RESEARCH PROGRESS ON THE APPLICATION OF PHASE ANGLE IN POSTOPERATIVE COMPLICATIONS OF LUNG CANCER
Keywords:
Phase angle, Lung cancer, Postoperative complications, Bioelectrical impedance analysis, Risk prediction, Nutritional assessmentAbstract
Phase angle (PhA) is the result of bioresistivity analysis (BIA) and is a physiological marker. In the past few years, the field of medical research has attracted more and more attention. In the field of oncology, PhA is particularly useful because it is related to the nutritional status and cell integrity of patients, and provides an important estimate of the risk of postoperative complications in surgical lung cancer population. Existing research shows that there may be a link between PhA and postoperative complications in lung cancer patients, but so far, research has been limited in terms of small sample size or lack of standard methods for evaluating PhA. This review outlines the physiological basis of PhA, the methods of measuring PhA, and the possibility of PhA affecting the risk of postoperative complications in patients with postoperative lung cancer. This review expands the study to integrate the latest articles published before to discuss the potential value and opportunities of using PhA in risk assessment in the future. This review ultimately aims to solve the current relationship between PhA and postoperative complications, evaluate the use of influencing factors or clinical interventions, and inform the basic practice of the evidence of lung cancer population in the postoperative nursing environment.References
[1] Suzuki Y, Kushimoto Y, Ishizawa H, et al. The phase angle as a predictor of postoperative complications in patients undergoing lung cancer surgery. Surg Today, 2023, 53(3): 332-337.
[2] Stellingwerf F, Beumeler LFE, Rijnhart-de Jong H, et al. The predictive value of phase angle on long-term outcome after ICU admission. Clin Nutr, 2022, 41(6): 1256-1259.
[3] Jiang N, Zhang J, Cheng S, et al. The Role of Standardized Phase Angle in the Assessment of Nutritional Status and Clinical Outcomes in Cancer Patients: A Systematic Review of the Literature. Nutrients, 2022, 15(1).
[4] Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis--part I: review of principles and methods. Clin Nutr, 2004, 23(5): 1226-1243.
[5] Bellido D, García-García C, Talluri A, et al. Future lines of research on phase angle: Strengths and limitations. Rev Endocr Metab Disord, 2023, 24(3): 563-583.
[6] Strong ME, Richards JR, Torres M, et al. Faradaic electrochemical impedance spectroscopy for enhanced analyte detection in diagnostics. Biosens Bioelectron, 2021, 177: 112949.
[7] Zou Y, Xu H, Cui J, et al. Association of Phase Angle with Overall Survival in Patients with Cancer: A Prospective Multicenter Cohort Study. Nutr Cancer, 2023, 75(3): 890-900.
[8] Davis MP, Yavuzsen T, Khoshknabi D, et al. Bioelectrical impedance phase angle changes during hydration and prognosis in advanced cancer. Am J Hosp Palliat Care, 2009, 26(3): 180-187.
[9] Aburto-Corona JA, Calleja-Núñez JJ, Moncada-Jiménez J, et al. The Effect of Passive Dehydration on Phase Angle and Body Composition: A Bioelectrical Impedance Analysis. Nutrients, 2024, 16(14).
[10] Cornejo-Pareja I, Vegas-Aguilar IM, Lukaski H, et al. Overhydration Assessed Using Bioelectrical Impedance Vector Analysis Adversely Affects 90-Day Clinical Outcome among SARS-CoV2 Patients: A New Approach. Nutrients, 2022, 14(13).
[11] Bosy-Westphal A, Danielzik S, Dörhöfer RP, et al. Phase angle from bioelectrical impedance analysis: population reference values by age, sex, and body mass index. JPEN J Parenter Enteral Nutr, 2006, 30(4): 309-316.
[12] Barbosa-Silva MC, Barros AJ, Wang J, et al. Bioelectrical impedance analysis: population reference values for phase angle by age and sex. Am J Clin Nutr, 2005, 82(1): 49-52.
[13] Mattiello R, Amaral MA, Mundstock E, et al. Reference values for the phase angle of the electrical bioimpedance: Systematic review and meta-analysis involving more than 250,000 subjects. Clin Nutr, 2020, 39(5): 1411-1417.
[14] Di Vincenzo O, Marra M, Antognozzi V, et al. Comparison of bioelectrical impedance analysis-derived phase angle in individuals with different weight status. Nutrition, 2023, 108: 111960.
[15] Costa Pereira JPD, Rebouças AS, Prado CM, et al. Phase angle as a marker of muscle quality: A systematic review and meta-analysis. Clin Nutr, 2024, 43(12): 308-326.
[16] Casirati A, Crotti S, Raffaele A, et al. The use of phase angle in patients with digestive and liver diseases. Rev Endocr Metab Disord, 2023, 24(3): 503-524.
[17] Arab A, Karimi E, Vingrys K, et al. Is phase angle a valuable prognostic tool in cancer patients' survival? A systematic review and meta-analysis of available literature. Clin Nutr, 2021, 40(5): 3182-3190.
[18] Han BG, Lee JY, Kim JS, et al. Clinical Significance of Phase Angle in Non-Dialysis CKD Stage 5 and Peritoneal Dialysis Patients. Nutrients, 2018, 10(9).
[19] Silva AM, Matias CN, Nunes CL, et al. Lack of agreement of in vivo raw bioimpedance measurements obtained from two single and multi-frequency bioelectrical impedance devices. Eur J Clin Nutr, 2019, 73(7): 1077-1083.
[20] Dupertuis YM, Pereira AG, Karsegard VL, et al. Influence of the type of electrodes in the assessment of body composition by bioelectrical impedance analysis in the supine position. Clin Nutr, 2022, 41(11): 2455-2463.
[21] Androutsos O, Gerasimidis K, Karanikolou A, et al. Impact of eating and drinking on body composition measurements by bioelectrical impedance. J Hum Nutr Diet, 2015, 28(2): 165-171.
[22] Varanoske AN, Harris MN, Hebert C, et al. Bioelectrical impedance phase angle is associated with physical performance before but not after simulated multi-stressor military operations. Physiol Rep, 2023, 11(6): e15649.
[23] Freitas SP, Júdice PB, Hetherington-Rauth M, et al. The impact of 2weeks of detraining on phase angle, BIVA patterns, and muscle strength in trained older adults. Exp Gerontol, 2021, 144: 111175.
[24] Prete M, Ballarin G, Porciello G, et al. Bioelectrical impedance analysis-derived phase angle (PhA) in lung cancer patients: a systematic review. BMC Cancer, 2024, 24(1): 608.
[25] Toso S, Piccoli A, Gusella M, et al. Altered tissue electric properties in lung cancer patients as detected by bioelectric impedance vector analysis. Nutrition, 2000, 16(2): 120-124.
[26] Liu XY, Kang B, Lv Q, et al. Phase angle is a predictor for postoperative complications in colorectal cancer. Front Nutr, 2024, 11: 1446660.
[27] Gulin J, Ipavic E, Mastnak DM, et al. Phase angle as a prognostic indicator of surgical outcomes in patients with gastrointestinal cancer. Radiol Oncol, 2023, 57(4): 524-529.
[28] Roccamatisi L, Gianotti L, Paiella S, et al. Preoperative standardized phase angle at bioimpedance vector analysis predicts the outbreak of antimicrobial-resistant infections after major abdominal oncologic surgery: A prospective trial. Nutrition, 2021, 86: 111184.
[29] Detopoulou P, Tsiouda T, Pilikidou M, et al. Dietary Habits Are Related to Phase Angle in Male Patients with Non-Small-Cell Lung Cancer. Curr Oncol, 2022, 29(11): 8074-8083.
[30] Shinohara S, Kobayashi K, Kasahara C, et al. Long-term impact of complications after lung resections in non-small cell lung cancer. J Thorac Dis, 2019, 11(5): 2024-2033.
[31] Tomborelli Bellafronte N, Atoui S, Carli F, et al. Preoperative Standardized Phase Angle Is Associated with Any and 30-Day Medical-related Postoperative Complications among Colorectal and Lung Surgical Patients: A Retrospective Analysis. Anesthesiology, 2025, 142(2): 405-408.
[32] Detopoulou P, Voulgaridou G, Papadopoulou S. Cancer, Phase Angle and Sarcopenia: The Role of Diet in Connection with Lung Cancer Prognosis. Lung, 2022, 200(3): 347-379.
[33] De Benedetto F, Marinari S, De Blasio F. Phase angle in assessment and monitoring treatment of individuals with respiratory disease. Rev Endocr Metab Disord, 2023, 24(3): 491-502.
[34] Kaluźniak-Szymanowska A, Krzymińska-Siemaszko R, Deskur-Śmielecka E, et al. Malnutrition, Sarcopenia, and Malnutrition-Sarcopenia Syndrome in Older Adults with COPD, Nutrients, 2021, 14(1).
[35] Villeneuve PJ. Interventions to avoid pulmonary complications after lung cancer resection. J Thorac Dis, 2018, 10(Suppl 32): S3781-s3788.
[36] Matsutani N, Yoshiya K, Chida M, et al. Postoperative empyema following lung cancer surgery. Oncotarget, 2018, 9(51): 29810-29819.
[37] Brunelli A, Xiume F, Al Refai M, et al. Air leaks after lobectomy increase the risk of empyema but not of cardiopulmonary complications: a case-matched analysis. Chest, 2006, 130(4): 1150-1156.
[38] Pischik VG, Maslak OS, Obornev AD, et al. Risk factors and outcomes of prolonged air leak after pulmonary resections. Indian J Thorac Cardiovasc Surg, 2019, 35(4): 564-568.
[39] Hazer S, Gülhan SŞ E, Solak N, et al. The Effect of Prognostic Nutritional Index in Postoperative Infection Following Lobectomy in Non-Small Cell Lung Cancer Patients. Cureus, 2023, 15(4): e37611.
[40] Li P, Li J, Lai Y, et al. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: a retrospective cohort study. J Thorac Dis, 2018, 10(10): 5755-5763.
[41] Ponholzer F, Ng C, Maier H, et al. Risk factors, complications and costs of prolonged air leak after video-assisted thoracoscopic surgery for primary lung cancer. J Thorac Dis, 2023, 15(2): 866-877.
[42] Bagheri R, Yousefi Y, Rezai R, et al. Atrial fibrillation after lung surgery: incidence, underlying factors, and predictors. Kardiochir Torakochirurgia Pol, 2019, 16(2): 53-56.
[43] Ziarnik E, Grogan EL. Postlobectomy Early Complications. Thorac Surg Clin, 2015, 25(3): 355-364.
[44] Kwon JH, Bang YJ, Kwon EJ, et al. Phase Angle as a Reliable Biomarker of Frailty to Predict Postoperative Outcomes in Patients Undergoing Off-Pump Coronary Artery Grafting: A Prospective Observational Study. J Cardiothorac Vasc Anesth, 2024, 38(1): 109-117.
[45] Shibata K, Kameshima M, Adachi T, et al. Association between preoperative phase angle and all-cause mortality after cardiovascular surgery: A retrospective cohort study. J Cachexia Sarcopenia Muscle, 2024, 15(4): 1558-1567.
[46] Mullie L, Obrand A, Bendayan M, et al. Phase Angle as a Biomarker for Frailty and Postoperative Mortality: The BICS Study. J Am Heart Assoc, 2018, 7(17): e008721.
[47] Popiolek-Kalisz J, Kalisz G, Zembala M. The Application of Bioelectrical Impedance Analysis Phase Angle in Cardiac Surgery. Nutrients, 2025, 17(11).
[48] Lee SY, Lee YJ, Yang JH, et al. The Association between Phase Angle of Bioelectrical Impedance Analysis and Survival Time in Advanced Cancer Patients: Preliminary Study. Korean J Fam Med, 2014, 35(5): 251-256.
[49] Władysiuk MS, Mlak R, Morshed K, et al. Bioelectrical impedance phase angle as a prognostic indicator of survival in head-and-neck cancer. Curr Oncol, 2016, 23(5): e481-e487.
[50] Ringaitiene D, Puodziukaite L, Vicka V, et al. Bioelectrical Impedance Phase Angle-Predictor of Blood Transfusion in Cardiac Surgery. J Cardiothorac Vasc Anesth, 2019, 33(4): 969-975.
[51] Axtell AL, Gaissert HA, Bao X, et al. Predictors of Venous Thromboembolism After Lung Cancer Resection. Ann Thorac Surg, 2024, 117(5): 998-1005.
[52] Falanga A, Ay C, Di Nisio M, et al. Venous thromboembolism in cancer patients: ESMO Clinical Practice Guideline. Ann Oncol, 2023, 34(5): 452-467.