Prognostic Impact of Preoperative Osteopenia for Patients with Resected Non-Small Cell Lung Cancer

OBJECTIVES: Osteopenia is an independent risk factor for a poor prognosis in several malignant tumours. However, its significance in lung cancer is unclear. In this retrospective cohort study, we aimed to evaluate the prognostic impact of preoperative osteopenia in patients with surgically resected non-small cell lung cancer. METHODS: We included 546 patients who underwent curative resection for clinical stage I-IIIA non-small cell lung cancer at our institute during 2013-2018. Bone mineral density was evaluated with computed tomographic measurement of pixel density in the core at the bottom of the 11th thoracic vertebra. The cutoff value was 148 and 111 Hounsfield units for men and women, respectively, based on the time-dependent receiver operating characteristic curve for overall survival. Patients were divided into osteopenia and non-osteopenia groups, and the associations of osteopenia with clinicopathological features and prognosis were analyzed. RESULTS: Two hundred fifty-one patients (46.0%) were classified into the osteopenia group. The rates of patients ≥70 years old and ever-smokers in the osteopenia group were higher than those in the non-osteopenia group. The 5-year overall survival (77.1% vs 91.5%) and recurrence-free survival (63.7% vs 80.0%) rates of the osteopenia group were worse than those of the non-osteopenia group. Multivariable analysis revealed that osteopenia was an independent poor prognostic factor for overall survival (hazard ratio [HR]: 2.2, 95% confidence interval [CI], 1.38-3.51, P < .001) and recurrence-free survival (hazard ratio: 1.5, 95% CI, 1.05-2.11, P = .024). CONCLUSIONS: Preoperative osteopenia is an independent poor prognostic factor for patients with resected clinical stage I-IIIA non-small cell lung cancer.