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Research Article
Gyeong-Won Lee
Gyeongsang National University Hospital, Gyeongsang National University College of Medicine
Corresponding Author
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Background: Cancer cachexia worsens the treatment outcomes of patients with small-cell lung cancer (SCLC). However, no reliable biomarker of cancer cachexia is yet known.
Methods: We retrospectively evaluated SCLC patients who received induction chemotherapy or concurrent chemoradiotherapy. The cachexia index (CXI) was calculated as the skeletal muscle index × serum albumin level (g/dL)/the neutrophil-to-lymphocyte ratio. Male and female cutoffs were defined based on a time-dependent receiver operating characteristic curve, and all patients divided into low- and high-CXI groups.
Results: Of 302 patients, 94 and 208 had low and high CXI values, respectively. Only one patient (1.1%) in the low-CXI group achieved a complete response (CR), whereas 35 of 208 patients (16.8%) in the high-CXI group achieved CRs (p < 0.001). More low-CXI patients (compared to the high-CXI patients) required early discontinuation of treatment because of treatment-related toxicity (20.2% vs. 6.3%, p < 0.001) and experienced treatment-related mortality (8.5% vs. 2.9%, p = 0.031). The median progression-free survival (PFS) and overall survival (OS) were significantly poorer in the low-CXI group than in the high-CXI group (5.8 vs. 6.9 months and 8.3 vs. 15.6 months, respectively, both p < 0.001). These differences did not vary according to cancer stage. On multivariate analysis, a low-CXI status was an independent poor prognostic factor for both PFS and OS.
Conclusion: A low CXI was associated with treatment intolerance, a poor treatment response rate, and a poor prognosis of SCLC.
Keywords
small-cell lung carcinoma, cachexia, sarcopenia, serum albumin, biomarkers
Figure 1
Figure 2
No competing interests reported.
This is a list of supplementary files associated with this preprint. Click to download.
- SupplementaryFigure1.tif
Supplementary Fig. 1 Time-dependent receiver operating characteristic (ROC) curve of the cachexia index (CXI) for the prediction of 12-month overall survival. Circles indicate CXIs of 5.23 in (A) male patients and 6.79 in (B) female patients. These cutoffs were determined by maximizing the Youden index.
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This preprint is under consideration at BMC Cancer. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Gyeong-Won Lee
Gyeongsang National University Hospital, Gyeongsang National University College of Medicine
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 08 Feb, 2021
No community comments so far
Editorial decision: Major revision
On 05 Mar, 2021
Reviewers agreed
On 14 Feb, 2021
Reviews received
Received 13 Feb, 2021
Reviewers agreed
On 11 Feb, 2021
Reviewers invited
Invitations sent on 11 Feb, 2021
Editor assigned
On 11 Feb, 2021
Editor invited
On 11 Feb, 2021
Submission checks complete
On 11 Feb, 2021
First submitted
On 02 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Cancer cachexia worsens the treatment outcomes of patients with small-cell lung cancer (SCLC). However, no reliable biomarker of cancer cachexia is yet known.
Methods: We retrospectively evaluated SCLC patients who received induction chemotherapy or concurrent chemoradiotherapy. The cachexia index (CXI) was calculated as the skeletal muscle index × serum albumin level (g/dL)/the neutrophil-to-lymphocyte ratio. Male and female cutoffs were defined based on a time-dependent receiver operating characteristic curve, and all patients divided into low- and high-CXI groups.
Results: Of 302 patients, 94 and 208 had low and high CXI values, respectively. Only one patient (1.1%) in the low-CXI group achieved a complete response (CR), whereas 35 of 208 patients (16.8%) in the high-CXI group achieved CRs (p < 0.001). More low-CXI patients (compared to the high-CXI patients) required early discontinuation of treatment because of treatment-related toxicity (20.2% vs. 6.3%, p < 0.001) and experienced treatment-related mortality (8.5% vs. 2.9%, p = 0.031). The median progression-free survival (PFS) and overall survival (OS) were significantly poorer in the low-CXI group than in the high-CXI group (5.8 vs. 6.9 months and 8.3 vs. 15.6 months, respectively, both p < 0.001). These differences did not vary according to cancer stage. On multivariate analysis, a low-CXI status was an independent poor prognostic factor for both PFS and OS.
Conclusion: A low CXI was associated with treatment intolerance, a poor treatment response rate, and a poor prognosis of SCLC.
Figure 1
Figure 2
No competing interests reported.
This is a list of supplementary files associated with this preprint. Click to download.
- SupplementaryFigure1.tif
Supplementary Fig. 1 Time-dependent receiver operating characteristic (ROC) curve of the cachexia index (CXI) for the prediction of 12-month overall survival. Circles indicate CXIs of 5.23 in (A) male patients and 6.79 in (B) female patients. These cutoffs were determined by maximizing the Youden index.
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