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    Histologic subtypes are not associated with the presence of sarcopenia in lung cancer. Kim Chang Rae,Kim Eun Young,Kim Young Saing,Ahn Hee Kyung,Kim Kun Woo,Jeong Yu Mi,Kim Jeong Ho PloS one BACKGROUND:Sarcopenia is prevalent and a known adverse prognostic effector in lung cancer (LCA). However, the relationship between sarcopenia and histology remains uncertain in LCA. METHODS:Consecutive patients with newly diagnosed LCA (n = 778) between June 2012 and February 2015 were retrospectively reviewed to identify factors associated with sarcopenia. Sarcopenia was defined as CT-determined L3 muscle index (muscle area at L3/height2) of < 55 cm2/m2 for men and < 39 cm2/m2 for women. RESULTS:Mean patient age was 67.7 ± 10.8 years, and most (73.1%) were male. The most prevalent histology was adenocarcinoma (44.0%) and 71.6% of patients had stage III or IV disease. The overall prevalence of sarcopenia was 48.2% (60.3% in men, and 15.3% in women). Univariable analysis showed sarcopenia was significantly associated with male gender, age (≥ 65 years), smoking status, lower BMI (< 23 kg/m2), advanced stage (III and IV), and high comorbidity score (Charlson index ≥ 3). Furthermore, the prevalence of sarcopenia was higher in squamous cell carcinoma (54.9%) and small cell LCA (56.4%) than in adenocarcinoma (39.8%). Multivariable analyses showed sarcopenia was independently associated with a male gender (odds ratio [OR], 11.13), elderly (OR, 2.02) and low BMI (OR, 6.28), stage IV (OR, 1.98), and high comorbidity (OR, 1.93). However, no significant association was found between histologic subtypes and sarcopenia. CONCLUSIONS:Sarcopenia was found to be significantly associated with old age, male gender, an advanced stage, comorbidities, and low BMI in LCA. However, histology subtype was not an independent factor for the presence of sarcopenia. 10.1371/journal.pone.0194626
    Sarcopenia and inflammation are independent predictors of survival in male patients newly diagnosed with small cell lung cancer. Go Se-Il,Park Mi Jung,Song Haa-Na,Kang Myoung Hee,Park Hee Jung,Jeon Kyung Nyeo,Kim Seok-Hyun,Kim Moon Jin,Kang Jung-Hun,Lee Gyeong-Won Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer PURPOSE:Sarcopenia is suggested to be associated with cancer-related inflammation. We assessed the clinical outcome of small cell lung cancer (SCLC) patients according to sarcopenia and the neutrophil-to-lymphocyte ratio (NLR). METHODS:A total of 117 male SCLC patients treated with first-line chemo- or chemoradiotherapy were assessed based on a retrospective chart review. The mass of the pectoralis muscle was measured by computed tomography and normalized to height. Patients with the lowest quartile of muscle mass were considered to have sarcopenia. Patients were classified into four groups according to their sarcopenia and NLR statuses: sarcopenia/high NLR, sarcopenia/low NLR, non-sarcopenia/high NLR, and non-sarcopenia/low NLR. RESULTS:Sarcopenic patients had lower progression-free survival (PFS) than did non-sarcopenic patients (median 6.0 vs. 7.5 months, p = 0.009), but the difference in overall survival (OS) was not statistically significant (median 10.5 vs. 13.5 months, p = 0.052). However, the OS of sarcopenic patients with high NLR was significantly lower than that in all other groups (median 3.2 vs. 16.0 vs. 12.5 vs. 13.7 months, respectively, p < 0.001), as was PFS (median 3.2 vs. 7.7 vs. 7.6 vs. 7.1 months, respectively, p < 0.001). On multivariate analysis, sarcopenia with high NLR was an independent prognostic factor for shorter PFS and OS. Early discontinuation of treatment (20.0 vs. 10.3 %) and treatment-related mortality (50.0 vs. 8.4 %) occurred more frequently in these patients than in the other groups (p < 0.001). CONCLUSIONS:In SCLC, sarcopenic male patients with high NLR have a poor prognosis and do not tolerate standard treatment. Intensive supportive care is needed in these patients. 10.1007/s00520-015-2997-x
    Relationship Between Preoperative Sarcopenia Status and Immuno-nutritional Parameters in Patients with Early-stage Non-small Cell Lung Cancer. Shoji Fumihiro,Matsubara Taichi,Kozuma Yuka,Haratake Naoki,Akamine Takaki,Takamori Shinkichi,Katsura Masakazu,Toyokawa Gouji,Okamoto Tatsuro,Maehara Yoshihiko Anticancer research BACKGROUND:Although the skeletal muscle in the region of the third lumbar vertebra (L3) is generally assessed in order to judge sarcopenia, not every patient with non-small cell lung cancer (NSCLC) undergoes computed tomography including the L3 region. We hypothesized that immuno-nutritional parameters could predict the existence of sarcopenia in patients with NSCLC. AIM:The aim of this study was to retrospectively investigate the correlation between preoperative sarcopenia and immuno-nutritional parameters in patients with early-stage NSCLC. PATIENTS AND METHODS:We selected 147 of patients with pathological stage I NSCLC who underwent preoperative measurement of immuno-nutritional parameters and CT including the L3 region. RESULTS:Preoperative sarcopenia was significantly associated with female gender (p=0.0003) and poor prognosis (p=0.0322). In Kaplan-Meier analysis of overall survival (OS) by preoperative sarcopenia status, the sarcopenic group had significantly shorter OS than the non-sarcopenic group (5-year OS: 87.27% vs. 77.37%, p=0.0131, log-rank test). In multivariate analysis, the preoperative sarcopenia status (hazard ratio=5.138; 95% confidence interval=2.305-11.676; p<0.0001) was an independent prognostic factor. Preoperative sarcopenia status was significantly related to controlling nutritional status score (p=0.0071) and Geriatric Nutritional Risk Index (GNRI) (p<0.0001). Spearman's correlation test showed good significant correlation between preoperative sarcopenia status and GNRI (r=0.348, p<0.0001). CONCLUSION:The preoperative GNRI is a simple and useful predictor for existence of preoperative sarcopenia which was associated with poor outcome in patients with early-stage NSCLC. 10.21873/anticanres.12168
    The value of physical performance measurements alongside assessment of sarcopenia in predicting receipt and completion of planned treatment in non-small cell lung cancer: an observational exploratory study. Collins Jemima T,Noble Simon,Chester John,Davies Helen E,Evans William D,Farewell Daniel,Lester Jason F,Parry Diane,Pettit Rebecca,Byrne Anthony Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer INTRODUCTION:The presence of muscle mass depletion is associated with poor outcomes and survival in cancer. Alongside muscle mass, assessment of muscle strength or physical performance is essential for the diagnosis of sarcopenia. Non-small cell lung cancer (NSCLC) is a prevalent form of cancer with high mortality, and Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) is commonly used to assess patients' suitability for treatment. However, a significant proportion of patients with good PS are unable to complete multidisciplinary team (MDT)-planned treatment. Little is known about the ability of objective measurements of physical performance in predicting patients' ability to complete MDT-planned treatment and outcomes in NSCLC. OBJECTIVES:We sought to establish whether physical performance, utilising the short physical performance battery (SPPB), alongside muscle mass measurements, was able to predict receipt and completion of MDT-planned treatment, with a focus on chemotherapy in NSCLC. MATERIALS AND METHODS:Participants with NSCLC treated through a single lung cancer MDT and ECOG PS 0-2 were recruited and the following assessed: body composition [bioelectrical impedance (BIA) and whole body dual-energy X-ray absorptiometry (DXA) in a subset], physical performance (SPPB), PS and nutritional status. We recorded receipt and completion of chemotherapy, as well as any adverse effects, hospitalisations, and treatment delays. RESULTS:We included a total of 62 participants with NSCLC, and in 26 of these, the MDT-planned treatment was chemotherapy. Participants with earlier stage disease and weight loss of <10% were more likely to complete MDT-planned treatment (p < 0.001 and p < 0.05). Patients with a higher total SPPB score were more likely to complete more cycles of chemotherapy as well as the full course. Quicker gait speeds and sit-to-stand times were associated with completion of three or more cycles of chemotherapy (all p < 0.05). For every unit increase in SPPB score, there was a 28.2% decrease in adverse events, hospitalisations and delays of chemotherapy (incidence rate ratio 0.718, p = 0.001), whilst ECOG PS showed no correlation with these outcomes. CONCLUSION:Assessing physical performance by SPPB is quick and simple to do in clinical settings and may give better indication of likely chemotherapy treatment course completion than muscle mass alone and ECOG PS. In turn, this may identify specific targets for early functional intervention and impact on MDT decision-making and prudent use of resources. 10.1007/s00520-017-3821-6
    Evaluation of sarcopenia in small-cell lung cancer patients by routine chest CT. Kim Eun Young,Kim Young Saing,Park Inkeun,Ahn Hee Kyung,Cho Eun Kyung,Jeong Yu Mi,Kim Jeong Ho Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer BACKGROUND:Single cross-sectional area of muscle at the third lumbar vertebra (L3MA) is gold standard to estimate skeletal muscle mass (SMM), and L3 muscle index (L3MI, L3MA/height(2)) is used to determine sarcopenia. The purposes of this study were to evaluate the relationship between SMM indices determined by routine chest CT and L3MI in patients with small-cell lung cancer (SCLC) and to suggest chest CT-derived diagnostic criteria for sarcopenia. METHODS:Area of pectoralis muscles at the aortic arch (PMA) and at L1 (L1MA) was retrospectively measured on chest CT images of 90 consecutive SCLC patients. Pearson's correlation and multiple linear regression analysis were used to assess relationships between L3MI determined by PET/CT and pectoralis muscle index (PMI) and L1 muscle index (L1MI) determined by chest CT. RESULTS:The correlation between L1MI and L3MI was stronger than that between PMI and L3MI (r = 0.851 vs. r = 0.447, p < 0.001). Multivariable regression analysis showed that L1MI was the only significant predictor of L3MI; L3MI = 0.963 × L1MI + 10.336 (R (2)  = 0.689, p < 0.001) for male and L3MI = 0.772 × L1MI + 16.518 (R (2)  = 0.777, p < 0.001) for female. Using this relationship, estimated cutoffs of L1MI for sarcopenia were 46 cm(2)/m(2) for male and 29 cm(2)/m(2) for female (L3MI cutoffs for sarcopenia are 55 cm(2)/m(2) for male and 39 cm(2)/m(2) for female). The sensitivity and specificity of L1MI cutoffs to determine sarcopenia were 98.2 and 100 %, respectively. CONCLUSIONS:Chest CT-determined L1MI is highly correlated with L3MI in SCLC patients. L1MI, as determined by chest CT, could be used to determine the presence of sarcopenia with suggested cutoffs of 46 cm(2)/m(2) for men and 29 cm(2)/m(2) for women. 10.1007/s00520-016-3321-0
    Cancer cachexia, sarcopenia and biochemical markers in patients with advanced non-small cell lung cancer-chemotherapy toxicity and prognostic value. Srdic Drazena,Plestina Sanja,Sverko-Peternac Ana,Nikolac Nora,Simundic Ana-Maria,Samarzija Miroslav Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer PURPOSE:Cancer cachexia and sarcopenia are frequently observed in cancer patients and associated with poor survival. The majority of studies of cancer cachexia and sarcopenia have been done in patients with solid tumors of different origins, and there are currently no good predictors of the benefit of chemotherapy or factors that predict survival in advanced cancer. The purpose of our prospective study was to evaluate prevalence of cachexia and sarcopenia using international consensus definition and criteria for diagnosis in patients with diagnosed advanced non-small cell lung cancer (NSCLC) stage IIIB and IV and their relation to chemotherapy toxicity and survival prediction. A secondary aim was to compare several biochemical markers (CRP, IL-6, protein, and albumin) with time to tumor progression in order to assess prognostic value or to guide a treatment. METHODS:Between December 2013 and April 2015, the prospective cohort study of 100 Caucasian patients with advanced NSCLC stage IIIB or IV, who were referred consecutively to Department for Respiratory Diseases "Jordanovac," was evaluated. Anthropometric measurements and biochemical data (CRP, albumin, protein, IL-6, haemoglobin) together with body composition measurements (total muscle cross-sectional area, lumbar skeletal muscle index) were obtained for each patient before starting with platinum-doublet therapy. Skeletal muscle cross-sectional area at the third lumbar vertebra was measured by computerized tomography, and sarcopenia was defined using a previously published cutoff point. Toxicity was assessed after cycle 1 of treatment and time-to-tumor progression was determined prospectively. RESULTS:One hundred patients with advanced lung cancer were recruited: 67 were male and median age was 64 years. The median time to disease progression was 187 days. The prevalence of cachexia and sarcopenia in study cohort was 69 and 47 %, respectively. CRP, IL-6, and albumin concentration in cachectic compared to non-cachectic patients demonstrated statistically significant difference (p = 0.020, p = 0.040, p = 0.003). Cachexia and sarcopenia were not found to be predictors of chemotoxicity nor was time to tumor progression. On the contrary, albumin concentration with established cutoff point of 37.5 g/L was clearly proved as the predictive factor of both chemotoxicity (OR (95 % CI) = 0.85; p < 0.001) and survival (HR (95 % CI) = 0.55). CONCLUSIONS:Albumin level has been shown to be more important predictive marker of chemotherapy toxicity and survival than cachexia and sarcopenia are. This approach in clinical settings can be used to guide the choice of oncologic treatment. 10.1007/s00520-016-3287-y
    Does sarcopenia affect outcome in patients with non-small-cell lung cancer harboring EGFR mutations? Rossi Sabrina,Di Noia Vincenzo,Tonetti Laura,Strippoli Antonia,Basso Michele,Schinzari Giovanni,Cassano Alessandra,Leone Antonio,Barone Carlo,D'Argento Ettore Future oncology (London, England) AIM:To evaluate gefitinib outcomes in EGFR-mutated non-small-cell lung cancer (NSCLC) patients harboring EGFR mutations, according to their sarcopenia status. PATIENTS & METHODS:We retrospectively evaluated 33 patients with advanced NSCLC and EGFR mutations (exon 19 or 21), dividing them into sarcopenic patients, with low skeletal muscle index ≤39 cm/m for women and ≤55 cm/m for men, and nonsarcopenic patients. RESULTS:Sarcopenia does not affect response to gefitinib treatment in EGFR mutated NSCLC patients, even if it is a bad prognostic indicator for overall survival (p = 0.035). CONCLUSION:Early recognition of sarcopenia is beneficial for prevention of cancer cachexia and detection of patients at potential risk of serious adverse events. Gefitinib dosage should be reduced and modulated in sarcopenic patients. 10.2217/fon-2017-0499
    Sarcopenia is an independent unfavorable prognostic factor of non-small cell lung cancer after surgical resection: A comprehensive systematic review and meta-analysis. Deng Han-Yu,Hou Liang,Zha Panpan,Huang Kai-Li,Peng Lei European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology BACKGROUND:Whether sarcopenia has any impact on long-term survival of patients with surgically treated non-small cell lung cancer (NSCLC) remains unclear. We conducted a meta-analysis focusing on current topic comprehensively for the first time. METHODS:We systematically searched relevant studies in PubMed, Embase, and Cochrane Library up to July 3, 2018. Data of 5-year overall survival (OS) and disease-free survival (DFS) rates as well as hazard ratio (HR) of OS were collected for analysis by using the STATA 12.0 package. RESULTS:A total of 6 cohort studies consisting of 1213 patients (422 patients with sarcopenia and 791 patients without) were included for analysis. Meta-analysis showed that patients with sarcopenia had a significantly lower 5-year OS rate (risk ratio (RR) = 1.63; 95% confidence interval (CI) = [1.13, 2.33]; P = 0.008) than those without, which was more prominent in patients with early-stage NSCLC. Sarcopenia was found to be an independent predictor of poor OS in patients with surgically treated NSCLC (HR = 2.85; 95%CI = [1.67, 4.86]; P < 0.001). With a limited sample size, there was no sufficient evidence of significantly different 5-year DFS rate between the two groups (RR = 1.14; 95%CI = [0.59, 2.17]; P = 0.70). However, in the subgroup of patients with early-stage NSCLC, sarcopenia was associated with a significantly lower 5-year DFS rate (RR = 1.59; 95%CI = [1.01, 2.52]; P = 0.046). CONCLUSION:Patients with sarcopenia had a significantly worse prognosis than those without after surgical resection of NSCLC especially in those at early stage. Sarcopenia is an independent unfavorable prognostic factor for patients with surgically treated NSCLC. (246 words). 10.1016/j.ejso.2018.09.026
    Impact of sarcopenia in patients with advanced non-small cell lung cancer treated with PD-1 inhibitors: A preliminary retrospective study. Shiroyama Takayuki,Nagatomo Izumi,Koyama Shohei,Hirata Haruhiko,Nishida Sumiyuki,Miyake Kotaro,Fukushima Kiyoharu,Shirai Yuya,Mitsui Yuichi,Takata So,Masuhiro Kentaro,Yaga Moto,Iwahori Kota,Takeda Yoshito,Kida Hiroshi,Kumanogoh Atsushi Scientific reports The aim of this study was to investigate the clinical impact of sarcopenia on the efficacy of programmed death (PD)-1 inhibitors. We retrospectively reviewed the medical records of all patients treated with nivolumab or pembrolizumab between January 2016 and September 2018 for previously treated advanced non-small cell lung cancer (NSCLC). The cross-sectional area of the psoas muscle at the level of the third lumbar vertebra on baseline computed tomography was assessed to calculate the psoas muscle index (PMI). Sarcopenia was defined based on PMI cut-off values for Asian adults (6.36 cm/m for males and 3.92 cm/m for females). A total of 42 patients were analysed. The prevalence of sarcopenia was 52.4%. Sarcopenia was significantly associated with poorer progression-free survival (PFS) (median, 2.1 vs. 6.8 months, p = 0.004). Compared to patients with sarcopenia, those without sarcopenia had a higher overall response rate (40.0% vs. 9.1%, p = 0.025) and 1-year PFS rate (38.1% vs. 10.1%). In conclusion, sarcopenia at baseline as determined using computed tomography is a significant predictor of worse outcome in patients with advanced NSCLC receiving PD-1 blockade. Screening for sarcopenia may help identify patients more likely to achieve a long-term response in routine clinical practice. 10.1038/s41598-019-39120-6
    Enhancing evaluation of sarcopenia in patients with non-small cell lung cancer (NSCLC) by assessing skeletal muscle index (SMI) at the first lumbar (L1) level on routine chest computed tomography (CT). Recio-Boiles Alejandro,Galeas Jose N,Goldwasser Bernard,Sanchez Karla,Man Louise M W,Gentzler Ryan D,Gildersleeve Jane,Hollen Patricia J,Gralla Richard J Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer PURPOSE:Ongoing cancer cachexia trials evaluate sarcopenia by skeletal muscle index (SMI) at the L3 vertebrae level, commonly used as a standard. Routine chest CT institutional protocols widely differ in including L3. We investigated whether SMI at L1 assessment, rather than L3, would be reliable and more practicable for non-small cell lung cancer (NSCLC). METHODS:NSCLC patients with routine CT chest had SMI measurements performed at L1 using Slice-O-Matic software. Accuracy of including L1 level, imaging quality, and ability to detect sarcopenia was collected and correlation of L1 SMI with body mass index (BMI) was performed. RESULTS:Thirty-seven patients with NSCLC (73 CT assessments) were enlisted at three institutions. Characteristics: 47% female; medians: age 59, KPS 80%; BMI 25.49, weight 72.97 kg, SMI 59.24. Sarcopenia was detected in 14.7% of patients; 20% had sarcopenic obesity. Of the 73 CTs, 94.5% included L1 (95% CI 86.6-98.5%). Three images (4%) were difficult to evaluate. Inclusion of L1 was similar among the three participating institutions (90.4 to 96.7% inclusion). BMI correlation with SMI was weak (r = 0.329). CONCLUSIONS:SMI assessment at L1 is achievable in patients with NSCLC receiving routine chest CT, with 96% having acceptable quality evaluations. Similar to results previously reported at L3, BMI showed poor correlation and low sensitivity to detect muscle mass loss. The use of CT at L1 is reliable and presents the opportunity for easier patient evaluation of sarcopenia in patients with lung cancer without the need for additional testing or radiation exposure. 10.1007/s00520-018-4051-2
    Clinical implications of sarcopenia in patients undergoing complete resection for early non-small cell lung cancer. Suzuki Yuzo,Okamoto Tatsuro,Fujishita Takatoshi,Katsura Masakazu,Akamine Takaki,Takamori Shinkichi,Morodomi Yosuke,Tagawa Tetsuzo,Shoji Fumihiro,Maehara Yoshihiko Lung cancer (Amsterdam, Netherlands) OBJECTIVES:Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength. We aimed to investigate sarcopenia in patients with stage I non-small cell lung cancer (NSCLC) who underwent complete resection, and the relationship of sarcopenia with clinicopathological factors. METHODS:All consecutive patients who underwent lung resection between January 2005 and December 2008 were enrolled in this retrospective study. Eligible patients were assigned to one of 2 groups according to the presence or absence of sarcopenia, as assessed by the sum of cross-sectional areas of skeletal muscles in the region of the third lumbar vertebra (L3) on preoperative computed tomography (CT). RESULTS:Sixteen of 52 male (30.8%) and 22 of 38 female (57.9%) patients were identified with sarcopenia (p=0.01). Patients with sarcopenia were more likely to have a low body mass index (BMI) (p<0.0001). Kaplan-Meier analysis showed that patients with sarcopenia had a significantly worse outcome than patients without sarcopenia (5-year-survival: 72.8% vs 85.8%, respectively, p=0.028). Multivariate analysis found that sarcopenia was a significant independent prognostic factor (hazard ratio: 7.09, p=0.0008). CONCLUSIONS:Sarcopenia identified on a cross-sectional CT image of the L3 level was associated with poor outcome with completely resected early-stage NSCLC. 10.1016/j.lungcan.2016.08.007
    Preoperative Computed Tomography-Determined Sarcopenia and Postoperative Outcome After Surgery for Non-Small Cell Lung Cancer. Kim E Y,Lee H Y,Kim K W,Lee J-I,Kim Y S,Choi W-J,Kim J H Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society BACKGROUND:Sarcopenia, reduced skeletal muscle mass, is associated with frailty, injuries, and mortality. The purpose of this study was to evaluate the impact of computed tomography-determined sarcopenia on surgical complications and outcomes after resection of non-small cell lung cancer. METHODS:For a total 272 non-small cell lung cancer patients that underwent surgery between 2011 and 2016, cross-sectional area of muscle at the third lumbar vertebra (L3) was retrospectively measured using preoperative chest computed tomography images. Sarcopenia was defined as an L3 muscle index of <55 cm/m for men and of <39 cm/m for women. Clinical characteristics, postoperative complications, disease-free survival, and overall survival of patients with or without sarcopenia were compared. RESULTS:A total of 60.3% ( n = 164) were male, and mean patient age was 62.9 ± 9.6 years. The prevalence of sarcopenia was 22.4% for all study subjects, 32.9% for men, and 6.5% for women. No significant difference was observed between patients with or without sarcopenia in terms of intensive care unit or hospital stay ( p = 0.502 and p = 0.378, respectively), and the presence of sarcopenia was not associated with postoperative complications. Furthermore, no significant difference was observed between the 3-year disease-free survival rate (74.3% vs 66.7%, p = 0.639) or 3-year overall survival rate (83.9% vs 87.7%, p = 0.563) of patients with or without sarcopenia. CONCLUSION:Sarcopenia as determined by preoperative computed tomography does not appear to have a negative impact on surgical outcome or overall survival for resected non-small cell lung cancer patients. 10.1177/1457496917748221
    Does sarcopenia have any impact on survival of patients with surgically treated non-small-cell lung cancer? Deng Han-Yu,Zha Panpan,Hou Liang,Huang Kai-Li Interactive cardiovascular and thoracic surgery A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Does sarcopenia have any impact on survival of patients with surgically treated non-small-cell lung cancer (NSCLC)?'. Altogether, 342 papers were found using the reported search, of which 9 cohort studies represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Eight of the studies measured skeletal muscle or total psoas cross-sectional area at the level of the first or third lumbar vertebra normalized for the square of height for defining sarcopenia, while 1 study used absolute measurement of total psoas cross-sectional area. Seven of 8 studies looking at overall survival found that patients with sarcopenia had significantly worse overall survival than those without after surgical resection of NSCLC, while 1 failed to show a difference. Five studies reported disease-free survival, with 3 studies showing no difference and 2 showing that patients with sarcopenia had a significantly worse disease-free survival than those without. One study found that sarcopenia was a predictor of early recurrence in NSCLC patient after surgical resection. Therefore, we conclude that sarcopenia could serve as a predictor of poor prognosis of patients with surgically treated NSCLC. 10.1093/icvts/ivz039
    Positive correlation between sarcopenia and elevation of neutrophil/lymphocyte ratio in pathological stage IIIA (N2-positive) non-small cell lung cancer patients. Tsukioka Takuma,Izumi Nobuhiro,Mizuguchi Shinjiro,Kyukwang Chung,Komatsu Hiroaki,Toda Michihito,Hara Kantaro,Miyamoto Hikaru,Nishiyama Noritoshi General thoracic and cardiovascular surgery OBJECTIVE:Surgical indication in stage IIIA (N2) non-small cell lung cancer is still controversial. Hence, there is a need for the identification of predictors of the postoperative outcome in these patients. Although sarcopenia is expected to be a novel predictor of postoperative outcome in these patients, the underlying clinical features of sarcopenia have not been well investigated. Elevation of neutrophil/lymphocyte ratio indicates cancer-associated inflammation and depression of anticancer immunity. We analyzed the influence of sarcopenia on postoperative prognosis, and investigated the relationship between sarcopenia and neutrophil/lymphocyte ratio in patients with stage IIIA (N2) non-small cell lung cancer. METHODS:We retrospectively investigated 69 patients with stage IIIA (N2) non-small cell lung cancer. We used the L3 muscle index as a clinical measurement of sarcopenia, and divided patients into the sarcopenic (n = 21) and the non-sarcopenic group (n = 48). We then investigated the effect of sarcopenia on postoperative prognosis, and evaluated the correlation between sarcopenia and neutrophil/lymphocyte ratio. RESULTS:This study included 47 males and 22 females. Univariate analysis revealed that sarcopenia, performance status, and serum cytokeratin-19 fragment level were predictors of poor prognosis; multivariate analysis revealed that performance status and sarcopenia were independent predictors of poor prognosis. The presence of sarcopenia was significantly correlated with neutrophil/lymphocyte ratio elevation. CONCLUSIONS:Sarcopenia is a novel predictor of poor prognosis in patients with stage IIIA (N2) non-small cell lung cancer. Neutrophil/lymphocyte ratio elevation might be the reason for poor prognosis in sarcopenic patients. 10.1007/s11748-018-0985-z
    Sarcopenia as Prognostic Factor in Lung Cancer Patients: A Systematic Review and Meta-analysis. Buentzel Judith,Heinz Judith,Bleckmann Annalen,Bauer Christoph,Röver Christian,Bohnenberger Hanibal,Saha Shekhar,Hinterthaner Marc,Baraki Hassina,Kutschka Ingo,Emmert Alexander Anticancer research BACKGROUND/AIM:Sarcopenia describes the loss of skeletal muscle mass. While this condition is associated with a high mortality in cancer patients, its influence on survival is still underestimated. PATIENTS AND METHODS:A systematic review for articles was performed using the PubMed database, Cochrane Library, Biomed Central, Science Direct and by manual search. We used data of overall survival in sarcopenic patients for assessing the death risk. We extracted hazard ratio estimates from univariate and multivariate Cox proportional hazards models for meta-analysis. RESULTS:A total of 15 studies were eligible for meta-analysis including a total of 2,521 lung cancer patients. Univariate meta-analysis revealed a two-fold increased death risk in sarcopenic patients; multivariate meta-analysis yielded a significant, three-fold elevated risk of death. This higher mortality is independent of tumour stage. CONCLUSION:Muscle loss is an independent risk factor for increased death risk in lung cancer patients independent of cancer stage. This argues for implementing screening for sarcopenia into cancer care. 10.21873/anticanres.13640
    Sarcopenia predicts poor postoperative outcome in elderly patients with lung cancer. Kawaguchi Yo,Hanaoka Jun,Ohshio Yasuhiko,Okamoto Keigo,Kaku Ryosuke,Hayashi Kazuki,Shiratori Takuya,Yoden Makoto General thoracic and cardiovascular surgery PURPOSE:Sarcopenia gradually progress with age; hence, it is necessary to define sarcopenia to predict postoperative outcomes in elderly patients with lung cancer. The purpose of this study is to propose a definition of sarcopenia in elderly patients with lung cancer, and to demonstrate the post operative outcomes. METHODS:Using computed tomography scans, the cross-sectional area (cm) of the psoas muscle at the third lumbar vertebral level was measured. The psoas area was normalized for height. The psoas muscle mass index was calculated as total psoas muscle area at L3 level/height (cm/m). RESULTS:A total of 173 patients aged > 75 years of age received lobectomy for non-small cell lung cancer in our hospital. We defined sarcopenia as the psoas muscle mass index under 3.70 cm/m in males and 2.50 cm/m in females, based on the morbidity rate. The postoperative complication rate was significantly higher in patients with sarcopenia (62.5%) than in those without sarcopenia (22.7%). The 5-year survival rate was 26.5% in patients with sarcopenia, and 66.3% in patients without sarcopenia. CONCLUSIONS:In elderly lung cancer patients, sarcopenia was observed to be a high risk for morbidity and predicted poor prognosis. 10.1007/s11748-019-01125-3
    Prognostic Value of Sarcopenia in Lung Cancer: A Systematic Review and Meta-analysis. Yang Ming,Shen Yanjiao,Tan Lingling,Li Weimin Chest BACKGROUND:Evidence regarding the association between sarcopenia (skeletal muscle depletion) and outcomes in patients with lung cancer varies across studies. We aimed to systematically review the prognostic value of sarcopenia in lung cancer. METHODS:We searched Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials through July 23, 2018 to identify retrospective or prospective cohort studies. We applied the Quality in Prognostic Studies instrument to assess the risk of bias in individual studies. We examined the heterogeneity and publication bias and performed subgroup analyses and sensitivity analyses. RESULTS:We included 13 studies (1,810 participants). The pooled prevalence of sarcopenia was 43% in patients with non-small cell lung cancer (NSCLC) and 52% in patients with small cell lung cancer (SCLC). Sarcopenia was associated with a shorter overall survival (OS) in patients with lung cancer (hazard ratio [HR], 2.23; 95% CI, 1.68-2.94). This association existed for both NSCLC (HR, 2.57; 95% CI, 1.79-3.68) and SCLC (HR, 1.59; 95% CI, 1.17-2.14). Sarcopenia was an independent predictor of shorter OS in both stage I-II NSCLC (HR, 3.23; 95% CI, 1.68-6.23) and stage III-IV NSCLC (HR, 2.19; 95% CI, 1.14-4.24). However, sarcopenia was not an independent predictor of disease-free survival in patients with NSCLC (HR, 1.28; 95% CI, 0.44-3.69). CONCLUSIONS:Sarcopenia is highly prevalent in patients with lung cancer (approximately one in two) and an important predictor of impaired OS in patients with SCLC or with different stages of NSCLC. 10.1016/j.chest.2019.04.115