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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Monday, August 19, 2024
The results of a multicohort study, which were published in JAMA Oncology, suggested that automated CT-derived body composition metrics may be of prognostic value in patients receiving systemic therapy for advanced or metastatic non–small cell lung cancer (NSCLC). Hugo J.W.L. Aerts, PhD, of Harvard Medical School, Boston, and colleagues thus recommended these measurements be considered along with other risk factors.
The investigators focused on 1,791 patients (nearly half female), of whom 487 (27.2%) received chemoimmunotherapy at the Dana-Farber Brigham Cancer Center (DFBCC; DFBCC-CIO), 825 (46.1%) received immune checkpoint inhibitor monotherapy at the DFBCC (DFBCC-IO), 222 (12.4%) were treated with durvalumab monotherapy in the phase I/II Study 1108 trial, and 257 (14.3%) were treated with chemotherapy in the phase III MYSTIC trial. Baseline and follow-up CT scans were analyzed using deep neural networks for automatic L3 slice selection and body compartment segmentation.
There appeared to be an association between CT-derived loss of skeletal muscle mass and worse oncologic outcomes across the cohorts (hazard ratio [HR] = 0.59 and 0.61 for overall and progression-free survival, respectively, in DFBCC-CIO; 0.74 for overall survival in DFBCC-IO; 0.46 and 0.47 for overall and progression-free survival, respectively, in Study 1108; 0.76 for progression-free survival in MYSTIC). According to the investigators, this association was most prominent among male patients. A Kaplan-Meier analysis revealed a nonsignificant association among female patients in the DFBCC-CIO and MYSTIC cohorts.
An increase of more than 5% in subcutaneous adipose tissue density was found to be associated with worse overall survival in the DFBCC-CIO (HR = 0.61), DFBCC-IO (HR = 0.62), and Study 1108 (HR = 0.56) cohorts. There also appeared to be a correlation between this change in fat quality and progression-free survival in the DFBCC-CIO cohort (HR = 0.73). Based on a Kaplan-Meier analysis, this change in subcutaneous adipose tissue was observed mostly in female patients.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
