Abstract
The aim of this study was to examine the relationship between PET-CT derived tumour glucose uptake as measured by maximum standard glucose uptake (SUVmax) and total lesion glycolysis (TLG), nutritional risk as measured by the malnutrition universal screening tool (MUST), CT derived body composition as measured by skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD), the systemic inflammatory response as measured by the modified Glasgow prognostic score (mGPS) and the neutrophil to lymphocyte ratio (NLR) and survival in patients with lung cancer, treated with radiotherapy. In a retrospective cohort study, 119 patients were included in final analyses. The majority of patients were over 65 (86%), female (52%), had a performance status (ECOG-PS) of 0 or 1 (57%), were at nutritional risk (57%), were overweight (53%), had visceral obesity (62%), had a normal SMI (51%), had a low SMD (62%) and were systemically inflammed (mGPS 1/2, 51%). An elevated TLG was associated with sex (p < 0.05), TNM stage (p < 0.001), MUST (p < 0.01) and mGPS (p < 0.01). An elevated mGPS was associated with age (p < 0.05), NLR (p < 0.01), MUST (p < 0.01), and TLG (p < 0.01). On univariate survival analysis, TNM stage (p < 0.01), mGPS (p < 0.05), NLR (p < 0.01), MUST (p ≤ 0.001), Low SMD (p < 0.05), SUVmax (p ≤ 0.001) and TLG (p < 0.001) were associated with overall survival. On multivariate survival analysis MUST (HR: 1.49 95%CI 1.12–01.98 p < 0.01) and TLG (HR: 2.02 95%CI 1.34–3.04 p = 0.001) remained independently associated with survival. In conclusion, elevated tumour metabolic activity was associated with more advanced stage, greater nutritional risk, the systemic inflammatory response and poorer survival but not body composition analysis in patients with lung cancer. These results suggest that detrimental body composition is not directly determined by tumour metabolic activity but rather an ongoing systemic inflammatory response.
Highlights
Cancer remains one of the leading causes of mortality worldwide and is responsible for approximately 8.8 million deaths per year[1]
It has been reported that skeletal muscle index (SMI) and skeletal muscle density (SMD) are inversely associated with measures of the systemic inflammatory response such as the neutrophil lymphocyte ratio (NLR) and modified Glasgow Prognostic Score[9,20,21,22,23,24,25,26]
All patients with clinically confirmed non metastatic lung cancer treated with radical radiotherapy in North Glasgow between June 2008 and December 2012, who underwent staging CT and 18F FDGPETCT imaging prior to their treatment at the Beatson Oncology Centre, Glasgow were included in the study
Summary
Cancer remains one of the leading causes of mortality worldwide and is responsible for approximately 8.8 million deaths per year[1]. The basis of the progressive nutritional and functional decline (often termed cachexia) in these patients is not clear This cachexia was considered to be due to the increased metabolic activity of the tumour (including the micro environment). It is possible to examine the metabolic activity of lung tumours with total lesion glycolysis (TLG) using clinically available Positron Emission Tomography (PET) to examine the uptake of glucose using the tracer 18F-2fluoro-2-deoxy-d-glucose (18FDG)[12]. It has been reported that SMI and SMD are inversely associated with measures of the systemic inflammatory response such as the neutrophil lymphocyte ratio (NLR) and modified Glasgow Prognostic Score (mGPS)[9,20,21,22,23,24,25,26]. Both the NLR and mGPS have been shown to be prognostic in patients with both operable and inoperable c ancers[15,16]
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