Body Composition as Prognostic Markers for Survival of Patients with Non-Metastatic Non-Small-Cell Lung Cancer
DOI:
https://doi.org/10.31584/jhsmr.2023980Keywords:
body composition, fat mass, non-metastatic non-small cell lung cancer, obesity paradox, prognosis, skeletal muscle, survivalAbstract
Objective: Lung cancer is the leading cause of cancer-related deaths. Although, previous research have shown that patients with non-small-cell lung cancer (NSCLC), with a higher body mass index (BMI), have a lower risk of death, only a few studies have examined the effects of body composition. Hence, this study examined the prognostic value of skeletal muscle mass and fat mass in patients with non-metastatic NSCLC.
Material and Methods: This was a retrospective cohort study; from 2008 to 2012. Eighty-eight of 130 non-metastatic NSCLC patients underwent computed tomography to assess paravertebral skeletal muscle, subcutaneous adipose tissue (SAT), and visceral adipose-tissue (VAT) at the 3rd lumbar vertebral level. Spearman correlation analysis was used to analyze body-composition correlations. Cox regression analysis was used to determine prognostic markers.
Results: Higher SAT and VAT indices were associated with a higher-survival probability (HR, 0.79; p-value=0.001 and, HR 0.88; p-value=0.016, respectively). In contrast, higher SAT density and VAT/SAT ratio were associated with a lower survival probability (HR 1.16, p-value=0.012; HR 1.28, p-value=0.006, respectively). Lower performance status and TNM stage 3 were associated with lower-survival probability (HR 2.60; p-value=0.004, HR 1.92; p-value=0.035, respectively).
Conclusion: The VAT index predicts a better prognosis for patients with non-metastatic lung cancer; however, visceralfat distribution, as measured by a high VAT/SAT ratio, is associated with a worse prognosis.
References
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5-29.
DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014;64:252-71.
Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 2010;77:655-61.
Srisam-Ang K, Podhipak A, Narksawat K, Supaattagorn P, Tipayamongkholgul M. Survival of patients with advanced non-small-cell lung cancer at Ubon Ratchathani Cancer Center, Thailand. Southeast Asian J Trop Med Public Health 2005;36:994-1006.
Davies NJ, Batehup L, Thomas R. The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br J Cancer 2011;105 (Suppl 1):S52-73.
Sinicrope FA, Foster NR, Yothers G, Benson A, Seitz JF, Labianca R, et al. Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer 2013;119:1528-36.
Halabi S, Ou SS, Vogelzang NJ, Small EJ. Inverse correlation between body mass index and clinical outcomes in men with advanced castration-recurrent prostate cancer. Cancer 2007;110:1478-84.
Sparano JA, Wang M, Zhao F, Stearns V, Martino S, Ligibel JA, et al. Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer 2012;118:5937-46.
Leung CC, Lam TH, Yew WW, Chan WM, Law WS, Tam CM. Lower lung cancer mortality in obesity. Int J Epidemiol 2011;40:174-82.
Parr CL, Batty GD, Lam TH, Barzi F, Fang X, Ho SC, et al. Body-mass index and cancer mortality in the asia-pacific cohort studies collaboration: pooled analyses of 424,519 participants. Lancet Oncol 2010;11:741-52.
Meyer HJ, Wienke A, Surov A. CT-defined low-skeletal muscle mass as a prognostic marker for survival in prostate cancer: a systematic review and meta-analysis. Urol Oncol 2022;40:103.e9-16.
Wong A, Zhu D, Kraus D, Tham T. Radiologically defined sarcopenia affects survival in head and neck cancer: a metaanalysis. Laryngoscope 2021;131:333-41.
Rinninella E, Cintoni M, Raoul P, Pozzo C, Strippoli A, Bria E, et al. Muscle mass, assessed at diagnosis by L3-CT scan as a prognostic marker of clinical outcomes in patients with gastric cancer: a systematic review and meta-analysis. Clin Nutr 2020;39:2045-54.
Buentzel J, Heinz J, Bleckmann A, Bauer C, Röver C, Bohnenberger H, et al. Sarcopenia as prognostic factor in lung cancer patients: a systematic review and meta-analysis. Anticancer Res 2019;39:4603-12.
Jeon YW, Park HS, Ko Y, Sung YS, Shim BY, Suh YJ, et al. Intermuscular fat density as a novel prognostic factor in breast cancer patients treated with adjuvant chemotherapy. Breast Cancer Res Treat 2021;189:759-68.
Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The eighth edition lung cancer stage classification. Chest 2017;151:193-203.
World Health Organization. Regional Office for the Western Pacific. The asia-pacific perspective: redefining obesity and its treatment. Sydney: World Health Organization; 2000.
Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 2008;33:997-1006.
Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012;24:69-71.
Contal C, O’Quigley J. An application of changepoint methods in studying the effect of age on survival in breast cancer. Computational Statistics & Data Analysis 1999;30:253-70.
Choi H, Park YS, Na KJ, Park S, Park IK, Kang CH, et al. Association of adipopenia at preoperative pet/ct with mortality in stage i non-small cell lung cancer. Radiology 2021;301:645-53.
Tan X, Peng H, Gu P, Chen M, Wang Y. Prognostic significance of the l3 skeletal muscle index and advanced lung cancer inflammation index in elderly patients with esophageal cancer. Cancer Manag Res 2021;13:3133-43.
Katsui K, Ogata T, Watanabe K, Yoshio K, Kuroda M, Yamane M, et al. Sarcopenia is related to poor prognosis in patients after trimodality therapy for locally advanced non-small cell lung cancer. Int J Clin Oncol 2021;26:1450-60.
Dohzono S, Sasaoka R, Takamatsu K, Hoshino M, Nakamura H. Low paravertebral muscle mass in patients with bone metastases from lung cancer is associated with poor prognosis. Support Care Cancer 2020;28:389-94.
Magri V, Gottfried T, Di Segni M, Urban D, Peled M, Daher S, et al. Correlation of body composition by computerized tomography and metabolic parameters with survival of nivolumab-treated lung cancer patients. Cancer Manag Res 2019;11:8201-7.
Baldessari C, Pecchi A, Marcheselli R, Guaitoli G, Bonacini R, Valoriani F, et al. Body composition and inflammation impact in non-small-cell lung cancer patients treated by first-line immunotherapy. Immunotherapy 2021;13:1501-19.
Yeoh AJ, Pedley A, Rosenquist KJ, Hoffmann U, Fox CS. The association between subcutaneous fat density and the propensity to store fat viscerally. J Clin Endocrinol Metab 2015;100:E1056-64.
Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011;12:489-95.
Önal Ö, Koçer M, Eroğlu HN, Yilmaz SD, Eroğlu I, Karadoğan D. Survival analysis and factors affecting survival in patients who presented to the medical oncology unit with non-small cell lung cancer. Turk J Med Sci 2020;50:1838-50.
Amato MC, Giordano C, Galia M, Criscimanna A, Vitabile S, Midiri M, et al. Visceral adiposity index: a reliable indicator of visceral fat function associated with cardiometabolic risk. Diabetes Care 2010;33:920-2.
Wankhede D. Evaluation of Eighth AJCC TNM Sage for Lung Cancer NSCLC: A Meta-analysis. Ann Surg Oncol 2021;28:142-7.
Popuri K, Cobzas D, Esfandiari N, Baracos V, Jägersand M. Body composition assessment in axial ct images using fembased automatic segmentation of skeletal muscle. IEEE Trans Med Imaging 2016;35:512-20.
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