Impact of pre-treatment C-reactive protein level and skeletal muscle mass on outcomes after stereotactic body radiotherapy for T1N0M0 non-small cell lung cancer: a supplementary analysis of the Japan Clinical Oncology Group study JCOG0403

J Radiat Res. 2021 Sep 13;62(5):901-909. doi: 10.1093/jrr/rrab065.


This study aimed to evaluate the impact of pretreatment C-reactive protein (CRP) and skeletal muscle mass (SMM) on outcomes after stereotactic body radiotherapy (SBRT) for T1N0M0 non-small cell lung cancer (NSCLC) as a supplementary analysis of JCOG0403. Patients were divided into high and low CRP groups with a threshold value of 0.3 mg/dL. The paraspinous musculature area at the level of the 12th thoracic vertebra was measured on simulation computed tomography (CT). When the area was lower than the sex-specific median, the patient was classified into the low SMM group. Toxicities, overall survival (OS) and cumulative incidence of cause-specific death were compared between the groups. Sixty operable and 92 inoperable patients were included. In the operable cohort, OS significantly differed between the CRP groups (log-rank test p = 0.009; 58.8% and 83.6% at three years for high and low CRP, respectively). This difference in OS was mainly attributed to the difference in lung cancer deaths (Gray's test p = 0.070; 29.4% and 7.1% at three years, respectively). No impact of SMM on OS was observed. The incidence of Grade 3-4 toxicities tended to be higher in the low SMM group (16.7% vs 0%, Fisher's exact test p = 0.052). In the inoperable cohort, no significant impact on OS was observed for either CRP or SMM. The toxicity incidence was also not different between the CRP and SMM groups. The present study suggests that pretreatment CRP level may provide prognostic information in operable patients receiving SBRT for early-stage NSCLC.

Keywords: C-reactive protein (CRP); lung cancer; sarcopenia; stereotactic body radiotherapy (SBRT).

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers
  • C-Reactive Protein / analysis*
  • Carcinoma, Non-Small-Cell Lung / blood
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / radiotherapy*
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Clinical Trials, Phase II as Topic / statistics & numerical data
  • Combined Modality Therapy
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Lung Neoplasms / blood
  • Lung Neoplasms / pathology
  • Lung Neoplasms / radiotherapy*
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Multicenter Studies as Topic / statistics & numerical data
  • Muscle, Skeletal / diagnostic imaging
  • Muscle, Skeletal / pathology*
  • Organ Size
  • Pneumonectomy
  • Radiosurgery / methods
  • Retrospective Studies
  • Sarcopenia / diagnostic imaging
  • Sarcopenia / etiology
  • Sarcopenia / pathology
  • Survival Rate
  • Tomography, X-Ray Computed
  • Treatment Outcome


  • Biomarkers
  • C-Reactive Protein