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CT-defined sarcopenia predicts treatment response in primary central nervous system lymphomas

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A Commentary to this article was published on 20 December 2023

Abstract

Objective

Body composition assessment derived from cross-sectional imaging has shown promising results as a prognostic biomarker in several tumor entities. Our aim was to analyze the role of low skeletal muscle mass (LSMM) and fat areas for prognosis of dose-limiting toxicity (DLT) and treatment response in patients with primary central nervous system lymphoma (PCNSL).

Methods

Overall, 61 patients (29 female patients, 47.5%) with a mean age of 63.8 ± 12.2 years, range 23–81 years, were identified in the data base between 2012 and 2020 with sufficient clinical and imaging data. Body composition assessment, comprising LSMM and visceral and subcutaneous fat areas, was performed on one axial slice on L3-height derived from staging computed tomography (CT) images. DLT was assessed during chemotherapy in clinical routine. Objective response rate (ORR) was measured on following magnetic resonance images of the head accordingly to the Cheson criteria.

Results

Twenty-eight patients had DLT (45.9%). Regression analysis revealed that LSMM was associated with objective response, OR = 5.19 (95% CI 1.35–19.94, p = 0.02) (univariable regression), and OR = 4.23 (95% CI 1.03- 17.38, p = 0.046) (multivariable regression). None of the body composition parameters could predict DLT. Patients with normal visceral to subcutaneous ratio (VSR) could be treated with more chemotherapy cycles compared to patients with high VSR (mean, 4.25 vs 2.94, p = 0.03). Patients with ORR had higher muscle density values compared to patients with stable and/or progressive disease (34.46 ± vs 28.18 ± HU, p = 0.02).

Conclusions

LSMM is strongly associated with objective response in patients with PCNSL. Body composition parameters cannot predict DLT.

Clinical relevance statement

Low skeletal muscle mass on computed tomography (CT) is an independent prognostic factor of poor treatment response in central nervous system lymphoma. Analysis of the skeletal musculature on staging CT should be implemented into the clinical routine in this tumor entity.

Key Points

• Low skeletal muscle mass is strongly associated with the objective response rate.

• No body composition parameters could predict dose-limiting toxicity.

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Abbreviations

CI:

Confidence interval

CR:

Complete response

CT:

Computed tomography

DLBCL:

Diffuse large B-cell lymphoma

DLT:

Dose-limiting toxicity

FFM:

Fat-free mass

FM:

Fat mass

HU:

Hounsfield unit

IMAT:

Intramuscular adipose tissue

L:

Lumbar

LSMM:

Low skeletal muscle mass

MRI:

Magnetic resonance imaging

OR:

Odds ratio

ORR:

Objective response rate

PCNSL:

Primary central nervous system lymphoma

PD:

Progressive disease

SAT:

Subcutaneous adipose tissue

SMA:

Skeletal muscle area

SMI:

Skeletal muscle index

TAT:

Total adipose tissue

VAT:

Visceral adipose tissue

VSR:

Visceral to subcutaneous ratio

WBRT:

Whole-brain radiotherapy

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Alexey Surov and Hans Jonas Meyer contributed equally for the work.

Authors and Affiliations

  1. Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany

    Alexey Surov

  2. Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany

    Alexey Surov, Mattes Hinnerichs & Vincenzo Ferraro

  3. Department of Radiology, University of Leipzig, Leipzig, Germany

    Hans Jonas Meyer

  4. Department of Hematology and Oncology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany

    Vanja Zeremski, Dimitrios Mougiakakos & Denise Wolleschak

  5. Department for Simulation and Graphics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany

    Sylvia Saalfeld

  6. Research Campus STIMULATE, Magdeburg, Germany

    Sylvia Saalfeld

  7. Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany

    Andreas Wienke & Alexandra Strobel

Authors
  1. Alexey Surov
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Correspondence to Alexey Surov.

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The scientific guarantor of this publication is Alexey Surov.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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• performed at one institution

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Surov, A., Meyer, H.J., Hinnerichs, M. et al. CT-defined sarcopenia predicts treatment response in primary central nervous system lymphomas. Eur Radiol 34, 790–796 (2024). https://doi.org/10.1007/s00330-023-09712-y

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  • DOI: https://doi.org/10.1007/s00330-023-09712-y

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