title: Visceral adipose tissue is prognostic for survival of diffuse large B cell lymphoma treated with frontline R-CHOP.
abstract: The potential role of visceral adipose tissue (VAT) as a prognostic factor in patients with diffuse large B cell lymphoma (DLBCL) treated with frontline rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) immunochemotherapy was explored. Total adipose tissue and VAT were measured by analyzing positron emission tomography (PET)/computed tomography (CT) images obtained during the initial staging of patients with DLBCL. The VAT ratio was calculated as follows: VAT ratio = VAT area/total adipose tissue area. Body mass index (BMI), sex, and International Prognostic Index (IPI) were also incorporated as co-variates in the final model of multivariate Cox regression analysis for survival. A total of 156 patients with DLBCL, who were treated with frontline R-CHOP, were enrolled in our study. The median patient age was 61 years, and 81 patients were male (51.9 %). The median cycle of R-CHOP was six. The IPI risk group was a strong prognostic factor for progression-free survival (PFS) and overall survival (OS) (p < 0.001). Obese BMIs were an independent prognostic factor for PFS, but not for OS in multivariate analyses, compared to patients with normal BMIs (HR = 0.43, 95 % CI = 0.19-0.98, and p = 0.046 for PFS). A high VAT ratio (third tertile) was an independent adverse prognostic factor for PFS and OS in multivariate analyses (HR = 2.87 and 2.66, 95 % CI = 1.30-6.32 and 1.30-5.44, and p = 0.009 and 0.007 for PFS and OS, respectively). VAT ratio was an independent prognostic factor for patients with DLBCL treated with first-line R-CHOP; thus, additional large prospective studies are warranted.
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, 75 Nowon-gil, Nowon-gu, Seoul, 139-706, South Korea. baramg@hanmail.net.|Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-gil, Nowon-gu, Seoul, 139-706, South Korea. baramg@hanmail.net.
authors.forename: Dong-Yeop
authors.initials: DY
authors.lastname: Shin
authors.affiliation: Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-gil, Nowon-gu, Seoul, 139-706, South Korea.
authors.forename: Areumnuri
authors.initials: A
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Korea Institute of Radiological and Medical Sciences, Nowon-gu, Seoul, South Korea.
authors.forename: Byung Hyun
authors.initials: BH
authors.lastname: Byun
authors.affiliation: Department of Nuclear Medicine, Korea Institute of Radiological and Medical Sciences, Nowon-gu, Seoul, South Korea.
authors.forename: Hansol
authors.initials: H
authors.lastname: Moon
authors.affiliation: Department of Family Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, Nowon-gu, Seoul, South Korea.
authors.forename: Soyeun
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Family Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, Nowon-gu, Seoul, South Korea.
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Ko
authors.affiliation: Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-gil, Nowon-gu, Seoul, 139-706, South Korea.
authors.forename: Min-Jung
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, 75 Nowon-gil, Nowon-gu, Seoul, 139-706, South Korea.|Department of Emergency Medical Preparedness, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Nowon-gu, Seoul, South Korea.
authors.forename: Hyo-Rak
authors.initials: HR
authors.lastname: Lee
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, 75 Nowon-gil, Nowon-gu, Seoul, 139-706, South Korea.
authors.forename: Hye-Jin
authors.initials: HJ
authors.lastname: Kang
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, 75 Nowon-gil, Nowon-gu, Seoul, 139-706, South Korea.
authors.forename: Im Il
authors.initials: II
authors.lastname: Na
authors.affiliation: Laboratory of Radiation Exposure & Therapeutics, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, 75 Nowon-gil, Nowon-gu, Seoul, 139-706, South Korea.|Division of Pathology, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, Nowon-gu, Seoul, South Korea.
authors.forename: Sunhoo
authors.initials: S
authors.lastname: Park
authors.affiliation: Division of Pathology, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, Nowon-gu, Seoul, South Korea.
authors.forename: Seung Sook
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, 75 Nowon-gil, Nowon-gu, Seoul, 139-706, South Korea.
authors.forename: Sung-Hyun
authors.initials: SH
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000187:drug effects* / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Body mass index; Diffuse large B cell lymphoma; Prognostic factor; R-CHOP; Visceral adipose tissue