HISLIS: Histology, Sarcopenia, and Lung Inflammation Score-A New Perspective for Lung Cancer Patients?

Since lung cancer remains a health problem worldwide and is the leading cause of cancer death, finding new tools that can help in the early identification of high-risk patients remains a key target.

A retrospective descriptive study of 70 patients diagnosed with lung cancer at the Clinical County Hospital Mureș was conducted. Information regarding the histopathological type of the tumor, the TNM stage at diagnosis, and the CBC-derived inflammatory status was obtained for all the included patients. Skeletal muscle area was measured at the level of the third lumbar vertebra (L3SMA), based on the patients' native CT scans, to identify sarcopenia. These four primary characteristics (the histopathological type of the tumor, the TNM stage, the systemic inflammatory status, and the sarcopenic changes) were integrated into a new severity score: the histology, sarcopenia, and lung inflammation score (HISLIS). Subsequently, based on the HISLIS score, the patients were divided into three severity grades (high, medium, and low).

Our results showed that patients diagnosed in late advanced TNM stages (III or IV) had the highest severity grade. The severity grade strongly correlated with the systemic inflammatory biomarkers, with the highest severity grades being associated with an increased inflammatory status. In addition, sarcopenic patients were diagnosed in more advanced TNM stages, exhibited higher HISLIS levels, and had a higher degree of systemic inflammation than non-sarcopenic patients. Sarcopenic patients also showed an impaired hematological profile, with hemoglobin (Hb) and hematocrit (Ht) levels being significantly decreased in sarcopenic patients.

Future prospective studies are needed to validate the HISLIS and integrate it into the routine clinical and paraclinical assessment of lung cancer patients, as it could represent a triage tool for the early identification of patients at higher risk of unfavorable outcomes. Combining critical information regarding the tumors' characteristics, such as TNM stage and histological characteristics, together with biological and imaging-derived information like the CBC-derived inflammatory status and the associated degree of sarcopenia, could lead to a complex approach and a personalized therapeutic regimen for this highly deadly condition.