The predictive value of sarcopenia and PET imaging metrics in metastatic non-squamous NSCLC

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AIM: Metastatic non-small cell lung cancer (NSCLC) patients face a poor prognosis, with a 5-year overall survival (OS) rate of under 10%. In this investigation, we examined the prognostic implications of sarcopenia and metabolic metrics obtained from 18F-FDG PET/CT imaging in individuals diagnosed with metastatic non-squamous NSCLC (nsNSCLC). METHODS: The investigation included 124 individuals with metastatic nsNSCLC who underwent 18F-FDG PET/CT imaging on diagnosis. Sarcopenia was determined by evaluating the skeletal muscle index at the L3 vertebral level. Metabolic metrics obtained from 18F-FDG PET/CT imaging, maximum standard uptake, metabolic tumor volume, and total lesion glycolysis were measured for whole body lesions (SUVmax_WB, MTV_WB, and TLG_WB) and primary tumors (SUVmax_T, MTV_T, and TLG_T). Primary endpoints examined were OS and the rate of sarcopenia diagnosis. RESULTS: Patients with sarcopenia, comprising 74.2% of the cohort, experienced a markedly reduced median OS of 4.7 months compared to 9.8 months in the non-sarcopenic cohort, which accounted for 25.8% of the population. Multivariate analysis revealed that sarcopenia, as well as metabolic metrics, including SUVmax_T, MTV_T, TLG_T, and SUVmax_WB, were independent predictors of OS in metastatic nsNSCLC patients. CONCLUSION: The presence of sarcopenia and unfavorable metabolic metrics on 18F-FDG PET/CT are linked to worse survival outcomes in metastatic nsNSCLC patients.

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