Supportive Care in Cancer

, Volume 24, Issue 11, pp 4721–4726 | Cite as

Evaluation of sarcopenia in small-cell lung cancer patients by routine chest CT

  • Eun Young Kim
  • Young Saing KimEmail author
  • Inkeun Park
  • Hee Kyung Ahn
  • Eun Kyung Cho
  • Yu Mi Jeong
  • Jeong Ho Kim
Original Article



Single cross-sectional area of muscle at the third lumbar vertebra (L3MA) is gold standard to estimate skeletal muscle mass (SMM), and L3 muscle index (L3MI, L3MA/height2) is used to determine sarcopenia. The purposes of this study were to evaluate the relationship between SMM indices determined by routine chest CT and L3MI in patients with small-cell lung cancer (SCLC) and to suggest chest CT-derived diagnostic criteria for sarcopenia.


Area of pectoralis muscles at the aortic arch (PMA) and at L1 (L1MA) was retrospectively measured on chest CT images of 90 consecutive SCLC patients. Pearson’s correlation and multiple linear regression analysis were used to assess relationships between L3MI determined by PET/CT and pectoralis muscle index (PMI) and L1 muscle index (L1MI) determined by chest CT.


The correlation between L1MI and L3MI was stronger than that between PMI and L3MI (r = 0.851 vs. r = 0.447, p < 0.001). Multivariable regression analysis showed that L1MI was the only significant predictor of L3MI; L3MI = 0.963 × L1MI + 10.336 (R 2  = 0.689, p < 0.001) for male and L3MI = 0.772 × L1MI + 16.518 (R 2  = 0.777, p < 0.001) for female. Using this relationship, estimated cutoffs of L1MI for sarcopenia were 46 cm2/m2 for male and 29 cm2/m2 for female (L3MI cutoffs for sarcopenia are 55 cm2/m2 for male and 39 cm2/m2 for female). The sensitivity and specificity of L1MI cutoffs to determine sarcopenia were 98.2 and 100 %, respectively.


Chest CT-determined L1MI is highly correlated with L3MI in SCLC patients. L1MI, as determined by chest CT, could be used to determine the presence of sarcopenia with suggested cutoffs of 46 cm2/m2 for men and 29 cm2/m2 for women.


Skeletal muscle mass Small-cell lung cancer Sarcopenia Cancer cachexia Tomography X-ray computed 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no proprietary, commercial, or financial interests that could be construed to have inappropriately influenced this study.


  1. 1.
    Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12:489–495CrossRefPubMedGoogle Scholar
  2. 2.
    Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, Murphy R, Ghosh S, Sawyer MB, Baracos VE (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31:1539–1547CrossRefPubMedGoogle Scholar
  3. 3.
    Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, Mackey JR, Koski S, Pituskin E, Sawyer MB (2009) Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res 15:2920–2926CrossRefPubMedGoogle Scholar
  4. 4.
    Meza-Junco J, Montano-Loza AJ, Baracos VE, Prado CM, Bain VG, Beaumont C, Esfandiari N, Lieffers JR, Sawyer MB (2013) Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma. J Clin Gastroenterol 47:861–870CrossRefPubMedGoogle Scholar
  5. 5.
    Fukushima H, Yokoyama M, Nakanishi Y, Tobisu K, Koga F (2015) Sarcopenia as a prognostic biomarker of advanced urothelial carcinoma. PLoS One 10:e0115895CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kim EY, Kim YS, Park I, Ahn HK, Cho EK, Jeong YM (2015) Prognostic significance of CT-determined sarcopenia in patients with small-cell lung cancer. J Thorac Oncol 10:1795–1799CrossRefPubMedGoogle Scholar
  7. 7.
    Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, Heymsfield SB (1985) Heshka S (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol 97:2333–2338CrossRefGoogle Scholar
  8. 8.
    Mitsiopoulos N, Baumgartner RN, Heymsfield SB, Lyons W, Gallagher D, Ross R (1998) Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol (1985) 85:115–122Google Scholar
  9. 9.
    Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE (2008) A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33:997–1006CrossRefPubMedGoogle Scholar
  10. 10.
    Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, Baracos VE (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629–635CrossRefPubMedGoogle Scholar
  11. 11.
    Go SI, Park MJ, Song HN, Kang MH, Park HJ, Jeon KN, Kim SH, Kim MJ, Kang JH, Lee GW (2016) Sarcopenia and inflammation are independent predictors of survival in male patients newly diagnosed with small cell lung cancer. Support Care Cancer 24(5):2075–2084CrossRefPubMedGoogle Scholar
  12. 12.
    Consultation WHOE (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163CrossRefGoogle Scholar
  13. 13.
    Kalemkerian GP, Gadgeel SM (2013) Modern staging of small cell lung cancer. J Natl Compr Cancer Netw 11:99–104Google Scholar
  14. 14.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older P (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing 39:412–423CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kim YS, Kim EY, Kang SM, Ahn HK, Kim HS (2015) Single cross-sectional area of pectoralis muscle by computed tomography—correlation with bioelectrical impedance based skeletal muscle mass in healthy subjects. Clin Physiol Funct Imaging. doi: 10.1111/cpf.12333

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Eun Young Kim
    • 1
  • Young Saing Kim
    • 2
    Email author
  • Inkeun Park
    • 2
  • Hee Kyung Ahn
    • 2
  • Eun Kyung Cho
    • 2
  • Yu Mi Jeong
    • 1
  • Jeong Ho Kim
    • 1
  1. 1.Department of RadiologyGachon University Gil Medical CenterIncheonRepublic of Korea
  2. 2.Division of Hematology and Oncology, Department of Internal MedicineGachon University Gil Medical CenterIncheonRepublic of Korea

Personalised recommendations