Atlan Philippe, Bayar Mohamed Amine, Lanoy Emilie, Besse Benjamin, Planchard David, Ramon Jordy, Raynard Bruno, Antoun Sami
Département Interdisciplinaire de Soins de Support, Gustave-Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France.
Service de Biostatistique et d'Epidémiologie, Gustave-Roussy, Université Paris-Saclay, F-94805, Villejuif, France.
Support Care Cancer. 2017 Nov;25(11):3365-3373. doi: 10.1007/s00520-017-3755-z. Epub 2017 Jun 8.
Advanced non-small cell lung cancer (NSCLC) is associated with weight loss which may reflect skeletal muscle mass (SMM) and/or total adipose tissue (TAT) depletion. This study aimed to describe changes in body composition (BC) parameters and to identify the factors unrelated to the tumor which modulate them.
SMM, TAT, and the proportion of SMM to SMM + TAT were assessed with computed tomography. Estimates of each BC parameter at follow-up initiation and across time were derived from a mixed linear model of repeated measurements with a random intercept and a random slope. The same models were used to assess the independent effect of gender, age, body mass index (BMI), and initial values on changes in each BC parameter.
Sixty-four patients with stage III or IV NSCLC were reviewed. The mean ± SD decreases in body weight and SMM were respectively 59 ± 3 g/week (P < 0.03) and 7 mm/m/week (P = 0.0003). During follow-up, no changes were identified in TAT nor in muscle density or in the proportion of SMM to SMM + TAT, estimated at 37 ± 2% at baseline. SMM loss was influenced by initial BMI (P < 0.0001) and SMM values (P = 0.0002): the higher the initial BMI or SMM values, the greater the loss observed. Weight loss was greater when the initial weight was heavier (P < 0.0001).
Our results demonstrate that SMM wasting in NSCLC is lower when initial SMM and BMI values are low. These exploratory findings after our attempt to better understand the intrinsic factors associated with muscle mass depletion need to be confirmed in larger studies.
晚期非小细胞肺癌（NSCLC）与体重减轻有关，这可能反映骨骼肌质量（SMM）和/或总脂肪组织（TAT）的消耗。本研究旨在描述身体成分（BC）参数的变化，并确定与肿瘤无关的调节这些参数的因素。
采用计算机断层扫描评估SMM、TAT以及SMM占SMM+TAT的比例。随访开始时及随访期间各BC参数的估计值来自具有随机截距和随机斜率的重复测量混合线性模型。相同的模型用于评估性别、年龄、体重指数（BMI）和初始值对每个BC参数变化的独立影响。
对64例III期或IV期NSCLC患者进行了回顾性分析。体重和SMM的平均±标准差下降分别为59±3g/周（P<0.03）和7mm/m/周（P=0.0003）。随访期间，未发现TAT、肌肉密度或SMM占SMM+TAT的比例有变化，基线时估计为37±2%。SMM的损失受初始BMI（P<0.0001）和SMM值（P=0.0002）的影响：初始BMI或SMM值越高，观察到的损失越大。初始体重越重，体重减轻越明显（P<0.0001）。
我们的结果表明，当初始SMM和BMI值较低时，NSCLC患者的SMM消耗较少。在我们试图更好地理解与肌肉质量消耗相关的内在因素后得出的这些探索性发现，需要在更大规模的研究中得到证实。
