The Effect of Sarcopenia and Metabolic PET-CT Parameters on Survival in Locally Advanced Non-Small Cell Lung Carcinoma

[18F]FDG PET/CT beyond staging: Prognostic significance of sarcopenia and adipose tissue metabolism in esophageal carcinomas

AIM

This study aimed to investigate the relationship between PET and CT parameters and sarcopenia, adipose tissue, and tumor metabolism in esophageal carcinoma (EC) and its impact on survival in EC.

METHOD

Our study included 122 EC patients who underwent PET/CT for staging. Muscle and adipose tissue characteristics were evaluated, including lumbar (L3) and cervical (C3) muscle areas, psoas major (PM) and sternocleidomastoid muscle (SCM) parameters, and PET parameters for visceral and subcutaneous adipose tissue (SAT). Sarcopenia was determined using CT images, with a threshold for muscle tissue at the L3 vertebral level, and its impact on overall survival (OS) was investigated.

RESULTS

Sarcopenia was detected in 48 patients. SULmax in the primary tumor (PT) was significantly higher in sarcopenic patients (SP). The frequency of distant metastasis was higher in SP and OS was significantly lower. In the locally advanced stage, sarcopenia status decreased survival. L3, PM, C3, and SCM muscle areas were highly correlated. Subcutaneous adipose tissue SUVmax was significantly increased in SP and those with distant metastasis. Univariate analysis identified PT SULmax, PT SUVmean, PT TLG, lymph node and distant metastasis, SAT SUVmax, and sarcopenia as poor prognostic factors, while multivariate analysis confirmed BMI, distant metastasis, PT SUVmean, PT TLG as independent predictors of OS.

CONCLUSION

This study demonstrated that sarcopenia, linked to reduced survival, correlates with primary tumor SULmax, distant metastasis, and subcutaneous tissue PET parameters, exerting a notable impact on survival, particularly in locally advanced stages. Attenuation-corrected CT can be used instead of diagnostic CT, and sarcopenia can be diagnosed using not only L3 but also C3 slices.

Evaluation of nutritional parameters that may be associated with survival in patients with locally advanced non-small cell lung carcinoma receiving definitive concurrent chemoradiotherapy: retrospective study conducted in a tertiary pulmonary hospital

Sarcopenia, defined as skeletal muscle loss, is thought to be a hallmark of cancer cachexia. It has an impact on mortality, especially in cancer patients. There are also opposing views regarding the relationship between definitive concurrent chemoradiotherapy (CRT) and sarcopenia in locally advanced lung cancer. Our aim was to investigate the prognostic effect of sarcopenia in our patients with locally advanced stage III non-small cell lung cancer (NSCLC) who received definitive concurrent CRT by using many markers, and to determine the overall survival (OS). The study was designed as a retrospective cohort. 54 patients with stage III NSCLC who received definitive concurrent CRT at the Radiation Oncology Unit of Health Sciences University Izmir Dr Suat Seren Chest Diseases and Surgery Training Hospital, between January 1, 2018 and December 31, 2019, were included in the study.92% of our patients were sarcopenic with international L3-skeletal muscle index (SMI) and Psoas muscle index (PMI) threshold values. The mean OS time was 32.4 months, and the 4-year survival rate was 38.9%. While the new threshold values specific to our patient group were 26.21 for SMI and 2.94 for PMI, SMI and PMI did not indicate OS with these values. Even with the new values, most proposed criteria for sarcopenia did not indicate OS. However, low BMI (≤21.30), low serum albumin (≤4.24 mg/dl) and low visceral fat tissue area (≤37) in univariate analysis, and low visceral fat tissue area (≤37) in multivariate analysis indicated OS. OS was poor in patients with low fat tissue area. In patients with stage III NSCLC who received definitive concurrent CRT, low visceral fat tissue area (≤37) indicated OS, rather than SMI, PMI and other sarcopenia indices.

The impact of sarcopenia on the efficacy of PD-1 inhibitors in non-small cell lung cancer and potential strategies to overcome resistance

Recent studies have revealed that sarcopenia can adversely affect the efficacy of PD-1 inhibitors in the treatment of non-small cell lung cancer (NSCLC). PD-1 inhibitors are immune checkpoint inhibitors widely used in the treatment of various cancers. However, NSCLC patients may have poorer outcomes when receiving PD-1 inhibitor treatment, and sarcopenia may affect the efficacy of PD-1 inhibitors through immune and metabolic mechanisms. In this article, we summarize the reported negative impact of sarcopenia on the effectiveness of PD-1 inhibitors in the treatment of NSCLC in recent years. Based on existing research results, we analyze the possible mechanisms by which sarcopenia affects the efficacy of PD-1 inhibitors and discuss possible strategies to address this issue. This could help to understand the impact of sarcopenia on the treatment of PD-1 inhibitors and provide more accurate expectations of treatment outcomes for clinicians and patients. Additionally, we present tailored intervention strategies for sarcopenic patients undergoing PD-1 inhibitor therapy, aiming to optimize treatment efficacy and enhance patient quality of life. Nevertheless, further research is warranted to elucidate the mechanisms through which sarcopenia impacts PD-1 inhibitors and to identify more efficacious intervention approaches for improving the effectiveness of PD-1 inhibitor treatment in sarcopenic patients.

Cachexia and Sarcopenia in Oligometastatic Non-Small Cell Lung Cancer: Making a Potential Curable Disease Incurable?

Among patients with advanced NSCLC, there is a group of patients with synchronous oligometastatic disease (sOMD), defined as a limited number of metastases detected at the time of diagnosis. As cachexia and sarcopenia are linked to poor survival, incorporating this information could assist clinicians in determining whether a radical treatment should be administered. In a retrospective multicenter study, including all patients with adequately staged (FDG-PET, brain imaging) sOMD according to the EORTC definition, we aimed to assess the relationship between cachexia and/or sarcopenia and survival. Of the 439 patients that were identified between 2015 and 2021, 234 met the criteria for inclusion and were included. The median age of the cohort was 67, 52.6% were male, and the median number of metastasis was 1. Forty-six (19.7%) patients had cachexia, thirty-four (14.5%) had sarcopenia and twenty-one (9.0%) had both. With a median follow-up of 49.7 months, median PFS and OS were 8.6 and 17.3 months, respectively. Moreover, a trend toward longer PFS was found in patients without cachexia and sarcopenia compared to those with cachexia and/or sarcopenia. In multivariate analysis, cachexia and sarcopenia were not associated with an inferior survival, irrespective of receiving radical treatment. High CRP was associated with inferior survival and could be a prognostic factor, helping the decision of clinicians in selecting patients who may benefit from the addition of LRT. However, despite the homogeneous definition of oligometastatic disease and the adequate staging, our subgroups were small. Therefore, further studies are needed to better understand our hypothesis and generating findings.