Impact of sarcopenia on early surgical outcomes in elderly patients following lung cancer surgery: a prospective cohort study
Bibliographic record
Abstract
Background: Sarcopenia, characterized by reduced muscle mass, strength, and physical performance, has been linked to poor surgical outcomes. Its prevalence increases markedly with age and has been associated with various adverse health conditions in the elderly, including mental health issues like cognitive impairment, quality of life and depression. However, its impact based on international criteria remains unclear in elderly patients undergoing lung cancer surgery. Therefore, we aimed to prospectively evaluate the association between sarcopenia, defined by international guidelines, and postoperative outcomes, as well as geriatric mental health, in this population. Methods: The LUng CAncer Surgery in sarcoPENia patients with old age (LUCAS-PEN) study (ClinicalTrials.gov identifier NCT05346185) prospectively enrolled patients aged ≥70 years undergoing curative lung cancer surgery. Sarcopenia was defined using the Asian Working Group for Sarcopenia (AWGS) criteria. The primary outcome was postoperative complication rates. Propensity score matching (PSM, 1:4) was performed to reduce selection bias. Geriatric mental health was assessed using the Korean version of the Geriatric Depression Scale (GDS-K), the Korean version of the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), EuroQoL Visual Analog Scale (EQ-VAS), and the Korean version of the Montreal Cognitive Assessment (K-MoCA). Results: Among 400 patients, 357 completed all assessments, and 24 (6.7%) were diagnosed with sarcopenia. Compared to non-sarcopenic patients, the sarcopenia group had a lower body mass index (22.73±2.63 vs. 23.29±2.87 kg/m2, P=0.38) and a higher proportion of clinical node (N) stage ≥1 (29.2% vs. 18.8%, P=0.40). Overall complication rates (25.0% vs. 21.6%, P=0.80) did not significantly differ. In multivariable analysis, neither sarcopenia nor its components were associated with postoperative complications. After PSM, complication rates remained similar between sarcopenic and non-sarcopenic groups (24.0% vs. 25.0%, P>0.99). However, the sarcopenia group had significantly worse mental health outcomes: higher GDS-K scores (6.5 vs. 3.0, P=0.001), lower EQ-5D-5L (0.829 vs. 0.728, P<0.001) and EQ-VAS scores (80 vs. 70, P=0.002), and a higher prevalence of cognitive impairment (27.8% vs. 7.2%, P=0.01). Conclusions: This is the first large prospective study to evaluate sarcopenia according to international guidelines for lung cancer surgery. In this prospective study applying AWGS criteria, sarcopenia was not associated with increased early postoperative complications in elderly patients undergoing lung cancer surgery. However, sarcopenia was linked to poorer mental health.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".