Lee Joongyo, Kim Kyung Hwan, Kim Jina, Lee Chang Geol, Cho Jaeho, Yoon Hong In, Cho Yeona
Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
Cancer Res Treat. 2025 Apr;57(2):422-433. doi: 10.4143/crt.2024.493. Epub 2024 Oct 30.
Sarcopenia is a poor prognostic factor in non-small cell lung cancer (NSCLC). However, its prognostic significance in patients with NSCLC receiving immune checkpoint inhibitors (ICIs) and its relationship with lymphopenia remain unclear. We aimed to investigate the prognostic role of sarcopenia and its effect on lymphocyte recovery in patients with stage III NSCLC treated with concurrent chemoradiotherapy (CCRT) followed by ICI.
We retrospectively evaluated 151 patients with stage III NSCLC who received definitive CCRT followed by maintenance ICI between January 2016 and June 2022. Sarcopenia was evaluated by measuring the skeletal muscle area at the L3 vertebra level using computed tomography scans. Lymphocyte level changes were assessed based on measurements taken before and during CCRT and at 1, 2, 3, 6, and 12 months post-CCRT completion.
Even after adjusting for baseline absolute lymphocyte count through propensity score-matching, patients with pre-radiotherapy (RT) sarcopenia (n=86) exhibited poor lymphocyte recovery and a significantly high incidence of grade ≥ 3 lymphopenia during CCRT. Pre-RT sarcopenia and grade ≥ 3 lymphopenia during CCRT emerged as prognostic factors for overall survival and progression-free survival, respectively. Concurrent chemotherapy dose adjustments, objective response after CCRT, and discontinuation of maintenance ICI were also analyzed as independent prognostic factors.
Our results demonstrated an association between pre-RT sarcopenia and poor survival, concurrent chemotherapy dose adjustments, and impaired lymphocyte recovery after definitive CCRT. Moreover, CCRT-induced lymphopenia not only contributed to poor prognosis but may have also impaired the therapeutic efficacy of subsequent maintenance ICI, ultimately worsening treatment outcomes.
肌肉减少症是非小细胞肺癌（NSCLC）的不良预后因素。然而，其在接受免疫检查点抑制剂（ICI）的NSCLC患者中的预后意义及其与淋巴细胞减少的关系仍不清楚。我们旨在研究肌肉减少症在接受同步放化疗（CCRT）后序贯ICI治疗的III期NSCLC患者中的预后作用及其对淋巴细胞恢复的影响。
我们回顾性评估了2016年1月至2022年6月期间接受根治性CCRT后序贯维持ICI治疗的151例III期NSCLC患者。通过计算机断层扫描测量L3椎体水平的骨骼肌面积来评估肌肉减少症。根据CCRT前、CCRT期间以及CCRT完成后1、2、3、6和12个月的测量结果评估淋巴细胞水平变化。
即使通过倾向评分匹配调整了基线绝对淋巴细胞计数，放疗前（RT）存在肌肉减少症的患者（n = 86）在CCRT期间仍表现出淋巴细胞恢复不良且≥3级淋巴细胞减少的发生率显著较高。放疗前肌肉减少症和CCRT期间≥3级淋巴细胞减少分别成为总生存期和无进展生存期的预后因素。同时还分析了同步化疗剂量调整、CCRT后的客观缓解情况以及维持ICI治疗的中断作为独立预后因素。
我们的结果表明，放疗前肌肉减少症与生存率低、同步化疗剂量调整以及根治性CCRT后淋巴细胞恢复受损之间存在关联。此外，CCRT引起的淋巴细胞减少不仅导致预后不良，还可能损害了后续维持ICI的治疗效果，最终使治疗结果恶化。
