CT-derived myosteatosis for baseline risk stratification of cardiotoxicity in patients with diffuse large B-cell lymphoma receiving anthracyclines

BACKGROUND: Baseline Risk Stratification for cancer therapy–related cardiac dysfunction (CTRCD) in patients with diffuse large B-cell lymphoma (DLBCL) receiving anthracyclines is crucial. Whether CT-derived myosteatosis can be used for baseline risk stratification of CTRCD in these patients remains unclear. This study aimed to investigate the significance of staging CT-derived myosteatosis in baseline risk stratification of CTRCD in patients with DLBCL receiving anthracyclines. METHODS: Patients with DLBCL receiving anthracyclines from two hospitals were retrospectively enrolled. CT body composition variables were measured at the third lumbar vertebra using staging CT. Myosteatosis was identified by the lowest gender-specific quartile of skeletal muscle density. Associations between CT body composition variables and CTRCD, as well as all-cause mortality were analyzed using binary logistic regression and Cox regression analysis, respectively. The performance of these variables for predicting CTRCD was assessed by receiver operating characteristic analysis. The DeLong test was used to compare the area under the receiver operating characteristic curve (AUC) of each variable. RESULTS: A total of 723 patients (392 male) were included. During a median follow-up of 65 months (IQR, 53–76 months), 180 patients developed CTRCD and 269 patients died. Individuals with myosteatosis (skeletal muscle density ≤ 18.7 HU for female or ≤ 27.8 HU for male) had 3.382 times higher odds of developing CTRCD compared to those without (95% CI: 1.294–7.556). The AUC of the combination of myosteatosis and heart failure association–international cardio-oncology society (HFA-ICOS) score for predicting CTRCD was higher than myosteatosis or HFA-ICOS score [0.828 (95% confidence interval (CI): 0.798, 0.855) vs. 0.719 (95%CI: 0.685, 0.751) vs. 0.586 (95%CI: 0.549, 0.622), all P < 0.001]. Myosteatosis was associated with all-cause mortality (Hazard ratio: 2.015, 95% CI: 1.360–2.994). CONCLUSIONS: CT-derived myosteatosis was an independent predictor of CTRCD and all-cause mortality in DLBCL patients treated with anthracyclines and improved baseline risk stratification of CTRCD.