{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:02:02Z","timestamp":1784523722321,"version":"3.55.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low skeletal muscle mass is associated with poor outcomes in non-small cell lung cancer (NSCLC), but whether the prognostic association differs by sex remains unclear. We evaluated the sex-stratified association between low skeletal muscle index (SMI) and overall survival in patients with advanced NSCLC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective analysis of 270 patients with advanced (stage III-IV) non-small cell lung cancer selected from a prospective cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f403) at Huadong Hospital. Baseline skeletal muscle index (SMI) was measured by bioelectrical impedance analysis (BIA) and dichotomized using AWGS thresholds (men &amp;lt;7.0\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; women &amp;lt;5.7\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Sex-stratified Cox proportional hazards regression was performed to assess the association between low SMI and overall survival, adjusting for age, disease stage, performance status, comorbidities, and treatment modality. Sensitivity analyses were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow-up of 392\u202fdays, 145 deaths occurred (53.7% mortality). In males, low SMI was independently associated with increased mortality risk (adjusted HR\u202f=\u202f1.67, 95% CI: 1.11\u20132.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.013); estimates were essentially unchanged after additional adjustment for smoking and albumin (HR range 1.58\u20131.68; all\n                      <jats:italic>P<\/jats:italic>\n                      \u202f&amp;lt;\u202f= 0.029). In females, no statistically significant association was detected (adjusted HR\u202f=\u202f0.81, 95% CI: 0.40\u20131.65,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.564), noting the limited power of the female subgroup. The sex-by-SMI interaction was also not statistically significant (\n                      <jats:italic>P<\/jats:italic>\n                      -interaction\u202f=\u202f0.115). Exploratory cutpoint analysis supports the applicability of the AWGS male threshold in males (7.0\u202fkg\/m2). Supplementary analyses using continuous SMI modeling, interaction testing, and sensitivity analyses excluding early deaths confirmed the robustness of these sex-stratified findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BIA-defined low skeletal muscle mass (low SMI) was independently associated with poorer overall survival in male patients with advanced NSCLC, whereas no statistically significant association was detected in women. Given the limited sample size and statistical power of the female subgroup, these sex-stratified findings should be interpreted cautiously. As this study evaluated low muscle mass rather than full AWGS-defined sarcopenia, the findings should be interpreted accordingly. These results, derived from a single-center retrospective cohort, are hypothesis-generating and require external validation in larger, multi-center cohorts before sex-stratified interpretation can be applied in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1816649","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T04:20:30Z","timestamp":1784521230000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex-stratified prognostic value of low skeletal muscle index in advanced non-small cell lung Cancer: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Xin-qi","family":"Li","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan-xu","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-tao","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-gang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Huadong Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.chest.2019.04.115","article-title":"Prognostic value of sarcopenia in lung Cancer: a systematic review and Meta-analysis","volume":"156","author":"Yang","year":"2019","journal-title":"Chest"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.1016\/j.clnu.2016.03.010","article-title":"Skeletal muscle Radiodensity is prognostic for survival in patients with advanced non-small cell lung Cancer","volume":"35","author":"Sj\u00f8blom","year":"2016","journal-title":"Clin Nutr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.clnesp.2021.04.021","article-title":"Measurement of body composition: agreement between methods of measurement by bioimpedance and computed tomography in patients with non-small cell lung Cancer","volume":"44","author":"Hansen","year":"2021","journal-title":"Clin Nutr ESPEN"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"112526","DOI":"10.1016\/j.nut.2024.112526","article-title":"Identifying low muscle mass and monitoring body composition changes in newly diagnosed Cancer patients: agreement between multifrequency bioelectrical impedance analysis and computed tomography","volume":"128","author":"Wang","year":"2024","journal-title":"Nutrition"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2164","DOI":"10.1038\/s43587-025-01004-y","article-title":"A focus shift from sarcopenia to muscle health in the Asian working Group for Sarcopenia 2025 consensus update","volume":"5","author":"Chen","year":"2025","journal-title":"Nat Aging"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1097\/COC.0000000000001152","article-title":"Prognostic impact of low muscle mass and inflammatory markers in stage III nonsmall cell lung Cancer Turkish oncology group and Turkish Society of Radiation Oncology Thoracic Cancer Study Group (08-005)","volume":"48","author":"Gumustepe","year":"2025","journal-title":"Am J Clin Oncol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1111\/1759-7714.15313","article-title":"Exploring previously used thresholds for computed tomography-defined low skeletal muscle mass in predicting functional limitations among lung Cancer patients","volume":"15","author":"Timsina","year":"2024","journal-title":"Thorac Cancer"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1245\/s10434-025-18553-6","article-title":"Skeletal muscle gauge as a prognosticator of survival in resected early-stage non-small cell lung Cancer","volume":"33","author":"Khan","year":"2026","journal-title":"Ann Surg Oncol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"4256","DOI":"10.21037\/jtd-22-273","article-title":"The association between thoracic sarcopenia and survival is gender specific in early-stage lung Cancer","volume":"14","author":"Wakefield","year":"2022","journal-title":"J Thorac Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0256365","DOI":"10.1371\/journal.pone.0256365","article-title":"Depletion of skeletal muscle mass adversely affects long-term outcomes for men undergoing gastrectomy for gastric Cancer","volume":"16","author":"Sakurai","year":"2021","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1093\/jjco\/hyx009","article-title":"Sarcopenia is a novel poor prognostic factor in male patients with pathological stage I non-small cell lung Cancer","volume":"47","author":"Tsukioka","year":"2017","journal-title":"Jpn J Clin Oncol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"112690","DOI":"10.1016\/j.nut.2025.112690","article-title":"Sex differences in the obesity paradox of body compositions in non-small cell lung Cancer","volume":"132","author":"Wei","year":"2025","journal-title":"Nutrition"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e70230","DOI":"10.1002\/jcsm.70230","article-title":"Body composition in Resectable non-small cell lung Cancer patients with preoperative sarcopenia: a propensity-matched analysis","volume":"17","author":"Wang","year":"2026","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3389\/fnut.2026.1727652","article-title":"Prognostic impact of sarcopenia on 5-year overall and progression-free survival in lung Cancer patients: a prospective cohort study","volume":"13","author":"Zhao","year":"2026","journal-title":"Front Nutr"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1007\/s12603-023-1940-y","article-title":"Long-term mortality risk in older adults with sarcopenia: an 11-year prospective cohort study comparing AWGS 2014 and AWGS 2019 guidelines for enhanced clinical utility and accurate risk prediction","volume":"27","author":"Liang","year":"2014","journal-title":"J Nutr Health Aging"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2414","DOI":"10.1016\/j.clnu.2023.10.006","article-title":"Different computed tomography parameters for defining Myosteatosis in patients with advanced non-small cell lung Cancer","volume":"42","author":"Zhang","year":"2023","journal-title":"Clin Nutr"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1000","DOI":"10.1002\/jcsm.12732","article-title":"Validating muscle mass cutoffs of four international sarcopenia-working groups in Japanese people using DXA and BIA","volume":"12","author":"Yamada","year":"2021","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1111\/ggi.70040","article-title":"Sarcopenia in heart failure: comparison of prognostic value between the Asian working Group for Sarcopenia 2014 and 2019 criteria","volume":"25","author":"Saito","year":"2025","journal-title":"Geriatr Gerontol Int"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1800","DOI":"10.1002\/jcsm.12977","article-title":"Serum creatinine and cystatin C-based diagnostic indices for sarcopenia in advanced non-small cell lung Cancer","volume":"13","author":"Tang","year":"2022","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1016\/j.ejso.2018.09.026","article-title":"Sarcopenia is an independent unfavorable prognostic factor of non-small cell lung Cancer after surgical resection: a comprehensive systematic review and Meta-analysis","volume":"45","author":"Deng","year":"2019","journal-title":"Eur J Surg Oncol: J Eur Soc Surg Oncol Br Assoc Surg Oncol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/j.jtho.2018.04.035","article-title":"Sarcopenia in resected NSCLC: effect on postoperative outcomes","volume":"13","author":"Nakamura","year":"2018","journal-title":"J Thorac Oncol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1158\/1055-9965.EPI-19-1134","article-title":"Associations of abdominal skeletal muscle mass, fat mass, and mortality among men and women with stage I-III colorectal cancer","volume":"29","author":"van Baar","year":"2020","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"5359","DOI":"10.3390\/cancers13215359","article-title":"Sarcopenia predicts Cancer mortality in male but not in female patients undergoing surgery for Cholangiocellular carcinoma","volume":"13","author":"J\u00f6rdens","year":"2021","journal-title":"Cancer"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/978-3-319-70178-3_9","article-title":"Sex differences in muscle wasting","volume":"1043","author":"Anderson","year":"2017","journal-title":"Adv Exp Med Biol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"2146","DOI":"10.1002\/jcsm.12998","article-title":"Sex specificity of pancreatic Cancer Cachexia phenotypes, mechanisms, and treatment in mice and humans: role of Activin","volume":"13","author":"Zhong","year":"2022","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10522-022-10002-1","article-title":"Male sex hormones, aging, and inflammation","volume":"24","author":"Ketchem","year":"2023","journal-title":"Biogerontology"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1016\/j.jpainsymman.2009.09.021","article-title":"Associations among hypogonadism, C-reactive protein, symptom burden, and survival in male Cancer patients with Cachexia: a preliminary report","volume":"39","author":"Del Fabbro","year":"2010","journal-title":"J Pain Symptom Manag"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1016\/S1470-2045(10)70021-8","article-title":"Male hypogonadism associated with advanced Cancer: a systematic review","volume":"11","author":"Vigano","year":"2010","journal-title":"Lancet Oncol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"682012","DOI":"10.3389\/fendo.2021.682012","article-title":"Sarcopenia and menopause: the role of estradiol","volume":"12","author":"Geraci","year":"2021","journal-title":"Front Endocrinol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"R1443","DOI":"10.1152\/ajpregu.00689.2009","article-title":"17\u03b2-estradiol attenuates exercise-induced neutrophil infiltration in men","volume":"300","author":"MacNeil","year":"2011","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s12192-009-0132-y","article-title":"Participation of HSP27 in the Antiapoptotic action of 17beta-estradiol in skeletal muscle cells","volume":"15","author":"Vasconsuelo","year":"2010","journal-title":"Cell Stress Chaperones"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1139\/h00-022","article-title":"Estrogen and gender effects on muscle damage, inflammation, and oxidative stress","volume":"25","author":"Tiidus","year":"2000","journal-title":"Can J Appl Physiol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/978-3-319-70178-3_2","article-title":"Sex differences in body composition","volume":"1043","author":"Bredella","year":"2017","journal-title":"Adv Exp Med Biol"}],"container-title":["Frontiers in 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