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17/11/2020 - Press release

Nutritional parameters of lung cancer and COPD patients could predict their 10-year survival rate

Low values of these parameters, along with other factors such as smoking, have been associated with poorer post-operative survival

Nutritional parameters such as body mass index and tests including albumin and total protein levels quantified prior to lung cancer surgery in patients with chronic obstructive pulmonary disease (COPD) predict their 10 year survival, regardless of tumour-related factors and/or chest surgery. This is reflected in the work of researchers from the CIBER of Respiratory Diseases (CIBERES) and doctors and researchers from the Hospital del Mar Pneumology Service and the Hospital del Mar Medical Research Institute research group on muscle wasting and cachexia in chronic respiratory diseases and lung cancer (IMIM-Hospital del Mar), published in the journal of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR)  Archivos de Bronconeumología.

The researchers studied the nutritional status of lung cancer and COPD patients who required surgery and the relationship of this with post-operative survival.  To do this, they analysed the nutritional status of 125 patients from Hospital del Mar, 87 of whom had COPD and lung cancer and 38 of whom had cancer but no COPD, before they underwent chest surgery. The patients were monitored for 10 years in order to study their differential survival rates according to the presence or absence of COPD.

Prior to surgery, the following parameters were assessed: body mass index (BMI), blood parameters such as albumin and total protein levels, and other clinical parameters (smoking history, cancer staging and histological subtype, COPD severity, lung function, and adjuvant therapy).

In the study, low scores for body mass index, albumin and total protein parameters were associated with a reduced 10-year survival, especially for lung cancer patients with COPD. Associated factors such as smoking also contributed to a higher mortality rate.

According to Esther Barreiro, a researcher at CIBERES, pneumologist at Hospital del Mar, researcher at the IMIM, and author of the study, "In this sample of patients with lung cancer and a good nutritional state, the BMI together with the albumin and blood protein levels measured prior to the operation predicted survival, above all in individuals with COPD." She goes on to say that "These findings are clinically relevant, as the nutritional parameter values were within the normal range in most of the patients analysed." For this reason, a comprehensive preoperative nutritional assessment should be included in the study of lung cancer patients, particularly those with chronic pulmonary obstruction.

Patients with COPD and sarcopaenia have lower skeletal muscle regeneration potential

Researchers from the same CIBERES group have also found that patients with severe COPD and sarcopaenia (loss of muscle mass and function) have decreased skeletal muscle regenerative potential compared to patients with the same respiratory disease but without sarcopaenia. This highlights the importance of assessing nutritional status as well as muscle mass and function, especially in the lower extremities, in patients with chronic obstructive pulmonary disease.

In this study published in the US Journal of Cellular Physiology, researchers found, in the vastus lateralis of the quadriceps muscle of 45 COPD patients (26 with and 14 without sarcopaenia), an increase in apoptosis (cell death) and myostatin markers, as well as a significant deficit in the muscle regenerative capacity in sarcopaenia patients (decreased regenerative potential of satellite cells), in addition to severe alterations in muscle structure.

Dr. Esther Barreiro indicates that, "All these changes detected can greatly influence the response to exercise training in patients with severe COPD and sarcopaenia. It is therefore important to include an assessment of the nutritional status and condition of the muscles in COPD patients, particularly those in the lower extremities, and specifically those that may be affected by exercise training."

Reference articles:

Preoperative body weight and albumin predict survival in patients with resectable lung neoplasms: role of COPD

J Tang, V Curull, D Ramis-Cabrer, X Duran, A Rodríguez-Fuster, R Aguiló Espases, E Barreiro. Arch Bronconeumol 2021 (in press). Impact factor: 4.957, Q1, Respiratory System. https://www.archbronconeumol.org/es-preoperative-body-weight-albumin-predict-avance-S0300289620302568

Deficient muscle regeneration potential in sarcopenic COPD paitents: Role of satellite cells

A Sancho-Muñoz, M Guitart, DA Rodríguez, J Gea, J Martínez-Llorens, E Barreiro. J Cell Physiol 2021 (in press). Impact factor: 5.546, Q1, Physiology, Q2, Cell Biology. https://onlinelibrary.wiley.com/doi/abs/10.1002/jcp.30073

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