{"title":"骨骼肌指数影响弥漫大 B 细胞淋巴瘤老年患者的治疗效果","authors":"Yui Niiyama-Uchibori, Haruya Okamoto, Akihiro Miyashita, Kentaro Mizuhara, Yuka Kanayama-Kawaji, Takahiro Fujino, Taku Tsukamoto, Shinsuke Mizutani, Yuji Shimura, Satoshi Teramukai, Junya Kuroda","doi":"10.1002/hon.3252","DOIUrl":null,"url":null,"abstract":"<p>Sarcopenia is a crucial factor in the physical fitness of elderly individuals. This study investigated the prognostic values of multiple parameters of sarcopenia in association with established prognostic factors in elderly Japanese patients with diffuse large B cell lymphoma (DLBCL). As candidate indicators for sarcopenia, the skeletal muscle index (SMI) (cm<sup>2</sup>/m<sup>2</sup>), the psoas muscle index, the erector spinae muscle index, the visceral fat index, the subcutaneous fat index, and the visceral to subcutaneous fat area ratio at the third lumbar level were assessed by computed tomography at their initial diagnosis in 102 patients with DLBCL over 75 years old those were diagnosed and treated in our institute from 2007 to 2020. The primary endpoint was overall survival (OS), and the secondary endpoint was progression-free survival (PFS). The median age of patients analyzed was 80 years at diagnosis. The sex-specific cut-offs for the indices adopted two approaches: (i) the historical cut-off values established in the previous study for healthy Japanese individuals (Hamaguchi Y. J Cachexia Sarcopenia Muscle. 2018), and (ii) each sex-specific lowest quartile in our cohort. As the results, SMI evaluated by the historical cut-off and sex-specific lowest quartile was identified as the most influential independent prognostic factor for both OS and PFS among various parameters for sarcopenia. Furthermore, we developed an elderly sarcopenia prognostic index (ESPI). ESPI, which combines SMI evaluated by the historical cut-off and LDH > ULN, demonstrated statistically significant prognostic impacts on OS and PFS. Moreover, compared to the R-IPI, ESPI showed the ability to identify intermediate-risk groups and indicated a trend toward improved predictive accuracy. Our study revealed that SMI is the most appropriate assessment method for evaluating sarcopenia and the critical prognostic factor in OS and PFS of elderly patients with DLBCL.</p>","PeriodicalId":12882,"journal":{"name":"Hematological Oncology","volume":"42 1","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Skeletal muscle index impacts the treatment outcome of elderly patients with diffuse large B cell lymphoma\",\"authors\":\"Yui Niiyama-Uchibori, Haruya Okamoto, Akihiro Miyashita, Kentaro Mizuhara, Yuka Kanayama-Kawaji, Takahiro Fujino, Taku Tsukamoto, Shinsuke Mizutani, Yuji Shimura, Satoshi Teramukai, Junya Kuroda\",\"doi\":\"10.1002/hon.3252\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Sarcopenia is a crucial factor in the physical fitness of elderly individuals. This study investigated the prognostic values of multiple parameters of sarcopenia in association with established prognostic factors in elderly Japanese patients with diffuse large B cell lymphoma (DLBCL). As candidate indicators for sarcopenia, the skeletal muscle index (SMI) (cm<sup>2</sup>/m<sup>2</sup>), the psoas muscle index, the erector spinae muscle index, the visceral fat index, the subcutaneous fat index, and the visceral to subcutaneous fat area ratio at the third lumbar level were assessed by computed tomography at their initial diagnosis in 102 patients with DLBCL over 75 years old those were diagnosed and treated in our institute from 2007 to 2020. The primary endpoint was overall survival (OS), and the secondary endpoint was progression-free survival (PFS). The median age of patients analyzed was 80 years at diagnosis. The sex-specific cut-offs for the indices adopted two approaches: (i) the historical cut-off values established in the previous study for healthy Japanese individuals (Hamaguchi Y. J Cachexia Sarcopenia Muscle. 2018), and (ii) each sex-specific lowest quartile in our cohort. As the results, SMI evaluated by the historical cut-off and sex-specific lowest quartile was identified as the most influential independent prognostic factor for both OS and PFS among various parameters for sarcopenia. Furthermore, we developed an elderly sarcopenia prognostic index (ESPI). ESPI, which combines SMI evaluated by the historical cut-off and LDH > ULN, demonstrated statistically significant prognostic impacts on OS and PFS. Moreover, compared to the R-IPI, ESPI showed the ability to identify intermediate-risk groups and indicated a trend toward improved predictive accuracy. 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引用次数: 0
摘要
肌肉疏松症是影响老年人体能的一个关键因素。本研究调查了日本老年弥漫性大 B 细胞淋巴瘤（DLBCL）患者肌肉疏松症的多个参数与既有预后因素的关联。作为 "肌肉疏松症 "的候选指标，我们通过计算机断层扫描评估了 2007 年至 2020 年期间在我院接受诊断和治疗的 102 名 75 岁以上 DLBCL 患者初诊时的骨骼肌指数（SMI）（cm2/m2）、腰肌指数、竖脊肌指数、内脏脂肪指数、皮下脂肪指数以及第三腰椎水平的内脏与皮下脂肪面积比。主要终点是总生存期（OS），次要终点是无进展生存期（PFS）。被分析患者确诊时的中位年龄为 80 岁。各项指标的性别特异性临界值采用了两种方法：(i) 先前研究中为日本健康人确定的历史临界值（Hamaguchi Y. J Cachexia Sarcopenia Muscle. 2018），以及 (ii) 我们队列中每个性别特异性最低四分位数。结果发现，在肌少症的各种参数中，以历史截止值和性别特异性最低四分位数评估的SMI是对OS和PFS最有影响的独立预后因素。此外，我们还开发了老年肌肉疏松症预后指数（ESPI）。ESPI结合了以历史截止值评估的SMI和LDH >ULN，对OS和PFS的预后影响具有统计学意义。此外，与 R-IPI 相比，ESPI 显示出识别中危人群的能力，并有提高预测准确性的趋势。我们的研究表明，SMI 是评估肌肉疏松症最合适的评估方法，也是老年 DLBCL 患者 OS 和 PFS 的关键预后因素。
Skeletal muscle index impacts the treatment outcome of elderly patients with diffuse large B cell lymphoma
Sarcopenia is a crucial factor in the physical fitness of elderly individuals. This study investigated the prognostic values of multiple parameters of sarcopenia in association with established prognostic factors in elderly Japanese patients with diffuse large B cell lymphoma (DLBCL). As candidate indicators for sarcopenia, the skeletal muscle index (SMI) (cm2/m2), the psoas muscle index, the erector spinae muscle index, the visceral fat index, the subcutaneous fat index, and the visceral to subcutaneous fat area ratio at the third lumbar level were assessed by computed tomography at their initial diagnosis in 102 patients with DLBCL over 75 years old those were diagnosed and treated in our institute from 2007 to 2020. The primary endpoint was overall survival (OS), and the secondary endpoint was progression-free survival (PFS). The median age of patients analyzed was 80 years at diagnosis. The sex-specific cut-offs for the indices adopted two approaches: (i) the historical cut-off values established in the previous study for healthy Japanese individuals (Hamaguchi Y. J Cachexia Sarcopenia Muscle. 2018), and (ii) each sex-specific lowest quartile in our cohort. As the results, SMI evaluated by the historical cut-off and sex-specific lowest quartile was identified as the most influential independent prognostic factor for both OS and PFS among various parameters for sarcopenia. Furthermore, we developed an elderly sarcopenia prognostic index (ESPI). ESPI, which combines SMI evaluated by the historical cut-off and LDH > ULN, demonstrated statistically significant prognostic impacts on OS and PFS. Moreover, compared to the R-IPI, ESPI showed the ability to identify intermediate-risk groups and indicated a trend toward improved predictive accuracy. Our study revealed that SMI is the most appropriate assessment method for evaluating sarcopenia and the critical prognostic factor in OS and PFS of elderly patients with DLBCL.
期刊介绍：
Hematological Oncology considers for publication articles dealing with experimental and clinical aspects of neoplastic diseases of the hemopoietic and lymphoid systems and relevant related matters. Translational studies applying basic science to clinical issues are particularly welcomed. Manuscripts dealing with the following areas are encouraged:
-Clinical practice and management of hematological neoplasia, including: acute and chronic leukemias, malignant lymphomas, myeloproliferative disorders
-Diagnostic investigations, including imaging and laboratory assays
-Epidemiology, pathology and pathobiology of hematological neoplasia of hematological diseases
-Therapeutic issues including Phase 1, 2 or 3 trials as well as allogeneic and autologous stem cell transplantation studies
-Aspects of the cell biology, molecular biology, molecular genetics and cytogenetics of normal or diseased hematopoeisis and lymphopoiesis, including stem cells and cytokines and other regulatory systems.
Concise, topical review material is welcomed, especially if it makes new concepts and ideas accessible to a wider community. Proposals for review material may be discussed with the Editor-in-Chief. Collections of case material and case reports will be considered only if they have broader scientific or clinical relevance.
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