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Supportive Care in Cancer

, Volume 24, Issue 11, pp 4495–4502 | Cite as

Cancer cachexia, sarcopenia and biochemical markers in patients with advanced non-small cell lung cancer—chemotherapy toxicity and prognostic value

  • Drazena SrdicEmail author
  • Sanja Plestina
  • Ana Sverko-Peternac
  • Nora Nikolac
  • Ana-Maria Simundic
  • Miroslav Samarzija
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Cancer cachexia Sarcopenia Non-small cell lung cancer Chemotherapy toxicity 

Notes

Compliance with ethical standards

The study was approved by the University Hospital Ethics Board.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Drazena Srdic
    • 1
    Email author
  • Sanja Plestina
    • 2
  • Ana Sverko-Peternac
    • 3
  • Nora Nikolac
    • 4
  • Ana-Maria Simundic
    • 5
  • Miroslav Samarzija
    • 6
  1. 1.Department for Respiratory Diseases “Jordanovac”University Hospital Centre ZagrebZagrebCroatia
  2. 2.Medical School University of Rijeka, Department for Respiratory Diseases “Jordanovac”University Hospital Centre ZagrebZagrebCroatia
  3. 3.Department for Diagnostic and Interventional RadiologyUniversity Hospital Centre Sestre MilosrdniceZagrebCroatia
  4. 4.University Department of ChemistryMedical School University Hospital Sestre MilosrdniceZagrebCroatia
  5. 5.Department of Medical Laboratory DiagnosticsUniversity Hospital “Sveti Duh”ZagrebCroatia
  6. 6.Medical School University of Zagreb, Department for Respiratory Diseases “Jordanovac”University Hospital Centre ZagrebZagrebCroatia

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