Weight loss and low body cell mass in males with lung cancer: relationship with systemic inflammation, acute-phase response, resting energy expenditure, and catabolic and anabolic hormones

The aim of the present study was to investigate, in human lung cancer, the relationship between weight loss and the existence of a low body cell mass (BCM) on the one hand, and the putative presence of systemic inflammation, an increased acute-phase response, anorexia, hypermetabolism and changes in circulating levels of several anabolic and catabolic hormones on the other. In 20 male lung cancer patients, pre-stratified by weight loss of greater than or equal to 10% (n = 10) or of < 10% (n = 10), the following measurements were performed: BCM (by dual-energy X-ray absorptiometry/bromide dilution), circulating levels of sTNF-R55 and sTNF-R75 (soluble tumour necrosis factor receptors of molecular masses 55 and 75 kDa respectively), interleukin-6, lipopolysaccharide-binding protein, albumin, appetite (scale of 0-10), resting energy expenditure (by indirect calorimetry) and circulating levels of catabolic (cortisol) and anabolic [testosterone, insulin-like growth factor-I (IGF-I)] hormones. Compared with the patients with a weight loss of < 10%, those with a weight loss of greater than or equal to 10% were characterized by higher levels of sTNF-R55 (trend towards significance; P = 0.06), and lower levels of albumin (27.4 compared with 34.4 mmol/l; P = 0.02), testosterone (13.2 compared with 21.5 nmol/l; P = 0.01) and IGF-I (119 com pared with 184 ng/ml; P = 0.004). In the patient group as a whole, the percentage weight loss was significantly correlated with sTNF-R55 (r = 0.59, P = 0.02), albumin (r = -0.63, P = 0.006) and IGF-I (r = -0.50, P = 0.02) levels. Height-adjusted BCM was significantly correlated with sTNF-R55 (r = -0.57, P = 0.03), sTNF-R75 (r = -0.50, P = 0.04), lipopolysaccharide-binding protein (r = -0.50, P = 0.04), albumin (r = 0.56, P = 0.02) and resting energy expenditure/BCM (r = -0.54, P = 0.03), and there was a trend towards a correlation with IGF-I concentration (r = 0.44, P = 0.06). We conclude that, in human lung cancer, weight loss and the presence of a low BCM are associated with systemic inflammation, an increased acute-phase response and decreased levels of IGF-I. In addition, a decreased BCM is associated with hypermetabolism.