Skeletal muscle radiodensity is prognostic for survival in patients with advanced non-small cell lung cancer

  • Bjørg Sjøblom
    Correspondence
    Corresponding author. Department of Oncology, Oslo University Hospital, Ullevål, Box 4956 Nydalen, 0424 Oslo, Norway. Tel.: +47 938 941 04; fax: +47 230 26 601.
    Affiliations
    Dept of Internal Medicine, Innlandet Hospital Trust, Hamar, Norway

    Dept of Oncology, Oslo University Hospital, Oslo, Norway
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  • Bjørn H. Grønberg
    Affiliations
    The Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    European Palliative Care Research Centre, Dept of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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  • Tore Wentzel-Larsen
    Affiliations
    Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway

    Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway

    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
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  • Vickie E. Baracos
    Affiliations
    Dept of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, Canada
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  • Marianne J. Hjermstad
    Affiliations
    European Palliative Care Research Centre, Dept of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
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  • Nina Aass
    Affiliations
    Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway

    Faculty of Medicine, University of Oslo, Norway
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  • Roy M. Bremnes
    Affiliations
    Dept of Oncology, University Hospital North Norway, Tromsø, Norway

    Dept of Clinical Medicine, Faculty of Medicine, University of Tromsø, Norway
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  • Øystein Fløtten
    Affiliations
    Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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  • Asta Bye
    Affiliations
    Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway

    Dept of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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  • Marit Jordhøy
    Affiliations
    Dept of Internal Medicine, Innlandet Hospital Trust, Hamar, Norway

    Faculty of Medicine, University of Oslo, Norway
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Published:April 01, 2016DOI:https://doi.org/10.1016/j.clnu.2016.03.010

      Summary

      Background & aims

      Recent research indicates that severe muscular depletion (sarcopenia) is frequent in cancer patients and linked to cachexia and poor survival. Our aim was to investigate if measures of skeletal muscle hold prognostic information in advanced non-small cell lung cancer (NSCLC).

      Methods

      We included NSCLC patients with disease stage IIIB/IV, performance status 0–2, enrolled in three randomised trials of first-line chemotherapy (n = 1305). Computed tomography (CT) images obtained before start of treatment were used for body composition analyses at the level of the third lumbar vertebra (L3). Skeletal muscle mass was assessed by measures of the cross sectional muscle area, from which the skeletal muscle index (SMI) was obtained. Skeletal muscle radiodensity (SMD) was measured as the mean Hounsfield unit (HU) of the measured muscle area. A high level of mean HU indicates a high SMD.

      Results

      Complete data were available for 734 patients, mean age 65 years. Both skeletal muscle index (SMI) and muscle radiodensity (SMD) varied largely. Mean SMI and SMD were 47.7 cm2/m2 and 37.4 HU in men (n = 420), 39.6 cm2/m2 and 37.0 HU in women (n = 314). Multivariable Cox regression analyses, adjusted for established prognostic factors, showed that SMD was independently prognostic for survival (Hazard ratio (HR) 0.98, 95% CI 0.97–0.99, p = 0.001), whereas SMI was not (HR 0.99, 95% CI 0.98–1.01, p = 0.329).

      Conclusion

      Low SMD is associated with poorer survival in advanced NSCLC. Further research is warranted to establish whether muscle measures should be integrated into routine practice to improve prognostic accuracy.

      Keywords

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