TY - JOUR
T1 - Synergic prognostic value of 3D CT scan subcutaneous fat and muscle masses for immunotherapy-treated cancer
AU - Decazes, Pierre
AU - Ammari, Samy
AU - Belkouchi, Younes
AU - Mottay, Léo
AU - Lawrance, Littisha
AU - De Prévia, Antoine
AU - Talbot, Hugues
AU - Farhane, Siham
AU - Cournède, Paul Henry
AU - Marabelle, Aurelien
AU - Guisier, Florian
AU - Planchard, David
AU - Ibrahim, Tony
AU - Robert, Caroline
AU - Barlesi, Fabrice
AU - Vera, Pierre
AU - Lassau, Nathalie
N1 - Publisher Copyright:
© 2023 BioMed Central Ltd.. All rights reserved.
PY - 2023/9/7
Y1 - 2023/9/7
N2 - Background Our aim was to explore the prognostic value of anthropometric parameters in a large population of patients treated with immunotherapy. Methods We retrospectively included 623 patients with advanced non-small cell lung cancer (NSCLC) (n=318) or melanoma (n=305) treated by an immune-checkpoint-inhibitor having a pretreatment (thorax-)abdomen-pelvis CT scan. An external validation cohort of 55 patients with NSCLC was used. Anthropometric parameters were measured three-dimensionally (3D) by a deep learning software (Anthropometer3DNet) allowing an automatic multislice measurement of lean body mass, fat body mass (FBM), muscle body mass (MBM), visceral fat mass (VFM) and sub-cutaneous fat mass (SFM). Body mass index (BMI) and weight loss (WL) were also retrieved. Receiver operator characteristic (ROC) curve analysis was performed and overall survival was calculated using Kaplan-Meier (KM) curve and Cox regression analysis. Results In the overall cohort, 1-year mortality rate was 0.496 (95% CI: 0.457 to 0.537) for 309 events and 5-year mortality rate was 0.196 (95% CI: 0.165 to 0.233) for 477 events. In the univariate Kaplan-Meier analysis, prognosis was worse (p<0.001) for patients with low SFM (<3.95 kg/m 2), low FBM (<3.26 kg/m 2), low VFM (<0.91 kg/m 2), low MBM (<5.85 kg/m 2) and low BMI (<24.97 kg/m 2). The same parameters were significant in the Cox univariate analysis (p<0.001) and, in the multivariate stepwise Cox analysis, the significant parameters were MBM (p<0.0001), SFM (0.013) and WL (0.0003). In subanalyses according to the type of cancer, all body composition parameters were statistically significant for NSCLC in ROC, KM and Cox univariate analysis while, for melanoma, none of them, except MBM, was statistically significant. In multivariate Cox analysis, the significant parameters for NSCLC were MBM (HR=0.81, p=0.0002), SFM (HR=0.94, p=0.02) and WL (HR=1.06, p=0.004). For NSCLC, a KM analysis combining SFM and MBM was able to separate the population in three categories with the worse prognostic for the patients with both low SFM (<5.22 kg/m 2) and MBM (<6.86 kg/m 2) (p<0001). On the external validation cohort, combination of low SFM and low MBM was pejorative with 63% of mortality at 1 year versus 25% (p=0.0029). Conclusions 3D measured low SFM and MBM are significant prognosis factors of NSCLC treated by immune checkpoint inhibitors and can be combined to improve the prognostic value.
AB - Background Our aim was to explore the prognostic value of anthropometric parameters in a large population of patients treated with immunotherapy. Methods We retrospectively included 623 patients with advanced non-small cell lung cancer (NSCLC) (n=318) or melanoma (n=305) treated by an immune-checkpoint-inhibitor having a pretreatment (thorax-)abdomen-pelvis CT scan. An external validation cohort of 55 patients with NSCLC was used. Anthropometric parameters were measured three-dimensionally (3D) by a deep learning software (Anthropometer3DNet) allowing an automatic multislice measurement of lean body mass, fat body mass (FBM), muscle body mass (MBM), visceral fat mass (VFM) and sub-cutaneous fat mass (SFM). Body mass index (BMI) and weight loss (WL) were also retrieved. Receiver operator characteristic (ROC) curve analysis was performed and overall survival was calculated using Kaplan-Meier (KM) curve and Cox regression analysis. Results In the overall cohort, 1-year mortality rate was 0.496 (95% CI: 0.457 to 0.537) for 309 events and 5-year mortality rate was 0.196 (95% CI: 0.165 to 0.233) for 477 events. In the univariate Kaplan-Meier analysis, prognosis was worse (p<0.001) for patients with low SFM (<3.95 kg/m 2), low FBM (<3.26 kg/m 2), low VFM (<0.91 kg/m 2), low MBM (<5.85 kg/m 2) and low BMI (<24.97 kg/m 2). The same parameters were significant in the Cox univariate analysis (p<0.001) and, in the multivariate stepwise Cox analysis, the significant parameters were MBM (p<0.0001), SFM (0.013) and WL (0.0003). In subanalyses according to the type of cancer, all body composition parameters were statistically significant for NSCLC in ROC, KM and Cox univariate analysis while, for melanoma, none of them, except MBM, was statistically significant. In multivariate Cox analysis, the significant parameters for NSCLC were MBM (HR=0.81, p=0.0002), SFM (HR=0.94, p=0.02) and WL (HR=1.06, p=0.004). For NSCLC, a KM analysis combining SFM and MBM was able to separate the population in three categories with the worse prognostic for the patients with both low SFM (<5.22 kg/m 2) and MBM (<6.86 kg/m 2) (p<0001). On the external validation cohort, combination of low SFM and low MBM was pejorative with 63% of mortality at 1 year versus 25% (p=0.0029). Conclusions 3D measured low SFM and MBM are significant prognosis factors of NSCLC treated by immune checkpoint inhibitors and can be combined to improve the prognostic value.
KW - Immunotherapy
KW - Melanoma
KW - Non-Small Cell Lung Cancer
UR - http://www.scopus.com/inward/record.url?scp=85170179319&partnerID=8YFLogxK
U2 - 10.1136/jitc-2023-007315
DO - 10.1136/jitc-2023-007315
M3 - Article
C2 - 37678919
AN - SCOPUS:85170179319
SN - 2051-1426
VL - 11
JO - Journal for ImmunoTherapy of Cancer
JF - Journal for ImmunoTherapy of Cancer
IS - 9
M1 - e007315
ER -