Do patients with nonmetastatic non-small cell lung cancer demonstrate altered resting energy expenditure?

Background. The cancer cachexia syndrome occurs in patients with non-small cell lung cancer (NSCLC) and includes elevated resting energy expenditure ( REE). This increase in REE leads to weight loss, which in turn confers a po or prognosis. This study was undertaken to determine whether the cancer cac hexia syndrome occurs in patients with nonmetastatic NSCLC. Methods. In this case-control study, 18 patients with nonmetastatic NSCLC ( stages IA to IIIB) were matched to healthy controls on age (+/- 5 years), g ender, and body mass index (+/- 3 kg/m(2)). Only 4 cancer patients had expe rienced > 5% weight loss. Cancer patients and controls were compared on the basis of: (1) unadjusted REE, as measured by indirect calorimetry; (2) REE adjusted for lean body mass, as measured by dual x-ray absorptiometry, (3) REE adjusted for body cell mass, as measured by potassium-40 measurement; and (4) REE adjusted for total body water, as measured by tritiated water d ilution. Results. We observed no significant difference in unadjusted REE or in REE adjusted for total body water. However, with separate adjustments for lean body mass and body cell mass, cancer patients manifested an increase in REE : mean difference standard error of the mean: 140 +/- 35 kcal/day (p = 0.00 1) and 173 +/- 65 kcal/day (p = 0.032), respectively. Further adjustment fo r weight loss yielded similarly significant results. Conclusions. These results suggest that the cancer cachexia syndrome occurs in patients with nonmetastatic NSCLC and raise the question of whether cli nical trials that target cancer cachexia should be initiated before weight loss. (C) 2001 by The Society of Thoracic Surgeons.