Associations between body composition and radiotherapy-related side-effects and health-related quality of life in patients with prostate or lung cancer: sub-analysis of the REQUITE trial.

内容摘要

Body composition is emerging as a prognostic biomarker in cancer and may be associated with treatment tolerance, side-effects, and health-related quality of life (HRQoL). It can be measured from imaging routinely acquired during patient care. We evaluated whether body composition metrics were associated with radiotherapy-related side-effects and HRQoL in patients with prostate or lung cancer using a prospective multicentre dataset. Radiotherapy planning computed tomography (CT) scans, patient and disease characteristics, and clinician- and patient-reported side-effects up to 24&#x202f;months post-treatment were obtained from the REQUITE study. Skeletal muscle and intramuscular adipose tissue were segmented at the L3 and T12 vertebrae for prostate and lung patients respectively using in-house software. Standardised total average toxicity scores captured composite acute and late clinician- and patient-reported side-effects and HRQoL. Gradient boosted machine models were developed for all endpoints with and without body composition variables. Predictor importance rankings and model performance (root mean squared error (RMSE)) were assessed. 279 lung and 848 prostate patients were available for analysis. Body composition variables were ranked in the top five most important variables for 9 of 12 endpoints. Body composition variables were ranked higher than body mass index for 9 of 12 endpoints. Adding body composition variables was associated with statistically significant (p&#x202f;<&#x202f;0.01) but small reductions in apparent/in-sample RMSE across endpoints. Body composition variables were frequently ranked among important predictors of radiotherapy-related side-effects and HRQoL, but their incremental improvement in apparent model fit was small. These findings suggest that CT-derived body composition may warrant further investigation as an exploratory imaging biomarker, but external validation and demonstration of clinically meaningful incremental value are required before clinical implementation.