The Effect of Skeletal Muscle Radiodensity and Psoas Muscle Index on Prognosis of Small-Cell Lung Cancer

Yıl 2021, Cilt: 2 Sayı: 2, 60 - 67, 16.07.2021

Hasan Sözel İsmail Beypınar , Yıldız Kılar Sözel Timur Sindel Sema Sezgin Göksu

https://doi.org/10.48176/esmj.2021.19

Öz

Introduction: Small cell lung cancer (SCLC) has a poor prognosis and accounts for about 15% of all lung cancer cases. This study was planned to investigate the prognostic value of skeletal muscle radiodensity (SMD) and psoas muscle index (PMI) in patients with SCLC.
Methods: The archive records of 253 patients with SCLC were retrospectively analyzed and 106 of them were included in the study. The overall survival (OS) and body mass index of the patients were calculated. The images of computed tomography (CT) at the time of diagnosis were retrieved for analysis. The cross-sectional area and the mean radiodensity of the psoas muscle at the third lumbar vertebral level on CT scan were measured for assessing SMD and PMI.
Results: While fifty-seven of 106 patients had an extensive disease, 49 patients were considered as the limited stage. SMD was significantly lower in patients with extensive disease. While OS was significantly different for low and high SMD groups, no difference was observed between them according to PMI categories. The median OS was 8 and 12 months in low and high SMD groups, respectively. In multivariate analysis, SMD remained a significant prognostic factor in terms of stage and age at diagnosis.
Conclusion: In the present study, it was found that SMD was an independent risk factor for OS, but PMI was not. The combined use of demographic and essential clinical information and SMD can enable to help physicians and patients to predict survival and thereby enhance medical decision making for newly diagnosed SCLC patients.

Anahtar Kelimeler

Small-Cell Lung Cancer, Skeletal Muscle Radiodensity, Psoas Muscle Index, Sarcopenia, Prognosis, Small-Cell Lung Cancer, Skeletal Muscle Radiodensity, Psoas Muscle Index, Sarcopenia, Prognosis

İskelet Kası Radyodansitesi ve Psoas Kası İndeksinin Küçük Hücreli Akciğer Kanserinin Prognozu Üzerine Etkisi

Öz

Giriş: Küçük hücreli akciğer kanseri (KHAK) kötü bir prognoza sahiptir ve tüm akciğer kanseri vakalarının yaklaşık %15'ini oluşturur. Bu çalışma, KHAK'li hastalarda iskelet kası radyodensitesi (İKD) ve psoas kas indeksinin (PKİ) prognostik değerini araştırmak için planlandı.
Yöntemler: KHAK'li 253 hastanın arşiv kayıtları retrospektif olarak incelendi ve 106 tanesi çalışmaya dahil edildi. Hastaların genel sağkalımı ve vücut kitle indeksi hesaplandı. Tanı anında bilgisayarlı tomografi (BT) görüntüleri değerlendirmeye alındı. İKD ve PKİ'yi değerlendirmek için BT taramasında üçüncü lomber vertebral seviyedeki psoas kasının enine kesit alanı ve ortalama radyodensitesi ölçüldü.
Bulgular: Toplam 106 hastanın 57'sinde yaygın hastalık varken, 49 hasta sınırlı evre olarak kabul edildi. İKD, sağkalım, yaygın hastalığı olan hastalarda önemli ölçüde daha düşüktü. Genel sağkalım, düşük ve yüksek İKD grupları için anlamlı farklılık gösterirken, PKİ kategorilerine göre aralarında fark gözlenmedi. Medyan sağkalım, düşük ve yüksek İKD gruplarında sırasıyla 8 ve 12 aydı. Multivariate analizde; İKD, tanı anındaki evre ve yaş açısından önemli bir prognostik faktör olarak saptandı.
Sonuç: Bu çalışmada, İKD'nin sağkalım için bağımsız bir risk faktörü olduğu, ancak PKİ için olmadığı bulunmuştur. Demografik ve temel klinik bilginin ve İKD'nin birlikte kullanılması, hekimlerin sağkalımı tahmin etmelerine yardımcı olabilir ve böylece yeni teşhis

Anahtar Kelimeler

Küçük Hücreli Akciğer Kanseri, İskelet Kası Radyodansitesi, Psoas Kas İndeksi, Sarkopeni, Prognoz

Kaynakça

• 1. Früh M, De Ruysscher D, Popat S, et al. Small-cell lung cancer (SCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(6):99-105.
• 2. Zhou T, Hong S, Hu Z, et al. A systemic inflammation-based prognostic scores (mGPS) predicts overall survival of patients with small-cell lung cancer. Tumor Biol. 2014; 36(1):337-43.
• 3. Morley JE, Baumgartner RN, Roubenoff R, et al. Sarcopenia. J Lab Clin Med. 2001;137:231–43.
• 4. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis. Age Ageing. 2010;39:412–423.
• 5. Kim CR, Kim EY, Kim YS, et al. Histologic subtypes are not associated with the presence of sarcopenia in lung cancer. PLoS One 2018;13(3):e0194626.
• 6. Wallengren O, Iresjö BM, Lundholm K, Bosaeus I. Loss of muscle mass in the end of life in patients with advanced cancer. Support Care Cancer. 2015;23(1):79-86.
• 7. Villaseñor A, Ballard-Barbash R, Baumgartner K, et al. Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study. J Cancer Surviv. 2012 Dec;6(4):398-406.
• 8. Levolger S, Van Vugt JLA, De Bruin RWF, IJzermans JNM. Systematic review of sarcopenia in patients operated on for gastrointestinal and hepatopancreatobiliary malignancies. Br. J. Surg 2015;102(12):1448-58.
• 9. Kawaguchi Y, Hanaoka J, Ohshio Y, et al. Sarcopenia predicts poor postoperative outcome in elderly patients with lung cancer. Gen Thorac Cardiovasc Surg 2019;67:949–54.
• 10. Cortellini A, Palumbo P, Porzio G, et al. Single-institution study of correlations between skeletal muscle mass, its density, and clinical outcomes in non-small cell lung cancer patients treated with first-line chemotherapy. Thorac Cancer. 2018;9(12):1623-30.
• 11. Mourtzakis M, Prado CMM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5):997-1006.
• 12. Shen W, Punyanitya M, Wang ZM, et al. Total body skeletal muscle and adipose tissue volumes: Estimation from a single abdominal cross-sectional image. J Appl Physiol. 2004;97(6):2333-8.
• 13. Cesari M, Fielding RA, Pahor M, et al. Biomarkers of sarcopenia in clinical trials-recommendations from the International Working Group on Sarcopenia. J Cachexia Sarcopenia Muscle. 2012;3(3):181-90.
• 14. Iltar U, Sözel H, Sözel YK, et al. Prognostic impact of the psoas muscle index, a parameter of sarcopenia, in patients with diffuse large B-cell lymphoma treated with rituximab-based chemoimmunotherapy. Leuk Lymphoma. 2020;10:1-9.
• 15. Aubrey J, Esfandiari N, Baracos VE, et al.Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol. 2014;210(3):489-97.
• 16. Anderson DE, D’Agostino JM, Bruno AG, et al. Variations of CT-based trunk muscle attenuation by age, sex, and specific muscle. J Gerontol A Biol Sci Med Sci. 2013 Mar;68(3):317-23.
• 17. Esfandiari N, Ghosh S, Prado CM, Martin L, Mazurak V, Baracos VE. Age, Obesity, Sarcopenia, and Proximity to Death Explain Reduced Mean Muscle Attenuation in Patients with Advanced Cancer. J Frailty Aging. 2014;3(1):3-8.
• 18. Martin L, Birdsell L, MacDonald N, et al. Cancer cachexia in the age of obesity: Skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47.
• 19. Sjøblom B, Grønberg BH, Wentzel-Larsen T, et alSkeletal muscle radiodensity is prognostic for survival in patients with advanced non-small cell lung cancer. Clin Nutr. 2016;35(6):1386-93.
• 20. Hamaguchi Y, Kaido T, Okumura S, et al. Proposal for new diagnostic criteria for low skeletal muscle mass based on computed tomography imaging in Asian adults. Nutrition. 2016;32(11-12):1200-5.
• 21. Kim EY, Kim YS, Park I, et al. Prognostic Significance of CT-Determined Sarcopenia in Patients with Small-Cell Lung Cancer. J Thorac Oncol. 2015;10(12):1795-9.
• 22. Miller BS, Ignatoski KM, Daignault S, et al. Worsening central sarcopenia and increasing intra-abdominal fat correlate with decreased survival in patients with adrenocortical carcinoma. World J Surg. 2012;36(7):1509-16.
• 23. Antoun S, Lanoy E, Iacovelli R, et al. Skeletal muscle density predicts prognosis in patients with metastatic renal cell carcinoma treated with targeted therapies. Cancer 2013;119(18):3377-84.
• 24. Rollins KE, Tewari N, Ackner A, et al. The impact of sarcopenia and myosteatosis on outcomes of unresectable pancreatic cancer or distal cholangiocarcinoma. Clin Nutr. 2016;35(5):1103-9.
• 25. Yang CW, Li CI, Li TC, et al. Association of sarcopenic obesity with higher serum high-sensitivity c-reactive protein levels in Chinese older males - A community-based study (Taichung Community Health Study-Elderly, TCHS-E). PLoS One 2015;10(7):e0132908.
• 26. Schaap LA, Pluijm SMF, Deeg DJH, Visser M. Inflammatory Markers and Loss of Muscle Mass (Sarcopenia) and Strength. Am J Med. 2006;119(6):526.e9-17.
• 27. Lu H, Ouyang W, Huang C. Inflammation, a key event in cancer development. Mol. Cancer Res. 2006;4(4):221-33.
• 28. Azad N, Rojanasakul Y, Vallyathan V. Inflammation and lung cancer: roles of reactive oxygen/nitrogen species. J Toxicol Environ Health B Crit Rev. 2008 Jan;11(1):1-15.
• 29. Proctor MJ, Morrison DS, Talwar D, et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 2011;47(17):2633-41.
• 30. He X, Zhou T, Yang Y, et al. Advanced lung cancer inflammation index, a new prognostic score, predicts outcome in patients with small-cell lung cancer. Clin Lung Cancer 2015;16(6):e165-71.
• 31. Porporato PE. Understanding cachexia as a cancer metabolism syndrome. Oncogenesis. 2016 Feb 22;5(2):e200.
• 32. Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: An international consensus. Lancet Oncol. 2011;12(5):489-95.
• 33. Wendrich AW, Swartz JE, Bril SI, et al. Low skeletal muscle mass is a predictive factor for chemotherapy dose-limiting toxicity in patients with locally advanced head and neck cancer. Oral Oncol. 2017;71:26-33.
• 34. Santarpia L, Contaldo F, Pasanisi F. Nutritional screening and early treatment of malnutrition in cancer patients. J Cachexia Sarcopenia Muscle. 2011 Mar;2(1):27-35.
• 35. Arends J, Baracos V, Bertz H, et al. Clin Nutr. 2017 Oct;36(5):1187-1196.
• 36. Talwar B, Donnelly R, Skelly R, Donaldson M. Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S32-S40.
• 37. Yip C, Dinkel C, Mahajan A, et al. Imaging body composition in cancer patients: visceral obesity, sarcopenia and sarcopenic obesity may impact on clinical outcome. Insights Imaging 2015;6(4):489-97.