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Fann Y, Teo W, Lee H, Liao C, Tsay Y, Huang T, Lo J. Regimen on Dnaja3 haploinsufficiency mediated sarcopenic obesity with imbalanced mitochondrial homeostasis and lipid metabolism. J Cachexia Sarcopenia Muscle 2024; 15:2013-2029. [PMID: 39132696 PMCID: PMC11446717 DOI: 10.1002/jcsm.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Sarcopenic obesity is characterized by excess fat mass and diminished muscular mass/function. DNAJA3, a mitochondrial co-chaperone protein, plays a crucial role in skeletal muscle development. GMI, an immunomodulatory protein, promotes myogenic differentiation through DNAJA3 activation. This study aims to elucidate the physiological effects of muscular Dnaja3 haploinsufficiency on mitochondrial dysfunction and dysregulated lipid metabolism and to assess the efficacy of GMI in rescuing sarcopenic obesity both in vitro and in vivo. METHODS We generated mouse strain with Dnaja3 heterozygosity (HSA-Dnaja3f/+) specifically in skeletal muscle. The body weight, body composition, and locomotor activity of WT and HSA-Dnaja3f/+ mice were examined. The isolated skeletal muscles and primary myoblasts from the WT and HSA-Dnaja3f/+ mice, at young or old age, were utilized to study the molecular mechanisms, mitochondrial respiration and ROS level, mitochondrial proteomes, and serological analyses, respectively. To evaluate the therapeutic efficacy of GMI, both short-term and long-term GMI treatment were administrated intraperitoneally to the HSA-Dnaja3f/+ young (4 weeks old) or adult (3 months old) mice for a duration of either 1 or 6 months, respectively. RESULTS Muscular Dnaja3 heterozygosity resulted in impaired locomotor activity (P < 0.05), reduced muscular cross-sectional area (P < 0.0001), and up-regulation of lipogenesis (ACC2) and pro-inflammation (STAT3) in skeletal muscles (P < 0.05). Primary myoblasts from the HSA-Dnaja3f/+ mice displayed impaired mitochondrial respiration (P < 0.01) and imbalanced mitochondrial ROS levels. A systemic proteomic analysis of the purified mitochondria from the primary myoblasts was conducted to show the abnormalities in mitochondrial function and fatty acid metabolism (P < 0.0001). At age of 13 to 14 months, the HSA-Dnaja3f/+ mice displayed increased body fat mass (P < 0.001), reduced fat-free mass (P < 0.01), and impaired glucose and insulin tolerance (P < 0.01). The short-term GMI treatment improved locomotor activity (P < 0.01) and down-regulated the protein levels of STAT3 (P < 0.05), ACC2, and mitochondrial respiratory complex III (UQCRC2) (P < 0.01) via DNAJA3 activation. The long-term GMI treatment ameliorated fat mass accumulation, glucose intolerance, and systemic inflammation (AST) (P < 0.05) in skeletal muscle, while enhancing thermogenesis (UCP1) (P < 0.01) in eWAT. GMI treatment promoted myogenesis, enhanced oxygen consumption, and ameliorated STAT3 (P < 0.01) through DNAJA3 activation (P < 0.05) in vitro. CONCLUSIONS Muscular Dnaja3 haploinsufficiency dysregulates mitochondrial function and lipid metabolism then leads to sarcopenic obesity. GMI emerges as a therapeutic regimen for sarcopenic obesity treatment through DNAJA3 activation.
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Affiliation(s)
- Yu‐Ning Fann
- Institute of Pharmacology, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Wan‐Huai Teo
- Institute of Oral Biology, College of DentistryNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Hsin‐Chen Lee
- Institute of Pharmacology, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Pharmacy, College of Pharmaceutical SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chen‐Chung Liao
- Mass Spectrometry Facility, Instrumentation Resource CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Cancer Progression Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yeou‐Guang Tsay
- Institute of Biochemistry and Molecular Biology, College of Life ScienceNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Tung‐Fu Huang
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Orthopedics and TraumatologyTaipei Veterans General HospitalTaipeiTaiwan
| | - Jeng‐Fan Lo
- Institute of Pharmacology, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Institute of Oral Biology, College of DentistryNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Cancer Progression Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Dentistry, College of DentistryNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of DentistryTaipei Veterans General HospitalTaipeiTaiwan
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Bonomi P, Moudgalya H, Gomez SL, Shah P, Basu S, Batus M, Martinka LB, Abdelkader A, Tzameli I, Cobain S, Collins S, Keliher EJ, Breen DM, Calle RA, Fidler MJ, Borgia JA. Frequency of weight and body composition increases in advanced non-small cell lung cancer patients during first line therapy. J Cachexia Sarcopenia Muscle 2024. [PMID: 39289919 DOI: 10.1002/jcsm.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/20/2024] [Accepted: 06/03/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND The primary objective of this study was to assess the frequency of body composition increases and their relationships to changes in body weight in two cohorts of real world, treatment-naïve, advanced non-small cell lung cancer (NSCLC) patients. One cohort received the current standard of care (CSOC), which consisted of immunotherapy and newer chemotherapy regimens, and the other cohort was treated with the former standard of care (FSOC), consisting only of older platinum-containing regimens. METHODS CSOC (n = 106) and FSOC (n = 88) cohorts of advanced NSCLC patients were included in this study. Weights were collected at each clinical visit, and body composition analysis from routine chest computed tomography via automated segmentation software assessed at baseline and at 6 and 12 weeks. Standard statistical methods were used to calculate relationships between changes in weight and in body composition. RESULTS The CSOC cohort contained 106 stage IV NSCLC patients treated between 16/12/2014 and 22/10/2020 while the FSOC cohort contained 88 stage III/IV NSCLC patients treated between 16/6/2006 and 18/11/2014. While each cohort exhibited decreases in median weight, body mass index (BMI), mean skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI) at the 6 and 12 week time points, a subset of patients experienced increases in these parameters. Using a threshold of ≥2.5% increase for weight, BMI, SMI, and SATI at the 12 week time point, both cohorts showed similar (20.5% and 27.3%) increases in these parameters. With a cut point of ≥5% increase at 12 weeks follow-up, 8.0% to 25.0% of the patients gained ≥5% in weight, BMI, SMI and SATI. Comparing these results in each cohort showed no significant differences. Pearson coefficients for weight change related to changes in SMI and SATI at 6 and 12 weeks ranged from 0.31 to 0.58 with all P values <0.02. Pearson coefficients for weight change at 12 weeks related to changes in VATI and IMATI ranged from 0.26 to 0.47 with all P values <0.05. Comparison of Pearson coefficients for each cohort showed no significant differences. CONCLUSIONS Although decreases in median weight, BMI, SMI and SATI were observed in both cohorts, similar percentage of patients in each cohort experienced increases in these parameters. These findings, plus the positive correlations between longitudinal measurements of weight, muscle mass and adipose tissue, indicate that weight gain in these patients involves increases in both muscle mass and adipose tissue. Upon validation, these findings could have implications for clinical trial design and for translational research in cancer cachexia.
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Affiliation(s)
- Philip Bonomi
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Hita Moudgalya
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, USA
| | - Sandra L Gomez
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, IL, USA
| | - Palmi Shah
- Department of Radiology, Rush University Medical Center, Chicago, IL, USA
| | - Sanjib Basu
- Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Marta Batus
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Levi B Martinka
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, USA
| | - Ahmed Abdelkader
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, USA
| | | | - Sonia Cobain
- Global Biometrics and Data Management, Pfizer R&D UK Ltd, Sandwich, UK
| | - Susie Collins
- Global Biometrics and Data Management, Pfizer R&D UK Ltd, Sandwich, UK
| | | | - Danna M Breen
- Internal Medicine Research Unit, Pfizer Inc., Cambridge, MA, USA
| | - Roberto A Calle
- Internal Medicine Research Unit, Pfizer Inc., Cambridge, MA, USA
| | - Mary Jo Fidler
- Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Jeffrey A Borgia
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
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Ma M, Luo M, Liu Q, Zhong D, Liu Y, Zhang K. Influence of abdominal fat distribution and inflammatory status on post-operative prognosis in non-small cell lung cancer patients: a retrospective cohort study. J Cancer Res Clin Oncol 2024; 150:111. [PMID: 38431748 PMCID: PMC10908607 DOI: 10.1007/s00432-024-05633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/26/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To evaluate the influence of visceral fat area (VFA), subcutaneous fat area (SFA), the systemic immune-inflammation index (SII) and total inflammation-based systemic index (AISI) on the postoperative prognosis of non-small cell lung cancers (NSCLC) patients. METHODS 266 NSCLC patients received surgery from two academic medical centers were included. To assess the effect of abdominal fat measured by computed tomography (CT) imaging and inflammatory indicators on patients' overall survival (OS) and progression-free survival (PFS), Kaplan-Meier survival analysis and Cox proportional hazards models were used. RESULTS Kaplan-Meier analysis showed the OS and PFS of patients in high-VFA group was better than low-VFA group (p < 0.05). AISI and SII were shown to be risk factors for OS and PFS (p < 0.05) after additional adjustment for BMI (Cox regression model II). After further adjustment for VFA (Cox regression model III), low-SFA group had longer OS (p < 0.05). Among the four subgroups based on VFA (high/low) and SFA (high/low) (p < 0.05), the high-VFA & low-SFA group had the longest median OS (108 months; 95% CI 74-117 months) and PFS (85 months; 95% CI 65-117 months), as well as the lowest SII and AISI (p < 0.05). Low-SFA was a protective factor for OS with different VFA stratification (p < 0.05). CONCLUSION VFA, SFA, SII and AISI may be employed as significant prognostic markers of postoperative survival in NSCLC patients. Moreover, excessive SFA levels may encourage systemic inflammation decreasing the protective impact of VFA, which may help to provide targeted nutritional support and interventions for postoperative NSCLC patients with poor prognosis.
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Affiliation(s)
- Mengtian Ma
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan Province, People's Republic of China
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan Province, People's Republic of China
| | - Muqing Luo
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan Province, People's Republic of China
| | - Qianyun Liu
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, 414000, Hunan Province, People's Republic of China
| | - Dong Zhong
- Department of Nuclear Medicine, XiangYa Hospital CentralSouth University, Changsha, 410005, Hunan Province, People's Republic of China
| | - Yinqi Liu
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan Province, People's Republic of China
| | - Kun Zhang
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, Changsha, 410007, Hunan Province, People's Republic of China.
- College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, 410208, People's Republic of China.
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Cardaci TD, VanderVeen BN, Bullard BM, McDonald SJ, Unger CA, Enos RT, Fan D, Velázquez KT, Frizzell N, Spangenburg EE, Murphy EA. Obesity worsens mitochondrial quality control and does not protect against skeletal muscle wasting in murine cancer cachexia. J Cachexia Sarcopenia Muscle 2024; 15:124-137. [PMID: 38062911 PMCID: PMC10834333 DOI: 10.1002/jcsm.13391] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/15/2023] [Accepted: 11/02/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND More than 650 million people are obese (BMI > 30) worldwide, which increases their risk for several metabolic diseases and cancer. While cachexia and obesity are at opposite ends of the weight spectrum, leading many to suggest a protective effect of obesity against cachexia, mechanistic support for obesity's benefit is lacking. Given that obesity and cachexia are both accompanied by metabolic dysregulation, we sought to investigate the impact of obesity on skeletal muscle mass loss and mitochondrial dysfunction in murine cancer cachexia. METHODS Male C57BL/6 mice were given a purified high fat or standard diet for 16 weeks before being implanted with 106 Lewis lung carcinoma (LLC) cells. Mice were monitored for 25 days, and hindlimb muscles were collected for cachexia indices and mitochondrial assessment via western blotting, high-resolution respirometry and transmission electron microscopy (TEM). RESULTS Obese LLC mice experienced significant tumour-free body weight loss similar to lean (-12.8% vs. -11.8%, P = 0.0001) but had reduced survival (33.3% vs. 6.67%, χ2 = 10.04, P = 0.0182). Obese LLC mice had reduced muscle weights (-24%, P < 0.0354) and mCSA (-16%, P = 0.0004) with similar activation of muscle p65 (P = 0.0337), and p38 (P = 0.0008). ADP-dependent coupled respiration was reduced in both Obese and Obese LLC muscle (-30%, P = 0.0072) consistent with reductions in volitional cage activity (-39%, P < 0.0001) and grip strength (-41%, P < 0.0001). TEM revealed stepwise reductions in intermyofibrillar and subsarcolemmal mitochondrial size with Obese (IMF: -37%, P = 0.0009; SS: -21%, P = 0.0101) and LLC (IMF: -40%, P = 0.0019; SS: -27%, P = 0.0383) mice. Obese LLC mice had increased pAMPK (T172; P = 0.0103) and reduced FIS1 (P = 0.0029) and DRP1 (P < 0.0001) mitochondrial fission proteins, which were each unchanged in Lean LLC. Further, mitochondrial TEM analysis revealed that Obese LLC mice had an accumulation of damaged and dysfunctional mitochondria (IMF: 357%, P = 0.0395; SS: 138%, P = 0.0174) in concert with an accumulation of p62 (P = 0.0328) suggesting impaired autophagy and clearance of damaged mitochondria. Moreover, we observed increases in electron lucent vacuoles only in Obese LLC muscle (IMF: 421%, P = 0.0260; SS: 392%, P = 0.0192), further supporting an accumulation of damaged materials that cannot be properly cleared in the obese cachectic muscle. CONCLUSIONS Taken together, these results demonstrate that obesity is not protective against cachexia and suggest exacerbated impairments to mitochondrial function and quality control with a particular disruption in the removal of damaged mitochondria. Our findings highlight the need for consideration of the severity of obesity and pre-existing metabolic conditions when determining the impact of weight status on cancer-induced cachexia and functional mitochondrial deficits.
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Affiliation(s)
- Thomas D Cardaci
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Brandon N VanderVeen
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Brooke M Bullard
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Sierra J McDonald
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Christian A Unger
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Reilly T Enos
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Daping Fan
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Kandy T Velázquez
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Norma Frizzell
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Espen E Spangenburg
- Department of Physiology, East Carolina University, Greenville, North Carolina, USA
- Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - E Angela Murphy
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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Tao J, Fang J, Chen L, Liang C, Chen B, Wang Z, Wu Y, Zhang J. Increased adipose tissue is associated with improved overall survival, independent of skeletal muscle mass in non-small cell lung cancer. J Cachexia Sarcopenia Muscle 2023; 14:2591-2601. [PMID: 37724690 PMCID: PMC10751412 DOI: 10.1002/jcsm.13333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/17/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The prognostic significance of non-cancer-related prognostic factors, such as body composition, has gained extensive attention in oncological research. Compared with sarcopenia, the prognostic significance of adipose tissue for overall survival in non-small cell lung cancer remains unclear. We investigated the prognostic value of skeletal muscle and adipose tissue in patients with non-small cell lung cancer. METHODS This retrospective study included 4434 patients diagnosed with non-small cell lung cancer between January 2014 and December 2016. Cross-sectional areas of skeletal muscle and subcutaneous fat were measured, and the pericardial fat volume was automatically calculated. The skeletal muscle index and subcutaneous fat index were calculated as skeletal muscle area and subcutaneous fat area divided by height squared, respectively, and the pericardial fat index was calculated as pericardial fat volume divided by body surface area. The association between body composition and outcomes was evaluated using Cox proportional hazards model. RESULTS A total of 750 patients (501 males [66.8%] and 249 females [33.2%]; mean age, 60.9 ± 9.8 years) were included. Sarcopenia (60.8% vs. 52.7%; P < 0.001), decreased subcutaneous fat index (51.4% vs. 25.2%; P < 0.001) and decreased pericardial fat index (55.4% vs. 16.5%; P < 0.001) were more commonly found in the deceased group than survived group. In multivariable Cox regression analysis, after adjusting for clinical variables, increased subcutaneous fat index (hazard ratio [HR] = 0.56, 95% confidence interval [CI]: 0.47-0.66, P < 0.001) and increased pericardial fat index (HR = 0.47, 95% CI: 0.40-0.56, P < 0.001) were associated with longer overall survival. For stage I-III patients, increased subcutaneous fat index (HR = 0.62, 95% CI: 0.48-0.76, P < 0.001) and increased pericardial fat index (HR = 0.43, 95% CI: 0.34-0.54, P < 0.001) were associated with better 5-year overall survival rate. Similar results were recorded in stage IV patients. For patients with surgery, the prognostic value of increased subcutaneous fat index (HR = 0.60, 95% CI: 0.44-0.80, P = 0.001) and increased pericardial fat index (HR = 0.51, 95% CI: 0.38-0.68, P < 0.001) remained and predicted favourable overall survival. Non-surgical patients showed similar results as surgical patients. No association was noted between sarcopenia and overall survival (P > 0.05). CONCLUSIONS Increased subcutaneous fat index and pericardial fat index were associated with a higher 5-year overall survival rate, independent of sarcopenia, in non-small cell lung cancer and may indicate a reduced risk of non-cancer-related death.
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Affiliation(s)
- Junli Tao
- Department of RadiologyChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University)Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
| | - Jiayang Fang
- Department of RadiologyChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University)Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
| | - Lihua Chen
- Department of RadiologyChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University)Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
| | - Changyu Liang
- Department of RadiologyChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University)Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
| | - Bohui Chen
- Department of RadiologyChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University)Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
| | - Zhenyu Wang
- Department of RadiologyChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University)Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
| | - Yongzhong Wu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University)Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
- Department of radiotherapyChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
| | - Jiuquan Zhang
- Department of RadiologyChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University)Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingP.R. China
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Lee JH, Kang D, Ahn JS, Guallar E, Cho J, Lee HY. Obesity paradox in patients with non-small cell lung cancer undergoing immune checkpoint inhibitor therapy. J Cachexia Sarcopenia Muscle 2023; 14:2898-2907. [PMID: 37964713 PMCID: PMC10751411 DOI: 10.1002/jcsm.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/30/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The obesity paradox in patients with advanced non-small cell lung cancer receiving immune checkpoint inhibitor therapy has been observed, but its underlying mechanism is not fully understood. We aimed to investigate whether body composition affects the prognostic impact of obesity, as determined by body mass index (BMI), on survival. METHODS This retrospective study evaluated the data collected from Asian patients who were treated with immune checkpoint inhibitors for advanced non-small cell lung cancer between October 2015 and October 2021. We used abdominal cross-sectional imaging to calculate the skeletal muscle and visceral fat indices (cm2 /m2 ) by dividing the cross-sectional areas of the skeletal muscle and visceral fat by the height squared. Cox proportional-hazards regression was performed to determine the correlation between BMI according to the Asia-Pacific classification, body composition metrics and overall survival. RESULTS We analysed the data of 820 patients (630 men and 190 women, with a mean age of 64.3 years [standard deviation: 10.4 years]) and observed 572 (69.8%) deaths with the 1-year mortality rate of 0.58 (95% confidence interval, 0.55-0.62). Obese BMI was associated with longer overall survival, independent of clinical covariates (hazard ratio, 0.64; 95% confidence interval: 0.52-0.80). The prognostic value of obese BMI remained after additional adjustments for skeletal muscle index (hazard ratio, 0.68; 95% confidence interval, 0.53-0.87) or visceral fat index (hazard ratio, 0.54; 95% confidence interval: 0.41-0.70). No association was observed between sex and the impact of BMI on overall survival (P-value for interaction >0.05). CONCLUSIONS In Asian patients with advanced non-small cell lung cancer who received immune checkpoint inhibitors, obese BMI was associated with favourable overall survival independent of skeletal muscle or visceral fat mass.
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Affiliation(s)
- Ji Hyun Lee
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST)Sungkyunkwan UniversitySeoulRepublic of Korea
| | - Jin Seok Ahn
- Department of Medicine, Division of Hematology‐Oncology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Eliseo Guallar
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreMDUSA
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST)Sungkyunkwan UniversitySeoulRepublic of Korea
- Department of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins Medical InstitutionsBaltimoreMDUSA
- Center for Clinical Epidemiology, Samsung Medical CenterSungkyunkwan UniversitySeoulRepublic of Korea
| | - Ho Yun Lee
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
- Department of Health Sciences and Technology, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST)Sungkyunkwan UniversitySeoulRepublic of Korea
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Kwon YJ, Yoon YC, Kim HS, Cha MJ, Park S, Lee JH. Prognostic significance of body mass index in small-cell lung cancer: Exploring the relationship with skeletal muscle status. J Cachexia Sarcopenia Muscle 2023; 14:2939-2947. [PMID: 37986687 PMCID: PMC10751438 DOI: 10.1002/jcsm.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/25/2023] [Accepted: 09/12/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND We investigated the prognostic significance of body mass index in small-cell lung cancer and explored whether skeletal muscle status affects the body mass index-survival relationship. METHODS This retrospective study evaluated data from patients who underwent platinum-etoposide chemotherapy for small-cell lung cancer between March 2010 and December 2021. Skeletal muscle status was assessed using non-contrast computed tomography images of baseline positron-emission tomography-computed tomography, with the skeletal muscle index defined as the cross-sectional area of skeletal muscle divided by height squared, and the average attenuation values of skeletal muscle. Cox proportional hazards regression analysis was used to determine the correlations of body mass index, skeletal muscle metrics, and overall survival. RESULTS We analysed the data of 1146 Asian patients (1006 men and 140 women, with a median age of 67 years [interquartile range: 61-72 years]), including 507 and 639 patients with limited and extensive disease, respectively. Being underweight, defined as a body mass index <18.5 kg/m2 , was associated with shorter overall survival, independent of clinical covariates in both the limited-disease (hazard ratio, 1.77; 95% confidence interval, 1.01-3.09) and extensive-disease (hazard ratio, 1.71; 95% confidence interval, 1.18-2.48) groups. The prognostic value of being underweight remained significant after additional adjustment for skeletal muscle index and attenuation in both limited-disease (hazard ratio, 1.96; 95% confidence interval, 1.09-3.51) and extensive-disease (hazard ratio, 1.75; 95% confidence interval, 1.17-2.61) groups. CONCLUSIONS Being underweight is an independent poor prognostic factor for shorter overall survival in Asian patients with small-cell lung cancer, regardless of skeletal muscle status.
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Affiliation(s)
- Yong Jae Kwon
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Min Jae Cha
- Department of Radiology, Chung‐Ang University HospitalChung‐Ang University College of MedicineSeoulRepublic of Korea
| | - Sehhoon Park
- Department of Medicine, Division of Hematology‐Oncology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Ji Hyun Lee
- Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
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Ouyang J, Yang Y, Zhou Y, Ye F, Wang Z, Li Q, Xu Y, Li L, Zhao X, Zhang W, Zhou A, Huang Z, Wang Y, Cai J, Zhao H, Zhou J. The MAPS-CRAFITY score: a novel efficacy predictive tool for unresectable hepatocellular carcinoma treated with targeted therapy plus immunotherapy. Hepatol Int 2023; 17:1519-1531. [PMID: 37707759 DOI: 10.1007/s12072-023-10580-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/06/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Body composition parameters (BCPs) are associated with mortality in patients with hepatocellular carcinoma (HCC). Our purpose was to develop a practical scoring model by BCP and the CRAFITY score to predict the overall survival (OS) and tumor response of patients with HCC who received targeted therapy plus immunotherapy. METHODS This retrospective study included 265 patients with HCC who received targeted therapy plus immunotherapy at 2 centers in China from August 2018 to February 2022. Univariate and multivariate Cox regression analyses were applied to analyze clinical factors and BCP. A scoring model based on independent risk factors was developed to predict OS and tumor response. Moreover, the model's prediction was further validated by an external cohort. RESULTS A total of 150 patients (55.5 ± 10.8 years) and 115 patients (55.0 ± 8.9 years) treated with lenvatinib or bevacizumab biosimilar plus anti-programmed death-1 (PD-1) antibody were included in training and validation cohorts, respectively. In the training cohort, independent predictive factors for OS included macrovascular invasion (p = 0.016), Child‒Pugh class (A vs. B, p = 0.001; A vs. C, p < 0.001), sarcopenia (p = 0.034), and the CRAFITY score (p = 0.011). Based on independent risk factors (MAcrovascular invasion, Child‒Pugh class, Sarcopenia, and the CRAFITY score) identified by multivariate analysis, a novel efficacy predictive tool named the MAPS-CRAFITY score was developed to predict OS. In all the training and validation cohorts, the OS differed significantly across the three groups based on the MAPS-CRAFITY score (< 2.1, 2.1-2.3, ≥ 2.4; p < 0.001). Moreover, the C-index of the MAPS-CRAFITY score was 0.720 and 0.761 in the training and validation cohorts, respectively. In both the validation and training cohorts, the MAPS-CRAFITY score was predictive of tumor response and disease control (p < 0.001). The AUCs of the MAPS-CRAFITY score for predicting disease control were 0.752 in the training cohort and 0.836 in the validation cohort. CONCLUSIONS The MAPS-CRAFITY score based on sarcopenia and the CRAFITY score is a reliable and practical tool for predicting the efficacy of targeted therapy plus immunotherapy in patients with unresectable HCC, and may help hepatologists and oncologists in clinical decision-making.
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Affiliation(s)
- Jingzhong Ouyang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Yi Yang
- Department of Hepatobiliary Surgery, Cancer Hospital, National Cancer Center, National Clinical Research Center for Cancer, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Key Laboratory of Gene Editing Screening and Research and Development (R & D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yanzhao Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Zhengzheng Wang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Qingjun Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China
| | - Ying Xu
- Department of Diagnostic Radiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lu Li
- Department of Diagnostic Radiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wen Zhang
- Department of Medical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Aiping Zhou
- Department of Medical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhen Huang
- Department of Hepatobiliary Surgery, Cancer Hospital, National Cancer Center, National Clinical Research Center for Cancer, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Key Laboratory of Gene Editing Screening and Research and Development (R & D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yong Wang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jianqiang Cai
- Department of Hepatobiliary Surgery, Cancer Hospital, National Cancer Center, National Clinical Research Center for Cancer, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
- Key Laboratory of Gene Editing Screening and Research and Development (R & D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Hong Zhao
- Department of Hepatobiliary Surgery, Cancer Hospital, National Cancer Center, National Clinical Research Center for Cancer, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
- Key Laboratory of Gene Editing Screening and Research and Development (R & D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jinxue Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China.
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Cheng X, Jiang S, Pan B, Xie W, Meng J. Ectopic and visceral fat deposition in aging, obesity, and idiopathic pulmonary fibrosis: an interconnected role. Lipids Health Dis 2023; 22:201. [PMID: 38001499 PMCID: PMC10668383 DOI: 10.1186/s12944-023-01964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is considered an age-related disease. Age-related changes, along with other factors such as obesity, hormonal imbalances, and various metabolic disorders, lead to ectopic fat deposition (EFD). This accumulation of fat outside of its normal storage sites is associated with detrimental effects such as lipotoxicity, oxidative stress, inflammation, and insulin resistance. This narrative review provides an overview of the connection between ectopic and visceral fat deposition in aging, obesity, and IPF. It also elucidates the mechanism by which ectopic fat deposition in the airways and lungs, pericardium, skeletal muscles, and pancreas contributes to lung injury and fibrosis in patients with IPF, directly or indirectly. Moreover, the review discusses the impact of EFD on the severity of the disease, quality of life, presence of comorbidities, and overall prognosis in IPF patients. The review provides detailed information on recent research regarding representative lipid-lowering drugs, hypoglycemic drugs, and lipid-targeting drugs in animal experiments and clinical studies. This may offer new therapeutic directions for patients with IPF.
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Affiliation(s)
- Xiaoyun Cheng
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Tongzipo Road 138, Yuelu District, Changsha, 410000, China
- Hunan Key Laboratory of Organ Fibrosis, Tongzipo Road 138, Yuelu District, Changsha, 410000, China
| | - Shuhan Jiang
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Tongzipo Road 138, Yuelu District, Changsha, 410000, China
- Hunan Key Laboratory of Organ Fibrosis, Tongzipo Road 138, Yuelu District, Changsha, 410000, China
| | - Boyu Pan
- Departments of Orthopedics, The Third Hospital of Changsha, Laodong West Road 176, Tianxin District, Changsha, 410000, China
| | - Wei Xie
- Department of Cardiology, Xiangya Hospital of Central South University, Furong Middle Road 36, Kaifu District, Changsha, 410000, China
| | - Jie Meng
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Tongzipo Road 138, Yuelu District, Changsha, 410000, China.
- Hunan Key Laboratory of Organ Fibrosis, Tongzipo Road 138, Yuelu District, Changsha, 410000, China.
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Yao S, Zeng L, Wang F, Chen K. Obesity Paradox in Lung Diseases: What Explains It? Obes Facts 2023; 16:411-426. [PMID: 37463570 PMCID: PMC10601679 DOI: 10.1159/000531792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Obesity is a globally increasing health problem that impacts multiple organ systems and a potentially modifiable risk factor for many diseases. Obesity has a significant impact on lung function and is strongly linked to the pathophysiology that contributes to lung diseases. On the other hand, reports have emerged that obesity is associated with a better prognosis than for normal weight individuals in some lung diseases, including pneumonia, acute lung injury/acute respiratory distress syndrome, chronic obstructive pulmonary disease, and lung cancer. The lesser mortality and better prognosis in patients with obesity is known as obesity paradox. While obesity paradox is both recognized and disputed in epidemiological studies, recent research has suggested possible mechanisms. SUMMARY In this review, we attempted to explain and summarize these factors and mechanisms, including immune response, pulmonary fibrosis, lung function, microbiota, fat and muscle reserves, which are significantly altered by obesity and may contribute to the obesity paradox in lung diseases. We also discuss contrary literature that attributes the "obesity paradox" to confounding. KEY MESSAGES The review will illustrate the possible role of obesity in the prognosis or course of lung diseases, leading to a better understanding of the obesity paradox and provide hints for further basic and clinical research in lung diseases.
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Affiliation(s)
- Surui Yao
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| | - Lei Zeng
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| | - Fengyuan Wang
- College of Animal and Veterinary Sciences, Southwest Minzu University, Chengdu, PR China
| | - Kejie Chen
- School of Public Health, Chengdu Medical College, Chengdu, PR China
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11
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Antoun S, Lanoy E, Ammari S, Farhane S, Martin L, Robert C, Planchard D, Routier E, Voisin AL, Messayke S, Champiat S, Michot JM, Laghouati S, Lambotte O, Marabelle A, Baracos V. Protective effect of obesity on survival in cancers treated with immunotherapy vanishes when controlling for type of cancer, weight loss and reduced skeletal muscle. Eur J Cancer 2023; 178:49-59. [PMID: 36403367 DOI: 10.1016/j.ejca.2022.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Association of high body mass index (BMI) with longer survival has been reported in patients on immune checkpoint inhibitors (ICIs), but results are inconsistent. This 'obesity paradox' is potentially confounded by the effects of BMI change over time and of skeletal muscle depletion. METHODS We conducted a secondary analysis of a prospective cohort, including consecutive patients receiving ICI treatment for melanoma (n = 411) and non-small cell lung cancer (NSCLC) (n = 389) in routine care. RESULTS In the univariable analysis of the entire population, overweight/obesity (BMI ≥ 25 kg/m2) was associated with longer survival (p < 0.01); however, this effect was limited to NSCLC (p < 0.01) and was absent in melanoma. Weight loss (WL) and reduced skeletal muscle mass were observed in patients within all BMI categories. WL was associated with shorter survival in multivariable analysis in both tumour sites (p < 0.01), and for NSCLC, BMI lost significance when WL was included (p = 0.13). In models further adjusted for CT-defined skeletal muscle mass, WL retained significance for both tumour types (p < 0.01), and reduced skeletal muscle only for NSCLC (p = 0.02) was associated with shorter survival. WL retained significance when biomarkers (lactate dehydrogenase enzyme, albumin and derived neutrophil to lymphocyte ratio) were added to the multivariable model. CONCLUSIONS The so-called 'obesity paradox', counterintuitive association between high BMI and longer survival, vanished when controlling for confounders, such as type of cancer, and manifestations of depletion (WL and reduced skeletal muscle mass).
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Affiliation(s)
- Sami Antoun
- Département Interdisciplinaire d'Organisation Du Parcours Patient, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France.
| | - Emilie Lanoy
- Département Interdisciplinaire d'Organisation Du Parcours Patient, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Samy Ammari
- Département d'Imagerie Médicale BIOMAPS, UMR1281 INSERM, CEA, CNRS, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France; ELSAN Département de Radiologie, Institut de Cancérologie Paris Nord, Sarcelles, France
| | - Siham Farhane
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Lisa Martin
- Department of Oncology, University of Alberta, Canada
| | - Caroline Robert
- Département d'Oncologie Medicale, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - David Planchard
- Département d'Oncologie Medicale, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Emilie Routier
- Département d'Oncologie Medicale, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Anne Laure Voisin
- Unité de Pharmacovigilance, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Sabine Messayke
- Unité de Pharmacovigilance, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Stephane Champiat
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Jean Marie Michot
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Salim Laghouati
- Unité de Pharmacovigilance, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
| | - Olivier Lambotte
- Université Paris Saclay, UMR1184 CEA, Inserm, Le Kremlin-Bicêtre, France; Service de Médecine Interne et Immunologie Clinique, Hôpital Bicêtre, Université Paris Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - Aurélien Marabelle
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy, Université Paris-Saclay, F-94800, Villejuif, France
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Takahara Y, Tanaka T, Ishige Y, Shionoya I, Yamamura K, Sakuma T, Nishiki K, Nakase K, Nojiri M, Kato R, Shinomiya S, Oikawa T, Mizuno S. Early recurrence factors in patients with stage III non-small cell lung cancer treated with concurrent chemoradiotherapy. Thorac Cancer 2022; 13:3451-3458. [PMID: 36281714 PMCID: PMC9750816 DOI: 10.1111/1759-7714.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The clinical characteristics and risk factors for cancer recurrence have not been well evaluated regarding early recurrence in patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC) who receive concurrent chemoradiotherapy (CRT). The aim of this study was to determine the clinical characteristics and risk factors of patients with stage III unresectable LA-NSCLC treated with CRT who developed early recurrence. METHODS We retrospectively reviewed the clinical records of 46 patients diagnosed with stage III unresectable LA-NSCLC treated with CRT at our center between July 2012 and July 2021. A tumor proportion score (TPS) < 50% was defined as "low expression" and a TPS > 50% was defined as "high expression." RESULTS A total of 17 (37.0%) patients had a confirmed recurrence within 1 year of treatment. More patients had a lower body mass index in the early recurrence group than in the later recurrence group (p = 0.038). A higher number of patients in the late recurrence group underwent surgery after CRT (p = 0.036). Patients with a higher TPS were more likely to experience late recurrence than early recurrence (p = 0.001), whereas more patients with stage N3 disease were in the early recurrence group (p = 0.011). Multivariate analysis identified lower TPS expression as an independent risk factor for early recurrence after CRT. Overall survival was prolonged in the late recurrence group (p < 0.001). CONCLUSIONS A lower TPS may be a predictor of early recurrence after CRT in patients with LA-NSCLC. These patients should be closely monitored for post-treatment recurrence.
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Affiliation(s)
- Yutaka Takahara
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Takuya Tanaka
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Yoko Ishige
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Ikuyo Shionoya
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Kouichi Yamamura
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Takashi Sakuma
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Kazuaki Nishiki
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Keisuke Nakase
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Masafumi Nojiri
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Ryo Kato
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Shohei Shinomiya
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Taku Oikawa
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
| | - Shiro Mizuno
- Department of Respiratory MedicineKanazawa Medical UniversityKahoku‐gunJapan
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13
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Lee D. Comment on: Obesity is Associated with Improved Postoperative Overall Survival, Independent of Skeletal Muscle Mass in Lung Adenocarcinoma by Lee et al. J Cachexia Sarcopenia Muscle 2022; 13:2576-2578. [PMID: 35965371 PMCID: PMC9530545 DOI: 10.1002/jcsm.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Duk‐Hee Lee
- Department of Preventive Medicine, School of MedicineKyungpook National UniversityDaeguSouth Korea
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14
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Lee JH, Hyung S, Lee J, Choi SH. Visceral adiposity and systemic inflammation in the obesity paradox in patients with unresectable or metastatic melanoma undergoing immune checkpoint inhibitor therapy: a retrospective cohort study. J Immunother Cancer 2022; 10:jitc-2022-005226. [PMID: 36002189 PMCID: PMC9413167 DOI: 10.1136/jitc-2022-005226] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The obesity paradox is a topic of increasing interest in oncology and epidemiology research. Although this phenomenon has been observed in melanoma patients receiving immune checkpoint inhibitors, little is known about its mechanism. We aim to investigate the prognostic value of obesity and its association with adiposity and systemic inflammation. METHODS This retrospective study evaluates the data of patients who received pembrolizumab or nivolumab for unresectable or metastatic melanoma between June 2015 and April 2021. The skeletal muscle index (SMI) and visceral fat index (VFI) (cm2/m2) were calculated by dividing the cross-sectional areas of skeletal muscle and visceral fat by height squared. The systemic immune-inflammation index (SII) was defined as the total peripheral platelet count×neutrophil/lymphocyte ratio. Cox proportional hazard regression analysis was conducted to determine the association with overall survival. RESULTS We analyzed 266 patients with a median age of 60 years (IQR 51-69 years; 135 men and 131 women). The protective effect of obesity was independent of covariates (HR 0.60; 95% CI 0.37 to 0.99; p=0.048), but disappeared after adjusting for VFI (HR 0.76; 95% CI 0.41 to 1.40; p=0.380) or SII (HR 0.71; 95% CI 0.42 to 1.18; p=0.186). An increase of 10 cm2/m2 in VFI was associated with longer overall survival after adjusting for covariates (HR 0.88; 95% CI 0.79 to 0.99; p=0.029). The prognostic value of VFI remained and predicted favorable overall survival after additional adjustment for SMI (HR 0.86; 95% CI 0.76 to 0.98; p=0.025), but disappeared with adjustment for SII (HR 0.92; 95% CI 0.82 to 1.03; p=0.142). An increase of 100×109/L in SII was associated with poor overall survival when adjusted for covariates (HR 1.08; 95% CI 1.05 to 1.11; p<0.001) or when additionally adjusted for VFI (HR 1.07; 95% CI 1.04 to 1.10; p<0.001). CONCLUSIONS Visceral adiposity and systemic inflammation are significant prognostic factors in patients with unresectable or metastatic melanoma receiving immune checkpoint inhibitors. The prognostic impact of visceral adiposity is dependent on systemic inflammation status.
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Affiliation(s)
- Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Sujin Hyung
- Innovative Institute for Precision Medicine, Samsung Medical Center, Seoul, The Republic of Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Sang-Hee Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
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Affiliation(s)
- Barry J A Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.,St Columba's Hospice Care, Edinburgh, UK.,Caledonian Cachexia Collaborative, Edinburgh, UK
| | - Richard J E Skipworth
- Caledonian Cachexia Collaborative, Edinburgh, UK.,Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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16
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Lee JH, Yoon YC, Kim HS, Cha MJ, Kim JH, Kim K, Kim HS. Obesity is associated with improved postoperative overall survival, independent of skeletal muscle mass in lung adenocarcinoma. J Cachexia Sarcopenia Muscle 2022; 13:1076-1086. [PMID: 35212195 PMCID: PMC8978026 DOI: 10.1002/jcsm.12956] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/03/2022] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although the obesity paradox is a topic of immense interest for oncologists and epidemiologists, the mechanism underlying this unexpected benefit of obesity is poorly understood. We explored the prognostic value of obesity and its association with skeletal muscle mass. METHODS This retrospective study evaluated the data of patients who underwent surgical excision for lung adenocarcinoma between January 2011 and December 2015. Body mass index was categorized according to the criteria of the Asia-Pacific classification. Cross-sectional areas of the skeletal muscle, subcutaneous fat, and visceral fat were measured. Skeletal muscle mass status was defined based on the cut-offs of skeletal muscle index (cm2 /m2 ), calculated as the area of skeletal muscle divided by height squared. Overall survival was estimated using the Kaplan-Meier method, and differences in survival probabilities were compared using the log-rank test. Cox proportional hazards regression analysis was conducted to determine the association with overall survival. RESULTS A total of 636 patients with a median age of 61 years (interquartile range, 54.0-68.5 years; 321 men and 315 women) were included. Obese patients (body mass index ≥ 25 kg/m2 ) had longer overall survival than non-obese patients (mean, 110.2 months vs. 98.7 months; log-rank P = 0.015). Under multivariable Cox proportional hazard regression analysis, obesity was associated with longer overall survival after adjusting for covariates (hazard ratio, 0.59; 95% confidence interval, 0.40-0.86; P = 0.007). The prognostic value of obesity remained and predicted favourable overall survival after additional adjusting for skeletal muscle mass status (hazard ratio, 0.57; 95% confidence interval, 0.36-0.89; P = 0.014), skeletal muscle index (hazard ratio, 0.53; 95% confidence interval, 0.33-0.84; P = 0.008), or skeletal muscle area (hazard ratio, 0.61; 95% confidence interval, 0.38-0.98; P = 0.041). No association was observed between skeletal muscle mass status and the impact of body mass index on overall survival (P for interaction = 0.512). CONCLUSIONS Obesity was associated with favourable overall survival, independent of skeletal muscle mass, after surgical excision of lung adenocarcinoma.
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Affiliation(s)
- Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hye Seung Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
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