Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea.
Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
BMC Cancer. 2021 May 17;21(1):563. doi: 10.1186/s12885-021-08300-x.
Cancer cachexia worsens the treatment outcomes of patients with small-cell lung cancer (SCLC). However, no reliable biomarker of cancer cachexia is yet known.
We retrospectively evaluated male SCLC patients who received induction chemotherapy or concurrent chemoradiotherapy. The cachexia index (CXI) was calculated as skeletal muscle index × serum albumin level (g/dL)/neutrophil-to-lymphocyte ratio. The CXI cutoff according to tumor stage was determined based on a time-dependent receiver operating characteristic curve, and all patients were divided into low- and high-CXI groups.
Of 267 patients, 83 and 24 patients with limited-stage disease (LD) and 123 and 37 patients with extensive-stage disease (ED) were assigned to the high- and low-CXI groups, respectively. Only one of 24 patients (4.2%) with LD in the low-CXI group achieved a complete response (CR), whereas 30 of 83 patients (36.1%) with LD in the high-CXI group achieved CRs (p = 0.004). More low-CXI patients required early discontinuation of treatment because of treatment-related toxicity compared to the high-CXI patients (37.5% vs. 16.9%, respectively, p = 0.030, for LD patients; 27.0% vs. 11.4%, respectively, p = 0.019, for ED patients). The median progression-free survival (PFS) and overall survival (OS) were significantly shorter in the low-CXI group than the high-CXI group (6.3 vs. 11.1 months and 7.5 vs. 20.6 months, respectively, both p < 0.001 for LD patients; 2.9 vs. 6.3 months and 5.8 vs. 12.8 months, respectively, both p < 0.001, for ED patients). On multivariate analysis, low-CXI status was an independent poor prognostic factor for both PFS and OS regardless of the tumor stage.
A low CXI was associated with treatment intolerance, poor treatment response rate, and poor prognosis in SCLC.
癌症恶病质会使小细胞肺癌（SCLC）患者的治疗结果恶化。然而，目前还没有可靠的癌症恶病质生物标志物。
我们回顾性评估了接受诱导化疗或同步放化疗的男性 SCLC 患者。通过骨骼肌指数×血清白蛋白水平（g/dL）/中性粒细胞与淋巴细胞比值计算恶病质指数（CXI）。根据时间依赖性接收者操作特征曲线确定了根据肿瘤分期的 CXI 截止值，并将所有患者分为低 CXI 组和高 CXI 组。
在 267 例患者中，局限性疾病（LD）患者中 83 例和 24 例，广泛期疾病（ED）患者中 123 例和 37 例分别被分配到高 CXI 组和低 CXI 组。低 CXI 组的 24 例 LD 患者中仅有 1 例（4.2%）达到完全缓解（CR），而高 CXI 组的 83 例 LD 患者中有 30 例（36.1%）达到 CR（p=0.004）。与高 CXI 患者相比，低 CXI 患者因治疗相关毒性而需要提前停止治疗的患者更多（分别为 37.5%和 16.9%，p=0.030，用于 LD 患者；分别为 27.0%和 11.4%，p=0.019，用于 ED 患者）。低 CXI 组的中位无进展生存期（PFS）和总生存期（OS）明显短于高 CXI 组（分别为 6.3 个月和 11.1 个月，7.5 个月和 20.6 个月，均为 p<0.001，用于 LD 患者；分别为 2.9 个月和 6.3 个月，5.8 个月和 12.8 个月，均为 p<0.001，用于 ED 患者）。多变量分析显示，低 CXI 状态是 PFS 和 OS 的独立不良预后因素，与肿瘤分期无关。
低 CXI 与 SCLC 患者的治疗不耐受、治疗反应率低和预后不良相关。
