Impact of preoperative nutritional status on longitudinal changes in pulmonary function and prognosis after lung cancer surgery

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OBJECTIVE: Preoperative nutritional status is a known prognostic factor in lung cancer surgery. However, its effect on postoperative pulmonary function over time remains unclear. This study evaluated the association between preoperative nutritional status and longitudinal respiratory changes andoutcomes after curative resection. METHODS: Patients who underwent resection for non-small cell lung cancer between January 2020 and December 2024 were prospectively analyzed. Patients were classified by prognostic nutritional index (PNI) into normal (PNI ≥ 50) and malnutrition (PNI < 50) groups. Pulmonary function, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1.0), and diffusing capacity of the lung for carbon monoxide (%DLco), was assessed preoperatively and at 6 and 12 months postoperatively. Changes were compared between lobectomy and sublobar resection by nutritional status. Overall survival (OS) and recurrence-free survival (RFS) were analyzed. RESULTS: Of 551 surgical patients, 294 were included. Low PNI was associated with significantly worse OS and RFS (P < 0.001 and P = 0.005, respectively). Patients with low PNI undergoing lobectomy showed poorer survival outcomes in unadjusted analyses, although interaction analysis demonstrated no significant modification of the prognostic impact of PNI by surgical procedure. Among patients undergoing lobectomy, postoperative FVC recovery differed according to nutritional status (p=0.016), whereas no significant differences were observed in FEV1.0 or %DLco. CONCLUSIONS: Low preoperative PNI was associated with poorer survival and may be associated with postoperative pulmonary functional recovery after lung resection. Preoperative nutritional status may warrant consideration alongside established clinical and oncological factors when planning surgical treatment.

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