Frontiers in nutrition · 2026
Sex-stratified prognostic value of low skeletal muscle index in advanced non-small cell lung Cancer: a retrospective cohort study.
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Li Xin-Qi, Wu Yan-Xu, Lu Yun-Tao, Zhao Ting, Zhu Ying-Gang
Аннотация
BACKGROUND: Low skeletal muscle mass is associated with poor outcomes in non-small cell lung cancer (NSCLC), but whether the prognostic association differs by sex remains unclear. We evaluated the sex-stratified association between low skeletal muscle index (SMI) and overall survival in patients with advanced NSCLC.
METHODS: We conducted a retrospective analysis of 270 patients with advanced (stage III-IV) non-small cell lung cancer selected from a prospective cohort (n = 403) at Huadong Hospital. Baseline skeletal muscle index (SMI) was measured by bioelectrical impedance analysis (BIA) and dichotomized using AWGS thresholds (men <7.0 kg/m2; women <5.7 kg/m2). Sex-stratified Cox proportional hazards regression was performed to assess the association between low SMI and overall survival, adjusting for age, disease stage, performance status, comorbidities, and treatment modality. Sensitivity analyses were performed.
RESULTS: During a median follow-up of 392 days, 145 deaths occurred (53.7% mortality). In males, low SMI was independently associated with increased mortality risk (adjusted HR = 1.67, 95% CI: 1.11-2.51, p = 0.013); estimates were essentially unchanged after additional adjustment for smoking and albumin (HR range 1.58-1.68; all P < = 0.029). In females, no statistically significant association was detected (adjusted HR = 0.81, 95% CI: 0.40-1.65, p = 0.564), noting the limited power of the female subgroup. The sex-by-SMI interaction was also not statistically significant (P-interaction = 0.115). Exploratory cutpoint analysis supports the applicability of the AWGS male threshold in males (7.0 kg/m2). Supplementary analyses using continuous SMI modeling, interaction testing, and sensitivity analyses excluding early deaths confirmed the robustness of these sex-stratified findings.
CONCLUSION: BIA-defined low skeletal muscle mass (low SMI) was independently associated with poorer overall survival in male patients with advanced NSCLC, whereas no statistically significant association was detected in women. Given the limited sample size and statistical power of the female subgroup, these sex-stratified findings should be interpreted cautiously. As this study evaluated low muscle mass rather than full AWGS-defined sarcopenia, the findings should be interpreted accordingly. These results, derived from a single-center retrospective cohort, are hypothesis-generating and require external validation in larger, multi-center cohorts before sex-stratified interpretation can be applied in clinical practice.
METHODS: We conducted a retrospective analysis of 270 patients with advanced (stage III-IV) non-small cell lung cancer selected from a prospective cohort (n = 403) at Huadong Hospital. Baseline skeletal muscle index (SMI) was measured by bioelectrical impedance analysis (BIA) and dichotomized using AWGS thresholds (men <7.0 kg/m2; women <5.7 kg/m2). Sex-stratified Cox proportional hazards regression was performed to assess the association between low SMI and overall survival, adjusting for age, disease stage, performance status, comorbidities, and treatment modality. Sensitivity analyses were performed.
RESULTS: During a median follow-up of 392 days, 145 deaths occurred (53.7% mortality). In males, low SMI was independently associated with increased mortality risk (adjusted HR = 1.67, 95% CI: 1.11-2.51, p = 0.013); estimates were essentially unchanged after additional adjustment for smoking and albumin (HR range 1.58-1.68; all P < = 0.029). In females, no statistically significant association was detected (adjusted HR = 0.81, 95% CI: 0.40-1.65, p = 0.564), noting the limited power of the female subgroup. The sex-by-SMI interaction was also not statistically significant (P-interaction = 0.115). Exploratory cutpoint analysis supports the applicability of the AWGS male threshold in males (7.0 kg/m2). Supplementary analyses using continuous SMI modeling, interaction testing, and sensitivity analyses excluding early deaths confirmed the robustness of these sex-stratified findings.
CONCLUSION: BIA-defined low skeletal muscle mass (low SMI) was independently associated with poorer overall survival in male patients with advanced NSCLC, whereas no statistically significant association was detected in women. Given the limited sample size and statistical power of the female subgroup, these sex-stratified findings should be interpreted cautiously. As this study evaluated low muscle mass rather than full AWGS-defined sarcopenia, the findings should be interpreted accordingly. These results, derived from a single-center retrospective cohort, are hypothesis-generating and require external validation in larger, multi-center cohorts before sex-stratified interpretation can be applied in clinical practice.