Prognostic Significance of CT-Determined Sarcopenia in Patients with Small-Cell Lung Cancer

Kim, Eun Young; Kim, Young Saing; Park, Inkeun; Ahn, Hee Kyung; Cho, Eun Kyung; Jeong, Yu Mi

doi:10.1097/jto.0000000000000690

Cited by 179 publications

(200 citation statements)

References 23 publications

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“…Also Sjøblom et al showed in 734 patients with NSCLC before first line chemotherapy that high muscle attenuation was a positive prognostic factor in a multivariate analysis (HR = 0.98, p = 0.001) [30]. However, contradicting to our and other results, SMI had no significant impact on survival in their study [4, 7, 8, 30]. In contrast to our study Sjøblom et al analyzed one time point before chemotherapy and not a second time point to show changes after chemotherapy as we did in this study [30].…”

Section: Discussioncontrasting

confidence: 79%

Prognostic Impact of CT-Quantified Muscle and Fat Distribution before and after First-Line-Chemotherapy in Lung Cancer Patients

et al. 2017

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IntroductionCachexia and sarcopenia are associated with poor outcome and increased chemotherapy-induced toxicity in lung cancer patients. However, the complex interplay of obesity, sarcopenia and cachexia, and its impact on survival in the context of first-line-chemotherapy is not yet understood.MethodsIn 200 consecutively recruited lung cancer patients (70 female, mean age 62y; mean BMI 25 kg/m2; median follow-up 15.97 months) with routine staging-CT before and after chemotherapy (CTX, mean interval: 4.3 months), densitometric quantification of total (TFA), visceral (VFA), and subcutaneous-fat-area (SFA), inter-muscular-fat-area (IMFA), muscle-density (MD), muscle-area (MA) and skeletal-muscle-index (SMI) was performed retrospectively to evaluate changes under chemotherapy and the impact on survival.ResultsWe observed increases in TFA, VFA, SFA, VFA/SFA, and IMFA (p<0.05–0.001), while there were decreases in MA, MD and BMI (p<0.05–0.001) after chemotherapy. High pre-therapeutic VFA/SFA was a predictive factor for poor survival (HR = 1.272; p = 0.008), high pre-therapeutic MD for improved survival (HR = 0.93; p<0.05). Decrease in BMI (HR = 1.303; p<0.001), weight (HR = 1.067; p<0.001) and SMI (HR = 1.063; p<0.001) after chemotherapy were associated with poor survival. Patients with ≥4 CTX-cycles showed increased survival (17.6 vs. 9.1months), less muscle depletion (SMIdifference: p<0.05) and no BMI loss (BMIdifference: p<0.001).ConclusionsAfter chemotherapy, patients exhibited sarcopenia with decreased muscle and increased adipose tissue compartments, which was not adequately mirrored by BMI and weight loss but by imaging. Particularly sarcopenic patients received less CTX-cycles and had poorer survival. As loss of BMI, weight and muscle were associated with poor survival, early detection (via imaging) and prevention (via physical exercise and nutrition) of sarcopenia may potentially improve outcome and reduce chemotherapy-induced toxicity.

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Section: Discussioncontrasting

confidence: 79%

Prognostic Impact of CT-Quantified Muscle and Fat Distribution before and after First-Line-Chemotherapy in Lung Cancer Patients

et al. 2017

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“…The optimal cutoff value of 1.29 was determined for assessing OS (Figure 1). 26 All patients were divided into 2 groups: AGR ≧1.29 (n = 197, 71.4%) and AGR < 1.29 (n = 79, 28.6%), the clinicopathological characteristics in each subgroup are described in Table 2. Patients with a higher AGR (≧1.29) were presented with a significantly lower LDH level ( P = 0.003) and a significantly higher BMI ( P = 0.024) compared with the patients with lower AGR.…”

Section: Resultsmentioning

confidence: 99%

“…3,26 Although SCLC is sensitive to cytotoxic agents and radiotherapy, the 5-year survival rate in SCLC patients is extremely low. 27 Over the years, the prognosis of SCLC patients has been slightly improved.…”

Section: Discussionmentioning

confidence: 99%

Pretreatment Albumin/Globulin Ratio Predicts the Prognosis for Small-Cell Lung Cancer

Zhou

Fang

et al. 2016

Medicine

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The pretreatment albumin/globulin ratio (AGR) has been used as a prognostic factor in various cancers. This study aimed to evaluate the predictive value of AGR in small-cell lung cancer (SCLC).We tested albumin and total proteins in plasma samples from 276 SCLC patients from our cancer center between January 2003 and December 2006. The AGR was defined by the formula: albumin/(total proteins–albumin). The correlation between AGR and overall survival (OS) was examined by Kaplan–Meier and Cox regression methods. For validation, AGR was used to evaluate the prognosis of SCLC in another independent group.Total 276 patients (testing) and 379 patients (validation) were finally enrolled. The median OS was 15.31 months for testing patients and 15.06 months for validation patients, respectively. We determined 1.29 as the cutoff value by using the biostatistical tool (Cutoff Finder), then the patients in the testing group were classified into 2 groups. Kaplan–Meier curves showed high AGR group had significantly longer OS than low AGR group (P = 0.026). According to multivariate analyses, AGR was an independent prognostic factor for OS of SCLC patients in the testing group (HR, 1.35, 95% CI: 1.01–1.81, P = 0.046). In the validation group, AGR was also verified as a predictive factor for OS (P < 0.001), and the risk of SCLC in the low AGR group was 1.43 times higher than that in the high AGR group (HR, 1.43, 95% CI: 1.05–1.94, P = 0.022).AGR is an independent prognostic marker in SCLC patients. Furthermore, it could be of great value in the management of SCLC patients.

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“…The clinical importance of sarcopenia is also being increasingly recognized in oncologic patients as a component of cancer cachexia syndrome [1,2]. Sarcopenia is a prevalent condition in cancer patients and is associated with functional impairment, increased risk of chemotherapy-related toxicities, and reduced survival [3][4][5][6]. The prognostic significance of sarcopenia in the oncology setting emphasizes the need for identifying its presence and for effective therapeutic interventions to increase SMM.…”

Section: Introductionmentioning

confidence: 98%

Evaluation of sarcopenia in small-cell lung cancer patients by routine chest CT

Kim

Park

et al. 2016

Support Care Cancer

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Prognostic Significance of CT-Determined Sarcopenia in Patients with Small-Cell Lung Cancer

Abstract: Sarcopenia as determined by CT could be used to predict prognosis in patients with SCLC. Optimum reference values to predict cancer-specific outcomes should be tailored by further studies.

Cited by 179 publications

References 23 publications

Prognostic Impact of CT-Quantified Muscle and Fat Distribution before and after First-Line-Chemotherapy in Lung Cancer Patients

Prognostic Impact of CT-Quantified Muscle and Fat Distribution before and after First-Line-Chemotherapy in Lung Cancer Patients

Pretreatment Albumin/Globulin Ratio Predicts the Prognosis for Small-Cell Lung Cancer

Evaluation of sarcopenia in small-cell lung cancer patients by routine chest CT

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