Prognostic value of changes in skeletal muscle index on serial computed tomography scans for overall survival in patients with advanced non-small cell lung cancer: a single-center retrospective study.
- 1Department of Radiology, The Second Affiliated Hospital of Henan University of Chinese Medicine (Henan Provincial Hospital of Traditional Chinese Medicine), Zhengzhou, China.
- 2Department of Radiology, The Second Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China.
- 3The Second Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China.
Abstract
Survival rates in advanced non-small cell lung cancer (NSCLC) vary substantially, and changes in host body composition may affect prognosis. Serial computed tomography (CT) can repeatedly quantify skeletal muscle index (SMI) at the L3 level, but its dynamic predictive value and clinically usable thresholds have not been systematically validated. This study systematically evaluates the predictive value of longitudinal SMI changes based on serial CT for overall survival (OS), validate early treatment thresholds, and test its incremental effect over clinical models and Response Evaluation Criteria In Solid Tumors (RECIST). A single-center retrospective cohort was established, including 451 patients with stage IIIB-IV NSCLC who received systemic therapy from 2018 to 2023. L3 SMI was extracted at baseline and follow-up CT; segmentation consistency intraclass correlation coefficient (ICC) ≥0.97. ΔSMI% was modeled as a time-dependent exposure (per 5% decrease) in multivariable Cox, and a 12-week landmark analysis was used to evaluate early ΔSMI% ≤-5%. Baseline missing data were handled with MICE (m=20). Combined with RECIST, we compared the C-index, Uno time-dependent area under the curve (AUC), and 12-month net reclassification improvement (NRI), and conducted decision curve analysis and 1,000 bootstrap calibration. Each 5% decrease in ΔSMI% was independently associated with increased death risk [hazard ratio (HR) =1.16, P=0.001], and higher baseline SMI was associated with reduced risk (per 10 cm2/m2 HR =0.87, P=0.006); the association between ΔSMI% and death risk was approximately linear (overall P=0.001). At the 12-week landmark analysis, early ΔSMI% ≤-5% was associated with worse survival (log-rank P=0.003), with an adjusted HR =1.68 (P=0.001). The correlation between early ΔSMI% and RECIST was weak (r=-0.18, P=0.001). On top of clinical covariates, adding baseline SMI and time-dependent ΔSMI% increased the corrected C-index from 0.67 to 0.71; 12-month NRI =0.19; AUC at 6/12 months was 0.71/0.70. Decision curves showed higher net benefit than treat all/none within threshold ranges 0.23-0.47 and 0.34-0.58; calibration was good. SMI dynamic metrics derived from serial CT constitute an independent and actionable prognostic signal in advanced NSCLC, enable early identification of high-risk patients within routine follow-up windows, and provide incremental gains in discrimination and net benefit over clinical models.
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BibTeX
@article{zhou2026prognostic,
title = {{Prognostic value of changes in skeletal muscle index on serial computed tomography scans for overall survival in patients with advanced non-small cell lung cancer: a single-center retrospective study.}},
author = {Yuan-Yuan Zhou and Yi-Ran Guan and Yi Wen and Feng-Li Du and Ming Li and Zhi-Xin Wang and Zhong-Jie Yang},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1968},
url = {https://europepmc.org/article/MED/42996941},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Prognostic value of changes in skeletal muscle index on serial computed tomography scans for overall survival in patients with advanced non-small cell lung cancer: a single-center retrospective study.
AU - Yuan-Yuan Zhou
AU - Yi-Ran Guan
AU - Yi Wen
AU - Feng-Li Du
AU - Ming Li
AU - Zhi-Xin Wang
AU - Zhong-Jie Yang
PY - 2026
DA - 2026/09/29
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1968
UR - https://europepmc.org/article/MED/42996941
AB - Survival rates in advanced non-small cell lung cancer (NSCLC) vary substantially, and changes in host body composition may affect prognosis. Serial computed tomography (CT) can repeatedly quantify skeletal muscle index (SMI) at the L3 level, but its dynamic predictive value and clinically usable thresholds have not been systematically validated. This study systematically evaluates the predictive value of longitudinal SMI changes based on serial CT for overall survival (OS), validate early treatment thresholds, and test its incremental effect over clinical models and Response Evaluation Criteria In Solid Tumors (RECIST). A single-center retrospective cohort was established, including 451 patients with stage IIIB-IV NSCLC who received systemic therapy from 2018 to 2023. L3 SMI was extracted at baseline and follow-up CT; segmentation consistency intraclass correlation coefficient (ICC) ≥0.97. ΔSMI% was modeled as a time-dependent exposure (per 5% decrease) in multivariable Cox, and a 12-week landmark analysis was used to evaluate early ΔSMI% ≤-5%. Baseline missing data were handled with MICE (m=20). Combined with RECIST, we compared the C-index, Uno time-dependent area under the curve (AUC), and 12-month net reclassification improvement (NRI), and conducted decision curve analysis and 1,000 bootstrap calibration. Each 5% decrease in ΔSMI% was independently associated with increased death risk [hazard ratio (HR) =1.16, P=0.001], and higher baseline SMI was associated with reduced risk (per 10 cm2/m2 HR =0.87, P=0.006); the association between ΔSMI% and death risk was approximately linear (overall P=0.001). At the 12-week landmark analysis, early ΔSMI% ≤-5% was associated with worse survival (log-rank P=0.003), with an adjusted HR =1.68 (P=0.001). The correlation between early ΔSMI% and RECIST was weak (r=-0.18, P=0.001). On top of clinical covariates, adding baseline SMI and time-dependent ΔSMI% increased the corrected C-index from 0.67 to 0.71; 12-month NRI =0.19; AUC at 6/12 months was 0.71/0.70. Decision curves showed higher net benefit than treat all/none within threshold ranges 0.23-0.47 and 0.34-0.58; calibration was good. SMI dynamic metrics derived from serial CT constitute an independent and actionable prognostic signal in advanced NSCLC, enable early identification of high-risk patients within routine follow-up windows, and provide incremental gains in discrimination and net benefit over clinical models.
SN - 2072-1439
SN - 2077-6624
ER -