Snoke Deena B, Atwood Gary S, Bellefleur Emma R, Stokes Alice M, Toth Michael J
Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, United States.
Dana Health Sciences Library, University of Vermont, Burlington, Vermont, United States.
Am J Physiol Cell Physiol. 2025 Mar 1;328(3):C872-C886. doi: 10.1152/ajpcell.01048.2024. Epub 2025 Jan 31.
Most patients with lung cancer experience cancer cachexia (CC), a syndrome of skeletal muscle and adipose tissue wasting. Knowledge of body composition changes in patients is limited, however, because most studies have been cross-sectional, comparing patients with noncancer controls or patients with and without CC. Few studies, in contrast, have evaluated body composition in patients with lung cancer over time. This review examines our current understanding of longitudinal body composition changes in patients with lung cancer and identifies modifying factors contributing to variation in muscle and adipose tissue wasting, focusing on biological sex. We identified 32 studies conducting longitudinal measurements of body composition by computed tomography, bioelectrical impedance, dual X-ray absorptiometry, or total body nitrogen, with a total of = 3,951 patients (35% female). All studies evaluated changes following diagnosis while patients were receiving treatment. Most studies reporting muscle-specific outcomes show decreased skeletal muscle mass, with more pronounced muscle wasting in males and male-enriched populations. In a small number of studies reporting muscle density, the majority show increased myosteatosis. Adiposity changes are less frequently reported, although wasting appears more prevalent in late-stage disease. Further studies are needed to define adipose changes along the lung cancer continuum. Our review emphasizes the need for balanced recruitment based on biological sex and sex-based analyses. In addition, consensus reporting of relevant patient data and outcomes in future studies will allow for meta-analysis and assist in the development of effective treatments for lung CC.
大多数肺癌患者会经历癌症恶病质（CC），这是一种骨骼肌和脂肪组织消耗的综合征。然而，关于患者身体成分变化的了解有限，因为大多数研究都是横断面研究，比较癌症患者与非癌症对照者或有CC和无CC的患者。相比之下，很少有研究评估肺癌患者随时间推移的身体成分。本综述探讨了我们目前对肺癌患者身体成分纵向变化的理解，并确定了导致肌肉和脂肪组织消耗差异的调节因素，重点关注生物性别。我们确定了32项通过计算机断层扫描、生物电阻抗、双能X线吸收法或全身氮含量对身体成分进行纵向测量的研究，共有3951名患者（35%为女性）。所有研究均评估了患者在接受治疗时诊断后的变化。大多数报告肌肉特异性结果的研究显示骨骼肌质量下降，男性和男性占多数的人群中肌肉消耗更为明显。在少数报告肌肉密度的研究中，大多数显示肌脂肪变性增加。虽然晚期疾病中脂肪消耗似乎更为普遍，但肥胖变化的报告较少。需要进一步研究来确定肺癌病程中脂肪的变化。我们的综述强调了基于生物性别进行均衡招募和基于性别的分析的必要性。此外，未来研究中对相关患者数据和结果进行共识报告将有助于进行荟萃分析，并协助开发针对肺癌CC的有效治疗方法。
