St Louis Veterans Affairs Medical Center, Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8056, St Louis, MO 63110, USA.
J Clin Oncol. 2012 Sep 10;30(26):3217-22. doi: 10.1200/JCO.2011.39.2100. Epub 2012 May 29.
Obesity increases the risk of death from many malignancies, including non-Hodgkin's lymphoma (NHL). In diffuse large B-cell lymphoma (DLBCL), the most common form of NHL, the association between body mass index (BMI) at diagnosis and survival is unclear.
We evaluated the association between BMI at diagnosis and overall survival in a retrospective cohort of 2,534 United States veterans diagnosed with DLBCL between October 1, 1998 and December 31, 2008. Cox modeling was used to control for patient- and disease-related prognostic variables.
Mean age at diagnosis was 68 years (range, 20 to 100 years); 64% of patients were overweight (BMI, 25 to < 30) or obese (BMI, ≥ 30). Obese patients were significantly younger, had significantly fewer B symptoms, and trended toward lower-stage disease, compared with other BMI groups. Cox analysis showed reduced mortality in overweight and obese patients (overweight: hazard ratio [HR], 0.73; 95% CI, 0.65 to 0.83; obese: HR, 0.68; 95% CI, 0.58 to 0.80), compared with normal-weight patients (BMI, 18.5 to < 25). Treatment during the rituximab era reduced the risk of death without affecting the association between BMI and survival. Disease-related weight loss occurred in 29% of patients with weight data 1 year before diagnosis. Cox analysis based on BMI 1 year before diagnosis continued to demonstrate reduced risk of death in overweight and obese patients.
Being overweight or obese at the time of DLBCL diagnosis is associated with improved overall survival. Understanding the mechanisms responsible for this association will require further study.
肥胖会增加多种恶性肿瘤（包括非霍奇金淋巴瘤[NHL]）死亡的风险。在弥漫性大 B 细胞淋巴瘤（DLBCL）这种最常见的 NHL 中，诊断时的体重指数（BMI）与生存之间的关系尚不清楚。
我们评估了 1998 年 10 月 1 日至 2008 年 12 月 31 日期间在美国被诊断为 DLBCL 的 2534 例退伍军人的诊断时 BMI 与总生存之间的关系。使用 Cox 模型控制患者和疾病相关的预后变量。
诊断时的平均年龄为 68 岁（范围为 20 岁至 100 岁）；64%的患者超重（BMI 为 25 至 <30）或肥胖（BMI 为≥30）。与其他 BMI 组相比，肥胖患者明显更年轻，B 症状明显更少，且疾病分期较低。Cox 分析显示，超重和肥胖患者的死亡率降低（超重：风险比[HR]，0.73；95%置信区间[CI]，0.65 至 0.83；肥胖：HR，0.68；95%CI，0.58 至 0.80），与体重正常的患者（BMI 为 18.5 至 <25）相比。在利妥昔单抗时代进行治疗可降低死亡风险，而不会影响 BMI 与生存之间的关系。在诊断前 1 年有体重数据的患者中，有 29%发生了与疾病相关的体重减轻。基于诊断前 1 年 BMI 的 Cox 分析继续显示超重和肥胖患者的死亡风险降低。
在诊断为 DLBCL 时超重或肥胖与总生存改善相关。为了进一步阐明这种相关性的机制，还需要开展进一步的研究。
