Effect of Preexisting Sarcopenia on Acute and Late Postoperative Pneumonia Among Patients With Oral Cavity Squamous Cell Carcinoma
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Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei;
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Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei;
Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung;
Division of Radiation Oncology, and
Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan;
Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung;
Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan;
Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei; and
Department of Management, College of Management, Fo Guang University, Yilan, Taiwan.
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Background: Whether preexisting sarcopenia is an independent risk factor for postoperative pneumonia (POP) for patients with oral cavity squamous cell carcinoma (OCSCC) remains unclear. Therefore, we conducted a propensity score–matched population-based cohort study to compare the risk of acute and late POP for patients with sarcopenic and nonsarcopenic OCSCC who underwent curative surgery. Patients and Methods: We included patients with OCSCC who underwent curative surgery and categorized them into 2 groups depending on whether they had preexisting sarcopenia. The patients in the sarcopenic and nonsarcopenic groups were matched at a ratio of 2:1. Results: The matching process yielded 16,257 patients (10,822 without sarcopenia and 5,435 with sarcopenia). In multivariate Cox regression analyses, the adjusted hazard ratio of POP for the group with OCSCC with preexisting sarcopenia was 1.20 (95% CI, 1.14–1.26; P<.0001) compared with the nonsarcopenic group. Among the patients with OCSCC who received curative surgery, those in the sarcopenic group exhibited a higher POP risk than those in the nonsarcopenic group for the following postoperative time periods: 31st to 90th day, 91st day to first year, first to second year, second to third year, third to fourth year, and fourth to fifth year. Conclusions: The high incidence of pneumonia persists for a long time in patients with OCSCC who receive curative surgery; this high incidence may even persist for 5 years after surgery, especially in patients with sarcopenia. For susceptible patients who are at risk for OCSCC, sarcopenia prevention measures (eg, exercise and early nutrition intervention) should be implemented.
Submitted May 20, 2022; final revision received August 4, 2022; accepted for publication August 8, 2022.
Author contributions: Conception and design: All authors. Data collection and assembly: Y.N. Chen, Chiang, Wu. Data analysis and interpretation: W.M. Chen, Shia, Wu. Administrative support: Wu. Manuscript writing: Y.N. Chen, Chiang, Huang, Wu. Final manuscript approval: All authors.
Data availability statement: The data sets supporting the study conclusions are included in the manuscript. We used data from the National Health Insurance Research Database and Taiwan Cancer Registry database. The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. The data used in this study cannot be made available in the manuscript, the supplemental files, or in a public repository due to the Personal Information Protection Act executed by Taiwan’s government, starting in 2012. Requests for data can be sent as a formal proposal to obtain approval from the ethics review committee of the appropriate governmental department in Taiwan. Specifically, links regarding contact information for which data requests may be sent to are as follows: http://nhird.nhri.org.tw/en/Data_Subsets.html#S3 and http://nhis.nhri.org.tw/point.html.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Research funding and financial support was provided by the Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital through award numbers 10908, 10909, 11001, 11002, 11003, 11006, and 11013 (S.Y. Wu).
Chun-Chi Huang, MD, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Number 83, Nanchang Street, Luodong Township, Yilan County, 265, Taiwan. Email: b8301054@gmail.com
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