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Prognostic Significance of CT-Determined Sarcopenia in Patients with Small-Cell Lung Cancer.

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer (2015-10-21)
Eun Young Kim, Young Saing Kim, Inkeun Park, Hee Kyung Ahn, Eun Kyung Cho, Yu Mi Jeong

The primary objective of this study was to determine the prognostic significance of computed tomography (CT)-determined sarcopenia in small-cell lung cancer (SCLC) patients. This retrospective study consisted of a total of 149 consecutive SCLC patients. The cross-sectional area of muscle at the level of the third lumbar vertebra (L3) was measured using baseline CT images. Sarcopenia was defined as a L3 muscle index of less than 55 cm/m for men and of less than 39 cm/m for women as proposed by international consensus of cancer cachexia. In addition, Korean-specific cutoffs for sarcopenia was also applied (49 cm/m for men and 31 cm/m for women). Overall survival (OS) and clinical characteristics of patients with or without sarcopenia were compared. Mean patient age was 68.6 ± 9.5 years. Most were male (85.3%) and 67.8% had extensive disease at time of diagnosis. Sarcopenia was present in 118 patients (79.2%) and was significantly related to an advanced age (p = 0.028), male sex (p < 0.001), lower body mass index (p < 0.001), and poor performance status (p = 0.049). Sarcopenic patients had shorter OS than nonsarcopenic patients (median: 8.6 months versus 16.8 months; p = 0.031). Multivariable analysis revealed that sarcopenia was an independent prognostic factor of poor survival (hazards ratio: 1.68; 95% confidence interval: 1.04-2.72; p = 0.034), along with extensive stage (p < 0.001), supportive care only (p < 0.001), and an elevated lactate dehydrogenase level (p = 0.020). Using Korean sarcopenia cutoffs, sarcopenic patients were also found to have poorer OS than nonsarcopenic patients, however, the survival difference was not statistically significant (median: 8.4 months versus 12.7 months; p = 0.144 by the log-rank test). Sarcopenia as determined by CT could be used to predict prognosis in patients with SCLC. Optimum reference values to predict cancer-specific outcomes should be tailored by further studies.

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Tantalum(V) ethoxide, 99.98% trace metals basis
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