Correlation of body composition by computerized tomography and metabolic parameters with survival of nivolumab-treated lung cancer patients
Received 2 April 2019
Accepted for publication 8 August 2019
Published 5 September 2019 Volume 2019:11 Pages 8201—8207
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Nicola Ludin
Peer reviewer comments 3
Editor who approved publication: Dr Kenan Onel
Valentina Magri1,*, Teodor Gottfried2,*, Mattia Di Segni3,4, Damien Urban2, Michael Peled5, Sameh Daher2, Ronen Stoff2, Jair Bar2,6,*, Amir Onn5,6,*
1Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-Patologiche, Umberto I, Policlinico di Roma, Sapienza, - Università di Roma, Rome, Italy; 2Thoracic Oncology Unit, Institute of Oncology, Sheba Medical Center, Ramat Gan 5262000, Israel; 3Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-Patologiche, Sapienza, Umberto I, Policlinico di Roma - Università di Roma, Rome, Italy; 4U.O.C. Diagnostica per Immagini, Presidio Ospedaliero San Paolo, Rome, Italy; 5Institute of Pulmonology, Sheba Medical Center, Ramat Gan 5262000, Israel; 6Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
*These authors contributed equally to this work
Correspondence: Michael Peled
Institute of Pulmonology, Sheba Medical Center, HaShomer, Ramat Gan 5262000, Israel
Tel +972 3 530 8420
Fax +972 3 530 8420
Purpose: Weight loss is a well-recognized prognostic parameter for survival of lung cancer patients. Computerized-tomography (CT)-based analysis of body composition and blood-based metabolic evaluation are promising prognostic tools. We aimed to assess the correlation between albumin, body mass index (BMI), skeletal muscle mass index (SMI), fat-free mass index (FFMI), fat mass index (FMI) and weight change, as well as their correlation with survival of lung cancer patients on nivolumab treatment.
Methods: Data were retrospectively collected. Weight was measured at a diagnosis of stage 4 disease and before start of nivolumab. Albumin levels were measured before starting nivolumab. BMI, SMI, FFMI, and FMI were evaluated from CT scans performed at start of nivolumab. Overall survival (OS) was from starting of nivolumab to death or censured at last follow-up. Statistical analysis was done to identify correlation between the various factors and between those factors and survival.
Results: Forty-six patients with advanced non-small cell lung cancer (NSCLC) were included. Median follow-up was 22 months. Pathology was Adenocarcinoma/Squamous/non-other specified in 25/15/6 respectively. All patients received nivolumab as an advanced-line treatment for stage IV NSCLC. We observed a significant correlation of weight loss (P=0.01, HR=2.85) and albumin (P=0.043, HR=0.34) with OS in multivariate analysis. A significant correlation was found between BMI to SMI, FFMI, FMI, and weight change.
Conclusion: Weight loss and low albumin levels are significant negative prognostic factors for NSCLC patients on immunotherapy. CT-based parameters of body composition remain to be proven as more reliable than standard clinical parameters.
Keywords: BMI, albumin, immunotherapy, weight, prognosis
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