Peripheral but not axial muscle mass is associated with early mortality in bone metastatic lung cancer patients at diagnosis.

OBJECTIVES: Identification of sarcopenia is a key issue in oncology. Several methods may be used to evaluate muscle mass in patients. Routine cancer follow-up computed tomography (CT) provides axial muscle mass whereas whole-body densitometry (DEXA) measures appendicular lean mass (ALM). Up to now, no studies have assessed, in cancer patients, the correlation between CT and DEXA muscle mass indicators and compared their prognostic value. METHODS: We included patients with synchronous bone metastases from lung adenocarcinoma at diagnosis. Diagnosis was confirmed by bone biopsy. Skeletal muscle area was determined semi-automatically on initial CT scan at the T7, T12, and L3 vertebral level using Osirix® software. The skeletal muscle index (SMI) was calculated as the ratio of muscle area to height squared. Standardised ALM/height squared data were obtained by DEXA assessment within a 30-day window of CT. RESULTS: A total of 65 patients were included; 47 (72%) were male. Mean±SD age was 65±11.4years. DEXA was available for 46 patients. The performance status was good (<1) for 39 patients. SMI indicators were significantly correlated with each other (rho from 0.3 to 0.7) but moderately correlated with ALM (rho from 0.1 to 0.7). ALM had a good discriminatory ability on 6-month survival (AUC 0.87 [0.76; 0.97]). ALM was associated with early mortality (<6months) (HR=0.29, 95% CI [0.15; 0.57]; P<0.001) but not with later mortality (>6months). In contrast, no significant effect was found for SMI. CONCLUSIONS: Peripheral muscle mass (standardized ALM by DEXA) but not axial muscle mass (SMI assessed by CT) was associated with early mortality (<6months) suggesting that cancer-induced muscle loss would affect differently appendicular muscles and axial muscles.

Bone, muscle, and metabolic parameters predict survival in patients with synchronous bone metastases from lung cancers.

BACKGROUND: Lung adenocarcinoma regularly induces bone metastases that are responsible for impaired quality of life as well as significant morbidity, including bone pain and fractures. We aimed at identifying whether bone and metabolic biomarkers were associated with the prognosis of lung adenocarcinoma patients with synchronous bone metastases. PATIENTS AND METHODS: POUMOS is a prospective cohort of patients diagnosed with lung adenocarcinoma and synchronous bone metastases. All patients underwent biopsy of bone metastases to confirm diagnosis, including genotyping of oncogenic drivers such as EGFR and KRAS. Whole-body composition was assessed using DEXA scan. Serum levels of C-reactive protein, HbA1C, calcaemia, sCTX, and DKK1 were also measured. RESULTS: Sixty four patients, aged (mean ±â€¯SD) 65 ±â€¯11 years, were included. Thirty-nine (61%) patients had a good performance status (PS 0-1); 56% had >5 bone lesions, and 41% a weight-bearing bone (femour or tibia) involvement. Median overall survival was 7 months. In multivariate analysis, HbA1c (HR = 1.69 [1.10-2.63] per 0.5% decrease; p = .02), DKK1 (HR = 1.28 [1.01-1.61] per 10 ng/mL increase; p = .04), and hypercalcaemia (HR = 2.83 [1.10-7.30]; p = .03) were independently associated with poorer survival. In the subgroup of patients with DEXA, sarcopenia was also associated with poorer survival (HR = 2.96, 95%CI [1.40-6.27]; p = .005). CONCLUSIONS: In patients with lung adenocarcinoma and synchronous bone metastases, bone, sarcopenia, and metabolic parameters were predictors of poor overall survival independently of common prognostic factors. We suggest that, in addition to oncological therapy, supportive treatment dedicated to bone metastases, muscle wasting, and energy metabolism are essential to improve prognosis.