Body composition and mortality in men receiving prostate radiotherapy: A pooled analysis of NRG/RTOG 9406 and NRG/RTOG 0126

Andrew M. McDonald, Lyudmila DeMora, Eddy S. Yang, John M. Hoyle, Andrew Lenzie, Grant R. Williams, Jeff M. Michalski, Don Yee, Jean Paul Bahary, Robert B. Den, Mack Roach, Robert Dess, Mark V. Mishra, Richard K. Valicenti, Harold Y. Lau, Samuel R. Marcrom, Luis Souhami, Lucas C. Mendez, Yuhchyau Chen, Desiree E. DoncalsStephanie L. Pugh, Felix Y. Feng, Howard M. Sandler

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: To validate the association between body composition and mortality in men treated with radiation for localized prostate cancer (PCa). Secondarily, to integrate body composition as a factor to classify patients by risk of all-cause mortality. Materials and Methods: Participants of NRG/Radiation Therapy Oncology Group (RTOG) 9406 and NRG/RTOG 0126 with archived computed tomography were included. Muscle mass and muscle density were estimated by measuring the area and attenuation of the psoas muscles on a single slice at L4–L5. Bone density was estimated by measuring the attenuation of the vertebral body at mid-L5. Survival analyses, including Cox proportional hazards models, assessed the relationship between body composition and mortality. Recursive partitioning analysis (RPA) was used to create a classification tree to classify participants by risk of death. Results: Data from 2066 men were included in this study. In the final multivariable model, psoas area, comorbidity score, baseline prostate serum antigen, and age were significantly associated with survival. The RPA yielded a classification tree with four prognostic groups determined by age, comorbidity, and psoas area. Notably, the classification among older (≥70 years) men into prognostic groups was determined by psoas area. Conclusions: This study strongly supports that body composition is related to mortality in men with localized PCa. The inclusion of psoas area in the RPA classification tree suggests that body composition provides additive information to age and comorbidity status for mortality prediction, particularly among older men. More research is needed to determine the clinical impact of body composition on prognostic models in men with PCa.

Original languageEnglish
Pages (from-to)685-696
Number of pages12
Issue number5
StatePublished - Mar 1 2023

Bibliographical note

Funding Information:
The authors thank the late Dr. James D. Cox of MD Anderson Cancer Center for his guidance and extensive work on the NRG/RTOG 9406 protocol design, development and his expertise in radiation oncology. This project was supported by grants U10CA180868 (NRG Oncology Operations), U10CA180822 (NRG Oncology SDMC), UG1CA189867 (NCORP), and U24CA180803 (IROC) from the National Cancer Institute (NCI).

Funding Information:
Felix Y. Feng reports consulting fees from Janssen, Bayer, PFS Genomics (termed April 2021), Myovant Sciences, Roivant Sciences, Astellas, Foundation Medicine, Varian, Bristol Meyers Squibb, Exact Sciences, and Novartis; receipt of stock options from Serimmune from serving on their scientific advisory board in 2020; and payment or honoraria from Bristol Meyers Squibb for two educational presentations. Dr. Feng reports his cofounder role at Artera, where he does not receive a salary, funding, or consulting fees from the company, only shares. He reports a leadership position with NRG Oncology, where he serves as the chair of the Genitourinary Cancer Committee. His role at NRG helps investigators design proposals for clinical trials that are then evaluated by the National Cancer Institute (NCI) for funding. All funding decisions are made by the NCI, not by NRG or by Dr. Feng. Mark V. Mishra reports support for attending meetings and/or travel from Varian Medical Systems. Howard M. Sandler reports consulting fees for his role as a member of the clinical trial steering committee for Janssen; he is also a member of the Board of Directors for ASTRO. Luis Souhami reports travel support from Varian Medical Systems and his participation on a Data Safety Monitoring Board or Advisory Board for AbbVie and Janssen. Grant R. Williams reports consulting fees from Cardinal Health and Carevive and payment or honoraria for presentations from Cardinal Health. Eddy S. Yang reports grants or contract from Eli Lilly and Puma Biotechnologies to UAB, and his participation on a Data Safety Monitoring Board or Advisory Board for AstraZeneca, Bayer, and Clovis. The other authors made no disclosures.

Publisher Copyright:
© 2022 American Cancer Society.


  • anthropometry
  • body composition
  • clinical trials
  • mortality
  • muscle mass
  • prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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