The association between skeletal muscle measures, nutritional risk, cachexia, and chemotherapy-induced toxicity in lung cancer patients / 中华临床营养杂志

ABSTRACT

Objective:Chemotherapy is the main treatment for lung cancer. However, chemotherapy-related toxicity has a high incidence, which brings adverse experiences to patients and seriously affects treatment plans and quality of life. Low skeletal muscle mass (SMM), malnutrition, and cachexia are related to a higher incidence of chemotherapy toxicity in cancer patients. The main purpose of this study is to evaluate the relationship between baseline body composition, nutritional status, cachexia, and lung cancer chemotherapy toxicity and dose-limiting toxicity (DLT).Methods:This is a single-center prospective study of lung cancer patients receiving chemotherapy for the first time. Body composition was measured using multi-frequency bioelectrical impedance, and the skeletal muscle index (SMI) was calculated. Grip strength and gait speed were used to assess muscle strength and function. The Asian Working Group on Sarcopenia (2019) criteria were used to evaluate the presence of sarcopenia. Cachexia was defined based on muscle mass and weight loss, while nutritional risk and malnutrition were evaluated based on the Nutritional Risk Screening 2002 and Global Leadership Initiative on Malnutrition criteria, respectively. Chemotherapy toxicity and DLT were defined according to the Common Terminology Criteria for Adverse Events and were divided into hematological, non-hematological, and DLT. The association between muscle condition, nutritional status, cachexia, and toxicity was evaluated by univariate and multivariate regression models.Results:The study included and analyzed 126 patients, with a median follow-up of 17.9 months (12-25 months). During chemotherapy, 27.8% of patients experienced grade 3/4 hematological toxicity, 14.8% experienced any ≥2 grade non-hematological toxicity, and 26.1% had any DLT. Old age and multiple comorbidities were risk factors for hematological, non-hematological toxicity, and DLT. Insufficient muscle strength and function could increase the incidence of hematological toxicity [ OR 1.121, 95% CI 1.048~2.865, P=0.031], and high SMI was a protective factor for DLT [ OR 0.638, 95% CI 0.242~0.083, P=0.021]. Conclusions:Lung patients with low SMI, low muscle strength and function have an increased risk of DLT and grade 3/4 hematological toxicity during chemotherapy. At the same time, elderly age and multiple comorbidities are also risk factors for chemotherapy toxicity and DLT. In clinical work, assessments should be conducted to identify high-risk populations for chemotherapy toxicity and preventive measures should be taken. Future research could consider adjusting chemotherapy plans based on different muscle statuses.