Abstract
BackgroundWhether muscle strength and physical performance should be components of sarcopenia remains controversial. This study evaluated the skeletal muscle index derived from computed tomography images at the 12th thoracic vertebra level (T12 SMI), handgrip strength, performance status, and their combination for predicting overall survival in patients with advanced non-small cell lung cancer.MethodsChest computed tomography, handgrip strength measurement, and bioelectrical impedance analysis were performed. Sarcopenia was defined based on the T12 SMI alone or the T12 SMI, handgrip, and/or physical performance (i.e. Asian Working Group for Sarcopenia [AWGS]-defined sarcopenia or severe sarcopenia).ResultsOverall, 639 participants were included; 488 (76.4%) died. At baseline, 160 (25.0%), 141 (22.1%), and 42 (6.6%) patients had computed tomography-defined sarcopenia, AWGS-defined sarcopenia, and AWGS-defined severe sarcopenia, respectively. Chest computed tomography-defined sarcopenia (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.65-2.43), AWGS-defined sarcopenia (HR, 2.00; 95% CI, 1.59-2.49), and AWGS-defined severe sarcopenia (HR, 3.01; 95% CI, 2.21-4.09) were more strongly associated with poor prognosis than a performance status score ≥2 (HR, 1.37; 95% CI, 1.10-1.73).ConclusionsAdding handgrip strength and the performance status score to chest computed tomography-defined sarcopenia improved its prognostic ability. Oncological sarcopenia research should focus on muscle mass, strength, and function.
Highlights
Sarcopenia is a skeletal muscle disorder characterized by a progressive and generalized loss of muscle quantity and quality [1]
We performed a priori subgroup analyses of multivariable Cox Models 1 and 2. Most of these analyses revealed that CTdefined sarcopenia, Asian Working Group for Sarcopenia (AWGS)-defined sarcopenia, and AWGSdefined severe sarcopenia were all significantly associated with poor prognosis (Figure 4)
We determined that Computed tomography (CT)-defined sarcopenia based on the T12 skeletal muscle index (T12 SMI) derived from a single-slice chest CT image was a Sarcopenia and Lung Cancer B
Summary
Sarcopenia is a skeletal muscle disorder characterized by a progressive and generalized loss of muscle quantity and quality [1]. Sarcopenia has become a major factor in the fields of oncological and geriatric research, several fundamental questions regarding sarcopenia remain unanswered [1]. There currently exist two major opinions about the definition of sarcopenia [7]. In the fields of geriatric and internal medicine, there is a consensus that sarcopenia should be defined based on low muscle mass, low muscle strength, and/or low physical performance [10, 11]. This knowledge gap regarding the definition of sarcopenia has hindered interdisciplinary cooperation [7]. This study evaluated the skeletal muscle index derived from computed tomography images at the 12th thoracic vertebra level (T12 SMI), handgrip strength, performance status, and their combination for predicting overall survival in patients with advanced non-small cell lung cancer
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