Lower Pectoralis Muscle Area Is Associated with a Worse Overall Survival in Non–Small Cell Lung Cancer

Abstract

Background Muscle wasting is a component of the diagnosis of cancer cachexia and has been associated with poor prognosis. However, recommended tools to measure sarcopenia are limited by poor sensitivity or the need to perform additional scans. We hypothesized that pectoralis muscle area (PMA) measured objectively on chest CT scan may be associated with overall survival in non-small cell lung cancer (NSCLC). Methods We evaluated two hundred fifty two cases from a prospectively enrolling lung cancer cohort. Eligible cases had CT scans performed prior to the initiation of surgery, radiation, or chemotherapy. PMA was measured in a semi-automated fashion while blinded to characteristics of the tumor, lung, and patient outcomes. Results Men had a significantly greater PMA than women (37.59 vs 26.19 cm2, P<0.0001). In univariate analysis, PMA was associated with age and BMI. A Cox proportional hazards model was constructed to account for confounders associated with survival. Lower pectoralis area (per cm2) at diagnosis was associated with an increased hazard of death of 2% (HRadj 0.98 [0.96, 0.99], P=0.044) while adjusting for age, sex, smoking, chronic bronchitis, emphysema, histology, stage, chemotherapy, radiation, surgery, BMI, and ECOG performance status. . Conclusions Lower pectoralis muscle area measured from chest CT scans obtained at the time of diagnosis of NSCLC is associated with a worse overall survival. Impact Pectoralis muscle area may be a valuable CT biomarker for sarcopenia associated lung cancer survival.

Preoperative Pectoralis Muscle Quantity and Attenuation by Computed Tomography Are Novel and Powerful Predictors of Mortality After Left Ventricular Assist Device Implantation

“…Because CT scans of the chest are often performed as part of LVAD surgical planning, we analyzed the pectoralis muscle as a potential predictor of outcomes based on previous studies in nonheart failure populations. [8][9][10] In this study, we report that unilateral pectoralis muscle attenuation 11 and quantity indexed to height (PHU m and PMI, respectively) were powerful predictors of mortality after LVAD and outperformed other traditional clinical variables tested in this data set.…”

“…Methods of pectoralis muscle analysis were based on the work conducted by Kinsey et al 9 Measures of cross-sectional area in cm 2 and mean Hounsfield units were obtained using Slice-O-Matic V5.0 software (Tomovision, Montreal, Canada) by a single reader who was blinded to patient outcomes. Once images were obtained in DICOM format, 5 to 10 minutes were required to measure each scan.…”

Early decrease in erector spinae muscle area and future risk of mortality in idiopathic pulmonary fibrosis

“…We reason that cachexia would be associated with the survival in IPF. www.nature.com/scientificreports www.nature.com/scientificreports/ Kinsey et al reported that a smaller pectoralis muscle area, as measured on CT images obtained at the time of diagnosis of non-small cell lung cancer, was associated with poorer overall survival 29 . McDonald et al reported that patients with a smaller pectoralis muscle area on CT scan tended to have a more severe expiratory air flow obstruction, lower quality of life scores and diminished exercise capacity, as compared with people with a lower BMI 30 .…”

Prevalence of malnutrition in COVID-19 inpatients: the Nutricov study

“…It showed a high prevalence (37.5%) of malnutrition in hospitalized patients with 26% of severe malnutrition. Median albuminemia was very low (24 [18][19][20][21][22][23][24][25][26][27] g/L) and pectoralis muscle area index was not associated with recent malnutrition. There were no association between recent malnutrition and the need for ICU admission.…”