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

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Cachexia 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.


In 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.


We 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.


After 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.

Autor: Johanna Nattenmüller , Raoul Wochner, Thomas Muley, Martin Steins, Simone Hummler, Birgit Teucher, Joachim Wiskemann, Hans-Ulric



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