ArticleWorld journal of surgical oncology2026
Bone mineral density as a prognostic marker in patients with non-small cell lung cancer undergoing neoadjuvant chemoimmunotherapy.
Article in World journal of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNon-small cell lung cancer (NSCLC) is the most common lung cancer, and surgery is the primary curative treatment approach. Recently, neoadjuvant immunotherapy combined with chemotherapy (NICT) has become an important strategy. However, not all patients benefit, underscoring the need for reliable prognostic biomarkers. Bone mineral density (BMD) is associated with the prognosis of various cancers. This study explores the relationship between computed tomography (CT)-derived BMD and prognosis in NSCLC patients treated with NICT.
methods101 stage IIA-IIIB NSCLC patients undergoing NICT and R0 resection surgery at our institution were included. Chest CT, highly correlated with dual-energy X-ray absorptiometry (DXA), was used to analyze the baseline and preoperative T10, T12, and L1 BMD. We analyzed disease-free survival (DFS) and overall survival (OS) through Kaplan-Meier survival curves, cox regression, and restricted cubic splines (RCS). Major pathologic response (MPR) and pathologic complete response (pCR) were compared through logistic regression. Subgroup analysis and sensitivity analysis were conducted to evaluate the accuracy of the results.
resultsMedian DFS was 22.58 months, and 14 patients experienced tumor recurrence or death. A significant decrease in BMD was observed at the T10, T12, and L1 vertebrae following NICT (p < 0.001). Patients with higher baseline and preoperative L1 BMD had significantly improved DFS (p = 0.002, p = 0.002). The prognostic value for BMD was confirmed through RCS analysis and multivariate Cox-regression analysis, as well as sensitivity analysis. Subgroup analysis revealed that the effect of L1 BMD on DFS showed significant interaction in age and MPR groups, suggesting age specific and treatment-response specific differences.
conclusionBoth baseline and preoperative L1 BMD are valuable, readily available, and independent prognostic biomarkers for DFS in NSCLC patients receiving NICT.
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