PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
Korean J Radiol. 2024 Mar;25(3):277-288. doi: 10.3348/kjr.2023.0949.
We previously found that the incidence of sarcopenia increased with declining glucose metabolism of muscle in patients with treatment-naïve diffuse large B-cell lymphoma (DLBCL). This study aimed to investigate the relationship between sarcopenia and muscle glucometabolism using F-FDG PET/CT at baseline and end-of-treatment, analyze the changes in these parameters through treatment, and assess their prognostic values.
The records of 103 patients with DLBCL (median 54 years [range, 21-76]; male:female, 50:53) were retrospectively reviewed. Skeletal muscle area at the third lumbar vertebral (L3) level was measured, and skeletal muscle index (SMI) was calculated to determine sarcopenia, defined as SMI < 44.77 cm²/m² and < 32.50 cm²/m² for male and female, respectively. Glucometabolic parameters of the psoas major muscle, including maximum standardized uptake value (SUVmax) and mean standardized uptake value (SUVmean), were measured at L3 as well. Their changes across treatment were also calculated as ΔSMI, ΔSUVmax, and ΔSUVmean; Δbody mass index was also calculated. Associations between SMI and the metabolic parameters were analyzed, and their associations with progression-free survival (PFS) and overall survival (OS) were identified.
The incidence of sarcopenia was 29.1% and 36.9% before and after treatment, respectively. SMI ( = 0.004) was lower, and sarcopenia was more frequent ( = 0.011) at end-of-treatment than at baseline. The SUVmax and SUVmean of muscle were lower ( < 0.001) in sarcopenia than in non-sarcopenia at both baseline and end-of-treatment. ΔSMI was positively correlated with ΔSUVmax of muscle ( = 0.022). Multivariable Cox regression analysis showed that sarcopenia at end-of-treatment was independently negatively associated with PFS (adjusted hazard ratio [95% confidence interval], 2.469 [1.022-5.965]), while sarcopenia at baseline was independently negatively associated with OS (5.051 [1.453-17.562]).
Sarcopenic patients had lower muscle glucometabolism, and the muscular and metabolic changes across treatment were positively correlated. Sarcopenia at baseline and end-of-treatment was negatively associated with the prognosis of DLBCL.
我们之前发现，初治弥漫性大 B 细胞淋巴瘤（DLBCL）患者的肌肉葡萄糖代谢降低与肌少症的发生率有关。本研究旨在通过基线和治疗结束时的 F-FDG PET/CT 研究肌少症与肌肉葡萄糖代谢之间的关系，分析这些参数在治疗过程中的变化，并评估其预后价值。
回顾性分析了 103 例初治 DLBCL 患者（中位年龄 54 岁[范围 21-76]；男：女=50：53）的资料。测量第三腰椎（L3）水平的骨骼肌面积，并计算骨骼肌指数（SMI）以确定肌少症，定义为男性 SMI＜44.77 cm²/m²和女性 SMI＜32.50 cm²/m²。同时测量 L3 处的最大标准化摄取值（SUVmax）和平均标准化摄取值（SUVmean）等肌肉葡萄糖代谢参数。还计算了治疗过程中 SMI、SUVmax 和 SUVmean 的变化，即ΔSMI、ΔSUVmax 和ΔSUVmean；同时还计算了 ΔBMI。分析了 SMI 与代谢参数之间的相关性，并确定其与无进展生存期（PFS）和总生存期（OS）的关系。
治疗前和治疗后肌少症的发生率分别为 29.1%和 36.9%。治疗结束时 SMI 更低（ = 0.004），且更常出现肌少症（ = 0.011）。在基线和治疗结束时，肌肉 SUVmax 和 SUVmean 均较低（＜0.001）。ΔSMI 与肌肉 SUVmax 的变化呈正相关（ = 0.022）。多变量 Cox 回归分析显示，治疗结束时的肌少症与 PFS 呈独立负相关（调整后的危险比[95%置信区间]，2.469[1.022-5.965]），而基线时的肌少症与 OS 呈独立负相关（5.051[1.453-17.562]）。
肌少症患者的肌肉葡萄糖代谢较低，治疗过程中的肌肉和代谢变化呈正相关。基线和治疗结束时的肌少症与 DLBCL 的预后呈负相关。
