P1055 - PREDICTION OF POSTOPERATIVE DECLINE IN EXERCISE TOLERANCE USING PREOPERATIVE CT-BASED RESPIRATORY MUSCLE INDICES IN PATIENTS WITH LUNG CANCER

P1055

PREDICTION OF POSTOPERATIVE DECLINE IN EXERCISE TOLERANCE USING PREOPERATIVE CT-BASED RESPIRATORY MUSCLE INDICES IN PATIENTS WITH LUNG CANCER

K. Shirado^1,*, T. Kido¹, K. Kawamitsu¹, M. Yasuda²

¹Rehabilitation, ²Chest Surgery, IIZUKA HOSPITAL, Iizuka, Japan

Rationale: Respiratory sarcopenia has been reported to be associated with poor postoperative outcomes in lung cancer¹, but it is unclear whether it is associated with exercise tolerance. This study aimed to determine which respiratory muscle indices assessed by preoperative computed tomography (CT) strongly predict a postoperative decline in exercise tolerance.

Methods: We included patients with lung cancer undergoing thoracic surgery in our retrospective study. Preoperative CT was used to evaluate five respiratory muscle indices: intercostal muscle Hounsfield Unit (HU), intercostal muscle index (IMI), diaphragm thickness index (DTI), pectoralis muscle index (PMI), and pectoralis muscle HU. The primary outcome was a ≥42 m decline in six-minute walk distance (6MWD) from preoperative to discharge. Each respiratory muscle index was included in a multivariable logistic regression model adjusted for age, sex, COPD, preoperative 6MWD, rehabilitation time during hospitalization, and surgical time. The predictive ability of each model was evaluated using receiver operating characteristic (ROC) analysis, and the area under the curve (AUC) was calculated to compare performance.

Results: Among the 139 patients (mean age 74 years, 60.4% male), 60 (43.2%) showed a postoperative decline in 6MWD. The model combining intercostal muscle HU and IMI achieved the highest predictive performance (AUC = 0.762, sensitivity = 0.617, specificity = 0.818). Predictive performance of the other models was lower.

Conclusion: CT-based assessment of intercostal muscle quality and quantity may help predict postoperative functional decline and support personalized rehabilitation and nutrition therapy for patients with respiratory sarcopenia.

References: 1. Han DJ, et al. Effects of respiratory sarcopenia on the postoperative course in elderly lung cancer patient: a retrospective study. J Cardiothorac Surg. 2025. 

Disclosure of Interest: None declared