Increased body mass index is associated with improved overall survival in extranodal natural killer/T-cell lymphoma, nasal type

Abstract

// Ya-Jun Li 1,2 , Ping-Yong Yi 1,2 , Ji-Wei Li 1,2 , Xian-Ling Liu 3 , Xi-Yu Liu 1,2 , Fang Zhou 1,2 , Zhou OuYang 1,2 , Zhong-Yi Sun 1,2 , Li-Jun Huang 1,2 , Jun-Qiao He 1,2 , Yuan Yao 1,2 , Zhou Fan 1,2 , Tian Tang 2,4 and Wen-Qi Jiang 5,6 1 Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China 2 The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China 3 Cancer Center of the Second Xiangya Hospital, Central South University, Changsha, Hunan, China 4 Radioactive Interventional Department, Hunan Cancer Hospital, Changsha, Hunan, China 5 State Key Laboratory of Oncology in South China, Guangzhou, China 6 Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China Correspondence to: Ping-Yong Yi, email: // Wen-Qi Jiang, email: // Keywords : body mass index, extranodal natural killer/T-cell lymphoma, prognosis, IPI, KPI Received : April 26, 2016 Accepted : November 30, 2016 Published : December 16, 2016 Abstract Objectives: The role of body mass index (BMI) in lymphoma survival outcomes is controversial. The prognostic significance of BMI in extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is unclear. We evaluated the prognostic role of BMI in patients with ENKTL. Methods: We retrospectively analyzed 742 patients with newly diagnosed ENKTL. The prognostic value of BMI was compared between patients with low BMIs (< 20.0 kg/m 2 ) and patients with high BMIs (≥ 20.0 kg/m 2 ). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) was also evaluated and compared with that of the BMI classification. Results: Patients with low BMIs tended to exhibit higher Eastern Cooperative Oncology Group performance status (ECOG PS) scores (≥ 2) ( P = 0.001), more frequent B symptoms ( P < 0.001), lower albumin levels ( P < 0.001), higher KPI scores ( P = 0.03), and lower rates of complete remission ( P < 0.001) than patients with high BMIs, as well as inferior progression-free survival (PFS, P = 0.003), and inferior overall survival (OS, P = 0.001). Multivariate analysis demonstrated that age > 60 years, mass > 5 cm, stage III/IV, elevated LDH levels, albumin levels < 35 g/L and low BMIs were independent adverse predictors of OS. The BMI classification was found to be superior to the IPI with respect to predicting patient outcomes among low-risk patients and the KPI with respect to distinguishing between intermediate-low- and high-intermediate-risk patients. Conclusions: Higher BMI at the time of diagnosis is associated with improved overall survival in ENKTL. Using the BMI classification may improve the IPI and KPI prognostic models.