Prognostic impact of fat tissue loss and cachexia assessed by computed tomography scan in elderly patients with diffuse large B-cell lymphoma treated with immunochemotherapy.

OBJECTIVES: Approximately 30% of DLBCL patients are older than 70 yr. This study evaluated the prognostic impact of a cachexia score (CS) including fat tissue loss (adipopenia) and sarcopenia as assessed by computed tomography (CT scan) in elderly DLBCL patients treated with chemotherapy and rituximab (R). METHODS: This retrospective analysis included 80 DLBCL patients older than 70 yr treated with R-CHOP or R-miniCHOP. Skeletal muscle (SM) and visceral (V) and subcutaneous (S) adipose (A) tissues were measured by analysing CT images at the third lumbar (L3) level. RESULTS: The median age of the patients was 78 yr. Forty-four and 46 patients were considered sarcopenic and adipopenic, respectively. The median progression-free survival (PFS) was 13.6 months in the adipopenic group and 49.4 months in the non-adipopenic group [hazard ratio (HR) = 2.27; 95% confidence interval (CI): 1.3-4; P = 0.0042]. The median overall survival (OS) was 25.7 months in the adipopenic group and 57.1 months in the non-adipopenic group (HR = 1.93; 95% CI: 1.05-3.55; P = 0.0342). A two-point CS including adipopenia and sarcopenia was created and defined two distinct risk groups with differences in outcomes that were highly significant. The CS was predictive of the prognosis in a multivariate analysis including body mass index (BMI) (< or ≥ 25 kg/m(2) ), age (< or ≥ 80 yr), international prognostic index (IPI) and albuminaemia (HR = 3.67; 95% CI = 1.93-6.97; P < 0.0001). CONCLUSION: A CS including sarcopenia and adipopenia, assessed by a single CT scan slice, predicts outcome independent of BMI and the IPI.

Relationship between the immunohistochemistry of the primary tumour and 18F-FDG-PET/CT at recurrence in patients with well-differentiated thyroid carcinoma.

PURPOSE: In patients thyroidectomized for well-differentiated thyroid carcinoma, the correlation between thyroglobulin (Tg) plasma level and F-fluoro-2-deoxy-D-glucose (F-FDG)-PET results is still a matter of debate. We evaluated whether the immunochemical profile of the primary tumour could be used as a predictor of positivity on F-FDG-PET/computed tomography (CT) when recurrence is confirmed. MATERIALS AND METHODS: A total of 26 patients (eight men, 18 women; 51±16 years old) were included. All of the patients had a histologically proven recurrence or a high level of Tg during follow-up and underwent a F-FDG-PET/CT following two intramuscular injections of rhTSH. The F-FDG-PET/CT scans were blindly analysed by three nuclear physicians. The results of the PET scans were classified as true positive, false positive or false negative. Nine antibodies were used for the immunochemical analysis (tissue microarray: hexokinase I, II and III; Tg; vascular endothelial growth factor; and glucose transporter type 1, CD31, CD68 and sodium iodide symporter). RESULTS: The PET scans were positive for 15 patients and negative for 11 patients. Hexokinase I was expressed in nine of the 26 primary tumours (7/26 for the isoforms). No single molecule expressed in the primary tumours was correlated with the F-FDG-PET/CT results. There was no association of antibody overexpression (clustering) in the primary tumours with the F-FDG-PET/CT results of the recurrences. CONCLUSION: In a larger series, we failed to confirm the preliminary results of Hooft and colleagues. This study did not allow for the determination of a single marker expressed in the primary tumours that would be predictive of F-FDG-PET/CT positivity when recurrence is suspected. Therefore, at present, immunochemistry does not appear to be a definitive tool for predicting the results of F-FDG-PET/CT in cases of recurrence.