Li Ya-Jun, Yi Ping-Yong, Li Ji-Wei, Liu Xian-Ling, Liu Xi-Yu, Zhou Fang, OuYang Zhou, Sun Zhong-Yi, Huang Li-Jun, He Jun-Qiao, Yao Yuan, Fan Zhou, Tang Tian, Jiang Wen-Qi
Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China.
The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.
Oncotarget. 2017 Jan 17;8(3):4245-4256. doi: 10.18632/oncotarget.13988.
The role of body mass index (BMI) in lymphoma survival outcomes is controversial. The prognostic significance of BMI in extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is unclear. We evaluated the prognostic role of BMI in patients with ENKTL.
We retrospectively analyzed 742 patients with newly diagnosed ENKTL. The prognostic value of BMI was compared between patients with low BMIs (< 20.0 kg/m2) and patients with high BMIs (≥ 20.0 kg/m2). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) was also evaluated and compared with that of the BMI classification.
Patients with low BMIs tended to exhibit higher Eastern Cooperative Oncology Group performance status (ECOG PS) scores (≥ 2) (P = 0.001), more frequent B symptoms (P < 0.001), lower albumin levels (P < 0.001), higher KPI scores (P = 0.03), and lower rates of complete remission (P < 0.001) than patients with high BMIs, as well as inferior progression-free survival (PFS, P = 0.003), and inferior overall survival (OS, P = 0.001). Multivariate analysis demonstrated that age > 60 years, mass > 5 cm, stage III/IV, elevated LDH levels, albumin levels < 35 g/L and low BMIs were independent adverse predictors of OS. The BMI classification was found to be superior to the IPI with respect to predicting patient outcomes among low-risk patients and the KPI with respect to distinguishing between intermediate-low- and high-intermediate-risk patients.
Higher BMI at the time of diagnosis is associated with improved overall survival in ENKTL. Using the BMI classification may improve the IPI and KPI prognostic models.
体重指数（BMI）在淋巴瘤生存结局中的作用存在争议。BMI在结外自然杀伤（NK）/T细胞淋巴瘤（ENKTL）中的预后意义尚不清楚。我们评估了BMI在ENKTL患者中的预后作用。
我们回顾性分析了742例新诊断的ENKTL患者。比较了低BMI（<20.0 kg/m²）患者和高BMI（≥20.0 kg/m²）患者的BMI预后价值。还评估了国际预后指数（IPI）和韩国预后指数（KPI）的预后价值，并与BMI分类的预后价值进行了比较。
与高BMI患者相比，低BMI患者往往表现出更高的东部肿瘤协作组体能状态（ECOG PS）评分（≥2）（P = 0.001）、更频繁的B症状（P < 0.001）、更低的白蛋白水平（P < 0.001）、更高的KPI评分（P = 0.03）以及更低的完全缓解率（P < 0.001），无进展生存期（PFS，P = 0.003）和总生存期（OS，P = 0.001）也较差。多因素分析表明，年龄>60岁、肿块>5 cm、Ⅲ/Ⅳ期、乳酸脱氢酶水平升高、白蛋白水平<35 g/L和低BMI是OS的独立不良预测因素。发现BMI分类在预测低风险患者的预后方面优于IPI，在区分中低风险和高中风险患者方面优于KPI。
诊断时较高的BMI与ENKTL患者总生存期的改善相关。使用BMI分类可能会改善IPI和KPI预后模型。
