Sex differences in the association of phase angle and lung cancer mortality

Abstract

BackgroundLung cancer is a lethal malignant tumor that is common worldwide and is associated with a high incidence of malnutrition. Phase angle (PA) is a simple, objective, and non-invasive indicator of body composition that has increasingly attracted attention as an indicator of the nutritional status and prognosis of patients with malignant tumors. This study aimed to investigate the association between the PA and overall survival in patients with lung cancer.MethodsThis study prospectively analyzed 804 lung cancer patients in the Investigation on Nutrition Status and its Clinical Outcome of Common Cancers (INSCOC) project from 40 hospitals in China. We used a restricted cubic spline to analyze the sex-specific association between PA and mortality in men and women with lung cancer. Cox regression analysis was used to evaluate the independent association between PA and mortality in men and women. Sensitivity analysis was performed. The Kaplan–Meier method was used to evaluate the survival of patients with high and low PA values.ResultsThere was an L-shaped association between PA and survival in both men and women with lung cancer (p = 0.019 and p = 0.121, respectively). Kaplan–Meier survival analysis suggested that patients with a high PA showed a better survival than patients with a low PA (p = 0.007 for men and p < 0.001 for women). Multivariate-adjusted Cox regression analysis showed that PA was an independent risk factor for mortality in men (HR = 0.79, 95% CI = 0.65–0.95, p = 0.015), but not in women (HR = 0.83, 95% CI = 0.67–1.04, p = 0.105).ConclusionPhase angle is an independent risk factor for the mortality of male lung cancer patients. However, its role in predicting the mortality of female lung cancer patients seems to be limited.

Bioelectrical impedance analysis—derived phase angle (PhA) in lung cancer patients: a systematic review

“…In the study by Ji et al [ 36 ], Pearson’s analysis showed an inverse correlation for age ( r = -0.238 p = < 0.001). Shi et al [ 39 ], showed both for men and women, higher PhA in younger (for both, p < 0.001); Spearman’s correlation analysis also showed that PhA was significantly correlated with age (men, r = -0.46, p < 0.001; women, r = -0.24, p < 0.001). In Castanho et al [ 44 ], Pearson’s correlation showed no significant results between PhA and age ( r = -0.32).…”

“…This systematic review includes several types of studies: five prospective studies [ 35 – 39 ], three observational studies [ 40 – 42 ], two retrospective studies [ 34 , 43 ] and one cross-sectional study [ 44 ]. Shi et al showed the highest number of patients involved (804).…”

“…All studies showed patients with confirmed cancer diagnosis: five studies evaluated NSCLC patients with stage III and IV [ 34 , 38 , 40 – 42 ]. Shi et al included adenocarcinoma, squamous cell carcinoma, SCLC and other type of LC patients in different stage of disease (from I to IV) [ 39 ]. Suzuki et al and Hui et al showed data on LC patients but did not specify cancer type or stage [ 43 , 45 ].…”

“…Results showed, by multifactorial analysis of variance, correlations between PhA and tumour size ( r = -0.55; p < 0.001) or Karnofski Performance Status (KPS) ( r = 0.44; P < 0.05). Three studies included patients not undergoing CHT, RT and without specific treatment information [ 37 , 39 , 45 ] while newly diagnosed patients and/or patients with ongoing therapies were evaluated in remaining studies [ 34 , 36 , 38 , 42 ]. Suzuki et al [ 43 ] evaluated LC patients after surgery while patients were evaluated after cancer treatment in two studies [ 40 , 41 ].…”

“…The main associations identified in selected studies, between PhA and different variables, are shown in Table 2 . In seven studies parameters related to BC have been evaluated [ 36 , 39 – 41 , 43 , 44 ]. Castanho et al [ 44 ] correlates PhA with arm circumference and weight loss over time.…”