Assessment of body composition and association with clinical outcomes in patients with lung and colorectal cancer.

Anisha Bhagwanani,Timothy JP Bray,Stuart Andrew Taylor,Margaret A Hall-Craggs,Naomi S Sakai

doi:10.1259/bjro.20210048

Abstract

Objectives:To assess body composition in patients with non-small cell lung cancer (NSCLC) and colorectal cancer using whole-body MRI and relate this to clinical outcomes.Methods:53 patients with NSCLC (28 males, 25 females; mean age 66.9) and 74 patients with colorectal cancer (42 males, 32 females; mean age 62.9) underwent staging whole-body MRI scans, which were post-processed to derive fat mass (FM), fat free mass (FFM) and skeletal muscle (SM) indices and SM fat fraction (FF). These were compared between the two cancer cohorts using two-sided t-tests and the chi-squared test. Measurements of body composition were correlated with outcomes including length of hospital stay, metastatic status and mortality.Results:Patients with NSCLC had significantly lower FFM (p = 0.0071) and SM (p = 0.0084) indices. Mean SM FF was greater in patients with NSCLC (p = 0.0124) and was associated with longer hospital stay (p = 0.035). There was no significant relationship between FM, FFM and SM indices and length of hospital stay, metastatic status or mortality.Conclusions:Patients with NSCLC had lower FFM and SM indices than patients with colorectal cancer and greater SMFF, indicating lower SM mass with fatty infiltration. These findings reflect differences in the phenotype of the two groups and suggest patients with lung cancer are more likely to require additional nutritional support.Advances in knowledge:Body composition differs between NSCLC and colorectal cancer. Patients with NSCLC have both a reduced SM mass and greater SM FF suggesting that they are more nutritionally deplete than patients with colorectal cancer.

Highlights

Patients with cancer are at high risk for malnutrition both as a result of the disease itself and the associated treatments
fat mass (FM) and fat free mass (FFM) were normalised for stature to derive the FM index and FFM index, respectively: ()
This study investigated the use of MRI to measure body composition in patients with colorectal cancer and non-s mall cell lung cancer (NSCLC) and the relation of body composition to clinical outcomes

Summary

Introduction

Patients with cancer are at high risk for malnutrition both as a result of the disease itself and the associated treatments. Malnutrition is defined as a state resulting from lack of intake or uptake of nutrition that leads to altered body composition, and it is known to result in poorer clinical outcomes from disease.[1] In patients with cancer, malnutrition results from both reduced food intake and metabolic disturbances, which are provoked by the activation of systemic inflammation.[1] The combination of loss of appetite and tissue breakdown leads to substantial loss of body weight, alterations in body composition and decreased functional capacity. It is estimated that 10–20% of deaths in patients with cancer are a result of malnutrition rather than the malignancy itself.[2,3] Change in body composition, the loss of skeletal muscle (with or without the loss of fat), is thought to be more important than weight loss in isolation. Whilst one in four patients with obesity are sarcopenic, the diagnosis is often overlooked given the elevated BMI.[12]

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