{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:35:15Z","timestamp":1787319315262,"version":"build-2736575974"},"reference-count":24,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This study aimed to evaluate the prognostic impact of baseline body composition measurements and changes in muscle and adipose tissue during treatment on overall survival (OS) in metastatic non-small cell lung cancer (NSCLC) patients treated with nivolumab. Materials and Methods: Eighty-eight metastatic NSCLC patients who were initiated on nivolumab between January 2022 and December 2024 were retrospectively analyzed. Body composition parameters were derived from baseline and 3-month 18F-FDG PET\/CT scans at the L3 level, including psoas muscle index (PMI), skeletal muscle index (SMI), intramuscular adipose content (IMAC), and subcutaneous fat density (SFD). Treatment-related changes in body composition were evaluated, and survival analyses were performed using Kaplan\u2013Meier estimates and Cox regression models. Results: Overall, 34.1% (n = 30) of patients were classified as sarcopenic. Median OS was significantly longer in non-sarcopenic patients (19 months vs. 5 months, p &lt; 0.001). In univariate analysis, older age, higher comorbidity burden, liver metastasis, baseline sarcopenia, and adverse treatment-related changes in muscle and nutritional parameters were found to be associated with OS. In multivariate analysis, only unfavorable changes in skeletal muscle (\u0394SMI; HR 3.39, p = 0.003) and subcutaneous fat radiodensity (\u0394SFD; HR 2.45, p = 0.02) remained independent adverse prognostic factors. Baseline body composition parameters did not maintain their independence in multivariate models. Conclusions: Our study demonstrates that muscle loss or insufficient gain and unfavorable changes in subcutaneous fat radiodensity during nivolumab treatment more strongly predict overall survival compared to baseline measurements. These findings highlight the clinical importance of monitoring dynamic body composition throughout treatment, rather than static assessments, in NSCLC patients receiving immunotherapy.<\/jats:p>","DOI":"10.3390\/medicina62010098","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T17:51:21Z","timestamp":1767376281000},"page":"98","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic Value of Treatment-Related Body Composition Changes in Metastatic NSCLC Receiving Nivolumab"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8994-2904","authenticated-orcid":false,"given":"Erkam","family":"Kocaaslan","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3562-5006","authenticated-orcid":false,"given":"Ali Kaan","family":"G\u00fcren","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7969-9464","authenticated-orcid":false,"given":"F\u0131rat","family":"Akag\u00fcnd\u00fcz","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Demirel","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1537-3032","authenticated-orcid":false,"given":"Mustafa Alperen","family":"Tun\u00e7","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"Pa\u00e7ac\u0131","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye\u015fim","family":"A\u011fyol","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u0131nar","family":"Erel","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6922-1018","authenticated-orcid":false,"given":"Abd\u00fcssamed","family":"\u00c7elebi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2726-1740","authenticated-orcid":false,"given":"Selver","family":"I\u015f\u0131k","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezgi","family":"\u00c7oban","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naz\u0131m Can","family":"Demircan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salih","family":"\u00d6zg\u00fcven","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep Ceren","family":"Balaban Gen\u00e7","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2575-5819","authenticated-orcid":false,"given":"Nargiz","family":"Majidova","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, VM Medical Park Maltepe Hospital, Istanbul 34843, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7312-3827","authenticated-orcid":false,"given":"Nadiye","family":"Sever","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Haydarpa\u015fa Numune Training and Research Hospital, Istanbul 34668, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0596-1559","authenticated-orcid":false,"given":"Murat","family":"Sar\u0131","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Marmara University Pendik Training and Research Hospital, 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Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1200\/JCO.21.01845","article-title":"Managing resistance to immune checkpoint inhibitors in lung cancer: Treatment and novel strategies","volume":"40","author":"Passaro","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17105","DOI":"10.1038\/nrdp.2017.105","article-title":"Cancer-associated cachexia","volume":"4","author":"Baracos","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.ejca.2015.12.030","article-title":"Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review","volume":"57","author":"Shachar","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1016\/S0140-6736(19)31138-9","article-title":"Sarcopenia","volume":"393","author":"Sayer","year":"2019","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1200\/JCO.2012.45.2722","article-title":"Cancer cachexia in the age of obesity: Skeletal muscle depletion is a powerful prognostic factor, independent of body mass index","volume":"31","author":"Martin","year":"2013","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"9","DOI":"10.14740\/wjon1225","article-title":"Sarcopenia and visceral adiposity did not affect efficacy of immune-checkpoint inhibitor monotherapy for pretreated patients with advanced non-small cell lung cancer","volume":"11","author":"Minami","year":"2020","journal-title":"World J. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1038\/bjc.2017.149","article-title":"Subcutaneous adiposity is an independent predictor of mortality in cancer patients","volume":"117","author":"Ebadi","year":"2017","journal-title":"Br. J. Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"754","DOI":"10.21873\/cdp.10392","article-title":"High Subcutaneous Adipose Tissue Radiodensity Predicts Poor Prognosis in Patients With Gastric Cancer","volume":"4","author":"Iida","year":"2024","journal-title":"Cancer Diagn. Progn."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/jcsm.12267","article-title":"Loss of skeletal muscle during systemic chemotherapy is prognostic of poor survival in patients with foregut cancer","volume":"9","author":"Daly","year":"2018","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"13036","DOI":"10.1038\/s41598-024-63806-1","article-title":"CT-based muscle and adipose measurements predict prognosis in patients with digestive system malignancy","volume":"14","author":"Zheng","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1038\/s41598-020-58498-2","article-title":"Weighing the role of skeletal muscle mass and muscle density in cancer patients receiving PD-1\/PD-L1 checkpoint inhibitors: A multicenter real-life study","volume":"10","author":"Cortellini","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kuno, H., Nishioka, N., Yamada, T., Kunimatsu, Y., Yoshimura, A., Hirai, S., Futamura, S., Masui, T., Egami, M., and Chihara, Y. (2024). The Significance of Longitudinal Psoas Muscle Loss in Predicting the Maintenance Efficacy of Durvalumab Treatment Following Concurrent Chemoradiotherapy in Patients with Non-Small Cell Lung Cancer: A Retrospective Study. Cancers, 16.","DOI":"10.3390\/cancers16173037"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Li, S., Liu, Z., Ren, Y., Liu, J., Lv, S., He, P., Yang, Y., Sun, Y., Chang, J., and Luo, D. (2022). Sarcopenia was a poor prognostic predictor for patients with advanced lung cancer treated with immune checkpoint inhibitors. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.900823"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e27282","DOI":"10.1016\/j.heliyon.2024.e27282","article-title":"Predictive impact of sarcopenia in advanced non-small cell lung cancer patients treated with immune checkpoint inhibitors: A retrospective study","volume":"10","author":"Feng","year":"2024","journal-title":"Heliyon"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"139","DOI":"10.14740\/wjon1289","article-title":"Sarcopenia and visceral adiposity are not independent prognostic markers for extensive disease of small-cell lung cancer: A single-centered retrospective cohort study","volume":"11","author":"Minami","year":"2020","journal-title":"World J. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1101\/gad.276733.115","article-title":"Mechanisms of metabolic dysfunction in cancer-associated cachexia","volume":"30","author":"Petruzzelli","year":"2016","journal-title":"Genes Dev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1038\/nrc3829","article-title":"Cancer cachexia: Understanding the molecular basis","volume":"14","author":"Busquets","year":"2014","journal-title":"Nat. Rev. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e70063","DOI":"10.1002\/jcsm.70063","article-title":"Loss of Skeletal Muscle Mass Is Associated with Reduced Cytotoxic T Cell Abundance and Poor Survival in Advanced Lung Cancer","volume":"16","author":"Nie","year":"2025","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1177\/1535370216683282","article-title":"The role of adipose tissue in cancer-associated cachexia","volume":"242","author":"Vaitkus","year":"2017","journal-title":"Exp. Biol. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Li, Y., Yu, Y., Lv, K., Ge, R., and Xie, X. (2025). Prognostic value of body adipose tissue parameters in cancer patients treated with immune checkpoint inhibitors. Front. Immunol., 16.","DOI":"10.3389\/fimmu.2025.1557726"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Tenuta, M., Gelibter, A., Pandozzi, C., Sirgiovanni, G., Campolo, F., Venneri, M.A., Caponnetto, S., Cortesi, E., Marchetti, P., and Isidori, A.M. (2021). Impact of sarcopenia and inflammation on patients with advanced non-small cell lung cancer (NCSCL) treated with immune checkpoint inhibitors (ICIs): A prospective study. Cancers, 13.","DOI":"10.3390\/cancers13246355"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.cyto.2012.10.023","article-title":"Adipose tissue-derived factors as potential biomarkers in cachectic cancer patients","volume":"61","author":"Batista","year":"2013","journal-title":"Cytokine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1111\/1440-1681.13740","article-title":"Prognostic value of inflammatory and nutritional indexes among advanced NSCLC patients receiving PD-1 inhibitor therapy","volume":"50","author":"Fang","year":"2023","journal-title":"Clin. Exp. Pharmacol. Physiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/1\/98\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T17:58:20Z","timestamp":1767376700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/1\/98"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["medicina62010098"],"URL":"https:\/\/doi.org\/10.3390\/medicina62010098","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,2]]}}}