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Comparative Study
, 14, 781-789

Cross-sectional and Longitudinal Assessment of Muscle From Regular Chest Computed Tomography Scans: L1 and Pectoralis Muscle Compared to L3 as Reference in Non-Small Cell Lung Cancer

Comparative Study

Cross-sectional and Longitudinal Assessment of Muscle From Regular Chest Computed Tomography Scans: L1 and Pectoralis Muscle Compared to L3 as Reference in Non-Small Cell Lung Cancer

Karin J C Sanders et al. Int J Chron Obstruct Pulmon Dis.


Background: Computed tomography (CT) is increasingly used in clinical research for single-slice assessment of muscle mass to correlate with clinical outcome and evaluate treatment efficacy. The third lumbar level (L3) is considered as reference for muscle, but chest scans generally do not reach beyond the first lumbar level (L1). This study investigates if pectoralis muscle and L1 are appropriate alternatives for L3.

Methods: CT scans of 115 stage IV non-small cell lung cancer patients were analyzed before and during tumor therapy. Skeletal muscle assessed at pectoralis and L1 muscle was compared to L3 at baseline. Furthermore, the prognostic significance of changes in muscle mass determined at different locations was investigated.

Results: Pearson's correlation coefficient between skeletal muscle at L3 and L1 was stronger (r=0.90, P<0.001) than between L3 and pectoralis muscle (r=0.71, P<0.001). Cox regression analysis revealed that L3 (HR 0.943, 95% CI: 0.92-0.97, P<0.001) and L1 muscle loss (HR 0.954, 95% CI: 0.93-0.98, P<0.001) predicted overall survival, whereas pectoralis muscle loss did not.

Conclusion: L1 is a better alternative than pectoralis muscle to substitute L3 for analysis of muscle mass from regular chest CT scans.

Keywords: body composition; computed tomography; muscle mass; respiratory disease.

Conflict of interest statement

Disclosure Anne-Marie C Dingemans reports a consulting or advisory role for Roche/Genentech, MSD Oncology, AstraZeneca, Pfizer, Lilly, Boehringer Ingelheim, Bristol-Myers Squibb, and Clovis Oncology, outside the submitted work. The other authors report no conflicts of interest in this work.


Figure 1
Figure 1
Skeletal muscle area on transverse computed tomography images at (A) pectoralis, (B) first lumbar level, and (C) third lumbar level.
Figure 2
Figure 2
Kaplan–Meier overall survival curve for patients with loss of muscle mass compared to patients without loss of muscle mass at the level of (A) pectoralis, (B) L1, and (C) L3. Abbreviations: L1, first lumbar vertebra; L3, third lumbar vertebra; OS, overall survival.

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