AI-Derived Body Composition Analysis Unveils Muscle Volume, Metformin-Associated Adipose Effects, and the Obesity Paradox in NSCLC: Clinical and Molecular Insights

Highlights

• Muscle volume measured by AI-driven CT segmentation exhibits a dose-dependent association with overall survival in NSCLC patients.
• The survival benefit of muscle volume is amplified in patients with elevated BMI and diabetes, underscoring a nuanced obesity paradox.
• Subcutaneous and intramuscular adipose tissues predict improved survival exclusively in metformin users, indicating therapeutic metabolic modulation.
• Molecular analyses reveal KRAS mutation enrichment in patients with higher adiposity and EGFR mutation with lower adiposity, linking genotype with body composition phenotypes.

Background