title: Cancer cachexia, sarcopenia and biochemical markers in patients with advanced non-small cell lung cancer-chemotherapy toxicity and prognostic value.
abstract: Cancer cachexia and sarcopenia are frequently observed in cancer patients and associated with poor survival. The majority of studies of cancer cachexia and sarcopenia have been done in patients with solid tumors of different origins, and there are currently no good predictors of the benefit of chemotherapy or factors that predict survival in advanced cancer. The purpose of our prospective study was to evaluate prevalence of cachexia and sarcopenia using international consensus definition and criteria for diagnosis in patients with diagnosed advanced non-small cell lung cancer (NSCLC) stage IIIB and IV and their relation to chemotherapy toxicity and survival prediction. A secondary aim was to compare several biochemical markers (CRP, IL-6, protein, and albumin) with time to tumor progression in order to assess prognostic value or to guide a treatment.
  
  
  
  Between December 2013 and April 2015, the prospective cohort study of 100 Caucasian patients with advanced NSCLC stage IIIB or IV, who were referred consecutively to Department for Respiratory Diseases "Jordanovac," was evaluated. Anthropometric measurements and biochemical data (CRP, albumin, protein, IL-6, haemoglobin) together with body composition measurements (total muscle cross-sectional area, lumbar skeletal muscle index) were obtained for each patient before starting with platinum-doublet therapy. Skeletal muscle cross-sectional area at the third lumbar vertebra was measured by computerized tomography, and sarcopenia was defined using a previously published cutoff point. Toxicity was assessed after cycle 1 of treatment and time-to-tumor progression was determined prospectively.
  
  
  
  One hundred patients with advanced lung cancer were recruited: 67 were male and median age was 64 years. The median time to disease progression was 187 days. The prevalence of cachexia and sarcopenia in study cohort was 69 and 47 %, respectively. CRP, IL-6, and albumin concentration in cachectic compared to non-cachectic patients demonstrated statistically significant difference (p = 0.020, p = 0.040, p = 0.003). Cachexia and sarcopenia were not found to be predictors of chemotoxicity nor was time to tumor progression. On the contrary, albumin concentration with established cutoff point of 37.5 g/L was clearly proved as the predictive factor of both chemotoxicity (OR (95 % CI) = 0.85; p < 0.001) and survival (HR (95 % CI) = 0.55).
  
  
  
  Albumin level has been shown to be more important predictive marker of chemotherapy toxicity and survival than cachexia and sarcopenia are. This approach in clinical settings can be used to guide the choice of oncologic treatment.
authors.affiliation: Department for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Jordanovac 104, Zagreb, 10 000, Croatia. drazena.bjelos@zg.t-com.hr.
authors.forename: Drazena
authors.initials: D
authors.lastname: Srdic
authors.affiliation: Medical School University of Rijeka, Department for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Jordanovac 104, Zagreb, 10 000, Croatia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Plestina
authors.affiliation: Department for Diagnostic and Interventional Radiology, University Hospital Centre Sestre Milosrdnice, Vinogradska 29, Zagreb, 10 000, Croatia.
authors.forename: Ana
authors.initials: A
authors.lastname: Sverko-Peternac
authors.affiliation: University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Vinogradska 29, Zagreb, 10 000, Croatia.
authors.forename: Nora
authors.initials: N
authors.lastname: Nikolac
authors.affiliation: Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, 10 000, Croatia.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Simundic
authors.affiliation: Medical School University of Zagreb, Department for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Jordanovac 104, Zagreb, 10 000, Croatia.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Samarzija
mesh_terms: D015415:Biomarkers / Q000737:chemistry*; D002100:Cachexia / Q000401:mortality*; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D055948:Sarcopenia / Q000401:mortality*
chemical_list: D015415:Biomarkers
keywords: Cancer cachexia; Chemotherapy toxicity; Non-small cell lung cancer; Sarcopenia