Introduction Most patients with primary CNS lymphoma (PCNSL) achieve durable remission whereas a minority die in the first year. Sarcopenia is a powerful predictor of mortality in brain and systemic cancers. Temporalis muscle thickness (TMT) is a validated radiographic measure of sarcopenia. We hypothesized that patients with thin TMT at diagnosis would have early progression and short survival. Methods Two blinded operators retrospectively measured TMT in 99 consecutive brain MRIs from untreated patients with PCNSL. Results We generated a receiver operator characteristic curve and chose a single threshold defining thin TMT in all patients as < 5.65mm, at which sensitivity and specificity for 1-year progression were 98.4% and 29.7% and for 1-year mortality were 97.4% and 43.5% respectively. Those with thin TMT were both more likely to progress (p < .001) and had higher rates of mortality (p < .001). These effects were independent of the effect of age, sex, and ECOG in a Cox regression. MSKCC score did not predict PFS or OS as well as TMT. Patients with thin TMT received fewer cycles of high-dose methotrexate (HD-MTX) and were less likely to receive consolidation but neither variable could be included in the Cox regression due violation of proportional hazards assumption. Conclusions We conclude that PCNSL patients with thin TMT are at high risk for early relapse and short survival. Future trials should stratify patients by TMT to avoid confounding.
Introduction: Primary CNS lymphoma (PCNSL) outcomes diverge between a majority of patients who achieve long term remission and a smaller minority who have aggressive disease course and die in the first year. Sarcopenia is increasingly recognized as a powerful predictor of mortality in brain and systemic cancers. Temporalis muscle thickness (TMT) is a validated radiographic measure of sarcopenia. We hypothesized that patients with TMT less than one standard deviation below the mean (“very thin TMT”) would go on to have shorter survival. Methods: Two blinded operators retrospectively measured TMT in 99 consecutive pretreatment brain MRIs from patients that were subsequently diagnosed with PCNSL. Results: On univariate analysis TMT predicted early progression (HR 4.25, 95% CI 1.95 – 9.29, p<0.001) and early mortality (HR 4.38, 95% CI 2.25 – 8.53, p<0.001), and these effects were maintained in subgroups of patients both <65 and ³65 years of age. Very thin TMT predicted mortality more robustly than IELSG or MSKCC scores. Patients with very thin TMT received fewer cycles of high-dose methotrexate (HD-MTX) and were less likely to receive consolidation. On multivariate analysis which included the covariates age, sex, TMT, ECOG, BMI, lifetime doses of HD-MTX, and consolidation, very thin TMT was independently associated with both early progression (HR = 7.87, 95% CI = 3.55 – 17.45, p<0.001) and short survival (HR 4.49, 95% CI = 1.94 – 10.40, p<0.001). Conclusions: We conclude that PCNSL patients with very thin TMT are at high risk for relapse and early mortality. Future trials should stratify patients by TMT to avoid potential confounding.
Sarcopenia refers to a loss of skeletal muscle mass, which has been associated with increased risk of injury and decreased ability to perform activities of daily living. In multiple cancers including systemic lymphomas, sarcopenia has been strongly associated with survival and may be an important way to risk stratify patients in clinical trials as well as routine practice. Temporalis muscle width has been reported as an indicator of sarcopenia and independent predictor of outcomes in multiple settings including glioblastoma, brain metastases and subarachnoid hemorrhage. We evaluated temporalis width in primary CNS lymphoma (PCNSL) patients at presentation and outcomes. Using an institutional database of immunocompetent PCNSL patients treated at the University of Washington, two independent readers reviewed the initial MRIs for 104 patients who presented from 2011-2021 and measured the width of the temporalis muscle on axial T1 images. Median duration of follow up was 42.2 months (range 0.59-125.9 months). Median age at diagnosis was 65 (range 19-90 years), and patients were 42.8% male, 57.2% female. Interrater variability was acceptable with an average intraclass correlation coefficient of 0.934. Temporalis measurements were normally distributed, with mean 0.79 cm and standard deviation 0.18 cm. We divided patients into two groups, those with temporalis width less than or greater than 1 standard deviation below the mean (absolute value 0.60 cm). Temporalis width was strongly associated with survival among all patients (χ2=15.5, p< 0.001) as well as patients 65 years or older (χ2=4.5, p=0.03). We conclude that sarcopenia as measured by temporalis muscle thickness is associated with survival in PCNSL and may be an important variable to consider in clinical trials and routine practice.
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