ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Association and predictive value of sarcopenic obesity for the prognosis of lung cancer patients receiving immune checkpoint inhibitors
Provisionally accepted
- 1Department of Nutrition, Henan Provincial People’s Hospital and Zhengzhou University People’s Hospital, Zhengzhou, Henan, China, Zhengzhou, China
- 2Department of Infection Management, Tianjin Union Medicine Center, Tianjin, 300130, P. R. China, Tianjin, China
- 3Department of Respiratory and Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou 450003, PR China, Zhengzhou, China
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Background: Sarcopenic obesity (SO) has been established as a reliable predictor of several types of cancer prognosis, but its role for the prognosis of lung cancer patients receiving immune checkpoint inhibitors (ICIs) remains unclear. This study aimed to explore the potential predictive value of SO on survival outcomes in lung cancer patients undergoing ICIs therapy. Methods: From May 2018 and October 2020, lung cancer patients who received immunotherapy at a tertiary hospital in Henan Province were retrospectively evaluated from the electronic medical record system. Data on demographic characteristics, biochemical markers, current disease and treatment, and nutrition-related information were documented. Sarcopenia was evaluated using the skeletal muscle index (SMI) (cm²/m²), which was calculated by measuring the muscle mass area from a cross-sectional CT image at the L3 vertebra level prior to immunotherapy. Results: Among the 119 participants, they were divided into normal, sarcopenia, obesity, and SO groups. Totally, 15.13% were diagnosed with SO. The results demonstrated that for 3-year survival rates, patients with SO had the highest mortality (median survival: 22.55 months), followed by those with sarcopenia alone (median survival: 28.29 months) and obesity alone (median survival: 28.99 months) (P<0.05). Multivariate Cox analysis indicated that SO (HR=3.479, 95% CI=1.374-8.814), creatinine level (HR=0.963, 95% CI=0.936-0.990), receiving ICIs as second-line therapy (HR=4.274, 95% CI=1.941-9.411), receiving ICIs as third-line or later therapy (HR=2.980, 95% CI=1.169-7.597), and ECOG-PS≥3 (HR=5.274, 95% CI=2.670-10.418) were independent factors associated with reduced 3-year survival time. Conclusion: SO was an independent prognostic factor for lung cancer patients receiving immunotherapy. Early identification and targeted management of sarcopenic obesity are crucial for optimizing treatment strategies and improving survival outcomes in ICI-treated lung cancer patients.
Keywords: Sarcopenic, Obesity, lung cancer, ICIS, ECOG-PS
Received: 18 Aug 2025; Accepted: 13 Feb 2026.
Copyright: © 2026 Yang, Wang, Qiao, Guan, Wang, Yang, Shen and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yongchun Chen
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