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PLoS One. 2017 Jan 20;12(1):e0169136. doi: 10.1371/journal.pone.0169136. eCollection 2017.

Prognostic Impact of CT-Quantified Muscle and Fat Distribution before and after First-Line-Chemotherapy in Lung Cancer Patients.

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Department of Diagnostic and Interventional Radiology, University Hospital, Im Neuenheimer Feld, Heidelberg, Germany.
Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld, Heidelberg, Germany.
Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany.
Translational Research Unit (STF), Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany.
Department of Thoracic Oncology, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, Germany.
Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at University of Heidelberg, Amalienstraße, Heidelberg, German.
Division of Medical Oncology, National Center for Tumor Diseases (NCT); Heidelberg University Hospital, Im Neuenheimer Feld, Heidelberg, Germany.



Cachexia and sarcopenia are associated with poor outcome and increased chemotherapy-induced toxicity in lung cancer patients. However, the complex interplay of obesity, sarcopenia and cachexia, and its impact on survival in the context of first-line-chemotherapy is not yet understood.


In 200 consecutively recruited lung cancer patients (70 female, mean age 62y; mean BMI 25 kg/m2; median follow-up 15.97 months) with routine staging-CT before and after chemotherapy (CTX, mean interval: 4.3 months), densitometric quantification of total (TFA), visceral (VFA), and subcutaneous-fat-area (SFA), inter-muscular-fat-area (IMFA), muscle-density (MD), muscle-area (MA) and skeletal-muscle-index (SMI) was performed retrospectively to evaluate changes under chemotherapy and the impact on survival.


We observed increases in TFA, VFA, SFA, VFA/SFA, and IMFA (p<0.05-0.001), while there were decreases in MA, MD and BMI (p<0.05-0.001) after chemotherapy. High pre-therapeutic VFA/SFA was a predictive factor for poor survival (HR = 1.272; p = 0.008), high pre-therapeutic MD for improved survival (HR = 0.93; p<0.05). Decrease in BMI (HR = 1.303; p<0.001), weight (HR = 1.067; p<0.001) and SMI (HR = 1.063; p<0.001) after chemotherapy were associated with poor survival. Patients with ≥4 CTX-cycles showed increased survival (17.6 vs. 9.1months), less muscle depletion (SMIdifference: p<0.05) and no BMI loss (BMIdifference: p<0.001).


After chemotherapy, patients exhibited sarcopenia with decreased muscle and increased adipose tissue compartments, which was not adequately mirrored by BMI and weight loss but by imaging. Particularly sarcopenic patients received less CTX-cycles and had poorer survival. As loss of BMI, weight and muscle were associated with poor survival, early detection (via imaging) and prevention (via physical exercise and nutrition) of sarcopenia may potentially improve outcome and reduce chemotherapy-induced toxicity.

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Conflict of interest statement

Patent Method and Device For Representing the Microstructure of the Lungs. IPC8 Class: AA61B5055FI, PAN: 20080208038, Inventors: W Schreiber, U Wolf, AW Scholz, CP Heussel. Consultation or other fees: Schering-Plough 2009, 2010; Pfizer 2008-2014; Basilea 2008, 2009, 2010; Boehringer Ingelheim 2010-2016; Novartis 2010, 2012, 2014; Roche 2010; Astellas 2011, 2012, 2015; Gilead 2011-2015; MSD 2011-2013; Lilly 2011; Intermune 2013-2014; Fresenius 2013, 2014; Olympus 2015. Research funding: Siemens 2012-2014; Pfizer 2012-2014; MeVis 2012, 2013; Boehringer Ingelheim 2015, 2016. Expert testimony: No. Tobacco Industry: No relation. Lecture fees: Gilead 2008-2014; Essex 2008, 2009, 2010; Schering-Plough 2008, 2009, 2010; AstraZeneca 2008-2012; Lilly 2008, 2009, 2012; Roche 2008, 2009; MSD 2009-2014; Pfizer 2010-2014; Bracco 2010, 2011; MEDA Pharma 2011; Intermune 2011-2014; Chiesi 2012; Siemens 2012; Covidien 2012; Pierre Fabre 2012; Boehringer Ingelheim 2012, 2013; Grifols 2012; Novartis 2013-2016; Basilea 2015, 2016; Bayer 2016. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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