Body Composition Assessment Provides Prognostic Information in Patients With Cancer Affected by Chronic Graft vs. Host Disease

IF 9.4 1区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Cachexia Sarcopenia and Muscle Pub Date : 2025-03-28 DOI:10.1002/jcsm.13759

Asmita Mishra, Ram Thapa, Kevin Bigam, Martine Extermann, Rawan Faramand, Farhad Khimani, Xuefeng Wang, Vickie Baracos, Joseph A. Pidala

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Abstract

Background

Additional tools are needed to assess mortality risk among patients with cancer. Patients with chronic graft vs. host disease (cGVHD) after allogeneic haematopoietic cell transplantation (HCT) represent a high-risk cancer population with mortality risk explained by cGVHD severity, but also informed by baseline comorbidities, functional status before and after HCT, and cumulative toxicity from the procedure and its complications. Radiographic body composition metrics from CT scans have previously shown association with complications in other populations.

Methods

We examined a single-centre consecutive series (2005–2016) of HCT recipients with cGVHD and CT-scans immediately proximal to cGVHD diagnosis to investigate association of radiographic body composition measures and mortality. Skeletal muscle index (SMI) and fat index (FI) were quantified on CT imaging at the 3rd lumbar (L3) and 4th thoracic (T4) vertebra. SM Hounsfield units (HU) were obtained to evaluate SM density. Cut points for SMI were from literature and cut points for FI were established by sex-specific optimal stratification.

Results

A total of n = 113 patients met the inclusion criteria for this analysis, aged 51.2 ± 10.5(SD) years and predominantly male (n = 71, 63%) and diagnosed with NHL (n = 110, 97%). Onset cGVHD NIH overall severity was mild in N = 56 (49%), moderate in 44 (38%) and severe in 15 (13%), with median time to cGVHD onset after HCT of 173 days [IQR 122;295]. A CT scan at 77 days [IQR 33;202] post HCT was selected for analysis. In multivariate analysis, CT-defined body fat ≥ 35% was independently associated with increased mortality (HR 2.094 (95% CI 1.060, 4.136), p = 0.033) overall. Patients of male sex had higher FI than females and showed a more prominent association between high FI and mortality. SMI as well as other indices of adiposity were not associated with survival in multivariable analysis including BMI, sarcopenic obesity and low skeletal muscle radiodensity. In exploratory analyses, we demonstrated similar results per CT chest at T4, suggesting possible future application to a larger HCT population.

Conclusions

These data support that radiographic body composition measures provide prognostic information among patients with cancer affected by cGVHD post-HCT and suggest that high body fat % is a promising candidate for future study. These findings suggest that low skeletal muscle mass alone does not predict for poor outcomes in HCT patients with cGVHD as previously described in other cancers. Independent validation of this work is needed, including further studies based on CT chest to enhance application to a larger HCT population.

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体成分评估为慢性移植物抗宿主病影响的癌症患者提供预后信息

背景：需要更多的工具来评估癌症患者的死亡风险。同种异体造血细胞移植（HCT）后慢性移植物抗宿主病（cGVHD）患者是高危癌症人群，其死亡风险由cGVHD严重程度解释，但也与基线合并症、HCT前后的功能状态、手术及其并发症的累积毒性有关。CT扫描的放射学身体成分指标先前显示与其他人群的并发症有关。方法：我们研究了2005-2016年单中心连续的cGVHD HCT受者和cGVHD诊断近端的ct扫描，以研究放射学体成分测量与死亡率的关系。在第3腰椎（L3）和第4胸椎（T4）的CT成像上量化骨骼肌指数（SMI）和脂肪指数（FI）。取SM Hounsfield单位（HU）评价SM密度。重度精神分裂症的分界点来自文献，FI的分界点由性别最佳分层确定。结果共有113例患者符合本分析的纳入标准，年龄为51.2±10.5（SD）岁，主要为男性（n = 71, 63%），诊断为NHL （n = 110, 97%）。发病cGVHD NIH总体严重程度为轻度56例（49%），中度44例（38%），重度15例（13%），HCT后cGVHD发病的中位时间为173天[IQR 122；295]。选择HCT后77天的CT扫描[IQR 33；202]进行分析。在多变量分析中，ct定义的体脂≥35%与总体死亡率增加独立相关（HR 2.094 (95% CI 1.060, 4.136), p = 0.033）。男性患者FI高于女性，且高FI与死亡率之间的相关性更为显著。在包括BMI、肌肉减少性肥胖和低骨骼肌放射密度在内的多变量分析中，SMI以及其他肥胖指标与生存无关。在探索性分析中，我们在T4时每台CT胸部显示了类似的结果，这表明未来可能应用于更大的HCT人群。结论这些数据支持x线体成分测量提供了hct后cGVHD患者的预后信息，并提示高体脂率是未来研究的一个有希望的候选者。这些发现表明，仅靠低骨骼肌量并不能预测cGVHD HCT患者的不良预后，正如之前在其他癌症中所描述的那样。需要对这项工作进行独立验证，包括基于胸部CT的进一步研究，以增强对更大HCT人群的应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.