Huang Zhifei, Guo Ziwen, Gao Bo, Li Shun, Yu Yaner, Zhu Shuangqiu, He Zelai, Chen Haiyan, Jiang Hao
Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China.
Joint Research Center for Regional Diseases of IHM, Bengbu Medical University, Bengbu, Anhui, China.
Front Nutr. 2025 Jul 1;12:1588391. doi: 10.3389/fnut.2025.1588391. eCollection 2025.
Metabolic and nutritional status are recognized as prognostic and predictive biomarkers in cancer treatment. However, there is limited research on oligometastatic non-small cell lung cancer (NSCLC) patients undergoing radiotherapy. We aimed to explore the independent and synergistic effects of body composition and immune-nutritional status on survival outcomes in these patients.
Patients with oligometastatic NSCLC who underwent radiotherapy between 2017 and 2022 were retrospectively included. The evaluated outcomes were overall survival (OS) and progression-free survival (PFS). The skeletal muscle index (SMI), subcutaneous fat index (SFI), and pericardial fat index (PFI) were obtained using computed tomography (CT) and normalized by height squared. Laboratory biomarkers were utilized to assess immune-nutritional status. Univariate chi-square tests and multivariate logistic regression analyses were employed to determine correlations between hematological parameters and body composition. We conducted K-M analyses, along with univariate and multivariate Cox regression analyses to evaluate survival outcomes.
102 patients [mean age 61.44 years, 51 males (50%)] were included. Compared to non-responders, responders exhibited a significantly lower prevalence of sarcopenia (44.93 vs. 55.07%, = 0.007) and demonstrated relatively better immune-nutritional scores. Logistic regression analyses revealed that a low Prognostic Nutritional Index (PNI) was a risk factor for SMI, SFI, and PFI. Multivariate Cox analyses revealed that C reactive protein-to-albumin ratio (CAR) (HR = 0.26; 95% CI 0.11-0.61; = 0.002) and PFI (HR = 2.73; 95% CI 1.06-7.01; = 0.037) were predictive factors for OS. CAR (HR = 0.34, = 0.001) and SFI (HR = 1.82, = 0.049) were independent prognostic markers for PFS. K-M analyses indicated that the group with high PNI and high SFI exhibited markedly improved OS and PFS, as well as the one with high PNI and without sarcopenia ( < 0.001).
Among oligometastatic NSCLC patients receiving radiotherapy, higher skeletal muscle and fat content, along with better immune-nutritional status, correlated with improved survival outcomes.
代谢和营养状况被认为是癌症治疗中的预后和预测生物标志物。然而，对于接受放疗的寡转移非小细胞肺癌（NSCLC）患者的研究有限。我们旨在探讨身体成分和免疫营养状况对这些患者生存结局的独立和协同作用。
回顾性纳入2017年至2022年间接受放疗的寡转移NSCLC患者。评估的结局为总生存期（OS）和无进展生存期（PFS）。使用计算机断层扫描（CT）获得骨骼肌指数（SMI）、皮下脂肪指数（SFI）和心包脂肪指数（PFI），并按身高平方进行标准化。利用实验室生物标志物评估免疫营养状况。采用单因素卡方检验和多因素逻辑回归分析确定血液学参数与身体成分之间的相关性。我们进行了K-M分析，以及单因素和多因素Cox回归分析以评估生存结局。
纳入102例患者[平均年龄61.44岁，男性51例（50%）]。与无反应者相比，有反应者的肌肉减少症患病率显著较低（44.93%对55.07%，P = 0.007），且免疫营养评分相对较好。逻辑回归分析显示，低预后营养指数（PNI）是SMI、SFI和PFI的危险因素。多因素Cox分析显示，C反应蛋白与白蛋白比值（CAR）（HR = 0.26；95%CI 0.11 - 0.61；P = 0.002）和PFI（HR = 2.73；95%CI 1.06 - 7.01；P = 0.037）是OS的预测因素。CAR（HR = 0.34，P = 0.001）和SFI（HR = 1.82，P = 0.049）是PFS的独立预后标志物。K-M分析表明，高PNI和高SFI组以及高PNI且无肌肉减少症组的OS和PFS均显著改善（P < 0.001）。
在接受放疗的寡转移NSCLC患者中，较高的骨骼肌和脂肪含量以及较好的免疫营养状况与改善的生存结局相关。
