a cross-sectional study. Prog Rehabil Med, 2024, 9: 20240014.
19. da Costa Teixeira LA, de Carvalho Bastone A, Soares LA, et al. Physical and inflammatory aspects associated to respiratory sarcopenia in community-dwelling older women. Sci Rep, 2025, 15(1): 18310.
20. Liu J, Li D, Ma H, et al. Early postoperative patient-reported outcomes of sarcopenia versus nonsarcopenia in patients undergoing video-assisted thoracoscopic surgery for lung cancer. Ann Surg Oncol, 2025, 32(2): 801-810.
21. Gustafsson T, Ulfhake B. Aging skeletal muscles: what are the mechanisms of age-related loss of strength and muscle mass, and can we impede its development and progression? Int J Mol Sci, 2024, 25(20): 10932.
22. Shinohara S, Otsuki R, Kobayashi K, et al. Impact of sarcopenia on surgical outcomes in non-small cell lung cancer. Ann Surg Oncol, 2020, 27(7): 2427-2435.
23. Lan Y, Ke Y, Sun D, et al. Associations of muscle-related metrics with respiratory disease in Chinese adults: a prospective cohort study. J Cachexia Sarcopenia Muscle, 2025, 16(1): e13650.
24. Martínez-Arnau FM, Onfría-Vivas R, Buigues C, et al. Effects of leucine administration in sarcopenia: a randomized and placebo-controlled clinical trial. Nutrients, 2020, 12(4): 932.
25. Kiss N, Loeliger J, Findlay M, et al. Clinical oncology society of Australia: position statement on cancer-related malnutrition and sarcopenia. Nutr Diet, 2020, 77(4): 416-425.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesImpact of respiratory sarcopenia on postoperative outcomes in non-small cell lung cancer: A propensity-score matching study

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