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Association of sarcopenia with survival and treatment response in brain metastasis of non-small cell lung cancer
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  • Published: 05 February 2026

Association of sarcopenia with survival and treatment response in brain metastasis of non-small cell lung cancer

  • Leon Schmidt1 na1,
  • Harald Krenzlin1,2 na1,
  • Anika Schmitz1,
  • Dragan Jankovic1,
  • Alice Dauth1,2,
  • Beat Alessandri1,
  • Clemens Sommer3,
  • Marc A. Brockman4,
  • Florian Ringel1 &
  • …
  • Naureen Keric1,2 

Scientific Reports , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Neurology
  • Surgical oncology

Abstract

Brain metastases are common in non-small cell lung cancer (NSCLC) and affect prognosis and survival. While frailty and sarcopenia are associated with the overall survival in NSCLC the impact on outcome and survival after surgery for brain metastasis is unknown. We therefore analyzed 179 patients (81 women) with NSCLC undergoing resection for brain metastasis between 2011 and 2020 retrospectively. Frailty was measured using the Clinical Frailty Scale (CFS). Temporal Muscle Volume (TMV) was assessed in preoperative T1w MRI. The median age was 63 years. Clinical frailty was present in about 20.6%. Mean follow-up was 11 months. Frailty correlated significantly with age (r = 0.36, p < 0.001) and smaller TMV (r=-0.24, p = 0.002). However, only measurement of TMV predicted impaired survival (median OS 34.5 vs. 10.3 months, p < 0.001). Physical performance after surgery was negatively affected by frailty (r=-0.72, p < 0.001) and positively by TMV (r = 0.2, p = 0.038). Major postoperative complications were more strongly associated with sarcopenia rather than frailty. Treatment response towards immunotherapy improved in the absence of sarcopenia (B = 2.48, p = 0.031). TMV is a predictor for survival after resection of brain metastasis and an indicator of treatment response to immunotherapy in patients with NSCLC. Accounting for sarcopenia in surgical decision making could improve patient selection for different treatment modalities.

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Funding

Open Access funding enabled and organized by Projekt DEAL.

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Author notes

  1. Leon Schmidt and Harald Krenzlin contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany

    Leon Schmidt, Harald Krenzlin, Anika Schmitz, Dragan Jankovic, Alice Dauth, Beat Alessandri, Florian Ringel & Naureen Keric

  2. Department of Neurosurgery, University Hospital Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Germany

    Harald Krenzlin, Alice Dauth & Naureen Keric

  3. Institute of Neurpathology, University Medical Center Mainz, Mainz, Germany

    Clemens Sommer

  4. Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany

    Marc A. Brockman

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Contributions

LS collected and analyzed the data and wrote the manuscript. HK designed the study, analyzed the data and wrote the manuscript. AS collected and analyzed the data. DJ and AD analyzed the data and wrote the manuscript. CS, MB and FR helped to design the study and wrote the manuscript. NK designed the study, analyzed the data and helped to write the manuscript. Sections of the presented data are part of the doctoral thesis of AS.

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Correspondence to Naureen Keric.

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Schmidt, L., Krenzlin, H., Schmitz, A. et al. Association of sarcopenia with survival and treatment response in brain metastasis of non-small cell lung cancer. Sci Rep (2026). https://doi.org/10.1038/s41598-026-37138-1

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  • Received: 09 September 2024

  • Accepted: 19 January 2026

  • Published: 05 February 2026

  • DOI: https://doi.org/10.1038/s41598-026-37138-1

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Keywords

  • Brain metastasis
  • Lung cancer
  • Immunotherapy
  • Frailty
  • Sarcopenia
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