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| 第3腰椎骨骼肌指数在弥漫大B细胞淋巴瘤患者中的临床意义探讨赵可1,江伟2,俞翔3,张苗1,宋腾1,李书苹1,邱鸣寒1,付瑛1,王华庆1通信作者:王华庆,Email:huaqingw@163.com |
| Exploration of the Clinical Significance of Lumbar 3 Skeletal Muscle Index in Patients with Diffuse Large B-cell LymphomaZHAO Ke1, JIANG Wei2, YU Xiang3, ZHANG Miao1, SONG Teng1, LI Shu-ping1, QIU Ming-han1, FU Ying1, WANG Hua-qing1 |
| 投稿时间：2024-07-19 修订日期：2024-10-14 |
| DOI： |
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| 中文关键词: 肌肉减少症 第3腰椎骨骼肌指数 弥漫大B细胞淋巴瘤 预后 计算机断层扫描 |
| 英文关键词:Sarcopenia Lumbar 3 skeletal muscle index Diffuse large B-cell lymphoma Prognosis Computed Tomography |
| 基金项目:国家自然科学基金(82070206),天津市医学重点学科(专科)建设项目(TJYXZDXK-053B) |
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| 中文摘要: |
| 目的：探讨弥漫大B细胞淋巴瘤(Diffuse large B-cell lymphoma, DLBCL)患者第3腰椎骨骼肌指数(Lumbar 3 skeletal muscle index, L3-SMI)与临床病理特征和预后的关系。方法：回顾性分析2016年至2022年天津市人民医院初诊并接受免疫化疗的153例DLBCL患者资料，使用计算机断层扫描测量腰3椎体水平截面的肌肉面积并计算L3-SMI，根据定义的性别特异性阈值，分为肌肉减少症组和非肌肉减少症组。分析两组临床特征、治疗效果及生存预后差异。结果：153例患者中，31 (20.3%)例诊断为肌肉减少症。与非肌肉减少症组相比，肌肉减少症组与更多的不良临床特征相关，包括B症状、结外受累≥2个部位、晚期(III-IV期)、较高的国际预后指数和美国东部肿瘤协作组评分、低体重指数(均P<0.05)。全组患者中肌肉减少症组疾病进展率(32.3% vs 17.2%)更高，治疗完全缓解率(35.5% vs 57.4%)和5年总生存(43.7% vs 65.2%)更低(均P<0.05)。多因素分析显示，L3-SMI、乳酸脱氢酶(Lactate dehydrogenase, LDH)和白蛋白(Albumin, ALB)是影响男性患者总生存时间(Overall survival, OS)的独立影响因素。男性患者中，肌肉减少症组和非肌肉减少症组5年OS分别为32.3%和62.3%，差异具有统计学意义(P=0.006)。对于合并LDH升高或ALB <40g/L的肌肉减少症组和非肌肉减少症组患者5年OS分别为0% vs 51.5%和11.4% vs 48.0%，差异具有统计学意义(均P<0.05)。结论：基于L3-SMI定义的肌肉减少症是判断男性DLBCL患者预后的重要指标。出现肌肉减少症的男性DLBCL患者，尤其是合并LDH升高或ALB <40 g/L的患者需要更个体化的治疗。 |
| 英文摘要: |
| Objectives: Exploring the relationship between Lumbar 3 Skeletal Muscle Index (L3-SMI) and clinical pathological features as well as prognosis in patients with Diffuse Large B-cell Lymphoma (DLBCL). Methods: 153 newly diagnosed DLBCL patients treated with immunochemotherapy at Tianjin Union Medical Center from 2016 to 2022 were retrospectively analyzed. The muscle area at the level of the third lumbar vertebra (L3) was measured using computed tomography (CT), and the L3-skeletal muscle index (L3-SMI) was calculated. Patients were classified into sarcopenia and non-sarcopenia groups based on gender-specific cutoffs. Differences in clinical characteristics, treatment effects and survival prognosis between the two groups were analyzed. Results: Among 153 patients, 31 (20.3%) were diagnosed with sarcopenia. Compared with non-sarcopenia group, sarcopenia group was associated with more adverse clinical features, including B symptoms, extranodal involvement sites ≥2, advanced stage (III-IV), higher IPI and ECOG scores, and lower BMI (all P<0.05). The sarcopenia group among the entire patient cohort exhibited a higher rate of disease progression (32.3% vs 17.2%), lower rate of complete remission (35.5% vs 57.4%), and lower 5-year overall survival (43.7% vs 65.2%) (all P<0.05). In multivariate analysis, L3-SMI, lactate dehydrogenase, and ALB were independent prognostic factors for overall survival (OS) in male patients. In male patients, the 5-year OS were 32.3% and 62.3% for the sarcopenia and non-sarcopenia groups, respectively, with a statistically significant difference (P=0.006). For patients with elevated LDH or ALB <40 g/L, the 5-year OS in the sarcopenia group compared to the non-sarcopenia group were 0% vs 51.5% and 11.4% vs 48.0%, respectively, with a statistically significant difference (both P<0.05). Conclusions: Sarcopenia defined by L3-SMI could serve as an important prognostic indicator in male DLBCL patients. Male DLBCL patients presenting with sarcopenia, especially those with elevated LDH or ALB <40 g/L, require more individualized treatment. |
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