Dorsal Muscle Attenuation May Predict Failure to Respond to Interleukin-2 Therapy in Metastatic Renal Cell Carcinoma

Acad Radiol. 2017 Sep;24(9):1094-1100. doi: 10.1016/j.acra.2017.03.003. Epub 2017 Mar 22.


Rationale and objectives: To explore whether the sarcopenia body type can help predict response to interleukin-2 (IL-2) therapy in metastatic renal cell carcinoma (RCC).

Materials and methods: Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant retrospective cohort study of 75 subjects with metastatic RCC who underwent pretreatment contrast-enhanced computed tomography within 1 year of initiating IL-2 therapy. Cross-sectional area and attenuation of normal-density (31-100 Hounsfield units [HU]) and low-density (0-30 HU) dorsal muscles were obtained at the T11 vertebral level. The primary outcome was partial or complete response to IL-2 using RECIST 1.1 criteria at 6 weeks. A conditional inference tree was used to determine an optimal HU cutoff for predicting outcome. Bonferroni-adjusted multivariate logistic regression was conducted to investigate the independent associations between imaging features and response after controlling for demographics, doses of IL-2, and RCC prognostic scales (eg, Heng and the Memorial Sloan Kettering Cancer Center [MSKCC]).

Results: Most subjects had intermediate prognosis by Heng (65% [49 of 75]) and the MSKCC (63% [47 of 75]) criteria; 7% had complete response and 12% had partial response. Mean attenuation of low-density dorsal muscles was a significant univariate predictor of IL-2 response after Bonferroni correction (P = 0.03). The odds of responding to treatment were 5.8 times higher for subjects with higher-attenuation low-density dorsal muscles (optimal cutoff: 18.1 HU). This persisted in multivariate analysis (P = 0.02). Body mass index (P = 0.67) and the Heng (P = 0.22) and MSKCC (P = 0.08) clinical prognostic scales were not significant predictors of response.

Conclusions: Mean cross-sectional attenuation of low-density dorsal muscles (ie, sarcopenia) may predict IL-2 response in metastatic RCC. Clinical variables are poor predictors of response.

Keywords: Morphometry; interleukin-2; metastatic renal cell carcinoma; response prediction; sarcopenia.

MeSH terms

  • Antineoplastic Agents, Immunological / therapeutic use*
  • Back Muscles / diagnostic imaging*
  • Carcinoma, Renal Cell / complications
  • Carcinoma, Renal Cell / drug therapy*
  • Carcinoma, Renal Cell / secondary
  • Contrast Media
  • Female
  • Humans
  • Interleukin-2 / therapeutic use*
  • Kidney Neoplasms / complications
  • Kidney Neoplasms / drug therapy*
  • Kidney Neoplasms / pathology
  • Male
  • Middle Aged
  • Neoplasms, Second Primary
  • Predictive Value of Tests
  • Prognosis
  • Response Evaluation Criteria in Solid Tumors
  • Retrospective Studies
  • Sarcopenia / complications
  • Sarcopenia / diagnostic imaging*
  • Tomography, X-Ray Computed
  • Treatment Failure


  • Antineoplastic Agents, Immunological
  • Contrast Media
  • Interleukin-2