Bonomi Philip, Moudgalya Hita, Gomez Sandra L, Shah Palmi, Basu Sanjib, Batus Marta, Martinka Levi B, Abdelkader Ahmed, Tzameli Iphigenia, Cobain Sonia, Collins Susie, Keliher Edmund J, Breen Danna M, Calle Roberto A, Fidler Mary Jo, Borgia Jeffrey A
Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL, USA.
Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, USA.
J Cachexia Sarcopenia Muscle. 2024 Dec;15(6):2311-2322. doi: 10.1002/jcsm.13534. Epub 2024 Sep 17.
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.
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.
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.
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.
本研究的主要目的是评估两组未经治疗的真实世界晚期非小细胞肺癌（NSCLC）患者身体成分增加的频率及其与体重变化的关系。一组接受当前的标准治疗（CSOC），包括免疫治疗和更新的化疗方案，另一组接受以前的标准治疗（FSOC），仅包括较旧的含铂方案。
本研究纳入了CSOC组（n = 106）和FSOC组（n = 88）的晚期NSCLC患者。在每次临床就诊时收集体重，并通过自动分割软件对常规胸部计算机断层扫描进行身体成分分析，在基线以及6周和12周时进行评估。使用标准统计方法计算体重变化与身体成分变化之间的关系。
CSOC组包含106例IV期NSCLC患者，于2014年12月16日至2020年10月22日接受治疗，而FSOC组包含88例III/IV期NSCLC患者，于2006年6月16日至2014年11月18日接受治疗。虽然每组在6周和12周时间点的中位体重、体重指数（BMI）、平均骨骼肌指数（SMI）和皮下脂肪组织指数（SATI）均有所下降，但有一部分患者这些参数有所增加。在12周时间点，以体重、BMI、SMI和SATI增加≥2.5%为阈值，两组这些参数的增加情况相似（分别为20.5%和27.3%）。在12周随访时以增加≥5%为切点，8.0%至25.0%的患者体重、BMI、SMI和SATI增加≥5%。比较每组的这些结果显示无显著差异。6周和12周时体重变化与SMI和SATI变化的Pearson系数范围为0.31至0.58，所有P值<0.02。12周时体重变化与内脏脂肪组织指数（VATI）和肌间脂肪组织指数（IMATI）变化的Pearson系数范围为0.26至0.47，所有P值<0.05。比较每组的Pearson系数显示无显著差异。
虽然两组的中位体重、BMI、SMI和SATI均有所下降，但每组中这些参数增加的患者比例相似。这些发现，加上体重、肌肉量和脂肪组织纵向测量之间的正相关性，表明这些患者体重增加涉及肌肉量和脂肪组织的增加。经证实后，这些发现可能对临床试验设计和癌症恶病质的转化研究具有启示意义。
