Abstract
BackgroundSarcopenia has been associated with poor survival among cancer patients. Normalized total psoas area (NTPA) has been used as a surrogate for defining sarcopenia. Few data exist characterizing the impact of sarcopenia and other metrics of fitness on clinical outcomes in patients with early-stage non-small cell lung cancer (NSCLC) treated non-invasively with stereotactic body radiotherapy (SBRT).MethodsTo assess the association between sarcopenia and clinical outcomes, we conducted a retrospective analysis of consecutive patients treated with SBRT from 2013 to 2019 . Overall survival (OS), local failure free survival (LFS), distant failure free survival (DFS), NTPA, body mass index (BMI), and Charlson comorbidity index (CCI) were included for analysis. NTPA was calculated by measuring the psoas volume at the L3 vertebra and normalizing for patient height and gender. Survival functions were evaluated using the Kaplan-Meier method. Log-rank test and Cox-proportional hazards were performed for categorical and continuous variables, respectively. Significance was set as p < 0.05.ResultsA total of 91 patients met the criteria. The median age was seven years and Karnofsky Performance Status score (KPS) was 80 (range: 60-100). Approximately 79% of patients had T1 tumors. Median radiation dose and number of fractions were 60 Gy (range: 45-60) and 5 fractions (range: 3-5). Median NTPA was 531.16 mm2/m2 (range: 90.4-1356.2). After normalization (sarcopenia: <385 mm2/m2, female; <585 mm2/m2, male), 39 patients (42.8%) had sarcopenia. NTPA had no association with OS (p = 0.7), LFS (p = 0.9), or DFS (p = 0.5). Increasing BMI was associated with improved OS (HR 0.90, 95% CI 0.83-0.98). With a median follow-up of 23.4 months, median OS was 60, 60, and 45.9 months (p = 0.37) in all patients, non-sarcopenic patients, and sarcopenic patients, respectively.ConclusionSarcopenia was not associated with OS, LFS, or DFS. Increasing BMI is associated with improved OS. Future, prospective work is needed to define the impact of sarcopenia and other fitness metrics on clinical outcomes among NSCLC patients treated non-invasively with SBRT.
Highlights
Lung cancer is the second most common malignancy in the United States, second only to prostate and breast cancer in men and women, respectively [1]
Normalized total psoas area (NTPA) had no association with overall survival (OS) (p = 0.7), local failure free survival (LFS) (p = 0.9), or distant failure free survival (DFS) (p = 0.5)
Given the lack of data regarding the role of sarcopenia and other metrics of fitness in patients with non-small cell lung cancer (NSCLC) treated non-invasively with stereotactic body radiotherapy (SBRT), we aimed to evaluate the potential role of sarcopenia, using normalized total psoas area (NTPA) as a surrogate prognostic factor in patients with NSCLC undergoing SBRT for definitive oncologic management
Summary
Lung cancer is the second most common malignancy in the United States, second only to prostate and breast cancer in men and women, respectively [1]. In addition to traditional risk factors, measures of overall fitness including sarcopenia and body mass index (BMI) have been associated with clinical outcomes in lung cancer patients [2]. Sarcopenia, partly defined as a loss of skeletal muscle mass, occurs as a natural part of the aging process [3]. This process is mainly determined by two factors: the initial amount of muscle mass and the rate of loss over time [4]. Medical conditions such as cancer can contribute to and accelerate muscle loss leading to sarcopenia. Few data exist characterizing the impact of sarcopenia and other metrics of fitness on clinical outcomes in patients with early-stage non-small cell lung cancer (NSCLC) treated non-invasively with stereotactic body radiotherapy (SBRT)
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