Camus Vincent, Lanic Helene, Kraut Jerôme, Modzelewski Romain, Clatot Florian, Picquenot Jean M, Contentin Nathalie, Lenain Pascal, Groza Luminata, Lemasle Emilie, Fronville Carole, Cardinael Nathalie, Fontoura Marie-Laure, Chamseddine Ali, Brehar Oana, Stamatoullas Aspasia, Leprêtre Stéphane, Tilly Hervé, Jardin Fabrice
Department of Haematology, Centre Henri Becquerel, Rouen, France; Centre Henri Becquerel, INSERM U918, IRIB, Rouen, France.
Eur J Haematol. 2014 Jul;93(1):9-18. doi: 10.1111/ejh.12285. Epub 2014 Mar 7.
Approximately 30% of DLBCL patients are older than 70 yr. This study evaluated the prognostic impact of a cachexia score (CS) including fat tissue loss (adipopenia) and sarcopenia as assessed by computed tomography (CT scan) in elderly DLBCL patients treated with chemotherapy and rituximab (R).
This retrospective analysis included 80 DLBCL patients older than 70 yr treated with R-CHOP or R-miniCHOP. Skeletal muscle (SM) and visceral (V) and subcutaneous (S) adipose (A) tissues were measured by analysing CT images at the third lumbar (L3) level.
The median age of the patients was 78 yr. Forty-four and 46 patients were considered sarcopenic and adipopenic, respectively. The median progression-free survival (PFS) was 13.6 months in the adipopenic group and 49.4 months in the non-adipopenic group [hazard ratio (HR) = 2.27; 95% confidence interval (CI): 1.3-4; P = 0.0042]. The median overall survival (OS) was 25.7 months in the adipopenic group and 57.1 months in the non-adipopenic group (HR = 1.93; 95% CI: 1.05-3.55; P = 0.0342). A two-point CS including adipopenia and sarcopenia was created and defined two distinct risk groups with differences in outcomes that were highly significant. The CS was predictive of the prognosis in a multivariate analysis including body mass index (BMI) (< or ≥ 25 kg/m(2) ), age (< or ≥ 80 yr), international prognostic index (IPI) and albuminaemia (HR = 3.67; 95% CI = 1.93-6.97; P < 0.0001).
A CS including sarcopenia and adipopenia, assessed by a single CT scan slice, predicts outcome independent of BMI and the IPI.
约30%的弥漫性大B细胞淋巴瘤（DLBCL）患者年龄超过70岁。本研究评估了恶病质评分（CS）对老年DLBCL患者预后的影响，该评分包括通过计算机断层扫描（CT扫描）评估的脂肪组织丢失（脂肪减少）和肌肉减少症，这些患者接受了化疗和利妥昔单抗（R）治疗。
这项回顾性分析纳入了80例年龄超过70岁、接受R-CHOP或R-miniCHOP治疗的DLBCL患者。通过分析第三腰椎（L3）水平的CT图像来测量骨骼肌（SM）、内脏（V）和皮下（S）脂肪（A）组织。
患者的中位年龄为78岁。分别有44例和46例患者被认为存在肌肉减少症和脂肪减少症。脂肪减少组的中位无进展生存期（PFS）为13.6个月，非脂肪减少组为49.4个月[风险比（HR）=2.27；95%置信区间（CI）：1.3 - 4；P = 0.0042]。脂肪减少组的中位总生存期（OS）为25.7个月，非脂肪减少组为57.1个月（HR = 1.93；95%CI：1.05 - 3.55；P = 0.0342）。创建了一个包括脂肪减少症和肌肉减少症的两点CS，并定义了两个不同的风险组，其结果差异具有高度显著性。在包括体重指数（BMI）（<或≥25 kg/m²）、年龄（<或≥80岁）、国际预后指数（IPI）和白蛋白血症的多变量分析中，CS可预测预后（HR = 3.67；95%CI = 1.93 - 6.97；P < 0.0001）。
通过单次CT扫描切片评估的包括肌肉减少症和脂肪减少症的CS可独立于BMI和IPI预测预后。
