Prognostic value of sarcopenia in patients with lung cancer treated with epidermal growth factor receptor tyrosine kinase inhibitors or immune checkpoint inhibitors

Jiahua Lyu; Ningjing Yang; Ling Xiao; Xinyu Nie; Jing Xiong; Yudi Liu; Min Zhang; Hangyue Zhang; Cunhan Tang; Shiyi Pan; Long Liang; Hansong Bai; Churong Li; Hao Kuang; Tao Li

doi:10.3389/fnut.2023.1113875

Prognostic value of sarcopenia in patients with lung cancer treated with epidermal growth factor receptor tyrosine kinase inhibitors or immune checkpoint inhibitors

Front Nutr. 2023 Mar 8:10:1113875. doi: 10.3389/fnut.2023.1113875. eCollection 2023.

Authors

Jiahua Lyu^{1

2}, Ningjing Yang², Ling Xiao¹, Xinyu Nie², Jing Xiong², Yudi Liu^{1

2}, Min Zhang², Hangyue Zhang², Cunhan Tang², Shiyi Pan¹, Long Liang², Hansong Bai², Churong Li², Hao Kuang², Tao Li^{1

2}

Affiliations

¹ School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
² Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

Abstract

Objectives: It remains controversial whether sarcopenia has any significant impact on the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) or immune checkpoint inhibitors (ICIs) in patients with advanced non-small cell lung cancer (NSCLC). Therefore, in this study, we aimed to assess the association between sarcopenia and clinical outcomes in patients with advanced NSCLC receiving EGFR-TKIs or ICIs as a first-line therapy.

Methods: We retrospectively enrolled 131 patients with advanced NSCLC treated with first-line EGFR-TKIs or ICIs between 1 March 2019 and 31 March 2021. To estimate sarcopenia, we calculated skeletal muscle index (SMI) as the ratio of skeletal muscle area (cm²) to height squared (m²). Associations between sarcopenia and overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method and log-rank tests, respectively. A Cox proportional hazards regression model was used to assess the factors associated with OS and PFS. The Student's t-test or Mann-Whitney U test was used to compare the SMI between patients with or without objective response and disease control. The chi-squared test was used to compare adverse events (AEs) between patients with and without sarcopenia.

Results: Among the 131 patients, 35 (26.7%) were diagnosed with sarcopenia. Sarcopenia was an independent predictor of poor OS and PFS (p < 0.05) overall and in the EGFR-TKI- and ICI-treated cohorts. Among all patients, those with sarcopenia showed significantly shorter OS and PFS than those without sarcopenia (median OS and PFS: 13.0 vs. 26.0 months and 6.4 vs. 15.1 months; both p < 0.001). These associations were consistent across the subtypes of most clinical characteristics. Statistically significant differences between the objective response (OR) and non-OR groups were also observed in the mean SMI (OR group, 43.89 ± 7.55 vs. non-OR group, 38.84 ± 7.11 cm²/m²; p < 0.001). In addition, we observed similar results with disease control (DC) and non-DC groups (DC group, 42.46 ± 7.64 vs. non-DCR group, 33.74 ± 4.31 cm²/m²; p < 0.001). The AEs did not differ significantly between the sarcopenia and non-sarcopenia groups.

Conclusion: Sarcopenia before treatment might be a significant predictor of poor clinical outcomes (shorter OS and PFS, fewer ORs, less DC) in patients with advanced NSCLC treated with EGFR-TKIs or ICIs as the first-line therapy.

Keywords: EGFR-TKIs; immune-checkpoint inhibitors; lung cancer; prognosis; sarcopenia.

Grants and funding

This work was supported by grants from the Project of Sichuan Science and Technology Department (grant number: 2021YJ0010).