Supportive Care in Cancer

, Volume 28, Issue 1, pp 389–394 | Cite as

Low paravertebral muscle mass in patients with bone metastases from lung cancer is associated with poor prognosis

  • Sho DohzonoEmail author
  • Ryuichi Sasaoka
  • Kiyohito Takamatsu
  • Masatoshi Hoshino
  • Hiroaki Nakamura
Original Article



Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients.


The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival.


The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17–2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors.


Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.


Bone metastases Prognosis Paravertebral muscle Psoas muscle Sarcopenia 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Al Husaini H, Wheatley-Price P, Clemons M, Shepherd FA (2009) Prevention and management of bone metastases in lung cancer: a review. J Thorac Oncol 4:251–259CrossRefGoogle Scholar
  2. 2.
    Bae HM, Lee SH, Kim TM, Kim DW, Yang SC, Wu HG, Kim YW, Heo DS (2012) Prognostic factors for non-small cell lung cancer with bone metastasis at the time of diagnosis. Lung Cancer 77:572–577CrossRefGoogle Scholar
  3. 3.
    Bauer H, Tomita K, Kawahara N, Abdel-Wanis ME, Murakami H (2002) Surgical strategy for spinal metastases. Spine 27:1124–1126CrossRefGoogle Scholar
  4. 4.
    Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE, Chow LQ, Vokes EE, Felip E, Holgado E, Barlesi F, Kohlhaufl M, Arrieta O, Burgio MA, Fayette J, Lena H, Poddubskaya E, Gerber DE, Gettinger SN, Rudin CM, Rizvi N, Crino L, Blumenschein GR Jr, Antonia SJ, Dorange C, Harbison CT, Graf Finckenstein F, Brahmer JR (2015) Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med 373:1627–1639CrossRefGoogle Scholar
  5. 5.
    Brodowicz T, O'Byrne K, Manegold C (2012) Bone matters in lung cancer. Ann Oncol 23:2215–2222CrossRefGoogle Scholar
  6. 6.
    Coleman RE (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 12:6243s–6249sCrossRefGoogle Scholar
  7. 7.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vandewoude M, Zamboni M (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412–423CrossRefGoogle Scholar
  8. 8.
    Gakhar H, Dhillon A, Blackwell J, Hussain K, Bommireddy R, Klezl Z, Williams J (2015) Study investigating the role of skeletal muscle mass estimation in metastatic spinal cord compression. Eur Spine J 24:2150–2155CrossRefGoogle Scholar
  9. 9.
    Go SI, Park MJ, Song HN, Kang MH, Park HJ, Jeon KN, Kim SH, Kim MJ, Kang JH, Lee GW (2016) Sarcopenia and inflammation are independent predictors of survival in male patients newly diagnosed with small cell lung cancer. Support Care Cancer 24:2075–2084CrossRefGoogle Scholar
  10. 10.
    Katagiri H, Okada R, Takagi T, Takahashi M, Murata H, Harada H, Nishimura T, Asakura H, Ogawa H (2014) New prognostic factors and scoring system for patients with skeletal metastasis. Cancer Med 3:1359–1367CrossRefGoogle Scholar
  11. 11.
    Kimura M, Naito T, Kenmotsu H, Taira T, Wakuda K, Oyakawa T, Hisamatsu Y, Tokito T, Imai H, Akamatsu H, Ono A, Kaira K, Murakami H, Endo M, Mori K, Takahashi T, Yamamoto N (2015) Prognostic impact of cancer cachexia in patients with advanced non-small cell lung cancer. Support Care Cancer 23:1699–1708CrossRefGoogle Scholar
  12. 12.
    Kuchuk M, Kuchuk I, Sabri E, Hutton B, Clemons M, Wheatley-Price P (2015) The incidence and clinical impact of bone metastases in non-small cell lung cancer. Lung Cancer 89:197–202CrossRefGoogle Scholar
  13. 13.
    Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, Murphy R, Ghosh S, Sawyer MB, Baracos VE (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31:1539–1547CrossRefGoogle Scholar
  14. 14.
    Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE (2008) A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 33:997–1006CrossRefGoogle Scholar
  15. 15.
    Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, Baracos VE (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629–635CrossRefGoogle Scholar
  16. 16.
    Rades D, Douglas S, Veninga T, Schild SE (2012) A validated survival score for patients with metastatic spinal cord compression from non-small cell lung cancer. BMC Cancer 12:302CrossRefGoogle Scholar
  17. 17.
    Reck M, Rodriguez-Abreu D, Robinson AG, Hui R, Csoszi T, Fulop A, Gottfried M, Peled N, Tafreshi A, Cuffe S, O'Brien M, Rao S, Hotta K, Leiby MA, Lubiniecki GM, Shentu Y, Rangwala R, Brahmer JR (2016) Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med 375:1823–1833CrossRefGoogle Scholar
  18. 18.
    Rief H, Omlor G, Akbar M, Welzel T, Bruckner T, Rieken S, Haefner MF, Schlampp I, Gioules A, Habermehl D, von Nettelbladt F, Debus J (2014) Feasibility of isometric spinal muscle training in patients with bone metastases under radiation therapy - first results of a randomized pilot trial. BMC Cancer 14:67CrossRefGoogle Scholar
  19. 19.
    Rosenberg IH (1997) Sarcopenia: origins and clinical relevance. J Nutr 127:990S–991SCrossRefGoogle Scholar
  20. 20.
    Shen W, Punyanitya M, Wang Z, Gallagher D, St-Onge MP, Albu J, Heymsfield SB, Heshka S (2004) Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985) 97:2333–2338CrossRefGoogle Scholar
  21. 21.
    Sjoblom B, Benth JS, Gronberg BH, Baracos VE, Sawyer MB, Flotten O, Hjermstad MJ, Aass N, Jordhoy M (2017) Drug dose per kilogram lean body mass predicts hematologic toxicity from carboplatin-doublet chemotherapy in advanced non-small-cell lung cancer. Clin Lung Cancer 18:e129–e136CrossRefGoogle Scholar
  22. 22.
    Sugiura H, Yamada K, Sugiura T, Hida T, Mitsudomi T (2008) Predictors of survival in patients with bone metastasis of lung cancer. Clin Orthop Relat Res 466:729–736CrossRefGoogle Scholar
  23. 23.
    Takayama K, Kita T, Nakamura H, Kanematsu F, Yasunami T, Sakanaka H, Yamano Y (2016) New predictive index for lumbar paraspinal muscle degeneration associated with aging. Spine 41:E84–E90CrossRefGoogle Scholar
  24. 24.
    Tan JH, Tan KA, Zaw AS, Thomas AC, Hey HW, Soo RA, Kumar N (2016) Evaluation of scoring systems and prognostic factors in patients with spinal metastases from lung Cancer. Spine 41:638–644CrossRefGoogle Scholar
  25. 25.
    Tang V, Harvey D, Park Dorsay J, Jiang S, Rathbone MP (2007) Prognostic indicators in metastatic spinal cord compression: using functional independence measure and Tokuhashi scale to optimize rehabilitation planning. Spinal Cord 45:671–677CrossRefGoogle Scholar
  26. 26.
    Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 30:2186–2191CrossRefGoogle Scholar
  27. 27.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108CrossRefGoogle Scholar
  28. 28.
    Wang C, Bai L (2012) Sarcopenia in the elderly: basic and clinical issues. Geriatr Gerontol Int 12:388–396CrossRefGoogle Scholar
  29. 29.
    Zakaria HM, Basheer A, Boyce-Fappiano D, Elibe E, Schultz L, Lee I, Siddiqui F, Griffith B, Chang V (2016) Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study. Neurosurg Focus 41:E12CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryYodogawa Christian HospitalOsakaJapan
  2. 2.Department of Orthopaedic SurgeryOsaka City University Graduate School of MedicineOsakaJapan

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