Usefulness of Pulmonary Rehabilitation in Non-Small Cell Lung Cancer Patients Based on Pulmonary Function Tests and Muscle Analysis Using Computed Tomography Images

Juwhan Choi, Zepa Yang, Jinhwan Lee, Jun Hee Lee, Hyun Koo Kim, Hwan Seok Yong, Sung Yong Lee, Juwhan Choi, Zepa Yang, Jinhwan Lee, Jun Hee Lee, Hyun Koo Kim, Hwan Seok Yong, Sung Yong Lee

Abstract

Purpose: The usefulness of rehabilitation in patients with reduced lung function before lung surgery remains unclear, and there is no adequate method for evaluating the effect of rehabilitation. We aimed to evaluate the usefulness of rehabilitation in patients with non-small cell lung cancer (NSCLC) undergoing lung cancer surgery.

Materials and methods: We retrospectively analyzed the medical records of NSCLC patients at Korea University Guro Hospital between 2018 and 2020. Patients were divided into two groups depending on whether they underwent rehabilitation. Pulmonary function test (PFT) data and muscle determined using chest computed tomography (CT) images were analyzed. Because the baseline characteristics were different between the two groups, propensity score matching was performed.

Results: Of 325 patients, 75 (23.1%) and 250 (76.9%) were included in the rehabilitation and non-rehabilitation (control) groups, respectively. The rehabilitation group had a worse general condition at baseline. After propensity score matching, 45 patients remained in each group. Pulmonary function (forced expiratory volume in 1 second, %) (p=0.001) and the Hounsfield unit of erector spinae muscle (p=0.001) were better preserved in the rehabilitation group. Muscle loss of 3.4% and 0.6% was observed in the control and rehabilitation groups, respectively (p=0.003). In addition, the incidence of embolic events was lower in the rehabilitation group (p=0.044).

Conclusion: Pulmonary rehabilitation is useful in patients with NSCLC undergoing lung surgery. Pulmonary rehabilitation preserves lung function, muscle and reduces embolic events after surgery. Pulmonary rehabilitation is recommended for patients with NSCLC undergoing surgery.

Keywords: Chronic obstructive pulmonary disease; Non-small-cell lung carcinoma; Pulmonary rehabilitation; Pulmonary surgical procedures.

Figures

Fig. 1
Fig. 1
HUESMcsa calculation. We drew the erector spinae muscles (first lumbar level) with a green line. For each computed tomography image, we calculated the muscle thresholds. The software program calculated the HUESMcsa (indicated in blue). (A) Muscle atrophy: HUESMcsa 975.8 cm2. (B) Muscle hypertrophy: HUESMcsa 5,910.1 cm2. HU, Hounsfield unit; HUESMcsa, Hounsfield unit of average intensity value of erector spinae muscle in cross-sectional area in computed tomography.
Fig. 2
Fig. 2
Flowchart of patient classification according to rehabilitation and propensity score matching.
Fig. 3
Fig. 3
Correlation analysis of pulmonary function test parameters and the HUESMcsa: Forced expiratory volume in 1 second (FEV1) (A) and forced vital capacity (FVC) (B). HU, Hounsfieldunit; HUESMcsa, Hounsfieldunit of average intensity value of erector spinae muscle in cross-sectional area in computed tomography.

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