在一线治疗期间晚期非小细胞肺癌患者体重和身体组成增加的频率

本研究的主要目标是评估两组真实世界、未接受治疗的晚期非小细胞肺癌（NSCLC）患者中身体组成增加的频率及其与体重变化的关系。一组接受当前标准治疗（CSOC），包括免疫治疗和更新的化疗方案，另一组接受旧的标准治疗（FSOC），仅包含较老的含铂方案。共有106例CSOC组和88例FSOC组的晚期NSCLC患者被纳入本研究。我们在每次临床随访时收集体重数据，并通过自动分割软件对常规胸部CT进行身体组成分析，评估基线及6周、12周的变化。采用标准统计方法计算体重与身体组成变化之间的关系。CSOC组包括2014年12月16日至2020年10月22日期间接受治疗的106例IV期NSCLC患者，而FSOC组包括2006年6月16日至2014年11月18日期间接受治疗的88例III/IV期NSCLC患者。尽管每个组在6周和12周时都表现出中位体重、体质指数（BMI）、骨骼肌指数（SMI）和皮下脂肪组织指数（SATI）的下降，但部分患者的这些参数出现了增加。以≥2.5%的增加作为12周时体重、BMI、SMI和SATI的阈值，两组均表现出类似的（20.5%和27.3%）参数增加。在以≥5%的增长为界的分析中，8.0%至25.0%的患者在体重、BMI、SMI和SATI方面达到了或超过了这一水平。不同组之间的比较显示没有显著差异。体重变化与SMI和SATI变化在6周和12周时的Pearson相关系数范围为0.31至0.58，所有P值均<0.02。体重变化与VAT指数（VATI）和IMATI变化在12周时的相关系数范围为0.26至0.47，所有P值均<0.05。各组间Pearson相关系数的比较未显示出显著差异。尽管两组中位体重、BMI、SMI和SATI均呈下降趋势，但每组中经验增加这些参数的患者比例相似。这些发现，加上体重、肌肉量和脂肪组织的纵向测量之间的正相关关系，表明这些患者的体重增加涉及肌肉和脂肪的同时增加。一旦验证，这些结果可能对临床试验设计和癌症恶液质的转化研究产生影响。

The primary objective of this study was to assess the frequency of body composition increases and their relationships to changes in body weight in two cohorts of real world, treatment-naïve, advanced non-small cell lung cancer (NSCLC) patients. One cohort received the current standard of care (CSOC), which consisted of immunotherapy and newer chemotherapy regimens, and the other cohort was treated with the former standard of care (FSOC), consisting only of older platinum-containing regimens.CSOC (n = 106) and FSOC (n = 88) cohorts of advanced NSCLC patients were included in this study. Weights were collected at each clinical visit, and body composition analysis from routine chest computed tomography via automated segmentation software assessed at baseline and at 6 and 12 weeks. Standard statistical methods were used to calculate relationships between changes in weight and in body composition.The CSOC cohort contained 106 stage IV NSCLC patients treated between 16/12/2014 and 22/10/2020 while the FSOC cohort contained 88 stage III/IV NSCLC patients treated between 16/6/2006 and 18/11/2014. While each cohort exhibited decreases in median weight, body mass index (BMI), mean skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI) at the 6 and 12 week time points, a subset of patients experienced increases in these parameters. Using a threshold of ≥2.5% increase for weight, BMI, SMI, and SATI at the 12 week time point, both cohorts showed similar (20.5% and 27.3%) increases in these parameters. With a cut point of ≥5% increase at 12 weeks follow-up, 8.0% to 25.0% of the patients gained ≥5% in weight, BMI, SMI and SATI. Comparing these results in each cohort showed no significant differences. Pearson coefficients for weight change related to changes in SMI and SATI at 6 and 12 weeks ranged from 0.31 to 0.58 with all P values <0.02. Pearson coefficients for weight change at 12 weeks related to changes in VATI and IMATI ranged from 0.26 to 0.47 with all P values <0.05. Comparison of Pearson coefficients for each cohort showed no significant differences.Although decreases in median weight, BMI, SMI and SATI were observed in both cohorts, similar percentage of patients in each cohort experienced increases in these parameters. These findings, plus the positive correlations between longitudinal measurements of weight, muscle mass and adipose tissue, indicate that weight gain in these patients involves increases in both muscle mass and adipose tissue. Upon validation, these findings could have implications for clinical trial design and for translational research in cancer cachexia.