Besutti Giulia, Massaro Fulvio, Bonelli Efrem, Braglia Luca, Casali Massimiliano, Versari Annibale, Ligabue Guido, Pattacini Pierpaolo, Cavuto Silvio, Merlo Domenico F, Luminari Stefano, Merli Francesco, Vaccaro Salvatore, Pellegrini Massimo
Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Front Nutr. 2021 May 7;8:620696. doi: 10.3389/fnut.2021.620696. eCollection 2021.
Baseline CT scans of 116 patients (48% female, median 64 years) with diffuse large B-cell lymphoma (DLBCL) were retrospectively reviewed to investigate the prognostic role of sarcopenia and fat compartment distributions on overall survival (OS), progression-free survival (PFS), and early therapy termination. Skeletal muscle index (SMI), skeletal muscle density (SMD), and intermuscular adipose tissue (IMAT) were quantified at the level of the third lumbar vertebra (L3) and proximal thigh (PT). Low L3-SMD, but not low L3-SMI, was associated with early therapy termination ( = 0.028), shorter OS (HR = 6.29; 95% CI = 2.17-18.26; < 0.001), and shorter PFS (HR = 2.42; 95% CI = 1.26-4.65; = 0.008). After correction for sex, International Prognostic Index (IPI), BMI, and R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), low L3-SMD remained associated with poor OS (HR = 3.54; 95% CI = 1.10-11.40; = 0.034) but not with PFS. Increased PT-IMAT was prognostic for poor OS and PFS after correction for sex, IPI, BMI, and R-CHOP therapy (HR = 1.35; CI = 1.03-1.7; = 0.03, and HR = 1.30; CI = 1.04-1.64; = 0.024, respectively). Reduced muscle quality (SMD) and increased intermuscular fat (IMAT), rather than low muscle quantity (SMI), are associated with poor prognosis in DLBCL, when measured at the L3 level, and particularly at the level of the proximal thigh. The proximal thigh represents a novel radiological landmark to study body composition.
对116例弥漫性大B细胞淋巴瘤（DLBCL）患者（48%为女性，中位年龄64岁）的基线CT扫描进行回顾性分析，以研究肌肉减少症和脂肪分布对总生存期（OS）、无进展生存期（PFS）及早期治疗终止的预后作用。在第三腰椎（L3）和大腿近端（PT）水平对骨骼肌指数（SMI）、骨骼肌密度（SMD）和肌间脂肪组织（IMAT）进行量化。低L3-SMD而非低L3-SMI与早期治疗终止相关（P = 0.028）、OS较短（HR = 6.29；95%CI = 2.17-18.26；P < 0.001）以及PFS较短（HR = 2.42；95%CI = 1.26-4.65；P = 0.008）。在校正性别、国际预后指数（IPI）、BMI和R-CHOP方案（利妥昔单抗、环磷酰胺、多柔比星、长春新碱、泼尼松）后，低L3-SMD仍与不良OS相关（HR = 3.54；95%CI = 1.10-11.40；P = 0.034），但与PFS无关。在校正性别、IPI、BMI和R-CHOP方案后，PT-IMAT增加对不良OS和PFS具有预后意义（HR分别为1.35；CI = 1.03-1.7；P = 0.03，以及HR = 1.30；CI = 1.04-1.64；P = 0.024）。当在L3水平尤其是大腿近端水平测量时，肌肉质量降低（SMD）和肌间脂肪增加（IMAT）而非肌肉量减少（SMI）与DLBCL预后不良相关。大腿近端是研究身体成分的一个新的影像学标志。
