Extracellular Water-to-total Body Water Ratio as an Objective Biomarker for Frailty in Lung Cancer Patients

Abstract

Background/Aim: Our previous study revealed the association between extracellular water-to-total body water ratio (ECW/TBW) and the therapeutic durability of chemotherapy and/or immune checkpoint inhibitors in advanced lung cancer. We retrospectively examined the usefulness of ECW/TBW in detecting frailty compared to other bioelectrical impedance (BIA) parameters in a larger number of patients. Patients and Methods: Lung cancer patients underwent BIA before anti-cancer therapy at our hospital between June 1, 2018 and July 31, 2020. Results: Of 99 patients, 26 were assigned to ECW/TBW≥0.4 (higher group: HG) and 57 to ECW/TBW<0.4 (lower group: LG). ECW/TBW increased significantly with performance deterioration and ageing. HG patients had significantly shorter time-to-treatment failure (TTF) than LG patients. In patients with performance status 0-1, those in the HG had shorter TTF than those in the LG. ECW/TBW was the only independent predictor of TTF according to multivariate analysis. Conclusion: ECW/TBW is an objective biomarker for detecting frailty among lung cancer patients.

Extracellular water to total body water ratio, a novel predictor of recurrence in patients with colorectal cancer

“…Previous studies have indicated that a high ECW/TBW was related to the volume of cancer 17 and poorer tolerance to cancer therapies 18 and induced postoperative complications in esophageal, 19 head and neck, 20 and lung cancers. 21 Moreover, poor prognoses in patients with metastatic cancers are known. 10 Furthermore, several reports have indicated that ECW/TBW, compared with other BIA parameters, such as muscle and fat mass, more accurately detects frailty, suggests that a high ECW/TBW might subsequently cause cachexia leading to sarcopenia and frailty in cancer patients.…”

“…In addition, accumulating evidence has shown that sarcopenia and frailty can be induced by various mechanisms, such as malnutrition, systemic inflammation, and other organ diseases. Previous studies have indicated that a high ECW/TBW was related to the volume of cancer 17 and poorer tolerance to cancer therapies 18 and induced postoperative complications in esophageal, 19 head and neck, 20 and lung cancers 21 . Moreover, poor prognoses in patients with metastatic cancers are known 10 .…”

“…Moreover, poor prognoses in patients with metastatic cancers are known 10 . Furthermore, several reports have indicated that ECW/TBW, compared with other BIA parameters, such as muscle and fat mass, more accurately detects frailty, 3,21,22 which suggests that a high ECW/TBW might subsequently cause cachexia leading to sarcopenia and frailty in cancer patients 22 . Recently, Katsura et al analyzed 114 cachexia cancer patients and concluded that ECW/TBW might be associated with mortality 23 .…”

Analysis of factors influencing the increase of extracellular water ratio in tumor patients without edema signs

“…However, studies related to early increases in extracellular water ratio in tumor patients lacking signs of edema have not been reported, and the clinical in uences are not clear. Recent studies have shown that increased extracellular water ratio is a risk factor for disease progression, recurrence and long-term survival [6][7], and can mediate early death in tumor patients through other factors [8]. This suggests that early attention and early intervention of edema can help to reduce adverse effects and improve patient prognosis.…”

Association between systemic inflammation and water composition and survival in colorectal cancer

“…Hirashima and Noda et al. ( 11 ) reported that a high extracellular water (ECW)/total body water (TBW) ratio was associated with frailty and poor treatment tolerance in patients with lung cancer ( 11 , 12 ). Due to the high water content of the human skeletal muscle, ICW is closely related to muscle mass.…”