Low Body Mass Index Is an Independent Prognostic Factor in Patients With Non-Small Cell Lung Cancer Treated With Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor

Abstract

BackgroundSarcopenia and obesity have been suspected as factors associated with efficacy of treatment and prognosis in various malignancies. This study aimed to investigate the association of pretreatment sarcopenia and visceral obesity with efficacy and prognosis of first- and second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) for patients with non-small cell lung cancer (NSCLC) and positive EGFR mutation.MethodsWe retrospectively collected 167 NSCLC patients with mutant EGFR who had started EGFR-TKI monotherapy between October 2007 and August 2018 at our hospital. We classified 167 patients into two groups, according to the definition of underweight based on the World Health Organization (WHO) body mass index (BMI) classification and the Japanese sex-specific cut-off values of the following computed tomography (CT) images-assessed markers of pretreatment sarcopenia or visceral obesity, such as psoas muscle index (PMI), intramuscular adipose tissue content (IMAC) and visceral-to-subcutaneous fat ratio (VSR) at lumbar vertebra L3 level. We compared overall survival (OS) and progression-free survival (PFS) of two groups by Kaplan-Meier curves and log-rank tests. Using multivariate Cox proportional hazard analyses adjusted by age, neutrophil-to-lymphocyte ratio, performance status, EGFR mutation types and EGFR-TKI lines, and extra-pulmonary metastases or three or more than 3 metastatic sites, we searched independent prognostic factors of OS and PFS of EGFR-TKI therapy.ResultsThe OS (median 26.0 vs. 32.3 months, P = 0.02) and PFS (9.1 vs. 14.8 months, P = 0.03) of patients with BMI < 18.5 were significantly shorter than those of patients with BMI ≥ 18.5. However, there was no significant difference in OS and PFS according to PMI, IMAC and VSR. The multivariate analyses detected only BMI < 18.5 as an unfavorable prognostic factor of shorter OS (hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.03 - 2.81, P = 0.04) and PFS (HR 1.72, 95% CI 1.11 - 2.67, P = 0.02).ConclusionsPretreatment underweight was a significant prognostic factor of poor PFS and OS of EGFR-TKI therapy. However, neither pretreatment sarcopenia nor visceral obesity was associated with prognosis of EGFR-TKI. Underweight may be a surrogate for advanced disease burden.

Sarcopenia and Visceral Adiposity Are Not Independent Prognostic Markers for Extensive Disease of Small-Cell Lung Cancer: A Single-Centered Retrospective Cohort Study

“…However, to our knowledge, ours was the first study that had directly focused on visceral adiposity in SCLC. Our results were consistent with our previous studies of NSCLCs treated with epidermal growth factor receptor-tyrosine kinase inhibitors [ 15 ] or with immune checkpoint inhibitor monotherapy [ 16 ]. Thus, our series of studies doubted visceral adiposity as a prognostic factor for various types of lung cancer.…”

“…We collected the following data: sex, age, BMI, smoking habits, Eastern Cooperative Oncology Group (ECOG) performance status (PS), distant metastases, venous blood test, treatment regimens, response of the first-line chemotherapy according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 [ 14 ], progression-free survival (PFS) and OS. Our definitions of response rate (RR), disease control rate (DCR), PFS and OS followed those in our previous studies [ 15 , 16 ]. The data was cut-off on December 31, 2019.…”

“…We also manually traced the bilateral multifidus muscles areas. The definitions and the Japanese sex-specific cut-off points of PMI [ 18 ], IMAC [ 19 ] and VSR [ 20 ] followed those of our previous studies [ 15 , 16 ].…”

Geriatric nutritional risk index as a prognostic marker of pTNM-stage I and II esophageal squamous cell carcinoma after curative resection

“…Concurrently, the BMI, which is calculated using body weight and height, is also used to assess the nutritional status of an individual. A low BMI is known to be a negative prognostic factor in several cancers [8,9].…”

High Body Mass Index Was Related to Favorable Therapeutic Efficacy of Epidermal Growth Factor Receptor Targeted Therapy in Advanced Non-Small Cell Lung Cancer

“…In at least 2 studies, BMI was not related to the e cacy of TKI therapy [14,15]. Reversibly, in a recently published paper, BMI was proposed as a positive marker for EGFR TKI treatment [16]. The seemingly paradoxical results might be a re ection of small-sized studies easily biased by miscellaneous factors.…”