Prognostic Significance of CT-Determined Sarcopenia in Patients with Small-Cell Lung Cancer. Issue 12 (December 2015)

• Record Type: Journal Article
• Authors: Kim, Eun Young; Kim, Young Saing; Park, Inkeun; Ahn, Hee Kyung; Cho, Eun Kyung; Jeong, Yu Mi
• Is Part Of: Journal of thoracic oncology. Volume 10:Issue 12(2015)
• Publication Date: 2015-12
• Subjects: Sarcopenia -- Skeletal muscle -- Prognosis -- Small-cell lung cancer -- Tomography -- X-ray computed; Chest -- Cancer -- Periodicals; Thoracic Neoplasms -- Periodicals; 616.99494005
• DOI: 10.1097/JTO.0000000000000690
• Languages: English
• ISSNs: 1556-0864

Abstract

Abstract : Introduction: The primary objective of this study was to determine the prognostic significance of computed tomography (CT)-determined sarcopenia in small-cell lung cancer (SCLC) patients. Methods: This retrospective study consisted of a total of 149 consecutive SCLC patients. The cross-sectional area of muscle at the level of the third lumbar vertebra (L3) was measured using baseline CT images. Sarcopenia was defined as a L3 muscle index of less than 55 cm 2 /m 2 for men and of less than 39 cm 2 /m 2 for women as proposed by international consensus of cancer cachexia. In addition, Korean-specific cutoffs for sarcopenia was also applied (49 cm 2 /m 2 for men and 31 cm 2 /m 2 for women). Overall survival (OS) and clinical characteristics of patients with or without sarcopenia were compared. Results: Mean patient age was 68.6 ± 9.5 years. Most were male (85.3%) and 67.8% had extensive disease at time of diagnosis. Sarcopenia was present in 118 patients (79.2%) and was significantly related to an advanced age ( p = 0.028), male sex ( p < 0.001), lower body mass index ( p < 0.001), and poor performance status ( p = 0.049). Sarcopenic patients had shorter OS than nonsarcopenic patients (median: 8.6 months versus 16.8 months; p = 0.031). Multivariable analysis revealed that sarcopenia was an independent prognostic factor of poor survival (hazards ratio: 1.68; 95% confidence interval: 1.04–2.72; p = 0.034), along with extensive stage ( p < 0.001), supportive care only ( p < 0.001), and an elevated lactate dehydrogenase level ( p = 0.020). Using Korean sarcopenia cutoffs, sarcopenic patients were also found to have poorer OS than nonsarcopenic patients, however, the survival difference was not statistically significant (median: 8.4 months versus 12.7 months; p = 0.144 by the log-rank test). Conclusions: 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.