Bioelectrical impedance phase angle in clinical practice: implications for prognosis in stage IIIB and IV non-small cell lung cancer

Abstract

BackgroundA frequent manifestation of advanced lung cancer is malnutrition, timely identification and treatment of which can lead to improved patient outcomes. Bioelectrical impedance analysis (BIA) is an easy-to-use and non-invasive technique to evaluate changes in body composition and nutritional status. We investigated the prognostic role of BIA-derived phase angle in advanced non-small cell lung cancer (NSCLC).MethodsA case series of 165 stages IIIB and IV NSCLC patients treated at our center. The Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of phase angle, independent of stage at diagnosis and prior treatment history.Results93 were males and 72 females. 61 had stage IIIB disease at diagnosis while 104 had stage IV. The median phase angle was 5.3 degrees (range = 2.9 – 8). Patients with phase angle <= 5.3 had a median survival of 7.6 months (95% CI: 4.7 to 9.5; n = 81), while those with > 5.3 had 12.4 months (95% CI: 10.5 to 18.7; n = 84); (p = 0.02). After adjusting for age, stage at diagnosis and prior treatment history we found that every one degree increase in phase angle was associated with a relative risk of 0.79 (95% CI: 0.64 to 0.97, P = 0.02).ConclusionWe found BIA-derived phase angle to be an independent prognostic indicator in patients with stage IIIB and IV NSCLC. Nutritional interventions targeted at improving phase angle could potentially lead to an improved survival in patients with advanced NSCLC.

Bioelectrical Impedance Phase Angle as a Prognostic Indicator of Survival in Head-and-Neck Cancer

“…In that study, the results applied to a general population with advanced cancer (breast, gastrointestinal, genitourinary gynecologic, head-and-neck, hematologic, lung, and others). Those authors and the authors of other publications 43 reported about various types of cancer; only a few studies have reported detailed data for single cancer types [30][31][32][33]37,43 : breast cancer, advanced non-small-cell lung cancer, colorectal cancer, hepatocellular carcinoma, and finally, in our study, hnc. In the present prospective study of a homogeneous population with advanced hnc, pa was observed to be as significant a reference test as the sga with respect to overall survival.…”

“…Earlier studies of bia in patients with cancer have mostly had a retrospective design [30][31][32][33] and have enrolled patients with mixed cancers or varying stages of disease 14,36,40,44,45 . The key issues in the prognosis of hnc patients are disease stage and tumour grade, but an effect of prior treatment was avoided because our study enrolled only treatment-naïve hospitalized patients with stage iii or iv disease.…”

“…The impact of nutrition on survival has been reported in single articles that also evaluated the association of pa with sga in patients with pancreatic cancer 30 or advanced colorectal cancer [31][32][33][34][35][36] . Here, however, we report such an assessment in hnc patients for the first time.…”

“…Reactance is the resistive effect produced by the tissue interfaces and cell membranes 25 . Thanks to its potential to detect changes in tissue electrical properties, pa has been found to be an indicator for cell membrane integrity, distribution of water between the intracellular and extracellular spaces, and prediction of body cell mass in various disease conditions [26][27][28][29][30][31][32][33][34] .…”

Body composition changes differ by gender in stomach, colorectal, and biliary cancer patients with cachexia: Results from a pilot study

“…For example, male patients with cancer experienced a positive correlation between PA and ICW, which suggests that cell wall integrity increases along with ICW, leading to a higher PA and longer survival in patients with cancer 11, 21. In contrast, female patients with cancer experienced a negative correlation between PA and ICW, and lower ICW was associated with higher PA, which contradicts the idea that a higher PA leads to longer survival 22. The lower ICW in females can be potentially linked to stress and inflammation with loss of cell integrity and muscle mass atrophy 20.…”