Prognostic Impact of Muscle Quantity and Quality and Fat Distribution in Diffuse Large B-Cell Lymphoma Patients

Abstract

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 (p = 0.028), shorter OS (HR = 6.29; 95% CI = 2.17–18.26; p < 0.001), and shorter PFS (HR = 2.42; 95% CI = 1.26–4.65; p = 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; p = 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; p = 0.03, and HR = 1.30; CI = 1.04–1.64; p = 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.

Prognostic Value of Sarcopenia in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP: A Systematic Review and Meta-Analysis

“…In Besutti's study, no significant difference was observed between different the BMI groups (<25, 25-30, ≥30) in terms of OS and PFS. However, sarcopenia in patients with obesity have the worst survival after further stratifying patients into sarcopenia and obesity group (18). As a result, the prognostic value of sarcopenia in DLBCL cancer patients with obesity, normal weight, and underweight should be further studied.…”

“…All included studies were retrospective cohort studies. The 12 included studies included 2,324 participants, among whom 996 were diagnosed with sarcopenia (18,19). Seven studies used SMI at the third lumbar vertebra level (L3) on computed tomography (CT) (CT-L3-SMI) for the measurement of skeletal muscle mass (18)(19)(20)(21)(22)(23)(24).…”

“…The 12 included studies included 2,324 participants, among whom 996 were diagnosed with sarcopenia (18,19). Seven studies used SMI at the third lumbar vertebra level (L3) on computed tomography (CT) (CT-L3-SMI) for the measurement of skeletal muscle mass (18)(19)(20)(21)(22)(23)(24). In the other three studies, SMD at the L3 level on CT imaging (CT-L3-SMD) was used for the measurement of skeletal muscle mass (18,21,25).…”

“…Seven studies used SMI at the third lumbar vertebra level (L3) on computed tomography (CT) (CT-L3-SMI) for the measurement of skeletal muscle mass (18)(19)(20)(21)(22)(23)(24). In the other three studies, SMD at the L3 level on CT imaging (CT-L3-SMD) was used for the measurement of skeletal muscle mass (18,21,25). In the two studies, skeletal muscle mass measured using SMI at the psoas level (CT-PM-SMI) (26) and fourth thoracic levels (CT-T4-SMI) (27) were used as the representative skeletal muscle mass of the whole body.…”

Cachexia index as a potential biomarker for cancer cachexia and a prognostic indicator in diffuse large B‐cell lymphoma

“…Sarcopenia is associated with shorter survival, reduced response to treatment, increased treatment‐related toxicities, frequent dose reduction, and early termination of treatment. 13 , 24 , 25 , 26 , 27 Hypoalbuminaemia is a predictive factor for shorter survival, decreased relative dose intensity of anthracycline and cyclophosphamide, and increased risk of TRM. 28 , 29 , 30 , 31 , 32 High NLR is also correlated with shorter survival, lower CR rate, advanced stage, higher LDH level, and increased risk of depression.…”