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

Sjøblom, Bjørg; Grønberg, Bjørn Henning; Wentzel‐Larsen, Tore; Baracos, Vickie E.; Hjermstad, Marianne Jensen; Aass, Nina; Bremnes, Roy M.; Fløtten, Øystein; Bye, Asta; Jordhøy, Marit S.

doi:10.1016/j.clnu.2016.03.010

Cited by 117 publications

(135 citation statements)

References 37 publications

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“…The SMD of human muscle can be obtained by CT scans and is measured as mean Hounsfield units (HU) of the cross‐sectional muscle area 21, 23. Recent studies on cancer patients have indicated that reduced SMD is associated with poorer survival,14, 24 and former results from the present population suggested that SMD may be a more important prognostic factor than skeletal muscle index (SMI) in advanced NSCLC 25. Despite the emerging evidence on the negative impact of low muscle mass, less attention has been paid to the importance of muscle wasting for muscle function in cancer.…”

Section: Introductionmentioning

confidence: 79%

Muscle mass and association to quality of life in non‐small cell lung cancer patients

Bye

Sjøblom

Wentzel‐Larsen

et al. 2017

J cachexia sarcopenia muscle

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BackgroundCancer wasting is characterized by muscle loss and may contribute to fatigue and poor quality of life (QoL). Our aim was to investigate associations between skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) and selected QoL outcomes in advanced non‐small cell lung cancer (NSCLC) at diagnosis.MethodsBaseline data from patients with stage IIIB/IV NSCLC and performance status 0–2 enrolled in three randomized trials of first‐line chemotherapy (n = 1305) were analysed. Associations between SMI (cm2/m2) and SMD (Hounsfield units) based on computed tomography‐images at the third lumbar level and self‐reported physical function (PF), role function (RF), global QoL, fatigue, and dyspnoea were investigated by linear regression using flexible non‐linear modelling.ResultsComplete data were available for 734 patients, mean age 65 years. Mean SMI was 47.7 cm2/m2 in men (n = 420) and 39.6 cm2/m2 in women (n = 314). Low SMI values were non‐linearly associated with low PF and RF (men P = 0.016/0.020, women P = 0.004/0.012) and with low global QoL (P = 0.001) in men. Low SMI was significantly associated with high fatigue (P = 0.002) and more pain (P = 0.015), in both genders, but not with dyspnoea. All regression analyses showed poorer physical outcomes below an SMI breakpoint of about 42–45 cm2/m2 for men and 37–40 cm2/m2 for women. In both genders, poor PF and more dyspnoea were significantly associated with low SMD.ConclusionsLow muscle mass in NSCLC negatively affects the patients' PF, RF, and global QoL, possibly more so in men than in women. However, muscle mass must be below a threshold value before this effect can be detected.

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Section: Introductionmentioning

confidence: 79%

Muscle mass and association to quality of life in non‐small cell lung cancer patients

Bye

Sjøblom

Wentzel‐Larsen

et al. 2017

J cachexia sarcopenia muscle

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121

137

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“…At baseline, deceased patients had a lower body mass index (24 kg/m 2 vs. 25 kg/m 2 , P = 0.026) and had lost more body weight (5.4% vs. 2.4%, P = 0.019) than alive patients. Moreover, deceased patients had more severe anorexia (SNAQ score: deceased vs. alive patients: 146, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 vs. 168, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20; P = 0.005), more symptoms (QLQ‐C30: deceased vs. alive patients: 33 2–66 vs. 15 6–69 ; P < 0.0001), a poorer quality of life (QLQ‐C30: deceased vs. alive patients: 58 16–100 vs. 66 0–100 ; P = 0.002) and a lower functional capacity (QLQ‐C30: deceased vs. alive patients: 64 18–97 vs. 82 33–100 ; P < 0.0001 and ECOG; P < 0.0001) than alive patients.…”

Section: Resultsmentioning

confidence: 99%

“…The muscle‐wasting process in cachexia is demonstrated by a reduction of muscle size and also an increase in muscle fat infiltration,2 as assessed by the muscle density measured by CT scan. Interestingly, low muscularity and muscle fat infiltration are recognized as independent risk factors of poor survival in cancer patients, regardless of body weight 3, 4, 5, 6. Therefore, it is expected that inhibition of muscle‐wasting process may represent an effective strategy to treat cancer cachexia.…”

Section: Introductionmentioning

confidence: 99%

Circulating Activin A predicts survival in cancer patients

Loumaye

Barsy

Nachit

et al. 2017

J cachexia sarcopenia muscle

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BackgroundSeveral experimental evidences pinpoint the possible role of Activin A (ActA) as a driver of cancer cachexia. Supporting this hypothesis, we showed recently that human cancer cachexia is associated with high ActA levels. Moreover, ActA levels were correlated with body weight loss and skeletal muscle density, two prognostic factors in cancer patients. Our goal was therefore to investigate the value of ActA to predict survival in cancer patients.MethodsPatients with colorectal or lung cancer were prospectively enrolled at the time of diagnosis or relapse between January 2012 and March 2014. At baseline, patients had clinical, nutritional, and functional assessment. Body composition and skeletal muscle density were measured by CT scan, and plasma ActA concentrations were determined. Overall survival (OS) was analysed since inclusion to 24 months later.ResultsSurvival data were available for 149 patients out of 152. Patients with high ActA (≥408 pg/mL) had lower OS than those with low levels, regardless the type of cancer (OS in colorectal cancer, 50% vs. 79%, P < 0.05; and in lung cancer, 27% vs. 67%, P = 0.001). The multivariable analysis confirmed the prognostic value of ActA independently of tumour stage or inflammatory markers, particularly in lung cancer. Low muscularity was also an independent prognostic factor.ConclusionsOur study demonstrates that high ActA level is an independent prognosis factor of survival in cancer patients. More than a basic marker of the severity of the neoplastic disease or of the inflammatory process, ActA seems to influence survival by contributing to the development of cachexia and loss of skeletal muscle mass.

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“…[85, 86] Skeletal muscle wasting and resultant functional impairment significantly affect QoL. Cancer-related muscle loss is multifactorial, resulting in asthenia and functional impairment similar to that seen in patients with age-related sarcopenia as well that manifested by active muscle break-down.…”

Section: 0 Muscle Weakness In Cancermentioning

confidence: 99%

Bone Pain and Muscle Weakness in Cancer Patients

Milgrom

Lad

Koniaris

et al. 2017

Curr Osteoporos Rep

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Purpose of review In this article we will discuss the current understanding of bone pain and muscle weakness in cancer patients. We will describe the underlying physiology and mechanisms of cancer-induced bone pain (CIBP) and cancier-induced muscle wasting (CIMW), as well as current methods of diagnosis and treatment. We will discuss future therapies and research directions to help patients with these problems. Recent Findings There are several pharmacologic therapies that are currenly in pre-clinical and clinical testing that appear to be promising adjuncts to current CIBP and CIMW therapies. Such therapies include resiniferitoxin, which is a targeted inhibitor of nociptive nerve fibers, and selective androgen receptor modulators, which show promise in increasing lean mass. Summary CIBP and CIMW are a significant causes of morbidity in affected patients. Current management is mostly palliative; however, targeted therapies are poised to revolutionize how these problems are treated.

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

Cited by 117 publications

References 37 publications

Muscle mass and association to quality of life in non‐small cell lung cancer patients

Muscle mass and association to quality of life in non‐small cell lung cancer patients

Circulating Activin A predicts survival in cancer patients

Bone Pain and Muscle Weakness in Cancer Patients

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