Changes in skeletal muscle mass during palliative chemotherapy in patients with advanced lung cancer

Figures & data

Table 1. Baseline characteristics.

		All patients n = 35		SMCAGain/stable n = 16		SMCALoss n = 19
Age, years	mean, SD	67.1	6.8	66.0	4.1	68.0	8.4
Gender
Female	n, (%)	17	49	7	44	10	53
Male		18	51	9	56	9	47
Stage of cancer^1	n, %
IIIB		6	17	3	19	3	16
IV		29	83	13	81	16	84
Performance status^2
0	n, %	4	11	1	6	3	16
1		29	83	14	88	15	79
2		2	6	1	6	1	5
Height, m	mean, SD	1.70	20.1	1.72	7.7	1.71	8.7
Weight, kg	mean, SD	71.5	14.4	72.2	12.9	70.8	15.7
BMI, kg/m^2,3	mean, SD	24.2	4.2	24.2	3.9	24.2	4.5
Underweight < 18.5	n, %	2	6	1	6	1	5
Normal 18.5–24.9		17	49	7	44	10	53
Overweight 25–29.9		13	37	7	4	6	32
Obese ≥ 30		3	9	1	6	2	11
WL, 3 months pre-study (kg)	mean, SD	3.4	4.5	5.0	5.8	1.9	2.3
< 5%	n, %	21	60	9	56	13	68
5–10%		9	26	3	19	5	26
> 10%		5	14	4	25	1	5
C-reactive protein (ml/g)	mean, SD	43.3	46.0	44.5	35.1	42.3	54.4
< 10	n, %	9	26	2	12	7	37
≥ 10		26	74	14	88	12	63
Albumin (m/l)	mean, SD	38.2	4.3	37.3	3.8	39	4.6
< 36	n, %	25	71	10	62	15	79
≥ 36		10	29	6	38	4	21
Skeletal muscle cross sectional area (cm^2)	mean, SD	121.9	30.8	124.9	32.2	119.3	30.2
Skeletal muscle index (cm^2/m^2)		41.1	9.0	41.0	7.6	40.8	9.6
LBM, kg		42.6	9.2	43.5	9.7	41.8	9.0
Sarcopenic at study entry^4	n, %	26	74	14	88	12	63
Not-sarcopenic		9	26	2	12	7	36

¹TNM-classification; ²European Collaborative Oncology Group; ³n = 29; ⁴Thresholds for sarcopenia were based on previously reported cut-off values for the skeletal muscle index, which was SMCA/body height² ≤ 38, 5 cm²/m² for women and > 52, 4 cm²/m² for men [20].

BMI, body mass index; LBM, lean body mass; SMCA, skeletal muscle cross sectional area; WL, weight loss.

Figure 1. Change in skeletal muscle cross sectional area in patients according to sarcopenia. Individual changes in skeletal muscle cross sectional area (SMCA) from pre- to post-chemotherapy (Y-axis) according to sarcopenia at baseline, measured in cm². Negative values indicate loss in muscle mass. Thresholds for sarcopenia were based on previously reported cut-off values for the skeletal muscle index, which were SMCA/body height 2; ≤ 38.5 cm²/m² for women and ≤ 52.4 cm²/m² for men [20]. Non-sarcopenic patients (n=9) are shown in the bars to the left, and sarcopenic (n=26) in the bars to the right. Black bars are SMCA Loss, Dotted grey bars are SMCA Stable and Light grey bars are SMCA Gain.

Figure 2. Change in skeletal muscle cross sectional area in patients according to response to treatment. (Includes Figure A, B and C). Individual changes in skeletal muscle cross sectional area (SMCA) from pre- to post-chemotherapy (Y-axis) according to response to treatment, measured in cm². Negative values indicate loss in muscle mass. Black bars are SMCA Loss, Dotted gray bars are SMCA Stable and Light gray bars are SMCA Gain.

Table II. Courses of chemotherapy, response evaluation and toxicity.

	All patients n = 35	SMCAGain/stable n = 16	SMCALoss n = 19
	n	n	n
Chemotherapy regimen
Carboplatin	35	16	19
Vinorelbine	13	4	9
Gemcitabine	22	12	10
Courses of chemotherapy
1A	35	16	19
1B	30	13	17
2A	34	16	18
2B	32	14	18
3A	32	16	16
3B	30	14	16
Dose reductions
1B	5	0	5
2A	17	6	11
2B	20	9	11
3A	23	10	13
3B	24	10	14
Treatment response^1
Complete or partial response	13	8	5
Stable disease	12	6	6
Progressive disease	10	8	2
Hematological grade 3–4 toxicity^2
Anemia	0	0	0
Neutropenia	28	13	15
Trombocytopenia	13	5	8
Non-hematological grade 3–4 toxicity^2
Neutropenic infection	3	1	2
Infection without neutropenia	3	1	2
Lung embolism	1	0	1

¹RECIST version 1.1; ² CTCAE v. 3.0.

SMCA, skeletal muscle cross sectional area.

Table III. Uni- and multivariate survival analysis.

	n	n events (deaths)	Uni-variate analysis				Multivariate analysis
			Median survival (months)	HR	95% CI	p–value	HR	95% CI	p–value
Gender
Men^a	18	13	7.9	1.4	0.6–2.9	0.422	1.0	0.4–2.3	0.909
Women	17	15	7.2
Performance status^1
0^a	4	3	8.5	1.8	0.5–6.3	0.347	2.5	0.3–19.5	0.398
1	31	25	7.5
Stage of cancer^2
IIIB^a	6	3	18.6	3.5	1.0–11.9	0.045	11.1	2.3–54.0	0.003
IV	29	25	7.4
Treatment regime
Gemcitabine^a	22	17	9.2	1.6	0.8–3.5	0.203	4.2	1.2–14.4	0.023
Vinorelbin	13	11	7.0
Treatment response^3
Disease control^a	25	18	10.7	5.3	2.2–12.8	< 0.001	4.8	1.6–15.0	0.007
Progression	10	10	4.1
BMI
≥ 25 kg/m^2a	16	11	7.4	0.6	0.3–1.6	0.196	0.8	0.7–2.6	0.721
< 25 kg/m^2	19	17	8.5
WL 3 months pre-study
< 5%^a	21	16	7.5	0.7	0.4–1.7	0.534	0.4	0.2–1.1	0.084
≥ 5%	14	12	7.9
C-reactive protein
< 10 ml/g^a	9	7	7.0	0.9	0.4–2.3	0.905	0.8	0.2–3.1	0.761
≥ 10 ml/g	26	21	7.9
Albumin
< 36 m/l^a	25	19	8.5	1.5	0.7–3.4	0.299	3.5	0.9–13.1	0.069
≥ 36 m/l	10	9	7.2
Baseline sarcopenia^4
No^a	9	6	7.9	1.4	0.6–3.4	0.492	2.1	0.5–9.2	0.330
Yes	26	22	7.5
SMCA change^5
Stable or gain^a	16	12	10.7	2.0	0.9–4.2	0.078	3.6	1.1–12.5	0.040
Loss	19	16	5.8
Global QoL^6
High QoL (score ≥ 65)^a	15	12	9.2	1.2	0.6–2.6	0.594	0.8	0.3–2.3	0.687
Low QoL (score < 65)	20	16	6.7
Appetite loss^6
No (score 0)^a	20	14	10.7	2.4	1.1–5.1	0.025	2.5	0.8–7.7	0.115
Yes (score 1–3)	15	14	6.2

^aReference category. ¹European Collaborative Oncology Group; ²TNM-classification; ³RECIST version 1.1; ⁴Thresholds for sarcopenia were based on previously reported cut-off points for the skeletal muscle index, which was SMCA/body height² ≤ 38, 5 cm²/m² for women and ≤ 52, 4 cm²/m² for men; ⁵Change in SMCA from pre- to post chemotherapy; ⁶Items extracted from the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ C30).

BMI, body mass index; QoL, quality of life; SMCA, skeletal muscle cross sectional area; WL, weight loss.

Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, et al. Total body skeletal muscle and adipose tissue volumes: Estimation from a single abdominal cross-sectional image. J Appl Physiol 2004;97:2333–8.

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