title: Sarcopenia and inflammation are independent predictors of survival in male patients newly diagnosed with small cell lung cancer.
abstract: OBJECTIVE
  Sarcopenia is suggested to be associated with cancer-related inflammation. We assessed the clinical outcome of small cell lung cancer (SCLC) patients according to sarcopenia and the neutrophil-to-lymphocyte ratio (NLR).
  
  
  METHODS
  A total of 117 male SCLC patients treated with first-line chemo- or chemoradiotherapy were assessed based on a retrospective chart review. The mass of the pectoralis muscle was measured by computed tomography and normalized to height. Patients with the lowest quartile of muscle mass were considered to have sarcopenia. Patients were classified into four groups according to their sarcopenia and NLR statuses: sarcopenia/high NLR, sarcopenia/low NLR, non-sarcopenia/high NLR, and non-sarcopenia/low NLR.
  
  
  RESULTS
  Sarcopenic patients had lower progression-free survival (PFS) than did non-sarcopenic patients (median 6.0 vs. 7.5 months, p = 0.009), but the difference in overall survival (OS) was not statistically significant (median 10.5 vs. 13.5 months, p = 0.052). However, the OS of sarcopenic patients with high NLR was significantly lower than that in all other groups (median 3.2 vs. 16.0 vs. 12.5 vs. 13.7 months, respectively, p < 0.001), as was PFS (median 3.2 vs. 7.7 vs. 7.6 vs. 7.1 months, respectively, p < 0.001). On multivariate analysis, sarcopenia with high NLR was an independent prognostic factor for shorter PFS and OS. Early discontinuation of treatment (20.0 vs. 10.3 %) and treatment-related mortality (50.0 vs. 8.4 %) occurred more frequently in these patients than in the other groups (p < 0.001).
  
  
  CONCLUSIONS
  In SCLC, sarcopenic male patients with high NLR have a poor prognosis and do not tolerate standard treatment. Intensive supportive care is needed in these patients.
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
authors.forename: Se-Il
authors.initials: SI
authors.lastname: Go
authors.affiliation: Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Park
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
authors.forename: Haa-Na
authors.initials: HN
authors.lastname: Song
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
authors.forename: Myoung Hee
authors.initials: MH
authors.lastname: Kang
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Park
authors.affiliation: Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
authors.forename: Kyung Nyeo
authors.initials: KN
authors.lastname: Jeon
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
authors.forename: Seok-Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Myongji Hospital, Goyang, Republic of Korea.
authors.forename: Moon Jin
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Gangnam-ro 79, Jinju, 660-702, Republic of Korea.
authors.forename: Jung-Hun
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Gangnam-ro 79, Jinju, 660-702, Republic of Korea. brightree24@gmail.com.
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000401:mortality* / Q000473:pathology; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects*; D011379:Prognosis; D012189:Retrospective Studies; D055948:Sarcopenia / Q000401:mortality* / Q000473:pathology; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology
keywords: Cachexia; Neutrophil-to-lymphocyte ratio; Prognosis; Sarcopenia; Small cell lung carcinoma; Toxicity