1813MO - Impact of systemic inflammation, intramuscular adipose tissue content, and EORTC-QLQ-CAX24 symptom scale on the prognosis of patients with advanced non-small-cell lung cancer

Background

Cancer cachexia, characterized by systemic inflammation and muscle wasting, have been associated with poor survival in non-small-cell lung cancer (NSCLC) patients (pts). We hypothesized whether neutrophil-to-lymphocyte ratio (NLR) and the intramuscular adipose tissue/skeletal muscle index (IMAC/SMI) are associated with prognosis in metastatic NSCLC (mNSCLC). We also considered the quality of life (QoL) assessed via the EORTC-QLQ-CAX24 questionnaire on the prognosis of mNSCLC.

Methods

We analyzed a prospective cohort study (Apr/2017 to May/2020) of pts diagnosed with histologically-proven, treatment-naive, mNSCLC. After signed informed consent, we evaluated pts about demographic features and QoL using the EORTC-QLQ-C30 and -CAX24 scales. We used the baseline NLR as a surrogate of systemic inflammation. IMAC/SMI was evaluated using baseline plain computed tomography imaging at the third lumbar vertebra level. To test our hypothesis that NLR and IMAC/SMI are associated with prognosis, we carried out a Cox multivariate regression and included age, gender, ECOG-PS, and histology as covariates.

Results

We collected 128 pts, median age 65 y.o. (23-86), 79 (62%) male. Lung adenocarcinoma was the predominant histology (66%). ECOG-PS was classified as 0-1 in 27 pts (21%) and 2-4 in 101 pts (79%). Median overall survival was 468, 335, 106, 59, and 20 days in pts with ECOG-PS 0, 1, 2, 3, and 4, respectively. Elevated NLR (Hazard ratio (HR) = 1.26, 95% confidence interval (CI) = [1.01 - 1.59], p=0.038), IMAC/SMI ratio (HR = 1.37, 95% CI = [1.03 - 1.84], p=0.032), and CAX24 score for food aversion (HR = 1.52, 95% CI = [1.13 - 2.03], p=0.006) were associated with worse prognosis in mNSCLC. Indeed, higher ECOG-PS (Spearman rho=0.208, p=0.027), CAX24 scores for food aversion (rho=0.197, p=0.036), loss of control (rho=0.212, p=0.024), and eating and weight loss worry domains (rho=0.219, p=0.020) were associated with elevated NLR levels.

Conclusions

Elevated NLR, IMAC/SMA ratio, and CAX24 score for food aversion are independently associated with worse survival in mNSCLC. These data underscore the importance of cachexia features as negative prognostic factors in mNSCLC.

Clinical trial identification

NCT03960034.

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

FAPESP grants 2015/22814-5 and 2016/20187-6.

Disclosure

All authors have declared no conflicts of interest.